| Previous Section | Index | Home Page |
Sir Sydney Chapman (Chipping Barnet): The hon. Member for Sutton and Cheam (Mr. Burstow) said that during the 18 years of Conservative government, we ran down the national health service. Would the hon. Member for Telford (David Wright) like to confirm that when we returned to office in 1979, expenditure on the health service was £8 billion, and that when we left in 1997 it was £42 billion? In the light of that, does the hon. Gentleman agree that, despite what he says, especially on targets, we are trying to get rid only of the contradictory targets that lead to a worse health service and that the whole emphasis should be on what we want to produce—a better managed national health service?
David Wright: I appreciate the hon. Gentleman's intervention. Undeniably, there were real-terms increases in health spending throughout the 18 years of a Conservative Government, and that resulted in improvements in services. However, services, including drugs and health care, have become more and more expensive over the years. I think that when the hon. Gentleman has heard my remarks he will acknowledge that we have made significant increases in health spending. I shall return to his point later.
In his speech, the Secretary of State outlined the progress that we are making nationally and gave some of the headline figures on health care. I want to tell the House how we are doing in Telford and Wrekin and in Shropshire. During the past three years, there has been an increase in investment of £25 million in capital developments and new service initiatives at the two main
acute hospitals in Shropshire—the Royal Shrewsbury hospital and the Princess Royal hospital in Telford. In addition, £19 million has been invested in moving services from the barracks-style buildings on the south site at the Royal Shrewsbury and opening new facilities to replace them in both Telford and Shrewsbury. In 18 years of a Conservative Government, we saw no progress on the Copthorne south site; progress has occurred only since the Labour Government were elected.Last year, trauma and orthopaedic clinics, a new X-ray department and an endoscopy unit were opened at the Princess Royal. In 2001, a new maternity unit was opened and the hospital has also created a new clean air theatre. A new gymnasium and a refurbished fracture clinic have been opened recently. The accident and emergency department has been fully refurbished. Future investment will deliver a range of new facilities for haematology and chemotherapy treatment; there will be day surgery theatres, a dermatology unit and a satellite renal unit.
There has been tremendous progress in capital investment. The Opposition often accuse us of putting in the cash while not securing delivery, so what is that investment delivering on targets? More patients are being treated more quickly and in better buildings than ever before. Between 1997–98 and 2002–03, the total number of cases seen by the two hospitals rose by about 12 per cent. to 433,000. That includes elective surgery, emergency in-patients, out-patient attendances and accident and emergency attendances. Even with that increase, in-patient and out-patient waiting lists fell dramatically. No in-patient is waiting more than 12 months and the total size of the list has fallen by 34 per cent.
By March 2003, no out-patients were waiting for more than 28 weeks and the number of people waiting for more than 13 weeks fell by more than 36 per cent. between 1998 and 2003. In the words of the chief executive of the trust, Neil Taylor:
- "Year on year activity is increasing, with the number of referrals from GPs and emergency cases going up, but our lists have been going down. The length of time that people are waiting for an operation has been significantly reduced."
Alongside that success in acute services, the PCT is making major progress in planning and delivering community-based services. In my constituency, two brand new GP surgeries have opened, in Dawley last year and in Oakengates this year. There has also been a large refurbishment at one of the most popular surgeries in the town. Resources allocated to the PCT will increase by £40 million to £152.9 million a year by 2005–06.
Chris Grayling (Epsom and Ewell): Is the hon. Gentleman aware that at least one PCT in Shropshire has been forced to use money allocated in this year's budget for the consultants' contract to help to bridge its financial gaps, such is the state of the financial
predicament it faces? As a result, now that the consultants' contract has been approved, that PCT will struggle to afford to pay for it.
David Wright: There are problems with acute services following the merger of two large hospital trusts, and there is certainly a need for us to invest more heavily in new and developing services on those two sites and in the consultants' contract. We also have some problems with the maternity services provided at Oswestry. So things are not all rosy, and I was going on to say that we have some problems and we can always do better. For example, the PCT does not receive its calculated fair share of resources at the moment. I hope to secure an Adjournment debate on that very issue in the next few weeks. The new junior doctors' hours are a cause for concern in relation to staffing capacity and funding, particularly in accident and emergency services. However, the number of student doctors in this country has risen by 50 per cent. since 1997.
In general, the picture is very good. There are more doctors and nurses working in the NHS now than at any time in the past 15 years, so there is an impressive pace of change and significant progress is being made. Increased resources and capacity, coupled with reforms to the NHS, have already had a direct and positive effect on the quality of treatment that NHS patients receive in Telford and Wrekin and Shropshire.
The question that the Opposition have to answer is that, if targets really are having
- "a detrimental effect on clinical outcomes",
I shall briefly consider the Opposition's proposals for the NHS and what their targets are. The Opposition have clearly decided to tear up the post-war consensus on health. Even Lady Thatcher, in the years that the hon. Member for Chipping Barnet (Sir Sydney Chapman) mentioned earlier, did not attempt to do what the Conservative leadership plans to do to the health service. They no longer believe in the fundamental principle that NHS health care should be available to all, free at the point of need.
