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5.13 pm
Dr. Andrew Murrison (Westbury): It is a great pleasure to follow the hon. Member for Keighley (Mrs. Cryer).
We have heard some tremendous contributions today. In particular, I should like to associate myself with the remarks made about the Royal Hospital Haslar by my hon. Friend the Member for Gosport (Mr. Viggers). I served at the Royal Hospital Haslar, and in my opinion, its demise has been the final nail in the coffin of the Defence Medical Services. Ministers should be under no illusion: the Defence Medical Services are a central part of our defensive capability. They are in a truly dreadful state and the situation must be addressed as a matter of urgency. I have to tell the Minister that the new centre for defence medicine at Selly Oak has not been well received by those who serve in the Defence Medical Services. It was a sad day indeed when the Royal Hospital Haslar, with all its potential, finally met its end.
It was also a great pleasure to hear the remarks of the hon. Member for Lewisham, Deptford (Joan Ruddock), some of which I agree with and some of which I disagree with. GM is an emerging technology, but the next one will undoubtedly be nanotechnology. Last week, I led a debate on that subject in Westminster Hall, but the response that I received from the Under-Secretary of State for Trade and Industry, the hon. Member for Edinburgh, South (Nigel Griffiths), was less than comprehensive. I have written to him in the hope that he might revisit the Hansard record and address the points that I put to him.
In particular, we need to know where we are going with the debate on nanotechnology, because I fear the some of the mistakes that were made in relation to the GM public debate might be repeated in that context. I hope that we will have learned lessons from that—especially in relation to the wisdom, or lack of it, of having the public debate before the full evidence was available to present to the public. That is a topsy-turvy way of proceeding. I hope that we do not repeat that mistake when we deal publicly, as we must, with the next emerging technology—nanotechnology.
During the summer, we will see the last days of community health councils. That worries many hon. Members; some of us argued in Committee that it was folly. I pay tribute to the work of the community health councils that have served my constituents for more than
a quarter of a century. I feel strongly that CHCs represented a good foundation on which to build, and I fear that after their demise our constituents will suffer from a lack of representation at that level. They have been valuable to me personally as a constituency MP in advising me of the feelings of people locally on health issues; they will be sorely missed.We have not covered health greatly in this summer Adjournment debate; that is strange, given that health is probably the No. 1 priority of most of our constituents—certainly, my mailbag suggests that that is the case. I pay tribute to the Government for being able to spend historically large sums of money on health. I equally pay tribute to their predecessor for providing the economy necessary to achieve that spend. We should never fool ourselves that we can get health care on the cheap. Spending is relatively easy: it should not be considered a proxy for achieving the good health care that we all want for our constituents. The tricky bit is achieving the health outcomes that Britons have the right to expect. In that context, it is disingenuous to talk euphemistically of investment when we really mean spending. Words mean what words say, and it is important, in the context of health, to talk of spending, not to assume that spending equals an investment that will produce a return.
Spending on health services increased in real terms by 22 per cent. at the turn of the century, but hospital activity went up by just 1.6 per cent. Indeed, by their own deeply flawed star rating measures, the Government are failing, despite their largesse. Only this week, we heard that the number of zero star rated trusts has increased and that the performance of ambulance services has gone down. Those statistics come with a health warning, because one cannot realistically expect a 22 per cent. rise in spend to produce a straight-line proportionate increase in activity of anything like 22 per cent., let alone a 22 per cent. increase in health outcomes: the marginal utility is manifestly much less. I suggest, however, that it should be significantly greater than 1.6 per cent.
It is our duty to ask what has gone wrong. Part of the answer clearly lies in public sector inflation running at 5.3 per cent. There is a whole raft of reasons for that, including salary costs, national insurance, pensions and the use of expensive agency staff. Health service inflation outstrips just about every other form of inflation. Despite rationing by the National Institute for Clinical Excellence, which has contained costs to some extent, the cost of drugs and medical devices is set to rocket.
Less obvious to outsiders would be the fact that many people are in the wrong jobs—non-productive jobs or jobs where the product is obscure. When I was in the Royal Navy, we reached the tipping point at which the number of admirals exceeded the number of ships afloat. It seems that we have reached that point in the NHS, with the number of bureaucrats exceeding the number of beds. That is nothing to be proud of. Allied with that is an incomprehensible budgetary framework in which health care managers are encouraged to spend in a short-term way—to adopt a "spend now or lose it" mentality. That has spawned a great range of jobs with no obvious purpose, as The Sunday Times rather unkindly highlighted at the weekend when it referred to what it described as rubbish jobs being thrown at a perceived public need, with little thought about what they would achieve in terms of outcomes.
So it is that between 1997 and 2002 the number of doctors and nurses went up by 15 per cent., but the number of administrators soared by 46 per cent. Many of those managerial jobs do good things—there is no denying that—but surely that deployment of our 22 per cent. uplift in resources at the turn of the century would have been better spent on health care staff who are directly involved in a hands-on way with patients. My Select Committee found that tens of million of pounds had been lost to the system—we had no idea where tens of millions of pounds had gone under the NHS cancer plan. Nobody appears to have accounted for it let alone had any idea about what positive outcomes it had produced. That is hopeless.
