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Mr. Deputy Speaker (Sir Alan Haselhurst): With the leave of the House, I will put together the Questions on motions 6 and 7.

Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

Postal Services

23 Jan 2002 : Column 981

Question agreed to.

Ministers of the Crown

Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

Question agreed to.


Mersey Tunnel

9.30 pm

Mr. Ben Chapman (Wirral, South): I rise to present a petition on behalf of the readers of the Liverpool Echo and the Wirral News, members of the Wirral chamber of commerce and many residents of Merseyside.

The petition declares that

To lie upon the Table.

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Bed Blocking (Bedfordshire)

Motion made, and Question proposed, That this House do now adjourn.—[Dan Norris.]

9.31 pm

Alistair Burt (North-East Bedfordshire): I am grateful to the House for the chance to raise the issue of bed blocking, which affects my constituents—indeed, it affects the whole county of Bedfordshire. I am pleased that the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), is to reply to the debate.

Bed blocking is not a new issue, nor is it in any way localised to my constituents. However, it is particularly acute in North-East Bedfordshire, for a combination of reasons. Bedfordshire county council suffers, as do all local authorities at the moment, from inadequate funding for its social services, which limits its capacity to provide support to patients on leaving hospital. That is compounded by severe problems in the care home sector, where homes are closing and beds are being lost.

Bedfordshire health authority is one of the poorest in the country, and the current pressures are therefore exaggerated in their effect, as no reserves are left to cover the problem. To cap it all, Bedfordshire is a growing county, with more people coming to live in new developments, as requested by the Government in their targets for homes. If services are inadequate now, what will they be like in a decade's time, when our population of over-75-year-olds is 20 per cent. higher? That is the synopsis of the problem.

Bedford hospital's delayed discharge figures for the past year tell the story. In the third quarter of 2000, there were 53 delayed discharges. That figure rose steadily through the year—188 in the next quarter, 232 the next and 223 the next—until by the third quarter of 2001 the figure was 304, a sixfold increase. The average length of stay of a bed-blocking patient is between four and 14 days. Unsurprisingly, the impact of bed blocking produces a shortage of beds, or no beds. No beds results in cancelled operations and delays in treatment for those who are long suffering and those with chronic illnesses. I was first alerted to that problem by the constituents' cases about which I heard in my advice centres during the autumn. When I queried the local NHS trust about the reason why operations were cancelled, the issue of bed blocking seemed all too often to loom as an answer.

In the third quarter of 2000, there were 107 same-day cancelled operations in Bedford hospital, of which 64 were the result of there being no beds. By the third quarter of 2001, that figure had risen to 285, of which 199 were the result of there being no beds. Waiting time targets at the hospital climbed inexorably. Patients were placed in inappropriate wards—medical cases in surgical wards, for example. They stayed in the accident and emergency department for the first time and 12-hour trolley waits began to be recorded.

Just before Christmas the decision was taken to close a theatre as there was no point in the hospital's keeping it open. In one week, none of the non-emergency elective surgery could take place in the other theatres. In plain commonsense terms, bed blocking means that, on any one day, between one and two wards are full of people who should not be there.

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All that takes place to the great distress of staff and management, who work very hard in difficult conditions and under considerable public scrutiny. Bedford hospital has not had an easy year and criticism is keenly felt by all levels of staff, as I found out when I dropped in at Christmas to speak to the people there. No one wants to address the difficulties of the hospital more than all those who work there, and they deserve praise for the mountain of excellent work that they do. I shall come to the hospital's and the trust's funding shortly, but I wish the new chief executive, Andrew Reed, and the new NHS trust chair, Helen Nellis, very well in their new roles.

The causes of bed blocking are varied. Some delays are inevitable as patients and families have good reason for a short delay as their loved ones re-adjust to coming out of hospital. Perhaps not all such cases should be designated as delays. An illness may mean that a family has to make new domestic arrangements for someone and, if they cannot be made overnight, some leeway is sensible. Perhaps a redesignation of the term "delayed discharge" might be sensible in such cases. However, when patients and families are unreasonable—I am told that there is evidence that some are—they should understand the impact of their actions in keeping a bed blocked.

