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Westminster Hall

Tuesday 14 December 2004

[Sir Nicholas Winterton in the Chair]

Health Services (Norfolk)

Motion made, and Question proposed, That the sitting be now adjourned.—[Margaret Moran.]

9.30 am

Mr. Richard Bacon (South Norfolk) (Con): Mr.   Deputy Speaker, it is a great pleasure to introduce the debate under your magnificent chairmanship—[Hon. Members: "Creep!"] Better to get one's creeping   in first, eh? It is also a pleasure to speak about England's greatest county, particularly when so many hon. Members who represent Norfolk are here. Such occasions always seem festive, even when the subject is as serious as the one that we are about to discuss. I note that my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard) has even dressed in Christmas colours, and that some representatives of old Labour are present, too.

The debate is about the financing of the health service in Norfolk, a serious subject. It will be partly about the funding itself, and partly about the uses of the funding and the pressure on it. At present, there is a serious deficit in the Norfolk health economy. According to recent figures supplied to me on 9 December by the Norfolk, Suffolk and Cambridgeshire strategic health authority, national health service bodies in Norfolk have forecast the following year-end positions in their most recent financial returns. Norwich primary care trust forecasts a deficit of just under £1.8 million. Southern Norfolk primary care trust in my constituency forecasts a deficit of £9.2 million—a reflection of the fact that it is by far the largest primary care trust in Norfolk. North Norfolk primary care trust forecasts a deficit of   £3.1 million, Broadland primary care trust one of £4.8 million, and West Norfolk primary care trust one of £1.7 million.

Alone among the primary care trusts, Great Yarmouth PCT is running a more or less balanced position, with a small surplus of about £100,000. Perhaps that is a reflection of the extra money that goes into Yarmouth. I shall not say that that is attributable to the hon. Member for Great Yarmouth (Mr. Wright), although I   am sure that he would like me to do so. There is no doubt, however, that Great Yarmouth is well funded compared with some of the other primary care trusts. Having projected a much bigger deficit earlier in the year, the Norfolk and Norwich hospital, our new flagship private finance initiative national health service trust, is now projecting a deficit of about £2 million. The Norfolk and Waveney mental health partnership has a break-even position. The King's Lynn and Wisbech NHS trust has a deficit of £7.9 million. The James Paget NHS trust, again in the constituency of the hon. Member for Great Yarmouth, has a break-even position and the East Anglian Ambulance national health service trust has a surplus of £750,000, although that is mainly due to a one-off asset sale of the ambulance station at Newmarket.
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The total deficit is about £29.7 million. That includes the repayment of deficits from the previous year of £6.6 million, of which £5.2 million is at King's Lynn hospital. It is worth noting that in each of the three previous financial years—1999–2000 to 2002–03—NHS bodies in Norfolk were in overall balance. The financial problem is relatively new to Norfolk, but not confined to the county—it is common throughout the national health service. However, it might be worse in Norfolk than elsewhere, which is an issue that I want the Minister to examine.

I refer to an estimate based on board papers published by the West Midlands strategic health authority. I commend the Government on the number of board papers now available across the country on the internet. If only central Government took the same attitude to the most interesting information about Departments. I certainly commend the Department for the guidance that it has given health authorities, hospitals and PCTs on what information should be made available to the public. At a meeting on 17 November, a strategic health authority assessment of the national position was that there was a deficit of £499 million in NHS organisations across the country. A board paper notes that 75 primary care trusts and 73 NHS hospital or other trusts forecast deficits.

One must acknowledge that the problems are complex and that there are no simple headline answers, but it is not enough for the NHS to say that it always needs more money, as more money has being going into it. Plainly, in some areas, including Norfolk, there has been a lack of tight management, which has led to extra financial problems. An obvious example of where problems have arisen, which has been widely referred to in the county, is the learning difficulties pooled fund. In that case, it is possible that managers took their eye off the ball—or, more probably, designed and developed a service without having enough regard for what was affordable in the context of all the other priorities.

Mr. Anthony D. Wright (Great Yarmouth) (Lab): I understood the hon. Gentleman's point about learning difficulty services, but is it not true that the county council is in charge of the financing of that service? The truth is that there has been overspend in the past two years, and although that was not down to the PCTs, in the end they had to pick up a proportion of the tab—55 per cent., I believe—without having had direct input into the way in which the budget was run.

Mr. Bacon : The hon. Gentleman makes a fair point.

Mrs. Gillian Shephard (South-West Norfolk) (Con): Of course services for people with learning difficulties depend heavily on co-operation and on part-funding in social services, but I remind the Chamber that Norfolk social services department is seriously underfunded because of the way in which the present Government have dealt with the funding of rural shire counties, because of the regulations that the Government have imposed on all aspects of social services and because of the Government's determination to ring-fence funds within social services, which means that there is almost no flexibility. The hon. Member for Great Yarmouth
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(Mr. Wright) is absolutely right: the problem in local government funding has been transferred to the health services.

Mr. Bacon : I am grateful to my right hon. Friend, and I agree with everything that she said. Of course, the hon. Member for Great Yarmouth is right to say that one should not blame the PCTs for the issue. The problem is complex, with some of the roots lying in Government provision of funding to the shire counties. There is also a more general problem relating to what the hon. Gentleman says: with joint working and joint funding arrangements, one has to make sure that the proper management is in place.

On a slightly separate subject—but one that makes my point—I was in Northern Ireland recently looking into a project for the Public Accounts Committee, and the person before us, the accounting officer, was pleased to say in the first 30 seconds of her evidence that her   department was responsible for only 2 per cent. of the budget that we were discussing and the other 98 per cent. was funded by a series of other agencies and Government bodies, yet it was she who had to account for it. The learning difficulties pooled fund run by PCTs and social services was to some degree an innovation; there is nothing quite the same elsewhere. However, when joint or partnership working arrangements are made, one has to be sure that one has adequate management arrangements in place. I do not think that that has always been the case.

When problems are identified it is not enough simply to say that the NHS always needs more money. Although the problems have complex causes, some of them are Government-inspired. Equally, it is not enough for the Government to say, "We've given the NHS some more money; now let it get on with it," as if to suggest that they have no responsibility for the extra pressures at present. The truth is that the Government have imposed a whole series of extra initiatives that have extra costs attached to them. There is a complex interplay between the money provided and what the Government insist that the NHS does with it. The Government are good at willing the ends, but not necessarily the means, and some of their initiatives are making life more difficult and expensive.

Perhaps the most striking such initiative is the so-called "Agenda for Change", which is bringing about a series of new pay arrangements, conditions and terms of employment for NHS staff under one heading. I talked to a finance director in Norfolk who said that

Paul Kemp, the finance director for Norfolk, Suffolk and Cambridgeshire SHA, said that

There is a series of other pressures. The European working time directive has an impact on hospital junior doctors' hours. Everyone understood that it was sensible to do something about the hours that such doctors were forced to work, which in some cases were ridiculous. It is good that junior doctors are working more sensible hours, but has the cost of implementing that reform been properly calculated?
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The costs of the new GP contract were supposed to be paid for out of GPs taking somewhat less—on average, I think, £6,000 per GP. That was to lead to the funding of the out-of-hours service, but there are many reports from primary care trusts that the implementation of the new GP contract has been underfunded or, in some cases, unfunded. In addition, out-of-hours cover is patchy, with some very good and some less good. A senior manager in the Norfolk health economy told me that he thought that the main thing that had been achieved in out-of-hours cover was the creation of confusion, so that in some cases people simply did not know where to go because of the profusion of options.

