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8 Jan 2003 : Column 177—continued
Mr. Stephen McCabe (Birmingham, Hall Green): Will the hon. Gentleman give way?
Mr. Chris Pond (Gravesham): Will the hon. Gentleman give way?
Dr. Fox: I look forward to hearing the answer to my question, but not from the Parliamentary Private Secretary.
Mr. McCabe: Given the hon. Gentleman's concern about health spending, will he tell us what proportion of the Tories' proposed 20 per cent. cut should, in his judgment, be inflicted on the health service?
Dr. Fox: I think that any party that wants to improve health care in this country must first decide what reforms to the system are required; once that has been done, it is prudent to decide what expenditure is required to deliver those reforms. The problem is that the current Government decided how much money they were going to spend before they had the foggiest idea how they would spend it. They have simply thrown money into a black hole, and they are raising taxes to do so, with all the implications that that has for the economy, but nothing is coming out on the other side.
Dr. Howard Stoate (Dartford) rose—
Mr. Tom Harris (Glasgow, Cathcart) rose—
Dr. Fox: I will take further interventions in a moment.
The Government's excuse is that they have been working not only within hospitals, but outside them, for example, in general practice—yet there is a record number of closed practice lists, so patients cannot get to see a GP; the waiting time to see a GP is lengthening; and there is a disaster in recruitment to general practice. Simply to meet the Government's target of staying where they were within the national plan, an extra 2,000 GPs had to be recruited between 2000 and 2004. How many were recruited in 2000? Eighteen. How many in
2001? Eighteen. How on earth do they propose to meet their targets when they cannot recruit the basic staff to the health service to do those jobs? The NHS plan is being turned into nothing more than a glorified wish list.
Dr. Stoate: The number of GPs currently practising is at record levels. As for the hon. Gentleman's point about the number of admissions falling in the past year, much of that is due to GPs now having many alternatives to admitting patients to hospital, such as patients being looked after in their home, or being referred to social services or care in the community. The fact that hospital admissions are falling is not necessarily a bad thing—it is a good thing.
Dr. Fox: There is nothing better in a debate than an own goal. As the Labour party constantly points out, it has been in office for six years. It takes nine years to train a GP, so if there is now a record number of GPs, it must be because they began training under the last Conservative Government.
Mr. Henry Bellingham (North-West Norfolk): Is my hon. Friend aware that a few years ago in my constituency, in the town of Hunstanton, one used to be able to see one's GP the following day, whereas it now takes up to three weeks? There is a crisis in primary care in my constituency.
Dr. Fox: That is a serious issue of great concern to our constituents, who, in the real world rather than the virtual NHS that Ministers talk about, are finding it much more difficult to see their GP when they want to, at short notice. That shows how extremely difficult things are in general practice now. We are finding it difficult to recruit GPs, and many are about to retire, which will make the situation worse. The increasing pressure on GPs, not least the huge burden of paperwork that they now face, is making it increasingly difficult for them to spend time with their patients, as opposed to dealing with the red tape.
Apart from the failures in primary care that my hon. Friend the Member for North-West Norfolk (Mr. Bellingham) mentioned, there are many other areas of policy delivery in which the Government have failed, despite what we all agree is a very large increase in spending. The mixed-sex wards, which were to be abolished, are still with us, and hospital-acquired infections are at a record level: 5,000 people died as a result of a hospital-acquired infection last year; that represents 1 per cent. of all deaths. That is a record, and we are out of line with what is happening in other countries. It is an absolute scandal. The number of hospital beds has fallen since Labour came to power, despite what it said it would do, yet the number of administrators has gone up.
The #280 million earmarked for cancer went to clearing NHS debts, and a further #255 million earmarked for cancer did not get through to the front line. The number of patients starting radiotherapy treatment within the Government's four-week target has fallen from 68 per cent. in 1998 to just 32 per cent. in 2000. There are 60,000 fewer care home beds. Last year there were 77,000 cancelled operations—a 54 per cent. increase since the year that the Government came to office.
