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NHS Trust Deficits

3. Tom Brake (Carshalton and Wallington) (LD): What estimate he has made of the total projected deficits in NHS trusts in England for the end of this financial year. [148786]

The Secretary of State for Health (Dr. John Reid): Audited information on the financial position of national health service trusts will be published in their individual annual accounts. These data will be available centrally in the autumn. We have no plans to publish unaudited information.

Tom Brake : I thank the Secretary of State for his response. Does he agree that many strategic health authorities, primary care trusts and acute trusts are suffering from years of underinvestment? Will he tell the House what assessment he has made of waiting times and of the number of beds and operations, in terms of requiring acute trusts such as my own, which I understand has a deficit of £8 million, to achieve financial balance in the year 2003–04?

Dr. Reid: I accept the hon. Gentleman's assertion that for many years—indeed, for decades—the NHS had been suffering from underinvestment. That is why the largest and longest ever sustained increases in investment under this Government are only now beginning to show distinct improvements: to some extent, trusts have been back-filling for the underinvestment that occurred in the years of the previous Government. I know that trusts in the hon. Gentleman's own area—Epsom and St. Helier, for instance—have been forecasting a deficit position for several months. However, with additional support provided by the local strategic health authority and local primary care trusts, it is expected to break even by the year end.

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It goes without saying that, despite those difficulties, the increased investment in the same area has resulted in 15 additional consultants in the past three years; 13 more modern matrons appointed; and a 15-bedded stroke unit, which opened at St. Helier in June 2002. The forecast income for the primary care trust—the most important matter there—has increased by £12.5 million, which is just over 6 per cent. Yes, there are difficulties because of the decades of underinvestment, but we should congratulate NHS staff on taking the investment and doing such a good job in carrying out significant improvements in every area.

Mr. Lindsay Hoyle (Chorley) (Lab): Is my right hon. Friend aware that some of the budget problems can arise, as in Chorley, where there has been a huge increase in population that has not been reflected in the NHS budget? We are talking about 10 per cent. growth year on year, so what can we do to ensure that the budget reflects that population growth?

Dr. Reid: As my hon. Friend knows, in the last internal redistribution of moneys to NHS trusts throughout the country, we tried to take a number of factors into account. For instance, need has now become a more important benchmark than in the past, which has affected the redistribution. In the next round, in addition to need, I shall have regard to demographic trends. If my hon. Friend can point me in the direction of any inequities of distribution resulting from under-assessed demographic trends, I shall certainly bear them in mind.

Mr. Tim Yeo (South Suffolk) (Con): Everyone knows that more money is being spent on the national health service, and, alas, everyone knows that far too much of that money is not reaching the front line. That is why a 37 per cent. increase in spending has produced only a 5 per cent. increase in activity. Will the Secretary of State now admit that many individual trusts do indeed face deficits as they approach the year end—including the trust where the chairman of the British Medical Association himself works? James Johnson warned in the autumn of a possible £7 million deficit in his trust's budget. Is it not the case that tackling that problem at the individual level can only be done at the expense of services to patients in areas that are not covered by one of the Government's numerous targets through which the Secretary of State determines the priorities that local managers have to follow?

Dr. Reid: I know the hon. Gentleman has double the jobs of anyone else, but he must try to get to grips with at least half of his portfolio—the health service. It is absolute rubbish to say that there has been a 37 per cent. input and a 5 per cent. output in productivity. [Hon. Members: "Your figures."] They are not our figures. They are figures that relate only to hospital consultants. They ignore, for instance, the 42 NHS walk-in centres and the 6.3 million calls made to NHS Direct—completely new services, only in existence for the past few years. They even regard the 25 per cent. reduction in deaths from coronary heart disease—because they result

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not from hospital consultants but from new drugs—as a fall in productivity in the health service. How perverse is that? The hon. Gentleman should at least give credit to NHS staff by accepting that in millions of ways—through NHS Direct, walk-in centres, more operations being performed in primary care trusts, better purchases of drugs, a 25 per cent. fall in mortality from cardiac-related disease, a 10 per cent. reduction in deaths from cancer—[Interruption.] Conservative Members sneer, but they should give some credit to NHS staff.