In an e-mail that others might have seen this morning, Waveney primary care trust talks about the 10 top tips for staying healthy in winter. It lists different things that people can do, including calling NHS Direct, looking things up on the internet and Lord knows what else. However, many people think that, although there is always a winter peak, the huge, aggressive increase in   emergency admissions throughout the country is directly related to, among other things, the confusion surrounding out-of-hours cover and the fact that many more people turn up at accident and emergency departments than would have done otherwise. That is particularly true when there is a shiny new flagship hospital that offers 24-hour cover—a hospital that always has its lights on, is always open and whose location people know. We have such a new hospital and despite the fact that the Government managed to build it without building an adequate road to get to it, it is still in some cases easier to drive to than the old Norfolk and Norwich hospital in the centre of town, simply because there is less traffic and one does not get blocked in quite the same way.

There is no doubt that emergency admissions have increased, and that is partly because of the out-of-hours arrangements. The Government have been experimenting with putting GPs into accident and emergency departments. Sir Nigel Crisp spoke about that recently and primary care trusts in Norfolk are talking about funding a full GP practice at the hospital. That is an interesting development and I look forward to seeing how it goes. Finally there is recognition of the fact that, rather than tell people what they should do and where they should go, we should follow what people are doing, and enable them to be seen in a way and at a time and a place that suits them, without the attendant costs that would normally arise if they were actually treated by the accident and emergency department. People arrive in the hospital, but are treated by GPs at GP costs.

There are many other financial pressures, such as the increasing cost of specialist mental health treatments. That has been made worse in Norfolk because it has been sending people out of county, in some cases to London, at very high costs. There is also the cost of the new consultant contract. Again, the Government may have underestimated the cost of that and may well have been out-negotiated by the consultants. In the face of rising prescription bills, the SHA has placed an emphasis on prescribing more generic drugs and fewer branded drugs, but that has been done for many years in the NHS. There is now quite a high rate of usage of generic drugs, so I do not think that there are huge cost savings to be gained from that. Let us also consider the
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costs of the national framework for IT in the health service. The main contracts let are worth £6.2 billion, but recently it was revealed that the additional costs if all the implementation is taken into account will be between three and five times more—in other words, between £18 billion and £30 billion over the next 10 years.

All those costs added together mean that primary care trusts have to run very hard just to stand still and to have any serious opportunity of coping, even with the extra funding that they have had. In Norfolk, we have the added problem of the private finance initiative: it is an open question to what extent that has increased overall costs. I am not dogmatic about the PFI. I have examined a lot of PFI projects in many different areas and there is no doubt that if one wants a hospital, prison or school delivered on budget and on time, the PFI is a good way of getting that. We have seen many examples of that across the country in different sectors. It is also true that criticisms of the PFI sometimes do not take adequate account of the potential costs and the risks that would have attended on a different approach. Conventional procurements are full of horror stories—take the examples of the British Library, the Jubilee line extension and Portcullis House, where the windows alone cost £23 million more than they were supposed to and the wrong kind of bronze was used on the roof, so it does not go bronze coloured. If I dare say so in the presence of the hon. Member for Norwich, North (Dr. Gibson), there is also the example of the Scottish Parliament, which is a locus classicus of how not to carry out a conventional procurement.

Let us be clear that the old way of carrying out a procurement has had its problems. That is not to say that we should not be questioning and critical about the PFI. It does appear—and the hon. Member for North Norfolk (Norman Lamb) has asked many questions about this, as have I—that the way in which the original contract for the hospital was let may have resulted in very large windfall refinancing gains. So far as the contractors are concerned, they will be shared on a 30:70 per cent. basis and will be crystallised immediately, and yet as far as the hospital is concerned they will have to be taken over the life of the contract.

Most people do not think that their local school or hospital ought to be put into an investment fund and traded by City institutions; if there is enough income around to make that possible, many people will question whether it would not be better for the money to go to the school or to the hospital, many of which have charitable activities going on alongside them because they have not got enough money for some of the things that they would like. A leading City investment banker who works in the securitisation area of the PFI recently told me:

But he added that, as a taxpayer, it really cheeses him off—except he did not use the word "cheeses". I feel that in your august company, Mr. Deputy Speaker, I should edit his words.

There are legitimate questions to be asked about the PFI. I think that the answer lies in having the greatest possible degree of transparency, so that we can form a fair assessment of the fair costs and the fair returns.
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After all, no one worries about schools or hospitals buying equipment from the private sector, and in the PFI we are essentially talking about buying services from the private sector instead. We should not have an ideological objection to the PFI, but we must examine it carefully.

The SHA has announced a number of measures that it proposes to take to improve the financial situation. I will not list all of those now, but details are available from the SHA. There are certain questions that I think are legitimate to ask of local health managers, particularly in relation to the learning difficulties pooled fund. Notwithstanding the point made by the hon. Member for Great Yarmouth, I emphasise that if we are to have joint working arrangements, we need joint management arrangements adequate to that task. Given the already considerable progress in prescribing generic drugs in recent years, is it realistic to suppose that that will provide serious savings in future? What can be done to reassure people that the so-called "better care for Norfolk" proposals, which aim to deliver cost-effective care closer to people's homes instead of in much more expensive hospital settings, are about getting closer to patients rather than saving costs? Are the out-of-hours arrangements now in place working well and communicated well so that people understand them when they are working well?

I honestly do not think that there is widespread bad   management locally. Huge extra activity is being imposed from the centre without the resources to pay for it. As I said, 75 primary care trusts and 73 NHS trusts across the country forecast deficits, which suggests to me that there is a systemic problem. Norfolk's deficit accounts for about 6 per cent. of the deficit of NHS organisations nationally—that is, in England—yet it has only about 1.6 per cent. of England's population. It may be that the Government are not only imposing costs on the NHS that are way in excess of the resources that they make available, but, in particular, that they have their sums wrong on Norfolk. There seems to be problem of asymmetry: the county had managed a position of financial balance until the rapid stream of reforms. Are we seeing the systemic underfunding of Norfolk?

Finally, I am interested in hearing the Minister's comments on the extra costs that the Department estimates will be imposed on Norfolk as a result of the national programme for IT in the health service. GPs and others have expressed many concerns that they may be forced to withdraw working systems that they have developed incrementally over a long time—systems in which they have faith and through which they have close relationships with IT suppliers—and to replace them with systems whose software in some cases has not yet even been written. Understandably, that is a cause of huge concern among GPs, who, after all, are the people closest to patients. If we are to see that kind of transformation with that kind of uncertainty and at huge cost, it is not surprising that people are concerned. I would be interested in the Minister's comment on that IT issue.

In conclusion, the Norfolk health economy faces serious problems that are not the result of overall bad management by local managers—notwithstanding the management issues that have to be dealt with—but
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primarily the result of a high level of extra activity and burdens imposed from the centre without the resources to pay for them.

Several hon. Members rose—

Mr. Deputy Speaker : Before I call the next speaker, may I offer right hon. and hon. Members some help? This is a 90-minute debate and the winding-up speeches will begin at half-past 10. I ask all Members who wish to participate—six Back Benchers want to do so—to look at the digital clock or glance at me and my body language as they speak. They will see when they have spoken for long enough.

