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Resolved,
That this House welcomes the Government's record extra investment in the National Health Service which has resulted in increases of 19,400 more doctors and 67,500 more nurses since 1997; supports the extra investment in training which has increased the intake of medical school students by 61 per cent. and nurse training students by 53 per cent. since 1997; notes that over one million NHS staff will benefit from improved terms and conditions; recognises that the international recruitment of healthcare professionals has already made a significant impact on the delivery of NHS services; notes the Government's commitment to ethical international recruitment, with its robust Code of Practice, the first of its kind in the world, ensuring that NHS organisations do not recruit staff from developing countries without the agreement of their government; and welcomes the sharing and transfer of experience and ideas that international recruitment brings to the health service.
DELEGATED LEGISLATION
Ordered,
That the Motion in the name of the Leader of the House relating to the Electoral Commission shall be treated as if it related to an instrument subject to the provisions of Standing Order No.118 (Standing Committees on Delegated Legislation) in respect of which notice has been given that the instrument be approved.—[Charlotte Atkins.]
WELSH GRAND COMMITTEE
Ordered,
That—
(1) the matter of the Draft Transport (Wales) Bill be referred to the Welsh Grand Committee for its consideration;
(2) the Committee shall meet at Westminster on Tuesday 20th July at 25 minutes past Nine o'clock and between Two o'clock and half-past Four o'clock to consider the matter of the Draft Transport (Wales) Bill, under Standing Order No. 107 (Welsh Grand Committee (matters relating exclusively to Wales)).—[Charlotte Atkins.]
NORTHERN IRELAND GRAND COMMITTEE (SITTINGS)
Motion made, and Question put forthwith, pursuant to Standing Order No. 116(1) (Northern Ireland Grand Committee (sittings)),
That—
(1) the draft Budget (No. 2) (Northern Ireland) Order 2004 be referred to the Northern Ireland Grand Committee;
(2) the Committee shall meet at Westminster on Thursday 8th July at half-past Two o'clock; and
(3) at that sitting—
(a) the Committee shall consider the instrument referred to it under paragraph (1) above; and
(b) at the conclusion of those proceedings, a motion for the adjournment of the Committee may be made by a Minister of the Crown, pursuant to paragraph (5) of Standing Order No. 116 (Northern Ireland Grand Committee (sittings)).—[Charlotte Atkins.]
Question agreed to.
PETITION
Mobile Phone Masts
Mr. Tony Colman (Putney) (Lab): I wish to present four separate petitions from constituents who live in Southfields and who object to proposals to erect Orange mobile telephone company masts in totally inappropriate locations. I shall not read each petition out, but they all end with the same paragraph. It states:
The Petitioners therefore request that the House of Commons urge Wandsworth Council to reject these planning applications on design grounds and that the Office of the Deputy Prime Minister re-examine planning law in relation to mobile phone masts in urban areas in order to give local authorities more power to reject such proposals in the future.
And the Petitioners remain, etc.
To lie upon the Table.
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NHS Services (East Sussex)
Motion made, and Question proposed, That this House do now adjourn.—[Vernon Coaker.]
8.3 pm
Mr. Nigel Waterson (Eastbourne): I am delighted to have secured this debate. Almost every week recently there has been bad news in the Eastbourne Herald about our local NHS. Indeed, it has often been the front-page story. The content of my mailbag and the subjects that arise in my advice surgeries, as well as anecdotal evidence, show the extent of the problems. Clearly, certain issues need to be addressed.
However, at the outset I want to place firmly on record my appreciation of the hard work done by doctors, nurses, administrators and other staff at all levels in my local NHS. I hear from many of my constituents about their experiences in hospital and elsewhere and I see the work of the staff at first hand during my regular visits.
Recent problems began with the restructuring of services for older people and the closure of All Saints hospital in my constituency. It has been closing for some time—since before I was first elected in 1992. It had some 105 beds at its height and tended to specialise in older patients who had had serious strokes or broken hips or legs. It was clear that the hospital had to close at some stage. It was very old, and unsuitable for the modern age, the fabric was decaying and it was even dangerous. The only issue was what to replace it with. I have made my own position clear from the outset.
A plan was originally produced in October 2003, but it was decided, in the jargon of the NHS, to "unhook" the closure from the plans to replace All Saints. This beggars belief. In any event, it began to emerge that there was an intention to close All Saints come what may on 31 March this year. That raised some real worries among my constituents, especially the families of patients at All Saints—so much so that the Bishop of Lewes and I took the unprecedented step of calling a joint press conference in the chapel of All Saints to express our deep concerns. It is inexplicable to me even now that it has been so difficult to drag the truth about the plans out of the local NHS organisations. All this has been happening against a background of serious and sustained levels of delayed discharges in our area.
At this point, the county council's health overview and scrutiny committee under Councillor Bill Bentley became involved and played an important role in the unfolding drama. To cut a long story short, All Saints closed—a little later than 31 March, but it closed. Its replacement provisions contain three main elements. First, there is a new ward at the district general hospital called Hailsham 2, which I visited recently. It is now full, and it provides in-patient treatment for those patients who need acute treatment. It is my impression that it is working well. It is almost entirely staffed by former members of staff of All Saints hospital.
Secondly, there is Firwood house, a facility that has undergone renovation and is designed for those who are close to going home at the end of their treatment. Yet even now it is not fully operational. Staffing is not up to the levels needed, so not all the beds are being used. We were originally assured that it would be fully operational by 30 April, and that has not happened.