Mr. Bill O'Brien (Normanton) (Lab): When the forecast for debts for NHS trusts is considered, what part will the strategic health authorities play in ensuring that such debts are not incurred? Will the debts of any local trust influence the future building of new hospitals in that area?

Dr. Reid: As I said earlier, we are confident that each trust, and indeed the NHS as a whole, will be in a position of balance at the end of the year. As in every business, certain trusts will be under pressure and will face temporary deficits. The rule is that they must be in balance over a cycle of up to five years. In the interim, they will be assisted either by savings found inside the trust in forthcoming years, or from the local strategic health authority, or from the primary care trust or from the NHS bank. That is perfectly normal business practice in the outside world. The NHS as a whole, and the individual trusts to which my hon. Friend refers, will be in balance by the end of the year.

Sir Nicholas Winterton (Macclesfield) (Con): I accept that the Government are desperately trying to reduce waiting lists and provide operations and treatment for those whose lives are in danger. However, if, after audit, it is clear that a hospital trust has created a deficit for itself because it has been doing precisely that—treating the people who need to be treated and providing life-saving operations and treatment—will the Secretary of State ensure that that trust has the resources so that it does not have to turn away those who need urgent treatment to save their lives?

Dr. Reid: Yes, of course. The point of the vast increase in resources that we are putting in is to enable more people to be treated more quickly across a whole further range of services. That is precisely what we are doing. When the hon. Member for South Suffolk (Mr. Yeo) attacks targets from the Opposition Front Bench, he forgets that, although the targets are general, they apply to what people want. They include reducing deaths from heart disease and ensuring faster access to heart surgery and clot-busting drugs. Which of those targets does the hon. Gentleman disagree with?

We are trying to ensure that the increased investment is matched by reform inside trusts from top to bottom so that they are more productive at any given level of capacity. I think Conservative Members should occasionally welcome that. For goodness' sake, it would be nice if Conservative Front Benchers just once thanked the people who work in the NHS for the significant improvements that they have achieved.

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NHS (Patient/Public Involvement)

4. Mr. David Kidney (Stafford) (Lab): If she will make a statement on progress in implementing the new arrangements for patient and public involvement in the NHS. [148787]

8. Linda Perham (Ilford, North) (Lab): If he will make a statement on the new arrangements for patient and public involvement in the health service. [148791]

The Minister of State, Department of Health (Ms Rosie Winterton): Ninety-nine per cent. of places on patients forums have been filled. Every local authority has a health scrutiny committee, every trust has a patient advice and liaison service, there is independent support for complainants and thousands of people have applied to become members of the first wave of foundation trusts. Those changes give real control and influence to NHS patients.

Mr. Kidney : I thank my hon. Friend for that answer. Will she accept my tribute to the Mid Staffordshire community health council, which has of course been compulsorily retired? It was always active and effective. May I tell her about my work to learn the new arrangements for patient and public involvement in Stafford, which has included meeting the senior managers of all the trusts? I have met Vanessa Day, the primary care trust patient advice and liaison service officer. I officially opened the PALS office at the hospital at Stafford, where I met Mandy Gibbs and Samantha Edmonton. I have also spoken to the forums co-ordinator Peter Goodman—

Mr. Speaker: Order. The hon. Gentleman must ask the Minister a question, not tell us what he has been doing. I know that he is a hard-working Member of Parliament, but it is not the purpose of a supplementary question to tell the House that.

Mr. Kidney: Does my hon. Friend agree with my conclusion that the new system is decidedly more comprehensive, modern and responsive than what went before?

Ms Winterton: I am grateful to my hon. Friend for playing such an active role in encouraging patient and public involvement in the NHS. He may recall that I wrote to all hon. Members on 1 December, informing them of the new arrangements and encouraging them to play exactly the part that he has played. I, too, pay tribute to the work of members of the CHCs and am glad that about 25 per cent. of former CHC members are now on patients forums. We have to build on the best practice that they showed us previously.