One third of all new nursing graduates and a quarter of medical graduates are now failing to practise, and last year the number of nurses choosing to leave the United Kingdom and work abroad was at a 10-year high—hardly a vote of confidence.
Mr. Tom Harris : On 20 December, The Daily Telegraph said that the Conservatives had to choose between two aspirations—one was the best possible health service whatever the cost, and the other was the best possible health service given a context of tax cuts—but they could not have both. Which one would the hon. Gentleman prefer?
Dr. Fox: There is not a country in the world that does not have limits on what it can spend on health care. The problem for all western countries is how to get the best value health provision out of a given budget. In the United Kingdom we have quite a divergent range of experience. In England, for example, expenditure has generally been well below the European average, and we have seen the problems related to that. Scotland, Wales and Northern Ireland have considerably higher expenditure, yet do not have higher outputs or better clinical outcomes; in fact, in some of the other parts of the United Kingdom the waiting lists are rising faster.
That raises questions not simply about the amounts of money but about the process. That is what the debate should focus on, and what I want to talk about in the substantive part of the debate is how the Government's plans for foundation hospitals will move the process forward so that we do not simply throw money at the system without substantial reform. I would say to the hon. Member for Glasgow, Cathcart (Mr. Harris) that without substantial reform we will simply raise taxes and spend more money, but we will get no delivery, and he will get no thanks from the electorate.
Mr. Richard Bacon (South Norfolk): My hon. Friend mentioned hospital-acquired infections. Is he aware that the rate of death from hospital-acquired infections is higher in this country than in the former Soviet Union? What does that say about the relationship between expenditure and performance?
Dr. Fox: I am not sure that is says a huge amount about the relationship between expenditure and performance, but it says a great deal about process, about the culture within the service, and about the way in which we allocate the available funding in our health care budget to preventive treatment, and basic cleanliness and hygiene. As I have said before, that is largely a matter of culture. It does not cost money or require a handout from the Chancellor of the Exchequer to wash one's hands between patients; it requires a particular approach to clinical care.
We have to ask why in this country the levels of hospital-acquired infection are so much higher than those in other countries. I have heard Labour Members say that that is because we contract out our cleaning—but that is one of the most preposterous ideas I have heard in my life. In Germany recently, when I was with a consultant, someone from the BBC said, XThis
hospital is so clean, you must have in-house cleaning." The consultant replied, XOf course we don't have in-house cleaning. We contract out our cleaning." The BBC representative said, XBut we've contracted out our cleaning, and our hospitals are filthy." The consultant replied, XIf you've contracted out your cleaning and your hospitals are filthy, why do you pay the contractors?" We should ask that question far more in this country than we do at present.The policy is not working because basically the Government have failed to tackle the No.1 problem in health delivery in this country—we have a centralised, bureaucratic and monolithic Whitehall-controlled system. The Government have made matters worse by piling on to that system a ludicrous, almost pathologically obsessive target culture, in contradiction to their rhetoric. They talk about devolving power within the NHS, and the Secretary of State has talked about the fact that primary care trusts can now spend 75 per cent. of the NHS budget. They can handle 75 per cent. of the NHS budget, but they do not have the discretion to decide how they spend it, which limits what they can do in their own locality and their freedom to do what they think necessary for their own health population. Consequently, the Secretary of State is still in control of the entire system, which is a big problem. That approach leads to deprofessionalisation—professionals on the front line, whether medical, nursing, administrative or managerial, with the skills to make appropriate decisions, are prevented from doing so by people in Whitehall who think that they always know best.
That is a recipe for demoralisation and makes recruitment and retention difficult, as we now see. It is also a recipe for distortion and dishonesty. Recently, one in eight hospital managers admitted to distorting figures to fit Government targets. One manager said:
- XAll chief executives in the region contrived to make the same 100 per cent. return to the Department of Health on the absence of waits in A and E. This was done with the encouragement of the regional director because we all agreed the requirement was meaningless".
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