In fact, the patient passport is a Trojan horse for privatising the service. The only people who will be able to benefit from it are those who can already afford to pay for private medical treatment. The vast majority of patients will not be able to exercise any choice under the Tory proposals because, if they want to exercise that choice, they will have to pay to do so.
Tim Loughton: The hon. Gentleman obviously has not read any of the proposals. Everyone would benefit from the patient passport, without any coercion to pay a penny, by being able to exercise choice and gain access to any NHS hospital in the country. That would be much more widespread than the bogus choice that the Secretary of State for Health is peddling. I want to make it absolutely clear that not a single person would be
coerced into paying a single penny for any treatment in the NHS. Labour Members must stop peddling this nonsense.
David Wright: The problem is that if people wanted to jump the waiting list, they would have to pay more money. The problem with the patient passport is that if people wanted health care, they would have to pay for it in addition to what they are currently paying through general taxation. If hon. Members visited the people who live on the estates that I represent, they would find that they could not afford that expense. They want a high quality NHS, funded from general taxation and free at the point of delivery, and I am very proud to stand up for those principles this evening.
The Opposition's plans would cost the NHS about £2 billion to enable the minority of patients to go private. The battle lines are drawn in relation to the NHS, and I am confident that the people of Telford are on the side of the Government.
9.4 pm
Mr. Ian Liddell-Grainger (Bridgwater): The targets cover a multitude of sins, but I have specialised in one issue. I am a member of the Public Administration Committee, as is my hon. Friend the Member for Chipping Barnet (Sir Sydney Chapman), and the Committee considered all the targets, not just those in the health service. The first thing we discovered was that there is a great raft of targets in the NHS. In fact, the Government announced the 62 targets during a Select Committee sitting. We had no idea—even though the Select Committee is Labour dominated—that that was going to happen. Those 62 targets are set at the top level, but by the time that they reach down to GPs on the ground, they can have multiplied because there are targets on targets. We discovered parts of hospitals that create targets for other targets, for consultants, doctors and anyone who works in the NHS.
The Committee went to Bristol to look at what was happening there—Bristol was chosen for no particular reason other than that it was fairly close to London and it has a good train service. What we found was startling. We expected to see only the top management, but we found ourselves in a room that was filled with people who worked in Bristol hospitals. The problem was that they all wanted to talk about targets to a Select Committee—I do not quite know whether they all understood what a Select Committee did, but that is not the point. They all said the same thing—that targets were damaging health care in this country. They said that they were damaging it for different reasons: some said that it was because they are confusing; some said that it was because they are not achievable; some said that they did not have the money to achieve them; others said that they had had no clear steer from the Government on what to try to achieve. Others, more worryingly, said that they were being bullied to hit targets, that they were being forced by managers into a position in which they had to berate staff to hit targets, and that ambulances were going around car parks where, at the end of the month, patients were being left on trolleys without wheels so that they could be counted as beds, not trolleys. We also discovered that people
needing eye tests were not being given the chance to have them because a target had to be hit at the end of the month. Up to 1,000 patients had been taken off a list relating to eye conditions—those suffering from glaucoma, diabetes and so on—because the target could not be guaranteed to be hit. That cannot be right.When we started to investigate further, nurses told us that they would start to take action—Ian Bogle made some famous statements to which I shall refer later—because they simply did not have the ability to achieve the targets. The point has been reached at which targets are being created in the health service that are not achievable and that the staff do not want to achieve, and the detrimental effect on patients and staff is out of all proportion to what they are trying to achieve.
The star rating system for hospitals is also a problem—Bath is the other prime example in the west country of a hospital that was in a terrible state. It could not achieve the star rating because it could not hit the Government's targets. Why? Because its expertise is not what the Government were trying to target—in that case, cancer. The same was true of my local hospital in Taunton, Musgrove Park, which is not a cancer specialist hospital, although it must still try to hit cancer targets. However, that is not what it is known for or good at.
When the permanent secretary at the Department of Health came to talk to the Committee, his view was that the targets system had to be streamlined. That is fine—all targets need to be streamlined—but that is not what is happening. When it starts from the top and the permanent secretary sets out what we must try to achieve, five or 10 years later—and some of the targets extend for up to a decade—the targets bear no relation to what they set out to do in the first place.
The Public Administration Committee—another member of which, the hon. Member for Pendle (Mr. Prentice), has just joined us in the Chamber—said that it was detrimental to have more than five targets. Lord Browne of BP said that no more than five to 10 targets should be set, and that we should expect to fail to meet two to three of them. People should not be forced down a particular line when they cannot hit targets. Lord Browne is a fairly astute character to say the least—he was certainly an impressive witness in front of the Select Committee—and his view is that an organisation cannot work on 62 targets; it must quarter the number, and if it does not it will cause instability. In an organisation such as BP, which is not national but international, we can imagine how that would be magnified.
