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14 Nov 2002 : Column 228—continued

Mr. Pound: Fifty years?

Mr. Pollard: Fifty-plus years. My mum took me to Rochdale infirmary 50 years ago to see about having my tonsils out, and I have been waiting ever since. The hospital has since shut down, and I believe that my records have been lost. I have to report to the House that my tonsils are well now, so I am really pleased that I did not have them out. I commend this Queen's Speech.

5.35 pm

Dr. Jenny Tonge (Richmond Park): What the hon. Member for St. Albans (Mr. Pollard) has just said shows what a useless operation a tonsillectomy was in many cases. How good it is that it does not happen quite so often nowadays.

Before I became an MP I spent nearly 33 years in the health service, and I can remember that there has been a minor or major reorganisation every year since 1974. That is why those working in the health service regard it as a bit rich for the Health Secretary to tell them that they must get used to change. There has been change every year for more than 20 years, and another one is not welcome.

It is certainly true that a lot more money has been put into the health service under this Government, and we welcome that, but as the hon. Member for Woodspring (Dr. Fox) said, unfortunately it has been accompanied by far more bureaucrats. Two thirds of the pages of the Health Service Journal are now occupied by advertising, whereas it used to occupy less than a third of the pages. The bureaucrats are setting up so many schemes, and have to employ so many people to fulfil the targets set by the Department of Health, that they are preventing money from reaching the patient. I wish that the Government would take that point on board.

An example of bureaucratic meddling recently occurred in my own area, in Kingston Hospital NHS trust. In August the chief executive was suddenly magicked away. The hospital needed refreshing, we were told, and he went just after the new strategic health authority was formed. He was the first health service manager I have come across in my entire career who was popular with all the hospital staff. They would do anything he wanted them to. The consultants supported him en masse, and the medical director resigned. What a fine decision that was from the top! In some extraordinary way, another chief executive has already been appointed without advertisement or interview. All of a sudden, someone was magicked up to fill that place. Such meddling from the top is absolutely outrageous.

The patients, too, are not very happy. I shall cite just one example. A year ago, a constituent of mine was given an appointment for a bone scan, which was to take place this month. She has just received a letter from St. George's hospital, saying that her bone scan cannot be done this month, and asking her to come back in November 2003. She will have had to wait two years for a routine scan that she needs. Things are not looking good. When I saw the Government's proposal on

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foundation hospitals, I must say that I thought it was quite a good idea. There is no question but that hospitals need freeing up; they need to be freed from the bureaucracy that is fed down from the top.

I am glad that I attended this debate because, as some hon. Members have said, it has been excellent. The right hon. Member for Holborn and St. Pancras (Mr. Dobson), my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) and the hon. Member for Hampstead and Highgate (Glenda Jackson) have made me think hard about this notion, and I should like to pose a few questions for those on the Government Front Bench. I am all in favour of pilot schemes. Let us choose a few foundation hospitals from all ranges—a good one, a middling one and a bad one—as the right hon. Member for Holborn and St. Pancras suggested. Let us see what happens in 12 months' time, and then spread the idea across the whole NHS, if it proves a good one. However, a two-tier system is a bad idea, for all the reasons that have been given by other hon. Members.

I remain extremely worried about the concept of membership of the proposed mutual organisations. As hon. Members have asked: who will be the members and who will be the voters? The local hospital for my constituency is in Kingston. Other hon. Members have talked about the crossover of patients between primary care trusts, many of which will place their contracts with different hospitals, so who will have ownership of those hospitals? Who will decide who can be members of those mutual societies? How long will it be before a charge is levied on people who want to be members of a hospital and they have to pay a membership fee? If a person is a member and a voter at a particular hospital—as if they were on its electoral roll—will they be able to obtain treatment anywhere they choose, or will they have to stick with that hospital? We need clarification.

Dr. Murrison: I, too, should like clarification. In her opening remarks, the hon. Lady said that there was too much change in the NHS and referred to her 33 years in the service, yet she went on to give a broad welcome to the idea of foundation hospitals. Does she want change or not? Although she is a Liberal Democrat, she cannot have it both ways.

Dr. Tonge: I fully appreciate the hon. Gentleman's comment. However, I was pointing out that people in the health service are thoroughly sick of change because there has been so much meddling. Nevertheless, they would welcome freedom from top-down management; there is no question about that. On this occasion I am speaking on behalf of colleagues and ex-colleagues in the NHS and not for myself or as a Liberal Democrat.

Hon. Members have observed that foundation hospitals in the south-east with a great deal of land would become rich, but that those riches would no longer be shared with the rest of the health service. However, what happens if foundation hospitals are mismanaged and get into debt? Will the Chancellor be happy to pay off those debts? Much more thought needs to go into such considerations.

