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12 Jul 2005 : Column 245WH—continued
NHS (Wales)
1.29 pm
David T.C. Davies (Monmouth) (Con): Thank you, Mr. Marshall. If it is not out of order, I should like to cut my speech slightly short, so that some of my colleagues will have time to speak in the 15 minutes that I believe are allocated to me.
In the light of what took place in London last week, let me make it clear that I very much applaud the work being done by doctors, nurses and other health service workers. As Members of Parliament, most of us will have visited our hospitals and GP clinics and will be well aware of the dedication of their staff. Let me make it clear, therefore, that the criticisms that I shall make are criticisms not of the work done by those workers, but of the system and the politicians who run it.
There is much to criticise in Wales. A report published by the Audit Commission in 2004 found that
In its summary, the report noted the following: one in four beds in Wales are being blocked; 17 per cent. of beds are being occupied by patients who should not be in the acute sector; the 40 per cent. increase in the Welsh health budget is not being used efficiently or effectively; and the NHS bodies continue to overspend, with the result that the financial deficit in the NHS has risen from £58 million to more than £100 million.
For many people, the problem starts when they want to see a GP outside normal working hours. For many months before the new GP out-of-hours service was set up, senior GPs were warning Assembly Members and, I believe, Members of Parliament, that the Assembly had not done its homework properly and that not enough doctors would be available. The Assembly Health Minister took absolutely no notice, and the resulting shambles was entirely predictable. The service certainly failed me when I needed to use it for my daughter, who fell ill on a Saturday morning and was unable to see a GP. It also failed the Assembly's Agricultural Minister, Carwyn Jones, who felt compelled publicly to speak out after no doctor was available to see his son.
Those who give up trying to see a GP out of hours are sometimes tempted to dial 999. If they do, the service that they get is not necessarily any better. According to the latest figures, only 57.5 per cent. of ambulances arrive within the target time frames. That might be partly because so many ambulance crews get tied up waiting with patients at accident and emergency units while beds are found. As the Minister will be well aware, crews cannot drop patients off until the hospital has checked them in, but with A and E units at hospitals such as the Royal Gwent running at full capacity, that can take hours. Meanwhile, more ambulances arrive, which means that fewer crews are available to deal with emergencies.
Adam Price (Carmarthen, East and Dinefwr) (PC): Does the hon. Gentleman agree that part of the underlying problem is the lack of capital expenditure in the Welsh NHS? In 2001–02 alone, total capital expenditure on health in Wales was minus £5 million—it was not even positive.
David T.C. Davies : I completely agree that capital expenditure plays a huge part in this, but we must also
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look at the organisation. If the system does not allow ambulance crews to go back to collecting people who make 999 calls before they have checked their current patient in, that will have a knock-on effect on the whole system.
I think that we would all agree that the greatest failure in the NHS in Wales is waiting list times, which have risen by 73 per cent. since 1999. One in 10 people in the Principality is on some form of waiting list. In September 2004, the percentage of patients on the in-patient waiting list who were waiting more than six months was 36 per cent. in Wales and just 9 per cent. in England. The percentage waiting more than 13 weeks for an out-patient appointment has been falling in England and rising in Wales.
Behind each of those grim statistics lie thousands of stories of individual patients waiting in pain. One constituent in Monmouth, whom I dealt with as an Assembly Member, was forced to sell his house to pay privately for the hip operation that he needed, because he would have had to wait many years on the NHS in Wales. Had he lived just a mile or so away, on the English side of Offa's dyke, he would have been seen in a maximum of six months, as opposed to the 18 months that was then the target in Wales.
Indeed, about two years ago, the local health board in Herefordshire was advising GPs not to recommend any of their patients to go to any Welsh hospital, because the waiting times were so bad. On virtually any measurement, the NHS is worse in Wales than in England. The fact that patients no longer have the right automatically to get treatment in England undermines the myth that our health service is a national one.
This is what others have said about the NHS in Wales. Someone commented that
"waiting lists are still unacceptably high and there is a danger that if the Assembly does not pursue reform as vigorously as it is pursued in England, the NHS in Wales will fall even further behind."—[Official Report, 18 November 2003; Vol. 413, c. 746.]
Those are the words not of Conservative politicians, but of three Welsh Labour Members of Parliament who were reluctantly forced to express views that are shared by many who have experience of the NHS in Wales. Despite all that, the Government are now considering giving the Welsh Assembly more powers in devolved areas such as health.