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The third element is community teams—rehab teams and others—looking after people in their own home. But again, the teams have been plagued by staffing problems so we do not have, in the words of the health overview and scrutiny committee, a "seamless provision" to replace All Saints. It remains a disgrace that all this provision was not put in place before All Saints closed. It is dispiriting that there has been so much open in-fighting between different parts of the NHS over this issue. It raises issues about the current structure of the NHS, which is a discussion for another day. It is deeply depressing that it has taken so much pressure to persuade the local NHS organisations of the value and importance of carrying the local community with them both in closing a much-loved local institution and in persuading them of the need for and effectiveness of the new arrangements.
All this is against a background of major financial problems in the NHS. We have a financial recovery plan. These days, we seem to have one almost every year. We also have a local delivery plan. It is worth spending a little time on the documents. They refer to the deficits that were built up in the previous year—the year that has recently finished—and they look at ways of trying to bring this deficit and the projected deficit in the current year under control. They look at decommissioning and what they call demand management, and they talk about significant bed reductions. The documents also make the point, which will be of interest to the Minister, that in 2001–02 all the organisations in East Sussex were able to balance their books, but in 2002–03 all of them, except the Bexhill and Rother PCT, reported a year-end financial deficit. The organisations have built up between them a deficit of some £26 million across the local health economy.
Rather dramatically, the documents say:
"The LHE has to get into recurring balance as a matter of urgency and is wholly committed to doing so."
I have to ask why there is such urgency. Can the Minister answer that point? Touchingly, the documents say that they have a project implementation weighting that is the product of the ease of implementation, multiplied by the anticipated resistance or "noise". I suppose that I count as part of that noise.
The organisations need to make a recurring saving of some £10 million. We have already lost 105 beds in All Saints hospital. They are now talking about a medium-term saving of some 200 additional beds, and they are looking to close between one and two wards on each of the two sites, Eastbourne and Hastings, in the current financial year. They also talk about significant savings to be achieved
"by de-commissioning of services and demand management".
Amazingly, my local hospital plans to ensure
"that up to 4,000 new outpatient referrals . . . will not be made"
in the current financial year. That is a significant number.
The documents also refer to something that they engagingly call "transformation" which involves "site and speciality rationalisation". That emerges from the previous management merger between the hospitals in my constituency and in Hastings. On the back of that,
22 Jun 2004 : Column 1315
they have carried out a clinical services review. They make the point—this is my central concern in this debate—that when the review was set up originally
"its remit did not include working within a reduced resource envelope".
My reading of that is that clinical decisions and priorities may be decided not by medical criteria, but by the pressures of the budgetary problems that are faced. As I have said, we have a £26 million black hole in our local health economy.
The county council has been proactive on the issue, and has made the point that it would make more sense to stop fining it for delayed discharges and to invest the money in intermediate care services. It makes this damning indictment:
"As it stands the shortcomings of the LDP pose a serious threat to the health and wellbeing of the people of East Sussex."
On top of all those problems, we have seen some recent unhelpful and probably unfounded speculations about the future of the children's ward in my local hospital. I have received assurances from the authorities that the recommendations of the clinical service review are clear: in-patient services for children should continue to be provided on both sites. I hope that the Minister will take the opportunity to repeat those assurances this evening.
My own position since the merger has been clear: I can see no case for any major services being moved from one site to the other, especially in light of the poor communications between Eastbourne and Hastings—of course, the Government could choose to do something about that, but that is beyond the scope of this debate—unless a convincing case were to be made on grounds of safety of patients.
The clinical services review is still under way, but I shall sum up the position. We have massive problems with bed blocking, or delayed discharges. The present figures, from a day or so ago, show that the trust has 964 acute beds, of which nearly 11 per cent. are filled by bed-blocking patients. There is what the local hospital describes as the collective financial problem of nearly £26 million that has to be found from somewhere, yet the hospital and the PCT say that they suffer extra pressure due to the significant elderly population. In our area, we have the country's highest proportion of over-85-year-olds.
"The actual allocation to Eastbourne Downs is based on historic levels and historic levels of spending with specific increases each year . . . Because the allocation is over target, the year-on-year increase for this year and next is less than the national average."
There is a squeeze on funding over the current period. The trust also notes that East Sussex
"has the second worst level of delayed transfers of social and non-social care in the country".
In the long term, some of the initiatives may be right. Of course, we should avoid unnecessary hospital admissions and that sort of thing where possible, but my overriding concern is that the whole process, including the clinical services review, will be poisoned by budgetary concerns and that it will be driven by financial rather than medical motives.
In conclusion, I have four questions for the Minister. First, may I have his assurance that he and the strategic health authority will take a close interest in the re-
22 Jun 2004 : Column 1316
provisioning of services for older people in East Sussex? Secondly, in due course, may we have as a serious option the possibility of a new, state of the art rehabilitation unit on the All Saints site? Thirdly, as there seems to be a recurring black hole in the finances of the local health economy of about £26 million, will he urgently review the formulae applying to East Sussex, with special regard to the high proportion of elderly people in the population? As I said, we have the highest number of over-85-year-olds in the country. Finally, will he ensure that budgetary pressures are not allowed to prejudice patient care or to distort clinical priorities in our area?
8.17 pm
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