Delays that may be put down to purely resource-based reasons—such as delay in assessment, delay in funding a package, delay in awaiting a domiciliary placement, delay in awaiting a nursing or residential care package—show a significant increase, from 24 in the third quarter of 2000 to 116 in the third quarter of 2001. The figure is more than four times greater.

Other categories listed as "other reasons" or "family reasons", which are both growing, also include cases where awaiting medical or social services or other public service support is a factor. They include waiting for an occupational therapist's assessment, or for a physiotherapist, or for adaptations to property.

However, disentangling actual figures and deciding which categories relate to which public service or to other reasons is not the main point of my debate. I wish to illustrate beyond question the significant increase in the bed blocking to which, following discussion with the NHS trust and social services, increased support and resources would be an answer. Both the NHS trust and social services in Bedfordshire county council speak warmly of their relationship with each other, and their shared responsibility for such matters is plainly one that they each welcome.

Social services funding in Bedfordshire was the subject of a debate in the House just before the Christmas recess opened by my hon. Friend the Member for South-West Bedfordshire (Andrew Selous). The deficiency in social services funding nationally has been the subject of surveys of directors of social services throughout the country in the past year. We are all aware that it appears to be a major problem for all of them. This year Bedfordshire will spend nearly 15 per cent. above its standard spending assessment. Next year's package hardly changes the overall picture, and there is a projected shortfall of £7 million. Without repeating everything that my hon. Friend said in the debate to which I have referred, I have to say that the shortfall is placing a dagger at the heart of services in the county and giving the county council, so well led by Philip Hendrie and his colleagues, an impossible job with its budget.

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The problem of social services funding in Bedfordshire is compounded by pressures in the care home sector, a destination for 76 of the 304 who, in the last quarter of 2001, were waiting unnecessarily in hospital beds. Inadequate funding over a number of years meant that Bedfordshire county council could afford no increase in fees paid to care homes in the independent sector. A recent district auditors' report confirms the pressures on the sector. Five homes have closed in the past year. The independent care home owners in the county—I am grateful for the assistance that I have received from Gordon Ward and Michael Glynn in providing figures for me—tell me that 10 more are under severe pressure this year, so perhaps a further 300 beds will go.

Care home owners' costs are conditioned by the market, but they are also coping with new Government pressures, from minimum wage legislation and health and safety regulations to the Care Standards Act 2000, for which they must pay—more cost and more regulation, but no more money. Their negotiations with the county council are blighted by those constraints on finance. Where would our county be without the very best quality of care that independent care homes can provide?

The national health service in the area was also the subject of a debate shortly before Christmas, opened by the hon. Member for Bedford (Mr. Hall), whom I am delighted to see in the Chamber. Its poor budget means that it cannot afford to apply more of its resources to its share in dealing with the problem, which it recognises is a joint responsibility. For example, the Bedford Hospital NHS trust funds 30 places in care homes because the local authority cannot afford to pick up the Bill.

To further demonstrate the parlous state of local NHS trust finance, a recent parliamentary answer revealed a 438 per cent. increase in the percentage of patients waiting more than 12 months for treatment since 1997. I say that to illustrate that I am discussing not a mid-winter local crisis, but a sustained deficiency now working corrosively right through the system. Bedfordshire health authority began 2001-02 some £17 million below target. Next year, despite what seems a generous settlement—the highest in the region—it will remain resolutely at the bottom of the funding scale. By comparison with our target share of the NHS budget, Bedfordshire's 2002-03 allocation is some 4 per cent. less than we ought to receive, equivalent to an £18.5 million gap.

Those figures will not be unfamiliar to the Minister, coming as they do from a letter to Lord Hunt of Kings Heath from Lesley Watts, the acting chair of Bedfordshire health authority. She points out that this small county, despite all the odds, has worked very hard to provide good-quality services, but that for the first time serious deficits are being reported by trusts that have always achieved their financial duties. Trusts in Bedfordshire are some of the lowest-cost providers in the country. Lesley Watts also points out that although the allocations announced for 2001–02 included broad percentages for increased figures for the subsequent two years, the recent allocations announced for 2002–03 make no mention of growth in future years.

