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5.53 pm
Mr. Paul Burstow (Sutton and Cheam) (LD): I should like to start by making some comments about the NHS, and then address other issues in the Budget, particularly preventive health.
Liberal Democrats support investment in the national health service. At the last general election, we had the courage and conviction to argue the case for increased taxation. We are delighted that that argument has been
won—during this Parliament, the necessary resources have finally been provided and we voted for the increase in national insurance that was approved by the House about a year ago. We wish to place on record our appreciation for the dedication and hard work of NHS staff, both on the front line and in the back office. It is important to stress the commitment of both groups and to register our appreciation, not least because the recent survey by the Commission for Health Improvement found that one in six front-line health care staff are victims of abuse and violence when performing their job of caring, nurturing, supporting and trying to help sick people get better. It is entirely unacceptable that staff should be thrown into that battlefield when they already have more than enough stress and worry in the discharge of their duties.There was a disappointing if predictable reaction to last week's work force survey, particularly the findings about the increase in the number of managers. Some people have a fixation about what those figures mean, how they are interpreted and what they show, but it is worth bearing it in mind that between 1997–98 and 2002–03, the management costs of the NHS fell from 5 to 3.9 per cent. I do not buy the argument that the NHS has too many managers, and nor do I buy the statistics that are often peddled to justify that argument, because they require a stripping-out of various staff who provide back-up support for front-line staff. However, NHS managers who are trying to do their job have their hands tied by red tape supplied by Whitehall and by the excessive number of targets that determine what goes on at local level to enable people to have choices about initiatives. That undoubtedly stifles the opportunity for innovation in the NHS at local level. It is only by freeing NHS managers and staff from the target and tick-box culture that still drives too much of the NHS from Whitehall that we can hope to get the full value of the investment that is going in. The Commission for Health Improvement commented on that only last week.
Dr. John Reid: May I place on record my gratitude to the hon. Gentleman for giving the lie to the constantly peddled myth that the NHS is over-managed? Does he accept that the percentage of managers in the NHS is, at under 3 per cent., far lower than in the private health care sector or the private sector? Since 1997, 224,000 more staff have been recruited, of whom 13,000 or 5 per cent. are managers. I wish to underline the distinction that he made between the task that managers face and the myth often peddled by the Conservatives, which is merely another way to beat the NHS. Their figures for managers are manufactured and are frankly not true.
Mr. Burstow: I am grateful to the Secretary of State. While I have many disagreements with him about priorities and approach, he is right on that point. It is important to put on record the facts about management, because a myth is being spread about the inappropriate deployment of money, which, it is said, is not reaching the front line. There are, however, some examples of money not reaching the front line, which I shall deal with in a minute.
I mentioned the work force survey, and it is worth looking at one or two of its findings. Last week, there was some premature back-slapping about the progress
that has been made. Undoubtedly, additional nurses and doctors have come into the national health service, which is welcome, but there are still grounds for serious concern, not least because of the demographic profile of the nurse population in this country. One in four nurses will be eligible for retirement in the next five years, and recruiting more nurses to replace such large numbers will be a hell of a challenge. Our health care system is increasingly dependent on the recruitment of nurses from overseas. I shall not address the ethics of that now, although there are still concerns about overseas recruitment. We are, however, competing for health care staff in a global market where other players are probably better equipped than we are to compete for our precious health care staff. The United States of America currently has a shortfall of 1 million nurses, and is trying to get UK nurses to work there. Plenty of other countries are likely to do the same thing. Health care recruitment is a global problem, and I do not yet see any international action being taken to ensure that we have an adequate supply to meet the needs of developed countries and to secure the long-term needs of developing countries.I shall focus on some of the other figures that emerged from the work force survey. For example, the number of midwives continues to be a cause for concern. The continuing shortage is hitting three quarters of maternity units, where vacancy rates have remained stubbornly high or have been rising since 1999. Given the importance of strengthening primary care, it is particularly worrying that the survey recorded a drop in the number of health visitors and district nurses. A report this month from the Commission for Healthcare Audit and Inspection draws our attention to the continuing crisis in the development and delivery of primary care, and the fact that staff shortages are leading to GPs closing lists, low staff morale and high workloads. All those factors jeopardise and slow down the development, expansion and improvement of primary care.
Although we celebrate the investment going into health care, it is worth putting on record the fact that there are a number of areas where taxpayers have every right to question whether they are getting value for money. The first such area is NHS spending on temporary doctors and nurses. Every day, £4 million is spent on agency staffing in the NHS. Last year, £1.4 billion was spent in the NHS in that way. Of course it is sensible to spend on agency staff as part of a strategy that makes the best use of permanent staff, but as the Audit Commission revealed only a couple of years ago, too many NHS trusts have lost control of their agency budgets, have no idea how much they are spending, and have no sense of direction and strategic purpose behind that expenditure. Consequently, they are fighting fires, never getting the budget under control. Year after year under this Government, expenditure on agency staff continues to rise.
There are other areas where there is cause for concern about whether the taxpayer is receiving value for money. The figures for MRSA infections were reported yesterday and today. A few years ago, the National Audit Office reported that hospital-acquired infections were costing £1 billion. At least 100,000 people suffer
from such infections, and possibly as many as 5,000 die every year—the Conservative health spokesman referred to those figures. It is fair to say that under the last Conservative Government, there was still a voluntary surveillance system that did not adequately convey to the NHS or anyone else the scale of the problem. It is only in the past few years that we have had a mandatory reporting system, which has provided a true picture of the scale of the problem: it is massive.The result of the failure to get to grips with the problem of infections over the past decade or more is that people stay in hospital for longer. That has knock-on effects: operations are cancelled because people who have got sicker while in hospital occupy beds. According to figures from the Department of Health, 17,000 patients had operations cancelled this winter. The number of operations cancelled has increased by 43 per cent. since 1997, so capacity is being wasted. It is not just a question of investing in more capacity; we must make sure that we use practices that avoid the wastage of existing capacity. Poor hygiene practice and under-resourced infection control teams make it difficult to overcome the problem.
I shall give a final example of an area where there is waste and room for much improvement, and which is costing the NHS a fortune. Every day, the NHS spends £2 million on treating the consequences of bed sores, which are eminently preventable in about nine out of 10 cases. The annual cost is £750 million and the vast majority of those cases could be prevented by simple practices and good nursing.
We heard an exchange between the Secretary of State and his Conservative opposite number, the hon. Member for South Suffolk (Mr. Yeo), about the Conservatives' plans for a patients passport. I regret that, despite the Secretary of State's best endeavours, we were unable to get any further clarification of what the policy means and, crucially, how the deadweight cost of the policy will be funded. Some 300,000 people already choose to have operations and other procedures in the private sector. They will be the first people banging on the door of a putative Conservative Secretary of State and saying, "Where are my patient passport pounds? I want them now."
The scheme would cost £1 billion, on a reasonable estimate. I understand that when the shadow Chancellor made his presentation, he was asked how it would be paid for. He said that the Conservatives did not yet know how much it would cost or how they would pay for it. I certainly hope that the consultation that the hon. Member for South Suffolk outlined will spell out in detail how they will fund that deadweight cost. A billion pounds will be passported out of the NHS, and not a single extra operation will be performed as a consequence. In their quest for savings, the Conservatives should identify that as a waste of money, as should the Secretary of State.
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