9.54 am

Dr. Ian Gibson (Norwich, North) (Lab): We meet again, Mr. Deputy Speaker. I shall pay attention to your body language; as long as you do not use your hands, that will be fine by me.

I find it difficult to be negative about anything in   Norfolk following the events that culminated at 5 o'clock last Saturday afternoon in a great victory for the Canaries over those horrible northern people from Bolton, who went home to think again. Things are quite vibrant in Norfolk at the moment. That is true of the health service as well, despite the fact that all of us as constituency Members of Parliament hear about the odd dirty toilet, the example of bad communication, the individual who has to wait a long time, and so on. I am aware of that in part as an MP and in part because I was on the hospital management committee of the Norfolk and Norwich hospital so many years ago that I cannot remember—I think I was in my twenties—and have been involved in it ever since.

This Friday I will be with the neonatal nursing team—one of the top teams in the country—which is going to show me its wares. I will robe up and go with that team to see the newborn babies. Such staff are subjected to pressures at this time of the year and I will see how they are handling that. I will then go to the cardiology unit, where once again following my scare in the west bank, attempts will be made to find my heart. I believe that I have one somewhere. Although some people think that I do not have a heart, I do and it seems to be functioning well, although the unit will have another look at it. I think that medical students will be looking at me, which scares me to death.

Let me quickly put the debate in context. There is a great book out at the moment called "Norwich Since 1550", edited by two professors at the university of East Anglia, Carole Rawcliffe and Richard Wilson. I guess that none of us were around in 1550, but the story of Norfolk, for year after year in every public service, leads us to the conclusion that we can do better. That much needs to be done is almost the motto of Norfolk about every event with which I have been involved. That is true today and no one is going to deny it.

I never expected the NHS to be perfect. So many events happen beyond our ken that problems are likely to arise. For example, will malaria come to Norfolk with   climate change? There are new diseases that are transmitted from animals to human beings, such as
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severe acute respiratory syndrome, and so on, and hepatitis C is suddenly a new problem, so new measures have to be taken. The Government are responding with their new initiatives. New technology has come along, including, for example, shunts in hearts and arteries. New drugs and vaccines are being discovered all the time in a highly scientific and technological age, which is recognised by the Government.

We want new services all the time and we want them to be delivered immediately for people, irrespective of their class, colour or creed. That happens more and more in Norfolk. We hear little about that kind of selection. Of course, there is private medicine, although there is no evidence that it is increasing—and although I would like to see it eliminated, it is still around. We need more resources for all the different things that are happening.

There has been a sudden splurge of activity around methicillin-resistant Staphylococcus aureus, and more money has been put into the problem. The infection unit at the local flagship hospital has recognised the problem and done something about it. Scanners have come in since I first got involved at a hospital: one's brain can be scanned in different ways and infarctions and all sorts of things can be seen. The local flagship hospital is trying to get magnetic resonance imaging scanners in Cromer, so that people do not have to be moved from Cromer to Norwich. There are problems with the kidney dialysis unit at Cromer, but the chief executive tells me—I   believe him—that although there is a financial problem, it will be sorted out early in the new year.

Through the Government's activity, the local hospitals and the wonderful dedicated staff who work there—not just the doctors and nurses, but all the other people, including some of the managers and the technicians who deliver the biopsies and treatment—form a tremendous force. We must not break the morale of those people; we must make them determined to respond to the new initiatives that come from Government but must be translated into the reality of the geography of a county such as Norfolk.

Mr. Keith Simpson (Mid-Norfolk) (Con): Does the hon. Gentleman recall being quoted in the Eastern Daily Press of Tuesday 30 November saying:

What did he mean?

Dr. Gibson : There is lots of money going in, but the real question is whether it is going to where it is needed. Who makes the decision? The Minister knows that I have campaigned hard in the cancer field, because, whether or not it is ring-fenced, the bulk of the money that goes to the primary care trusts does not always get into cancer. The East Anglian cancer network should receive that money and prioritise it for cancer services. That should also be the case for cardiology and mental health, which are the highlights of the Government's
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campaign. There should be a cardiology unit in Norfolk to prevent patients having to move down to Papworth, and people are currently campaigning for that.

Mr. Paul Burstow (Sutton and Cheam) (LD): Does the hon. Gentleman share my concern that if we ring-fence every Government priority, there may not be any money left for anything else?

Dr. Gibson : Yes, that might happen, but I do not think that it will. The ring-fencing of certain prioritised areas will deliver better health in the county. The flagship arenas in health need that method of resourcing, and I would be happy to see that approach initially in cancer, mental health and cardiology, because those are the problems that afflict the largest number of people.

There are problems surrounding private finance initiative, about which the hon. Member for North Norfolk (Norman Lamb) and I have often talked. I would love to see the documents on the PFI contract. Early in 1997—the health service in Norfolk really has changed since 1997—my right hon. Friend the Member for Norwich, South (Mr. Clarke) and I tried to gain access to the details, but we were not allowed to because of commercial secrecy. I will get hold of that information somehow, because we should see the details of that PFI contract.

Norman Lamb (North Norfolk) (LD): Is the hon. Gentleman watching the Deputy Speaker's body language?

Dr. Gibson : I have observed finger movements, so I will wrap up.

Representatives of the flagship hospital assure me—I   tend to believe them—that the financial deficit is being   handled. A few months ago it was estimated to be £15 million, but it is now down to £2 million. The staff show amazing dedication and initiative, and I believe that the problems will be eliminated so that new diseases can be treated. With the help of Government initiative and new financial plans, the county will handle the problem. The hospital will remain a flagship hospital, and Norfolk will stay at the top of the league in terms of star status or whatever replaces that rating system. At the moment that position is shaky, but I have great confidence that the people in place will help the medical school to attract amazing doctors, nurses and other staff, and that Norfolk will remain top of the league.

10.3 am

Mrs. Gillian Shephard (South-West Norfolk) (Con): I congratulate my hon. Friend the Member for South Norfolk (Mr. Bacon) on securing this debate on an extremely important subject for all of us in Norfolk. I am particularly pleased to have the chance to raise my anxieties about health funding. The last time I spoke about health in Westminster Hall, I drew the attention of the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), to the view of school health advisers in the West and Southern Norfolk PCT teams that their services were both underfunded and overstretched. The West Norfolk
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PCT was at that time running with 42 per cent. of its appropriate staff quota, and the Southern Norfolk PCT described itself as "seriously depleted".

The Under-Secretary will be aware that on page 7 of "Every Child Matters: Next Steps", the Government state that there is a

and "multi-disciplinary teams".

However, the reality on the ground in the school health service in both PCTs at that time was described by the Southern Norfolk PCT as follows:

I particularly wanted to face the Minister of State, Department of Health at that time with the problem on the ground because of the amount of hype that the Government have attached to the co-ordination of services for children. On that occasion she said:

She continued:

Yet, as my hon. Friend the Member for South Norfolk has pointed out, a letter dated 9 December 2004 from the SHA tells us that between them the PCTs and trusts in Norfolk have a deficit of nearly £30 million. The Southern Norfolk PCT is forecast to have a deficit of nearly £9 million and West Norfolk PCT a deficit of £2 million. What has become of the increase of £27   million about which we were told on 16 June? Where has it gone? Was the Minister of State mistaken on that occasion? I do not expect the Minister to have all the answers now, but I would like a letter from her so that I can pass it to the trusts and to the school nursing service, whose representatives took the trouble to attend the debate. She might pay particular attention to the Minister of State's comment to the effect that steps must be taken to ensure that it is possible to enlarge the school nursing services. There is scant chance of that given the deficits that the two PCTs are facing.