What is to be done? As far as local authority social services are concerned, the additional funds announced late last year are a recognition by Government of both the problem and the solution. An extra £447,000 was announced until April 2002, and I believe that there is a figure double that for the whole of next year. The money

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is being well spent on buying in extra services for making assessments, on extra places in residential and nursing homes and on some limited recruiting, but the problem is that the money is time limited for 18 months.

As I hope I have illustrated to the Minister, the problem is not short term. If there is no guarantee of continued funding to meet the needs, few long-term commitments can be made, because the council dare not take on more cost if it is going to lead to increased budgetary pressure. That is bound to make it more cautious, and solutions to the problems will not be implemented. Future local government settlements must address that social services differential. It is now too serious, both in Bedfordshire and nationwide, to be left alone.

The NHS must have an uplift in funding commensurate with its needs in Bedfordshire. There is definitely an answer to that. According to the Chancellor's pre-Budget report, some £700 million of NHS money was unspent last year. This is the Minister's moment. This is the time when she can, with her natural compassion and the force of argument, seize the Dispatch Box and say, "I've got some money for you." That unspent NHS money can come to a place where it will be well used; the underfunding of Bedford hospital historically and all the pressures exerted on it will be a thing of the past when the hon. Lady makes that declaration—if not now, then in two or three minutes' time in her reply. I am making a serious point: it is difficult to defend tight budgeting if £700 million is unspent.

A plea coming from the NHS and Roger Gwynne Jones, the executive member of the council responsible for the social services portfolio, is, "No more initiatives." They want extra uplift in core funding, instead of so much new money being tied into new initiatives that always have to be bidden for, tying up money, entailing bureaucracy and demonstrating lack of trust in local discretion which, I am afraid, is becoming the Government's hallmark. Will the Government try to give an uplift in funding, as opposed to depending on the public sector bidding for new initiatives, which does not allow it discretion and means travelling along the Government's tramlines?

Finally, I shall set the issue in the context of a growing Bedfordshire population, the major point that I want to drive home to the Minister. I have outlined the issues facing hospitals, and could do so for every public service in Bedfordshire, a small, historically prosperous and independent county which has tended not to come top of the pile when looking for support. It has not wished to do so because its independence is matched by its people's pride and their ability to cope and support one another.

Bedfordshire is no longer in charge of its own growth and development; in future, it will march to the beat of the Whitehall drum, as plans for new building on greenfield and brownfield sites alike have an impact. What does that mean for population growth? I have some illustrative figures from the county. In 1996, Bedfordshire's population was 367,300; the over-65 population was 49,700; and the over-75 population, 21,800. In 2001, the population was 385,800; the over-65 population was 53,400; and the over-75 population, 24,400. In less than a decade, in 2011, the total population will be 419,000; the over-65 population will be 64,200; and the over-75 population will be 28,800. According to

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my calculations, that is roughly a 10 per cent. increase in the general population now, but a 20 per cent. increase in the over-75 population.

Judging from the attitude and words of all the county's Members of Parliament, it is not content to play catch-up any longer. We are putting down a marker, and I should be grateful if the Minister, in the comprehensive spending review, takes into account the pressures of population growth in a county such as ours. I do not mean taking account of them in the figures, which look good and will no doubt look good when the hon. Lady repeats them tonight, but in meaningful changes on the ground in public services. It is already difficult to work in those services in Bedfordshire but, with the population growth that I have suggested, it will be more difficult in a decade. Given both bed blocking, the subject of tonight's debate, and the over-75 population increase, how will those services cope?

I am grateful for the time and the attention that the House and the hon. Lady have given me. The hon. Lady understands the problems well; I should be grateful if she would explain her understanding of the symptomatic problems of a growing county and reassure my constituents and me that she will apply my suggestions to other public services so that the problems that my county faces will not be experienced in future, and so that hope can be given to the hard-pressed and hard-working people in the public services and those whom they serve.

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