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6.41 pm
Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): It is a pleasure to follow the right hon. Member for South-West Norfolk (Mrs. Shephard) and to have heard her interesting contribution to the debate. It will be of interest to people in Devon and Cornwall, where biofuels offer new diversification potential in farming crops.
I welcome the opportunity to make a contribution to the debate on health. Successive Budgets since 1997 have provided sound public finances and the basis for significant increases in resources for all our public services. They have enabled us to tackle the significant under-investment of previous decades, which was perhaps most apparent in the health service.
During the 1997 election campaign, it seemed as though people on every doorstep related a difficult story about employment. My constituency has experienced some of the most dramatic falls in unemployment in the country. I remember when my right hon. Friend the Member for Darlington (Mr. Milburn), who made an interesting contribution to the debate, visited my constituency in 1996. We discussed the way in which solving unemployment could contribute significantly to reducing poverty and the attendant stress and ill health. We have made progress on employment.
In the 2001 election campaign, however, when I knocked on some 4,000 doors, I was struck by the fact that we still had much to do for the health service, even though we had put in place important building blocks on which to base the investment that was announced in the Budget that followed the election. I want to consider what the investment is achieving and what it will and can achieve. I also want to discuss the Government's commitment to spend money, which is matched by their commitment to efficiency. I stress to my hon. Friends on the Front Bench that that is matched by the commitment of our local health authority, primary care trust and acute hospital trust to ensuring that we get value for money. I want to make one or two points, of which my hon. Friend the Minister may be able to take note to help us to do exactly that.
First, I want to consider the scale of investment as it affects Plymouth and what has happened since 1997. Funding for the former South and West Devon health authority increased from £367 million to approximately £500 million. That is a significant investment, which will set us on course for the 10-year plan to double health investment. Successive Budgets provide for that and dedicate so much more money to our health service than in the past.
Primary care trust funding for Plymouth will increase from £230 million to approximately £272 million between 2003–04 and 2005–06. We will get a new diagnostic and treatment centre, the Vanguard project, which is funded with £129 million of private finance initiative money. We have a £39 million extension to the south-west cardiothoracic centre at Derriford hospital. In an intervention on my right hon. Friend the Secretary of State, I mentioned that that enabled us to increase the number of cardio-patients from 700 in the mid-1990s to 1,850 this year.
I will answer the rhetorical question that I posed. Previously, people were referred to Bristol and Brompton, and the unit was built on the premise that some 500 people would be treated locally. We continue to send some 500 people to Bristol and Brompton but we are now treating 1,300 people. I suspect that many of them would have suffered an early death through the previous lack of investment in our health service.
In the primary care trust that now covers the former South and West Devon health authority area, the number of people who wait more than 13 weeks for out-patient treatment has decreased by a substantial 66 per cent. since 1997. That is one indicator of good value for money. Primary care trusts spend 75 per cent. of the money for the health service, thus enabling doctors to be our champions. That is accompanied by the radical new way in which hospital funding operates. The hon. Member for Sutton and Cheam (Mr. Burstow) referred to that method of payment by results. I make a plea to my hon. Friend the Minister to examine the way in which we might refine the tariff systems that are being introduced.
The system has teething problems, which especially affect high cost, low volume services such as those that specialist hospitals like Derriford provide. For example, a cardiac bypass operation has the same hospital reference group and therefore the same tariff as a quadruple bypass operation. Such a system is likely to result in Plymouth hospitals trust losing more than £1 million in cardiothoracics alone, owing to distorting effects in the case mix. My hon. Friend knows that we, like many southern hospital trusts, have an accumulated deficit in hospital funding. I hope that we have the opportunity to discuss that with her before the system is fully rolled out.