I should like to make one other point, about the elderly mentally ill. We are told that the number of high-cost specialist mental health treatments has increased. Will the Minister specify those costs and tell us whether there is any connection between them and the planned closure of 100 beds for the elderly mentally ill, to be replaced with just 20 beds at the Julian hospital in Norwich? The planned closures have caused outrage—and no wonder. The future of the units is being consulted on at the moment, but the relatives affected are naturally immensely anxious about whether care in the community can really work for those clients.

Of course those dedicated people who provide care in the community for every group do their utmost to provide care, but does the Minister know about the reality on the ground? Given limited budgets, growing lists of clients, and above all the distances that have to be travelled and the sheer logistics of caring for people
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in far-flung communities, the relatives' anxiety is well placed. Without adequate and regular supervision, particularly as regards medication, such clients can rapidly deteriorate, causing a quite different kind of crisis—according to the SHA, the sort of crisis that has contributed to our budgetary problems.

The Minister cannot look to social services for help, not least because of the Government's imposition of unrealistic regulations on the sector, and also partly because of the squeeze on rural local authority funding. The Minister and her colleagues are constantly telling people that more money is being spent on health, and I   am sure that is true. Yet the reality is that health services in Norfolk are £30 million in the red. Where has the money from the 66 tax rises in seven years of this Government gone? As my hon. Friend the Member for South Norfolk and the hon. Member for Norwich, North (Dr. Gibson) said, the money is going in but it is not being used to benefit the patients and the clients. Where is it?

These are the questions to which we want answers from the Minister today. We want to know how it can have happened, when extra money has gone in, that there is a £30 million deficit, which will affect every client and patient in Norfolk. According to the Government, people are happy to pay extra taxes. I am sure that those people who should be benefiting from increased health services in Norfolk would like to think that those taxes are going to help them and their families.

10.9 am

Mr. Anthony D. Wright (Great Yarmouth) (Lab): I add my congratulations to the hon. Member for South Norfolk (Mr. Bacon) on securing today's timely debate. While we are talking about the financing of the NHS in Norfolk, I shall concentrate on my constituency, where there is a good story to be told. As has already been said, the targets for the funding of the various strands of the NHS in Great Yarmouth have already been met. I congratulate the managers of the NHS services in my constituency.

I am delighted that the Great Yarmouth PCT has managed to improve its rating from one star to two this year, and that the James Paget Healthcare NHS trust has met or exceeded all key targets for performance ratings. I am also delighted by the increase in access to primary care professionals, which, coupled with the high rate of health improvement, has shown that the benefits have increased and have sustained Government investment in local NHS services.

The income received by Great Yarmouth PCT is set to increase by 9.9 per cent. from 2003–04 to 2004–05, and by 11.2 per cent. from 2004–05 to 2005–06, from £96   million to more than £117 million. Funding increases have meant better NHS services delivered by the Great Yarmouth PCT. New national service framework-compliant mental health services, such as   crisis intervention, home treatment and assertive outreach, are now in place. Brand new single-sex mental   health ward accommodation is due to open in June 2005. Additionally, £250,000 is being invested in tackling substance misuse, including the NHS provision of clinical treatment and a new role for the independent sector, which will be in place from May 2005.
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Better services thanks to increased funding have meant better results. There have been significant reductions in maximum waiting times for acute care, which are now down to a maximum of nine months. Further improvements are being implemented to ensure that no patient waits for longer than six months. Primary care waiting time targets of 48 hours to see a GP and 24 hours to see a primary care professional have also consistently been achieved.

In addition, increased financing has allowed the PCT to engage with local strategic partnerships to focus on the real health and social issues affecting Great Yarmouth, including coronary heart disease, cancers, smoking prevalence, mental health, substance misuse and teenage pregnancy rates. I am incredibly proud of the fact that Great Yarmouth officially has the highest quit rate for smoking among NHS services in the east of   England—more than twice the regional average. Thanks to increased funding, the PCT is also overachieving on rates of progress towards a 50 per cent. reduction in teenage pregnancy by 2010, and is on target to surpass Government targets on reducing premature death from coronary heart disease, which is predicted to reach 14 per cent. by 2005, as opposed to 2010.

The James Paget Healthcare NHS trust is benefiting from similar funding increases, which have resulted in more services and beds and in reduced waiting times. Thanks to a massive £56.7 million capital investment in the trust for the next five years, exciting new services can continue to be designed, building on recent successes. Only last year, I had the pleasure of joining Princess Anne at the opening of a new intensive care unit at the trust. It took two years to build and cost £1.2 million, about half of which was raised by dedicated local fundraisers and donations to the hospital's intensive care appeal. A new stroke unit has also been opened, in line with Government efforts, and will be developed further in the next few years. Indeed, I cannot remember a time during the past few years when the builders have been away from the hospital. Millions of pounds have been invested, and we are reaping the benefits in my constituency.

Capacity plans developed in Great Yarmouth have shown that there will be sufficient beds to meet future demands, taking account of rigorous Government targets such as reduced waiting times. To complement the excellent work done by staff at the trust, there will be 52 extra staff, including 17 doctors and 30 nurses over the period in question. That is possible only because of the increased investment in the hospital—contrary to what local Conservatives say. They insist on telling the story of the hospital going into a £4 million deficit, with many redundancies among doctors and nurses. Perhaps after today they will retract that lie and congratulate the NHS in Great Yarmouth instead of criticising it. Perhaps they will also congratulate the Government on that massive investment.

Expanding mental health care services throughout Norfolk has been an important element of the overall improvement in health care provision that is visible in my constituency today. The mental health service in Norfolk has too often been treated as a Cinderella service, suffering from many years of Tory underfunding. That used to be true of Great Yarmouth, but last year I spoke at the opening of the community mental health resource centre, built as a result of
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increased Government funding, which will provide an operational base for community staff, medical staff, psychologists and therapists.

Mental health care services across Norfolk are benefiting from increased funding, with a rapid expansion in acute services to allow more patients to be   treated in their own homes, with fewer hospital admissions. Increased funding has allowed the Norfolk and Waveney mental health partnership NHS trust to provide additional services such as around-the-clock access to crisis services, rapid response following referral, and intensive intervention and support in the early stages of a crisis. For the first time, we can begin to praise the level of care being made available for the mentally ill in Norfolk.

I am keenly aware of the fact that the continued increase in funding for the NHS in Norfolk should deliver the best and most efficient services possible. Great Yarmouth is a prime example of the fact that the Government are achieving that aim in Norfolk. According to the most recent financial returns received by the SHA, my local PCT and hospital respectively are in surplus and breaking even, with the Norfolk and Waveney mental health partnership NHS trust also breaking even. [Interruption.] I do not know whether that was a hint through body language, Mr. Deputy Speaker, but I shall in any case wind up my speech.