Linda Perham: Is my hon. Friend aware that the all-party group on community health councils hopes to re-form tomorrow as the all-party group on patient and public involvement in health, to work with the Commission for Patient and Public Involvement in Health to support the new arrangements to which she and my hon. Friend the Member for Stafford (Mr. Kidney) referred and to ensure that the voices of NHS users are heard in the provision of services, to which the

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Government have committed record levels of investment? Would my hon. Friend like to come to a future meeting of the group?

Ms Winterton: I thank my hon. Friend for that invitation and I should be delighted to meet the group. I know that my hon. Friend has always played an active part in these matters; I believe that she herself was a member of a CHC before 1997. As I said, it is important that we in Parliament not only do everything that we can to encourage people to get involved in determining the provision of local health services but also that we thank them for the time that they give voluntarily. I should be delighted to accept my hon. Friend's invitation.

Rev. Martin Smyth (Belfast, South) (UUP): I welcome the voluntary help that is being given, but does the Minister agree that in appointing non-executive directors we must ensure that they are equipped to deal with the issues that trusts require, and that they have business and other skills? The Minister mentioned complaints procedures. Is there not a danger that many people are complaining not because they want to but because when public representatives raise issues with trust boards and hospital authorities, they are told that the questions cannot be answered unless people make an actual complaint? Surely, that does not help the health of the nation.

Ms Winterton: The hon. Gentleman will be aware that an independent body undertakes appointments.

On complaints in general, through the independent complaints advocacy services and the patient advice and liaison services, we have set up a system to provide independent support for complainants. In addition, we are looking at the whole system for redress in the NHS, in the recently published document "Making Amends".

Miss Anne McIntosh (Vale of York) (Con): Without disclosing to the hon. Lady the contents of my diary, may I ask her to tell the House what the new arrangements are for mentally ill patients and the huge increase in the resources of the medical profession that they are taking up? Will the new arrangements also take into account the implications of the working time directive for doctors and nurses with mental health qualifications, who are spending huge amounts of time and resources? Will we need more doctors as a result of the directive?

Ms Winterton: Obviously, challenges lie ahead in that direction, and the Department as a whole is considering the issue. It will be for individual patients forums to look into the arrangements made locally, in conjunction with both acute and primary care trusts.

Kali Mountford (Colne Valley) (Lab): Anyone involved in public consultation on health knows that when an issue is big enough we can easily fill a room, but that it can be dispiriting to turn up to a meeting in a cold room on a Thursday night to find that only three people have attended. I am sure that it is not my hon. Friend's intention that the new public involvement in health excludes public consultation, especially on major issues such as the reconfiguration of hospital services. I, too, want to see greater ongoing public involvement in the

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health service, but can she reassure me that the new arrangements will not reduce public consultation when a matter concerns the whole community?

Ms Winterton: I agree with my hon. Friend. There are two ways of achieving that under the new system. First, the patients forums can set up separate sub-committees to consider particular issues of local involvement—[Interruption.] The Opposition sneer, but it is important that people get involved. We know that there is interest and that, for example, more than 1,000 extra people applied for places on patients forums. It is important that Members of the House do all that we can to encourage that. Secondly, overview and scrutiny committees will also have a consultative role, which they did not have before, particularly to consider the reconfiguration of services. Put together, that will increase consultation and encourage the type of involvement that we want.

Hywel Williams (Caernarfon) (PC): The Minister will know that community health councils in Wales have been retained and, indeed, strengthened. What arrangements are in place to ensure that the NHS in England can learn about the rather more progressive practice in my country?

Ms Winterton: I am sure that the commission will take every opportunity to learn any relevant lesson from the Welsh situation. As I have said, we want to build on the best that community health councils provided. However, it is true that the service was patchy in some areas. We have tried to have a system that has national standards, so that we know that the same service will be available everywhere not only to consult patients, but to have a robust complaints procedure.

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