Other aspects need to be considered. For example, pay represents 65 per cent. of hospital costs. Derriford has an effective pay review programme to identify savings and ensure that the money is concentrated on front-line services. For example, it runs a locum bank to try to achieve some cost savings. However, the market forces factor that applies to the hospital reference group increases or reduces the tariff. Plymouth hospitals trust has had its tariff reduced by 7 per cent. from the average. Consequently, St. Mary's NHS trust in London, which has the highest market forces factor, will earn 42 per cent. more per patient than Plymouth hospitals trust for performing the same procedure. That cannot merely represent the differences in the cost factors that operate—undoubtedly, things are more expensive in London, but not by that amount. In 2000–01, Plymouth hospitals trust undertook a piece of work that revealed that the average cost per employee was £27,000. If we make a comparison with other trusts that have similar costs per employee, we find that East London and The City Mental Health NHS Trust has a 30 per cent. higher staff market forces factor than that trust, yet London weighting would amount to no more than a difference of 11 per cent. I therefore hope, as the hon. Member for Sutton and Cheam argued, that we will examine that before it is rolled out much further.
The primary care trust is also working hard to deliver our community and mental health services in Plymouth. Against the background of considerable challenges, I am pleased that it achieved a two-star rating in the first such exercise this year. Those challenges arise from the health inequalities that have grown up over several decades. As a result of the doubtful legacy of my Conservative predecessor, I represent the poorest ward in England on the 1995 index of local conditions. Our primary care trust must meet challenges such that a man living in inner-city Plymouth, which I represent, will die 10 years earlier than his counterpart living in the leafy suburbs, which are covered by the same primary care trust.
The trust is committed to meeting those changes, and has some innovative programmes. For instance, it has one of the most successful smoking cessation programmes in the country at present. Were my right hon. Friend the Secretary of State for Health present, I would have congratulated him on his efforts to take part in his own smoking cessation programme and invited him, as I have done on two occasions already this evening, to visit Plymouth to see the good work being done in that respect. Another programme with which we have had particular success, and which in years to come—although it is not possible to see the immediate payback—will help to reduce social inequalities, is the work to reduce teenage pregnancy, which, of course, is often accompanied by single parenthood and the sort of poverty that leads to a vicious cycle of ill health, unemployment and other problems.
Our primary care trust has also worked hard with the acute hospital to reduce the prescribing budget, without, of course, reducing the quality of prescribing practice to patients. That has been particularly successful, and it has been able to save seven-figure sums by entering into partnership with consultants in the acute hospital to try to get the prescribing regime right for those in hospital. Therefore when they come out of hospital, the PCT is able to ensure that their medication can continue in a value-for-money way.
The trust has been so successful in doing this that I was caught in a double bind earlier this year when I was approached by constituents, Mr. and Mrs. Tomes, on behalf of their son, Ashleigh. In that regard, my right hon. Friend the Secretary of State mentioned in his opening speech the great advances that will come as a result of new gene therapies. Some of those are already on-stream, and some of them address rare diseases, so the medicines being developed are therefore required in small numbers, and their developmental costs are very high. If, as in the case of my constituents and those of some 39 other Members of the House, 40 people in the country can benefit from a particular therapy, the cost of developing it and then delivering it will be very high. Recently, I went with an all-party group and members of the Society of Multipolysaccharide Diseases to discuss with the Minister of State some of the issues in relation to prescribing for such rare diseases, and we were much impressed by his grasp of the human issues associated with parents knowing that a drug is available. In this case, the drug can range in cost between £80,000 and £140,000 per prescription per year, and more and more such drugs will come on-stream. That will be an additional challenge to already hard-pressed primary care trust budgets. We will work with the Minister of State, who is seized of the challenge that faces us in the future.
The Red Book refers to the 10-year framework for science and innovation. I welcome the announcement that the key focus of the Government's commitment to science will be to ensure that clinical research plays its full part in generating health and economic benefits, and that that will be matched by the increase in national health service funding for research and development.
This Government have made serious inroads into the health challenges, with serious money and serious investment. They are serious about delivering a framework to deliver good health outcomes from that investment, and about making sure that there are
enough health care staff, with good terms and conditions. Labour Members will know that that has come about by choice not chance, and if choice not chance informs the next election, this and successive Budgets will give the British people confidence to deliver the strong and stable economy that will allow our public services, which are so important to them, to continue to develop.
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