There is a good-news story to be told in the Great Yarmouth area, which shows that there has been strict funding management. I am sure that with similar management and control, and increased funding from the Government, we will see the turn-around in fortunes in other parts of Norfolk that we have seen in Great Yarmouth.

10.16 am

Norman Lamb (North Norfolk) (LD): I congratulate the hon. Member for South Norfolk (Mr. Bacon) on securing the debate. He and I have a similar view on one    issue: the private finance initiative. We are not philosophically opposed to the PFI, but have real concerns about how it has operated. The massive deficit that we in Norfolk face should be a cause of concern, particularly given the legal obligation on trusts to break even. The strategic health authority produced a brief, which the hon. Gentleman referred to, that talked about the different causes of the financial pressures. It did not mention one particular cause that I wish to spend a few moments talking about: the cost of the PFI.

A recently published report of research commissioned by the Association of Chartered Certified Accountants concluded that trusts with PFI hospitals are more likely than the average to be in deficit. Its overall conclusion was that

The problems in Norfolk are exacerbated because we were one of the pioneer PFI contract areas. The extra cost of being a pioneer has been demonstrated by the fact that £100 million was released as a result of refinancing. As the hon. Gentleman mentioned, 70 per
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cent. of that sum went to the private partners, and only 30 per cent. to the trust. I have referred the issue to the National Audit Office and I await its response. I hope that its conclusion will reflect the belief of many in the Norfolk health economy that we are, in effect, paying a premium for being one of the PFI pioneers and that the Government should therefore provide extra support for Norfolk to take account of that additional cost.

I am anxious about one aspect in particular of the PFI contract. Concerns were voiced earlier this year about negative pressure rooms, which are used for isolating patients with infectious diseases. Loose ducting was found above the ceilings and rooms were not fit for the purpose. The cost of getting the facility right was £80,000, which was paid by the trust, not by the private sector partners. The NAO was asked to investigate and it concluded that it could not exclude the possibility of fraud. It has referred the case to the Counter Fraud and Security Management Service in the Department of Health. We await that body's conclusions, but that must be a serious concern.

Every patient in Norfolk is very worried about the effect of the financial pressures. The strategic health authority talks about efficiency savings, but there is a thin line between efficiency savings and cuts in services. The right hon. Member for South-West Norfolk (Mrs. Shephard) referred to dementia services. The proposed closure of small hospital units is causing immense concern. Dr. Ian Mack, a former chair of a primary care group in Norfolk, believes that the proposed cuts are financially driven. The "better care for Norfolk" strategy—an initiative from the primary care trusts in the county—amounts to a proposal to close beds in cottage hospitals and local hospitals and to replace them with better care for people in their own homes. That is a good initiative in itself, but if the aim really is to improve patient service, the outreach services—the care in people's homes—should be developed first, and how many beds can be cut decided only after that has been done. Cutting the beds first puts the cart before the horse.

The hon. Member for Norwich, North (Dr. Gibson) mentioned a dialysis unit proposed for Cromer hospital, which will be of massive benefit to local people. The chief executive of the Norfolk and Norwich hospital says that it is

Yet we are now being told that the strategic health authority is putting a block on the development. My message to the SHA and the Minister is that they should remove that block and allow local decision making. If local people decide that that much-needed initiative is needed for clinical purposes, let them proceed with it.

There is also a fear in Norfolk that cottage hospitals are at risk because of the state of the health economy in that county. I shall be grateful if the Minister provides reassurance that there will not be closures.

A lot of good work is being done in Norfolk, and I acknowledge that extra money is going in. The Liberal Democrats supported that, unlike the Conservatives—[Hon. Members: "Rubbish!"] The Conservatives did not support the extra money through national insurance. That money is needed, and some good things are happening. The Norfolk and Norwich hospital is doing a lot of very good work to improve efficiency—for example, the chairman of that trust wants to get the
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operating theatres working for much more of the working week, which is a good thing. However, that good work could be threatened by the financial pressures. I urge the Minister to provide extra support for Norfolk, specifically because of the extra cost of the private finance initiative.

10.22 am

Mr. Keith Simpson (Mid-Norfolk) (Con): I congratulate my hon. Friend the Member for South Norfolk (Mr. Bacon) on raising this important subject and colleagues on raising important points. The tone was lowered by the hon. Member for North Norfolk (Norman Lamb); as usual, the Liberal Democrats want to have it both ways in every way and any way they can.

I shall concentrate briefly on a number of points connected with the Broadland PCT, which covers two thirds of my constituency. Overall, Norfolk health services are £30 million in deficit, but I believe that one of the key factors in that is the Government's failure to   recognise the impact of the growth in Norfolk's population and the likely increase in that growth over the next few years.

With a budget of £120 million, Broadland PCT faces a £4.9 million deficit. The chief executive admits that there has been growth in the NHS budget, but says that that has to be measured against the requirements attached to the extra money. Waiting times for operations must be reduced to six months; new contracts for staff must be introduced; emergency admissions, which increased by 10 per cent. last year, must be covered; and the cost burden of running a new hospital must be met. Can the Minister produce a table comparing the extra moneys received by Broadland PCT with itemised expenditure for the four extra requirements, so that I can see whether they entail a surplus, a break–even, or a deficit position?

Broadland PCT has said that the key to cutting its deficits lies in taking certain measures. First, it says that there are savings to be made on GP prescribing budgets. I would like the Minister to say how she thinks that will be achieved and what impact it will have on patients. Secondly, the trust can sell surplus land at, for example, St. Michael's hospital in Aylsham. That, however, is controversial not least in terms of the impact on the local    community in my constituency. Finally, the "better care for Norfolk" strategy is cited—but how will the implementation of those measures reduce the Broadland primary care trust's deficit?

My constituents are, to say the least, cynical about some of the Government's promises. The Minister might not be aware that, as part of joined-up government, the Department for Transport has just announced that it is cutting the planned new access roads from the A47 to the Norfolk and Norwich hospital. It might be easy to get to that hospital from Norwich, but at certain times of day it is almost impossible to get there from the rest of Norfolk.

I conclude by asking the Minister a series of specific questions. I realise that, given the time, she might not be able to answer them today, so I shall be grateful if she responds to me in writing. Does she believe that the Norfolk health service deficits are normal? Does she
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believe that local managers have put measures in place to reduce the deficits? What impact will those measures have on health care for my constituents and those who work in the health service? What measures does the Minister think that the Government need to implement, or to reduce, or to stop, which will enable Norfolk health services to avoid such deficits in future?

10.26 am

Mr. Henry Bellingham (North-West Norfolk) (Con): I am grateful to my hon. Friend the Member for Mid-Norfolk (Mr. Simpson) for speaking so briefly that I have the time to speak. I also congratulate my hon. Friend the Member for South Norfolk (Mr. Bacon) on introducing the debate.

There are growing expectations among our constituents, because the Government keep telling us that everything is getting better and better and that far more money is being invested. However, what is happening on the ground? I receive increasing numbers of letters from constituents complaining about problems in the NHS. I do not know whether that is to do with growing expectations, or because things are not getting better. However, I wish to flag up four areas on which I hope the Minister will comment.

First, I have had a volley of letters about long waits for MRI scans. I have one letter from someone who is having to wait 40 weeks, as is another person who lives in Snettisham and who is in a great deal of pain. Another waited nine months, then decided to go private. People expect to be able to use modern technology and when those raised expectations cannot be satisfied they are disappointed.