I want to talk about more local issues. Somerset Coast primary care trust, which is in my constituency, has three small hospitals: Minehead, Williton and Bridgwater. Our problem is that they supply one major hospital, Musgrove Park in Taunton. There is no straightforward bus service from any of those hospitals to Taunton. If people have to see a consultant, they have to rely on an ambulance car service, the one ambulance that is based in west Somerset, or a bus. The bus may or may not get people to the hospital in time, but they know that they must spend the whole day there, whether they like it or not.
When people get to the hospital in Taunton, they sometimes discover that the consultant cannot see them. That might happen because there is a problem at the end
of the month—it is funny how problems build up toward the end of each month. Cancellations occur, people cannot be fitted in, or machines break down. People then have to wait at the hospital because they have difficulty getting back from there.In west Somerset, wards have to be shut periodically to allow staff to be transferred to the main hospital in Taunton to ensure that targets are hit. That happens regularly and we accept it because we have no choice—people in rural areas do not have a choice because where else can they go? We have paired up with hospitals in Dorset. People who go to the next main hospital from Taunton have to get to Poole or Bournemouth. I drove down to that area on Friday night and it took me more than two hours. The sort of roads that people have to use make it difficult to get there. How can transferring people by car to a hospital in Bournemouth hit targets? Surely the common-sense approach would be to transfer people from Somerset to Bristol or Exeter, but that is not happening.
A further problem is the general practitioner service in rural areas. I have been to see all my local GPs and they are an extremely good bunch who work hard. However, they cannot recruit replacements for retiring GPs, although they have tried. They cannot find GPs who are willing to set up home in rural areas. The opposite was true in the old days, but there are now fewer GPs in the area. One of my local rural surgeries, which has four or five doctors, has been continually advertising for a GP, but it cannot find one—that cannot be right. The problem is that if one GP retires in a place such as Bridgwater, 3,000 extra patients have to go to a different surgery for what is called "the time being". However, that does not happen for "the time being" because the problem has still not been resolved, although the PCT and the strategic health authority have tried extremely hard to address it. The situation has arisen because they are trying to hit targets, but it is not working. Doctors say that they must keep pushing people through, so they do not want to refer people to other services. We need doctors to start at the beginning with the patients whom they have. All the lists for doctors in the east of my constituency are closed, so some people cannot get a doctor.
For some unknown reason, the headquarters of our mental health service is in my constituency—I do not know whether that says anything about the constituency's hon. Member. The head of the service has moved on, which is fine, but we are left with a massive problem. We have lost bed after bed after bed. We cannot look after people with mental health problems from Bridgwater or Somerset. Worse still, in order to hit targets, people from outside our area are being referred there, and they take up the beds that we have left. That happens because areas such as Bristol that have too many patients have been told that they must hit targets, so they push people down the road and send them out to places such as Somerset, Dorset, Wiltshire and Gloucestershire. That cannot be right. We are losing beds because we do not have the money to pay for them, yet our area's people cannot get beds because of draconian measures from the centre to hit targets. The system is badly wrong.
We are trying to resolve the long-term effect of targets on old folk. One of the towns in my constituency has the highest proportion of elderly people in the county.
However, so many care beds have been lost in my area that doctors are forced to refer patients to hospital for overnight stays. A person cannot get a bed in an emergency because we do not have sufficient beds to take up the slack.Members of the PAC know how many beds have been lost in long-term and short-term care. If doctors cannot put old people into a care place overnight, they refer them to hospital, but hospitals do not want them because they take up extra beds. The hospital's attitude is, "We don't want them because it does not work for our targets", so those people are pushed out again. In my constituency, more and more people have been put back into the community too quickly and without adequate care and back-up. To judge by the letters I receive, the situation is getting worse.
The figures show that the level of care in the community has dropped dramatically. Again, that may be the result of a target. All I know for certain is that people are coming back into my community and are not getting the care they need to ensure that they are properly looked after. The situation in accident and emergency departments is also worrying. Don Mackechnie, an accident and emergency consultant, said:
- "I am appalled to see how A&E departments have been forced into taking extraordinary measures for a week-long period just to meet political targets."
The targets are political. They are targets for targets' sake. When we wrote the PAC report, we said that it is not possible to use targets as a means in themselves. That does not work, as has been proven over the past five years. A good target is a target that is achievable, but we cannot break the organisation that we are trying to get the best out of in the process. If we break the organisation, we get what happened in Bristol—deceit, difficulties and problems of low morale. I do not know where the doctors will come from, but they will not want to enter a service in which they are berated because they cannot hit a target. Political targets have one use only, which is to try to ensure that the money that is supposedly being pumped into the health service gets there. I tell the Minister that it is not and it is going wrong.
| Next Section
| Index | Home Page |