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The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne): I sincerely congratulate the hon. Member for Boston and Skegness (Mark Simmonds) on securing the debate and providing such a thorough analysis. He takes a keen interest in health issues in Boston and Skegness, and on 22 June he raised financial matters in Lincolnshire in private office correspondence with my right hon. Friend the Secretary of State for Health. I also congratulate my hon. Friend the Member for Lincoln (Gillian Merron), who has also raised health issues in the region with my Department. I know that she has discussed the matters at the heart of the debate with local bodies responsible for budgetary decisions.
I hope that the hon. Gentleman will indulge me as I briefly sketch out the backdrop to the debate. We are halfway through a 10-year plan to transform the NHS, turning it from the creaking service that we inherited in 1997 into a well resourced, patient-centred service that is fit for purpose in the 21st century. We are therefore introducing national standards, which, over time, will set out the entitlement to health care for residents, including the constituents of the hon. Member for Boston and Skegness. Those standards are backed by a tripling of health investment to £90 billion a year in the next few years. The changes are already delivering record falls in deaths from coronary heart disease and from cancer, and in the number of suicides. I pay tribute to the staff throughout the national health service for their work in securing those achievements.
The hon. Gentleman was concerned about the risk to services. I noticed in the Lincolnshire papers that I perused in preparation for tonight's debate some of the changes that are taking place in Lincolnshire and Lincoln. I was delighted to read of the outstanding performance of the accident and emergency department at United Lincolnshire Hospitals NHS Trust, which the hon. Gentleman mentioned. That department consistently sees 97 per cent. of A and E patients within four hours, which
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is a far cry from the days when people had to take a sleeping bag to A and E. Its performance is so good that it was awarded a special performance bonus of £100,000. I was delighted to read of the opening at Lincoln county hospital of £4.25 million-worth of specialist wards for elderly care and of a new stroke unit, which was opened by the Princess Royal. I was impressed by an innovative new scheme—the first in the country—devised by Lincolnshire Ambulance and Health Transport Service NHS Trust designed to alert the A and E department of patient details before the patient arrives. All those innovations were made possible by new investment.
The purpose of tonight's debate, however, is to discuss not what has been achieved so far but what needs to be better. At the heart of our deliberations this evening is the question of money. Lincolnshire is a beautiful county, and the hon. Gentleman's constituency is a beautiful place. I am a great fan of its church architecture in particular. The delivery of health care in Lincolnshire carries challenges which, while not unique, are rare. First, there is the demographic challenge, to which the hon. Gentleman alerted the House, particularly in the east Lincolnshire coastal area. Between 1999 and 2004, population growth peaked at 25 per cent. in the 57-year-old age group. As the hon. Gentleman mentioned, postcode analysis demonstrates that the majority of those people were relocating to east Lincolnshire from the former industrial areas of Nottingham, Leicestershire and south Yorkshire, with associated high levels of long-term conditions and health needs, which are reflected in mortality figures that are higher than those for the indigenous population. The rural nature of the county is also a factor. The cost of provider services in Lincolnshire partly reflects the complexities of delivering health services to a dispersed population. For example, the United Lincolnshire Hospitals NHS Trust runs five A and E departments, which serve a population of about 640,000 people with over an hour's drive time between individual sites.
To remedy that problem, the Government have introduced a new system of funding for local health care, which first creates a baseline of what local need looks like and, secondly, sets out a plan for increasing funding in different places to meet that baseline. That involves significant change for the hon. Gentleman's primary care trust, and I am grateful that he has recognised that. From 2003–04 to 2005–06, there is an increase of about £67 million, and in the next couple of years, there will be an increase of £87.5 million, making a total of £154 million by 2007–08. That should go a considerable way towards allaying concerns about change. That £154 million boost is not under-recognition, and it will have a major impact on our ability to finance innovations such as the new contract for consultants. We have always made it clear, however, that where there is new investment there must be reform. Central to reform in Lincolnshire is action to tackle the deficits in local health budgets, and I think that the hon. Gentleman made an excellent job of laying those out to the House. I would go slightly further and say that if no further action is taken and there is no reform ahead, the local health community forecasts that overspending this year will rise to about £13 million by the end of March 2006.
I am glad to hear that the reform required to accompany the extra £154 million investment now appears to be in hand. Central to that is ensuring that best practice in the rest of the country arrives in the hon.