A constituent of mine who had a stroke while in South Africa received daily speech therapy in that country. When he returned to west Norfolk, he was told that he could have only two sessions of speech therapy over the next five weeks, and probably two sessions a month from then onwards.

There are problems in accident and emergency at the Queen Elizabeth hospital in King's Lynn. I have an e-mail from a constituent whose child had to wait 10 hours in A and E. She says:

We have all had letters about orthopaedic services from people who are waiting for hip operations, knee operations or elbow replacements. I have three recent letters about waiting times for such operations: one from someone in West Walton, one from someone in South Creek, and one from someone who lives in King's Lynn. The average wait for those operations is nine to 10 weeks, which in my judgment is too long.

I accept that the staff are doing their best—there is a great deal of professionalism among management, doctors and ancillary staff—and the vast majority of patients are satisfied with the treatment that they receive. However, the other day my local paper reported that King's Lynn's Queen Elizabeth hospital was in crisis and "under siege", with disease spreading, wards closed, operations cancelled and longer waiting times.

I find it ironic that in this day and age we are unable to get a grip on very simple matters such as hygiene in hospitals. Firmer management and more imagination
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on the part of management are needed. The staff, who long to do their best, need that extra measure of leadership and inspiration. They need more help from the top. Rather than put every possible administrative hurdle in the way of staff, the Government should combine the extra money with ways of bringing out the best in the staff, who want to work hard and solve the problems. As my hon. Friend the Member for Mid-Norfolk said a moment ago, our constituents expect better than what is happening now. I hope that the Minister will provide some answers this morning.

Mr. Deputy Speaker : Before I call the Liberal Democrat spokesman to wind up for his party, I thank all hon. Members for their co-operation in this important debate.

10.30 am

Mr. Paul Burstow (Sutton and Cheam) (LD): I am grateful for the opportunity to take part in this useful debate and I congratulate the hon. Member for South Norfolk (Mr. Bacon) on securing it. It is always useful to air concerns about local budgetary difficulties. Those concerns are probably mirrored up and down the country in PCTs and local health economies grappling with underlying deficits, struggling to make the books balance from one year to the next while gently slicing away at certain services, particularly those that do not enjoy the benefit of being subject to Government targets and priorities.

I was interested in the fact that the hon. Member for North-West Norfolk (Mr. Bellingham) suggested that what was needed to enable local NHS organisations to improve and deal with their financial problems was more help from the centre. We have had too much "help" from the centre for far too long—that is the problem—so I was surprised to hear that suggested as a remedy to the local difficulties in Norfolk. My remedy and that of my colleagues would be to set the NHS free from central Government interference, and allow it a great deal more flexibility to make its own decisions about its priorities and to meet the needs of its local population.

Mrs. Shephard : Will the hon. Gentleman give way?

Mr. Burstow : I suspect that my next remarks may relate to the issue that has provoked the right hon. Lady's desire to intervene, so I shall finish the point before giving way.

Hon. Members have all spoken about the financial state of the local health economy in Norfolk. I reflect on the fact that when my hon. Friend the Member for North Norfolk (Norman Lamb) and I went through the Lobby in support of the extra funding that is now going to the NHS, it was not so crowded as to suggest that the massed ranks of the Conservative party were going through it with us. The record clearly shows that the Conservatives have not supported extra investment in this Parliament. Their Front-Bench spokesman must explain how his party would have improved the financial position across the board in Norfolk.

Mrs. Shephard : The hon. Gentleman was quite wrong in his forecast of what I was going to say. I was going to say that he obviously had not been listening to the points
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made by my hon. Friends and me, and other speakers. The fact is that the Government's ring-fencing and the decisions taken centrally have had a great effect on the funding problems in Norfolk and elsewhere. Everyone made that point, so I am surprised that the hon. Gentleman missed it.

Mr. Burstow : The right hon. Lady and I are in accordance on that matter. I was reflecting on other comments made by her hon. Friends. Perhaps she will need to check the record after this debate to see the point that I was picking up on.

The hon. Member for South Norfolk rightly identified the £29.7 million financial deficit in the local health economy and the way in which the organisations in Norfolk are trying to deal with it. One of my concerns—it is a concern not just in Norfolk, but across the country—is that pressure from strategic health authorities to deal with such financial difficulties often leads to one-off savings being identified. Such savings mask the problem from one year to the next but never deal with the underlying financial gap. In that regard, it would be particularly interesting to explore in more detail than today's debate has allowed precisely how Norfolk and Norwich university hospital NHS trust has moved from an original forecast deficit of £20 million to one of just £2 million now, to what extent it is just deferring problems rather than addressing them, and whether the recovery plans that are being put in place are realistic.

In that respect, I draw attention to the briefing produced for this debate in which the strategic health authority notes that there are problems dealing with the forecast deficits because of the inability to make the required levels of efficiency savings. The SHA, in its board papers of 1 October, says:

There was also concern about the delivery of financial recovery plans, especially ambitious ones. There are clearly some serious problems there that need to be addressed.

Hon. Members who have spoken before me have described adequately the financial pressures on our health economy, so I do not need to rehearse them. However, such pressures are common to many health economies across the country. It is also worth noting that our mailbags reflect the fact that people tend to write to us when things go wrong in the NHS—a point that the hon. Members for Norwich, North (Dr. Gibson) and for Great Yarmouth (Mr. Wright) made.

I join my hon. Friend the Member for North Norfolk in praising the work of NHS staff in making the very best of the resources available to them to deliver the very best of health care. We should do all we can to support and encourage that. However, I remain concerned about the culture of targets and tick boxes, which the Government have raised to such a pre-eminent position in the NHS that it gets in the way of identifying the needs of local populations and making sure that they are properly met.

The right hon. Member for South-West Norfolk (Mrs. Shephard) quite rightly referred to the changes in the service provided to the elderly mentally ill. I agree with my hon. Friend the Member for North Norfolk
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that if there is to be a change in the numbers of beds available, the necessary services to support people in the community should be put in place before those changes are made, and even then a clear assessment should be made of longer-term requirements. People in my area, including my colleague Ian Mack, and I are worried that the changes will ultimately result in means-tested nursing care beds. There is real concern that there has been a tightening of the eligibility criteria for NHS continuing care, which means that individuals wind up out of pocket and paying for basic health care. That cannot be a good outcome for people in Norfolk, or anywhere else for that matter.

The PFI has been mentioned as perhaps being at the core of the financial difficulties in Norfolk, and my hon. Friend the Member for North Norfolk has asked an awful lot of questions to try to shed more light on that.   The fundamental criticism that my Opposition colleagues and I make of the PFI is about the completely opaque nature of the process. It is difficult to know whether the PFI represents genuine value for taxpayers' money, whether it delivers good services, and whether the risk undertaken by the private sector warrants windfall profits of some £100 million going back into the investors' pockets so soon after the completion of projects. Of course the private sector deserves its reward for taking risks, but that does not seem to be entirely reflected in how the Norwich and Norfolk PFI contract has developed. My hon. Friend is entirely right to raise those concerns.