Last week, I asked the Chancellor of the Exchequer whether the data on which he was relying for his comparison by 2005 of EU spend and UK spend on health care were weighted or unweighted, projected or static, or whether they were based on the Office for National Statistics' newly computed data, which involve heath care spend by a raft of organisations outwith the NHS—charities, churches, nursing homes and so on. He addressed the first point honestly and said that it was weighted. On the other two, he was obscure, so we have to make our own conclusions on that.
Government spending on health care and education centrally seems to sit uneasily with the deficits that we see locally in our schools and hospitals. That is a great concern in my area, where the strategic health authority has a huge deficit—almost insurmountable, I would suggest—which it is being told to get on with sorting out itself, with little assistance, it seems, from the centre. How much worse will that get when local, apparently accountable and democratic governing bodies sit and are responsible for these budgets? I suspect that Ministers will rusticate responsibility even more.
It is glib and dishonest to say that the increase in spending must go hand in hand with reform without a clear vision of what that reform means. Somewhere along the way, the Government have lost the plot, and our constituents' health expectations are the poorer for it.
5.22 pm
Mr. Tony McWalter (Hemel Hempstead): The principal topic with which I am going to deal this afternoon—I shall speak briefly, in case you have the chance, Mr. Deputy Speaker, to fit in two other speakers—is a riveting one: multi-agency working. Some Members will be surprised to hear me use such an expression, because even the expression "new Labour" has yet to pass my lips. To speak in the language of it might therefore seem strange.
Multi-agency working, however, is basically quite a good idea. It says that what we must do is get different people—social services, local borough councils, the police service, the probation service and everyone else who might have some share of a problem—to work together rather than carve it up so that each does their different thing and nothing much joins together. My experience, however, is that we have a long way to go. I want the Government to consider seriously whether,
when it is clear that multiple agencies need to be involved in a problem, we should try to get somebody to take lead responsibility for it.Let me give an example from my constituency. I was approached by two very worried parents, both aged over 70 and frail in health, the mother suffering from cancer. They were the parents of someone whom I will call Joe Bloggs. Joe was in prison and about to come out. He had been given a two-and-a-half year sentence but was being let out on licence after a year and a half. He had been a heroin addict and was clean. I discovered that he was going to come out a week before he did so because his parents simply did not know to whom to turn. As Members of Parliament, we can get access to a lot of people whom others cannot normally get hold of, so when his parents came to see me, I was able to speak to the governor of the prison, the chief probation officer, the head of social services, and someone at the housing department. I spent a week doing all that, but at the end of it all, this man was coming out of prison clean, but with no prospect at all of remaining so.
The man's parents were told that there were two possible arrangements for when he came out of prison. The first was that no one would meet him; the second was that they could meet him. However, they were very frail and upset, their grandchildren often stayed with them in their house, and there was no way that someone who needed that level of care and attention could be looked after at home. So, in the end, I agreed to do it. I got up at 5.45 am and went to the prison with the parents. I had made all the arrangements. The prison then told us that he would be released at 9 am. At 10.30 am, he finally emerged, so we had already lost an hour and a half out of the day in which we could have been trying to solve his problem.
I then took him to his home, where his parents helped him in various ways. I wanted the bond between him and his parents to be established before I moved him on, because he would otherwise have thought that they did not care. He also needed to know, however, that it was impossible for his parents to look after him. He understood that, and we left his home and went to the probation office. The probation office is meant to be the lead agency for someone on licence, but the probation officer in charge of the case was a probationer himself, so it went to another probation officer.
Three days before the man came out of prison, I had to tell the probation office that this prisoner had cerebral palsy. "Oops!", they said, "Sorry, we didn't know that he was disabled. That's a different category." I thought that we might now be able to get some help. The ex-prisoner was determined to get the help that people who have been drug addicts need. He was also determined not to come back to Hemel Hempstead, where all his old contacts were. After four hours in the probation office, I had to go off and see another constituent for a couple of hours—someone who was dying—and when I got back on the case, I found that the first thing that they had done when I left was to phone his frail, elderly parents to say, "Come and get him." His parents went to get him from the probation office—luckily they were able to drive there—and they brought him away. Finally, I saw him again that evening established in a house in which it was absolutely clear that he would be dragged back into his drug habit in no time at all.
The probation office did not even know the phone number of social services. The local borough council housing department had had a dispute with the man about the rent from the last time that he had lived there, and even though his parents had cancelled his tenancy, it had not been cancelled. The whole business was surrounded by utter incompetence. There was nobody to say, "He's my case. I'll try to see this through." Unless we have a lead agent for this sort of case, the only thing that people like this will be able to do is to go back on the street and start robbing. This guy was a pusher, and very well known in the area, but he wanted to get off the drugs. But in the end, the whole system, with dozens of people being paid very high salaries, could make absolutely nothing happen. I ask the House to consider whether we are ever going to get things right unless we can appoint a lead agent in these cases to take responsibility for people like that.
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