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Gentleman's constituency. It is clear, and it is accepted by local management, that the NHS in Lincolnshire has not moved far enough or fast enough in modernising service delivery. While there are pockets of excellent practice, too many services are still provided along a traditional model. In particular, far too many patients are transported and admitted to hospital, and once there they spend too long in an acute care setting.
Change in practice needs to be considered carefully, but the achievements to date should provide some measure of comfort. The hon. Gentleman said that the changes proposed were inexplicable, so I shall try to shed a little light on them. Over the past year, for example, United Lincolnshire Hospitals Trust has improved patient pathways across primary care, acute care and social services, enabling the average length of stay to be reduced from 7.9 days in 2003–04 to just 6.7 days in 2004–05. That is an 18 per cent. improvement in just a couple of years, which has allowed the trust to reduce its overall bed stock by 110 or 8.8 per cent. to 1,141 across all sites.
Crucially, that has been achieved without reducing the levels of service provision or activity at any of the sites operated by the trust. In fact, quite the opposite—over the same period the local health community succeeded in reducing the maximum in-patient waiting time not for one specialty, but for all specialties, including orthopaedics, to six months by April 2005, significantly ahead of the national target, which was December 2005.
Over the next year, 2005–06, the combined effect of a 5 per cent. reduction in emergency admissions, equivalent to seven patients per day across the whole of Lincolnshire, and a continued reduction in the length of stay to an average of 5.5 days, which is national best practice, will enable a further 143 beds to become free. Let me be clear: the reduction in bed numbers will not reduce local people's access to health services. If there are ward closures, they will be general wards and will therefore not result in the closure of any local specialties.
I want to go slightly further tonight and reassure the hon. Gentleman that reducing surplus beds does not form part of any current plans to reconfigure the status of individual sites. The only services that will be moving this year from Boston Pilgrim to Lincoln County are those being centralised in order to comply with guidance from the National Institute for Health and Clinical Excellence, particularly in respect of "Improving Outcomes" guidance for cancer services.
The response to the challenges that the hon. Gentleman sketched out are measures rooted in local consultation. The direction of travel, I understand, for local health service redesign in Lincolnshire was set out in two key local health community documents. The first was the Lincolnshire acute services strategy, which was developed and formally consulted on during the summer of 2003. Local community stakeholders, including expert patients, were involved in preparing the proposals. Consultation with patients was undertaken in the Boston locality to help develop the plans.
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Secondly, all six NHS organisations in Lincolnshire, together with the county council, have developed a 10-year Lincolnshire health and social care strategic framework. That sets out the acute services strategy in a wider context and has been endorsed by all the trust boards. It was formally signed off in March 2005 by the Lincolnshire health and social care partnership board, which includes a cabinet member from Lincolnshire county council.
Beyond that, the path to balance is set out in the new community-wide financial recovery plan developed in partnership with the county council, among others. Change, of course, is difficult, but ultimately every community must decide what shape its local health service needs to take in order to deliver the standards that are set out nationally. There is a measure of cross-party consensus on this. It was the hon. Member for South Cambridgeshire (Mr. Lansley) who recently thundered to an audience that
I agree with him up to this point: that the NHS should not be micro-managed from Whitehall. The role of Health Ministers and the Department of Health is to secure adequate resources and to set out a strategic framework for the NHS to work within. It is right and proper that the decisions on prioritisation are taken locally, and we have put decision making where it needs to be—in the hands of the local NHS.
The quid pro quo, however, is that if we are to run services locally there must be local engagement and consultation. I understand that that is now happening. First, the local health community is working collectively and with partners to finalise the NHS financial recovery plan. Following a presentation of the emerging proposals to the Lincolnshire health and social care overview and scrutiny committee yesterday, a revised submission will be made to the SHA on 15 July. Secondly, the SHA has scheduled individual monthly progress meetings with the chief executives of East Lincolnshire PCT and United Lincolnshire Hospitals Trust, as well as a monthly review meeting with the chief executive of West Lincolnshire PCT to monitor cross-organisational actions. Thirdly, exceptional board-to-board meetings led by the chair and chief executive of the SHA have been arranged with the United Lincolnshire Hospitals Trust and East Lincolnshire PCT for 8 and 14 July respectively.
In summary, this is about the delivery of local services. We have increased funding for primary care trusts very significantly. It is now for PCTs to decide on their local priorities. All NHS organisations—I am sure that the hon. Gentleman would not demur from this ambition—must live within the resources that they are allocated. Although that may mean some service change, the overall direction of travel is towards investment in improving the NHS locally and nationally. That is changing the health and well-being of people in this country, including the hon. Gentleman's constituents.
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