I hope that the Minister will show that she recognises the fact that, because the Norfolk and Norwich University hospital PFI was in the vanguard of that method of financing capital projects, things were done that would not be done in the same way today. As a consequence, the NHS is bearing costs that it will not have to bear in future. There is a need to reflect in the organisation of funding the additional premium costs that my hon. Friend talked about. It would be helpful if the Minister said something about that.Today's debate has helpfully aired concerns about a particular health economy—concerns that are shared by many across the country.

10.38 am

Mr. John Baron (Billericay) (Con): I add my congratulations to my hon. Friend the Member for South Norfolk (Mr. Bacon) on introducing the debate, which is on a very important subject. We have heard many worthwhile contributions.

The situation is serious: there is no doubt about it. The forecast deficit is about £30 million. Five of the 75 primary care trusts and I think three of the 73 NHS trusts forecasting a year-end deficit are in Norfolk. Our   central contention is that the Minister and her colleagues have imposed a number of exceptional costs on the NHS that are far in excess of the financial resources made available to the trusts. That is the major reason why there are such large deficits in Norfolk. Some of those additional costs have already started to   bite. They include the unfunded costs of the new GP   contract and the new consultants' contract, and the   unfunded impact of the European working time
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directive. Some of the costs, such as those associated with "Agenda for Change", have yet to bite, but in the years to come, front-line services will also be forced to shoulder the burden of the NHS programme for IT.

Conservative Members have tried to warn the Government about those proposed changes and where they fall short. On 21 April, we held a debate in    Opposition time that drew attention to the Government's failure to prepare the NHS for changes to doctors' working hours. At the time, the working time directive was still some months away, GPs had only begun to hand over their responsibility for providing out-of-hours services and there was time for the Government to ensure that the NHS could handle the changes and to ensure that NHS organisations would not be forced into debt. However, that opportunity was not seized by the Government.

On 22 June, we held another debate, again in Opposition time, which drew attention to the problems that the NHS was having in implementing "Agenda for   Change". Again, the Government failed to heed our    warnings. Furthermore, we held a debate on 11 November, which drew attention to the problems of the national programme for IT. Not only is there a dearth of experience in the NHS on that subject—for example, four out of every 10 PCTs do not have an IT director—but the costs of the IT programme are unfunded. The declared costs are something like £6 billion, but some independent sources suggest that the costs will rise to something in excess of £18 billion, which is three times the other amount. The shortfall—the unfunded costs of the programme—will fall on PCTs and will adversely affect front-line services. That is money that health services in Norfolk can ill afford to do without.

Largely because of those additional costs imposed by central Government, as we have heard on numerous occasions Norfolk's trusts will be forced to accept unplanned support, and their star ratings will be adversely affected because of their deficits. That is unfair to the NHS staff who work in the region, because it is not they but the Government who have burdened their organisations with unfair and unfunded financial requirements. For all their hard work and success in caring for patients this year, they will be branded failures by the Government, when the actual failure lies with the Government. Star ratings may be a good instrument for measuring hotels, but they are not a very good one for measuring complex organisations such as hospitals and PCTs.

What is worrying about the future is that according to the financial director of the SHA there are a number of financial risks to the Norfolk health economy. The first is that emergency activity will continue to rise. We would contend that the cause of that is the new GP contract. Since it was introduced from April this year, the number of attendances in accident and emergency has risen aggressively—from something like 3.7 million in the quarter ending April 2004 to almost 4.6 million in the quarter ending September.

The truth is that because many patients are now not able to see a GP out of hours, they present themselves at A and E. The impact of that on the local health economy is immense. Each GP consultation costs about £17. By
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contrast, each A and E attendance costs £77. According to one Norfolk PCT chief executive, the percentage increase in A and E attendances is still rising.

That represents a substantial additional burden on the NHS that is not being recognised by this Government. That is one of the main reasons why we are seeing ballooning deficits in the Norfolk health economy—particularly when we bear in mind the growing population—and that is before the additional costs of providing a skeleton out-of-hours service are factored in. A poll of PCTs in September found a

It is patient care that is being affected.

The second financial risk, according to the strategic health authority that is responsible for Norfolk, is due    to the Government's unfunded costs of the implementation of "Agenda for Change". That was rolled out on 1 December, so it is early days. However, it is likely that the impact on Norfolk's health economy will be severe. Unfortunately, the Government have no real idea of how "Agenda for Change" will impact on the NHS.

The Minister will be aware of the concerns of radiographers that their hourly rate of pay will fall. Speech and language therapists have expressed similar concerns, but we do not seem to be receiving anything by way of a response from the Government. The fact is that the pilot implementer sites were poorly designed, a    point that is becoming accepted generally. The Government do not have enough information about the impact on the NHS of "Agenda for Change" and, if past form is anything to go by, they will not have provided enough funding for its implementation, so individual NHS organisations will plunge deeper into the red.

Since the Government have been in power, there have been 66 tax increases and a massive increase in spending on the NHS. No one can deny the Government's good intentions, and it would be churlish not to accept that there have been some improvements in the NHS. However, bearing in mind the money that has gone in, there have not been as many improvements as there should have been. Increasingly, patients and taxpayers are asking where the money is going. Despite the massive increase in funding, nearly 1 million patients are on the waiting list. According to the latest figures, average waiting times are rising. Those figures come not    from Conservative central office but from the Department of Health, whose hospital episode statistics, table 2, 1999 to 2004, suggest that average hospital waiting times have increased by five days since 1999.

Patients are not seeing benefits on the front line. The Government have been successful in getting rid of the longer waiting times, but at the cost of average waiting times rising. They cannot deny that, given that the figures are their own. The massive increase in spending has resulted in only a 5 per cent. increase in hospital treatments—a point reinforced by the Department's own figures. Let us be clear: the Conservative party has committed itself to matching the Government's spending plans on health. We will increase spending by £34 billion by 2009–10. We do not want there to be misunderstandings of the kind that one or two hon. Gentlemen have tried to create. We will match the Government's spending.
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What does not divide the parties is how much money is to be spent. What does divide the Government and the Conservatives is how it is spent. How can we best make sure that the money reaches front-line services so that   patients benefit? At the moment, that does not happen in many areas. A lot of money is being wasted, perhaps for two key reasons. First, the Government have introduced a massive increase in targets, which has resulted in a growth in managers and bureaucracy. The number of new managers has grown at three times the rate of the number of new nurses and doctors. As a result, clinical priorities are being distorted. We should get rid of targets. The NHS has been a political football for far too long. We must allow the medical professionals to make the key decisions about patient care. Politicians should step back and allow the medical professionals to get on with the job.

Dr. Gibson : What about patients?

Mr. Baron : Perhaps the hon. Gentleman would like to intervene.

The second reason why so much money is being wasted is that the Government are forcing on NHS trusts several misguided policies that have not been properly funded by the Government. We have heard many examples of such policies during this important debate. That fact is also contributing to the financial crisis in Norfolk. One of the sad consequences of what has happened is that, because of the star rating systems and various other mechanisms imposed by the Government, the NHS staff will be blamed for the financial deficits, when in reality they are working extremely hard and deserve our congratulations. Because of the way in which the system is constructed at present, partly because of star ratings, the impression will be created that what is happening is the staff's fault, whereas in reality, it is the Government's fault.