During my years in the NHS, I served as chair of social services in the London borough of Richmond for five years, so I saw both sides of the divide and the

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constant buck passing between social services departments and health authorities. Because of my health service days, I have much sympathy with the Government's desire to get patients out of hospital beds quickly. For example, some social services departments make an absolute meal of home care packages and the process goes on for weeks and weeks. It should be speeded up and home care should be carried out by social services if it is within their resources.

Residential care is a big problem in the south-east, especially in south-west London. Local authorities should be given more time and more financial help to manage the movement of patients out of acute beds and into residential care. What happened to intermediate care beds? What happened to the plans for low-tech beds?

I shall not dwell on the mental health Bill. I am delighted that the Government are thinking again. Many changes are needed in mental health services, not least proper funding for the scandalous care in the community scheme, which rapidly became neglect in the neighbourhood. Before the Government even think about reorganising mental health services, however, we need proper funding not only for more psychiatric nurses and social workers in that field, but also for more beds. Everything will depend on their availability.

I am sure that we shall have further opportunities to discuss changes in mental health services, and as I know that other Members want to speak in this debate, I shall conclude my remarks. I do not envy the Government in their task. I know enough about the health service to realise how difficult the problems are. I share some interest in and have some sympathy with what they are trying to do, but they should think again—and hard—before they take the route that they propose.

5.44 pm

Mr. Stephen Pound (Ealing, North): We have heard much that is wise and well informed this afternoon. We have also heard, from the hon. Member for Richmond Park (Dr. Tonge), an extraordinary description of the strange goings on in Richmond—a strange part of the world where consultants and chief executives apparently appear, reappear and disappear in a puff of smoke in what is clearly Hogwarts hospital. She described a circumstance that I have never before suspected, although I had often wondered what strange magic in the air made people vote Liberal Democrat.

Dr. Tonge: Given what has happened at Kingston hospital recently, Harry Potter would have been very useful. He would have made a much better job of it.

Mr. Pound: From the hon. Lady's description, I rather suspected that Lord Voldemort was in charge of the hospital.

Talking of evil, my hon. Friend the Member for Stalybridge and Hyde (James Purnell), the golden boy—in fact, the increasingly golden-haired boy—of a future Labour Administration, described foundation hospitals as the dynamo of change driving the engine of choice, or vice versa, using that graphic expression so elegantly enunciated by my good friend the hon. Member for Cardiff, West (Kevin Brennan). I take some issue with my hon. Friend the Member for Stalybridge and Hyde,

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as it is not good enough to say that foundation hospitals will enable best practice to spread throughout the national health service. There is nothing to prevent best practice from spreading throughout the NHS now. All one and two-star hospitals should by all means aspire to the higher tier, but I dread the thought of a replication in the health service of the scandal of sink secondary schools. I sincerely hope that that will not happen, and I have confidence that those on the Labour Front Bench will ensure that it does not. However, we have to put a marker down now.

I declare an interest, as the national health service and I were born together, in the first week of July 1948. I know what it is like to be 54 years old, fairly rocky, and in need of modernisation and an urgent cash injection. The important point is that although—as we did not have television in Fulham in those days—I am one of a great many children, my eldest brother, who was born in 1946, died at the age of three months and my next brother, who was born in 1947, also died at that age. I was born in 1948 under the NHS—one of the first children to be born under the NHS—and although it may not please all right hon. and hon. Members, I live in rude good health. I experienced the two-tier health service. I do not want to see it again.

I raised the subject of cross-charging policies between social services and health services with my right hon. Friend the Secretary of State for Health earlier. Many hon. Members have touched on that issue. Local authorities in London can be charged up to #120 per night for any patient who is what is colloquially known as bed blocking. Earlier, I mentioned the situation of the London borough of Ealing, where 38 patients who are the responsibility of the borough are still in various hospitals—Ealing, Hammersmith, Central Middlesex and Charing Cross—even though they are fit for medical discharge. That is not because of any idleness or lack of activity or interest on the part of the borough, but because we have lost more than 100 beds in independent nursing homes in the past year. That was caused by house prices in London, and we do not have any control over it.

The local authority faces the prospect of having to transfer #2.2 million to the acute hospitals as a result of something that is beyond its control. Ealing is performing well as a local authority, particularly in social services, but we have a #5.2 million overspend. Social services are demand led. One cannot tell people not to claim. Although there is a virement from central Government, we are still overspent because we have spent above the standard spending assessment. A substantial proportion of that overspend—about #2 million—is entirely due to elderly person placement costs, and cross-charging policies can only exacerbate that situation.

In his response to my earlier question, the Secretary of State referred, quite rightly, to the additional money that is flowing into the national health service. The figure works out to about 6 per cent. of additional funding in 2003–04. The trouble is that the local

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authorities will not receive these funds until the financial year 2003–04, but they are faced with a #120 per night per patient impost now.


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