10.49 am

The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson) : I am delighted to respond to the debate. I congratulate the hon. Member for South Norfolk (Mr. Bacon) on securing it. I have   listened to the concerns expressed by the hon. Gentleman and several other hon. Members about the financing of health services in Norfolk and the financial position across the Norfolk health community. As they know full well, our policy is that primary care trusts have specific local knowledge and expertise; that they   are responsible for improving health, securing the   provision of all health services and integrating health   and social care; and, to reflect that greater responsibility, that they control 80 per cent. of the total NHS budget at a local level.

It would be helpful to remind Members of the investment that we have made in the health service in Norfolk. My hon. Friends have mentioned it, but we have heard very much less from Conservative Members about the investment and the things that it has been buying for patients—a word not often used by Conservative Members—as part of improving health care.

Since we came to power the average real-terms annual increase across the health service has been 6.2 per cent., and the spend is set to rise on average a further
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7.1 per cent., in real terms, during each of the next three years. That compares to just 3 per cent. a year under the Conservatives.

Mr. Baron : Will the Minister give way?

Miss Johnson : I would like to make progress. The hon. Gentleman can intervene later if he wishes.

That investment means that NHS expenditure will top £92 billion by 2007–08, and we are committed to seeing that funding devolved to local level.

I would like to join other Members—again, particularly my hon. Friends—in congratulating staff on the contributions that they have made. One of the striking things about Conservative Members is the frequency with which they criticise health service staff. Waiting times are falling across Norfolk. There are no   patients waiting for more than nine months for in-patient treatment at the Norfolk and Norwich university hospital NHS trust. In 1997, more than 1,000 patients were waiting for more than nine months. [Interruption.] Hon. Members are muttering from a sedentary position. I take it that it is a mutter of congratulation at the thought of the 1,000 or so patients no longer on that waiting list. There has been a 17 per cent. reduction since 1997 in out-patients waiting 13 weeks or more.

Mr. Baron : The Minister is missing the point. No one denies that the extra money has gone in, but it is not reaching front-line services. The hon. Lady has not addressed my central point, which is that, although longer waiting times may be being eliminated, according to the Department's own figures, average waiting times are rising. Will the Minister address that central point?

Miss Johnson : I shall not take many interventions if they are likely to be that long. I was making exactly the point about how the investment is reaching the front line. Services to patients at the front line are improving. Patients with suspected cancer are now seen by a specialist within two weeks of urgent GP referral. That was not even measured by the previous Government—still less do Conservative Members acknowledge our success in these matters.

There has been investment in facilities, as my hon. Friends have said. I would like to recall a few—not all—of the highlights: new facilities at the James Paget Healthcare NHS trust include a new day-care centre, an ophthalmology theatre and an upgraded intensive care unit. A new emergency admission and discharge unit will open in February 2005; a new computerised tomography scanner has been installed in upgraded facilities and a second CT scanner and replacement MRI scanner will be installed during 2005.

The hon. Member for North-West Norfolk (Mr. Bellingham) mentioned waiting times for MRI scans. In the West Norfolk PCT, the waiting time is now 22 weeks, owing to a visit by a centrally funded MRI service in September. Two new primary care premises are being built in north Norfolk and an existing surgery is being expanded. "Better care for Norfolk", launched in April 2004, aims to provide enhanced services for
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patients across the areas of Broadland, Norwich and north and south Norfolk. Those services will allow NHS treatment closer to home and give more help to people with long-term conditions such as asthma and diabetes.

Mr. Bellingham : Is it true that average waiting times have increased?

Miss Johnson : I have been explaining to the hon. Gentleman how we have been improving the health service. He is well aware that the statistics he uses are much disputed.

Mr. Baron : Will the Minister give way?

Miss Johnson : No. I need to make progress.

Over the years 2003–04 to 2007–08, the plans across the area mean that there will be an increase on average of 7.2 per cent., over and above inflation. That amounts to Norfolk getting an additional £224 million—an increase of 31.6 per cent. Of course, the effective and efficient use of those significant additional resources will always be challenging.

I was grateful to the hon. Member for South Norfolk for recognising that some of the issues are complex. Equally, some things are simple. One simple fact is that Norfolk and Norwich hospital's A and E performance is in the top five, out of 400 hospitals across the country. Another simple fact is that we are putting in all this additional money. As the hon. Member for Sutton and Cheam (Mr. Burstow) recalled, the Conservative party voted against the rise in the investment in the health service. I do not want to hear pious lectures from the hon. Member for Billericay (Mr. Baron) about what they would do with money in the NHS and what they would maintain. His right hon. and learned Friend the Leader of the Opposition has committed himself to a   £35 billion cut. The Conservative party's flagship policy—Conservative Members dare not speak its name because they do not support it sufficiently—is to introduce a patient's passport. That means removing money from the NHS to support a few people in accessing private treatment.

Mr. Baron : Rubbish.

Miss Johnson : I shall give way to the hon. Gentleman.

Mr. Baron : That is not the policy. The Minister is totally misconstruing our policy. The bottom line is that the Minister cannot answer some simple questions. She is making the point about all this extra investment but cannot tell us why average waiting times are rising and why we still have nearly 1 million patients on the waiting list. Those are Department of Health statistics. Will the Minister address that issue?

Miss Johnson : The hon. Gentleman is well aware that only recently the Opposition had a debate on this subject and failed to make any progress. I will not go over something that was debated in the Chamber for several hours. I return to the point that I was making, because the hon. Gentleman does not want to address it. The patient's passport is the Opposition's policy. That, together with cuts, is their answer to the health service.
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Conservative Members can sit there for an hour and a half having a debate about the health service without mentioning it, or the word "patient", once.

Several hon. Members rose

Mr. Deputy Speaker : Order. The Minister is replying to the debate. She must be shown courtesy.

Miss Johnson : I have just a few minutes left. I will not give way because I want to address some of the other points that hon. Members have raised. Several hon. Members referred to the PFI.

Mr. Keith Simpson : On a point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker : I do not believe that there can be a point of order, but I will hear it because I respect the hon. Gentleman.

Mr. Simpson : I did not expect the Minister to be able to answer all the questions my colleagues or I put to her. I simply want to ask her whether she will reply to some of the—

Mr. Deputy Speaker : Order. That is not a point of order. The Minister gives way when she wishes to do so.

Miss Johnson : That was another waste of a minute.

As a result of a refinancing deal on PFI, the Norfolk and Norwich trust will receive £1 million a year for the next 30 years, which is the life of the PFI contract. Refinancing benefits both the private and public sector, as partnerships should. All the PFI schemes—this one is no exception—have already demonstrated value for money when compared with a public sector comparator at the time of signing. The many gains to the trust are a bonus. The gain is being used to reduce the hospital's annual charge, making money available for other purposes.

I am aware that the hon. Member for North Norfolk (Norman Lamb) has addressed the question of the NAO investigation and the PFI scheme. The NAO will shortly be responding to him. I welcome that move as he will now have a final, authoritative, independent and objective report on the subject. If the hon. Gentleman wishes, I am more than willing to ensure that the Department supplies its views on its conclusions.

I shall conclude because I do not think I have any more time to answer questions—[Interruption.] That is because the digital clock is flashing. I should point out that it is not unusual for the NHS to be reporting deficits at this time of the financial year—

Mr. Deputy-Speaker : Order. Time is up. We thank the Minister for her reply. Will hon. Members leaving the Chamber please do so quietly?

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