Mr. Stephen Crabb (Preseli Pembrokeshire) (Con): Is my hon. Friend aware of the comments of Dr. Tony Calland, the chairman of the Welsh council of the British Medical Association, two weeks ago? He described the NHS in Wales as being "in intensive care", and said that the interference of the Welsh Assembly Government with the implementation of the Welsh consultants' contract was "unprofessional and distinctly unhelpful". Is it not a damning indictment of the
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Assembly's administration of this vital public service that our health professionals say that they have no confidence in the Assembly's role in this matter?
David T.C. Davies : It is a damning indictment. I was not aware of that quote, but I am aware of one by Roy Lilley, an independent consultant in the health sector who described the Welsh NHS as a basket case, and said:
It is clear that the problem is deep rooted. Why, therefore, are the Government considering giving even more power to the Welsh Assembly over health? Given its performance, we should be asking whether the time has come to consider taking powers away from the Assembly, particularly in areas in which it clearly cannot deliver. Ministers and Members will know that there is a clear precedent for that, because central Government have the power to take over certain functions of local authorities—as has the Welsh Assembly—if they consistently fail to deliver. What central Government have given, they should be able to take away. The failure to do so needlessly condemns one in 10 people who live in Wales to languish in pain while they wait for operations.
If we considered taking powers away from the Assembly when it cannot deliver, there would be a huge incentive for the Assembly and its Ministers to improve their performances in areas in which they lag behind England. The Minister for Education and Lifelong Learning has presided over the closure of numerous small junior and infant schools, and is about to authorise Education and Learning Wales to use a new funding formula that will almost certainly lead to the closure of school sixth forms.
Various local authorities have been so underfunded for years that council taxes have risen. In Monmouthshire, they rose by an average of 134 per cent. before rebanding over the past five or six years. If the Ministers responsible for those actions knew that failure to reach a certain level of performance would result in their responsibilities being taken over by central Government and the loss of their ministerial pay, cars and perks, they would suddenly have a strong incentive to deliver.
I therefore urge the Minister to build clauses into the proposed legislation being proposed to the Assembly that would allow powers to be removed, just as we are considering allowing powers to be added. It should be spelt out to the First Minister that those powers will be used unless there are significant improvements in the Assembly's performance.
Adam Price : Surely, the failures that the hon. Gentleman describes—I do not disagree on them—are those of the Labour Government in Cardiff Bay rather than of democratic devolution. His party wanted to form a Government in Cardiff Bay; surely these are political issues of the failure of the Labour party.
David T.C. Davies : I fully accept the hon. Gentleman's point. I have no doubt that political decisions taken by the left-of-centre Labour party in Wales contribute greatly to the problem. However, it
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will be another two years until a Welsh Assembly election and many people cannot wait that long. If the Assembly cannot do a better job of fulfilling its responsibilities, it falls on central Government to remove those responsibilities, just as we would with a failing local authority in England or Wales. [Interruption.] I am happy to give way again if the hon. Gentleman wants. At the same time as giving away extra powers to the Assembly, the Minister needs to consider the possibility of taking powers away.
Adam Price : The hon. Gentleman is being generous, but is he saying that he has more faith in Labour in London than he has in Labour in Cardiff?
David T.C. Davies : Amazingly enough, I am saying that with regard to the NHS. The hon. Gentleman has access to the same statistics as I have and they are clear. The NHS in England is in a better situation by far than the NHS in Wales. That is not a political statement, but a statement of fact that he can verify himself. I ask the Minister the same question: does he believe that people receive a better service from the NHS in England or in Wales? Also, does he agree with Welsh Labour MPs who have openly criticised the performance of the NHS in Wales or is he prepared to say publicly that they are wrong?
For the sake of those who have had to wait hours on trolleys in A and E units, who cannot see their GP on weekends, who suffer the indignity of being assessed on a mixed-sex ward—as many still do—or who are forced to make enormous financial sacrifices, such as selling their house, to get an operation in Wales that they would get in months in England, the time has come for the Government to act. The time has come for central Government to consider making the Assembly relinquish its powers over the health service. The Assembly's management of the NHS has been a lamentable failure, as many Labour MPs would agree. The Minister should remove the powers of the Assembly to run the NHS and allow central Government to reassert its responsibilities, for the sake of all those who are on waiting lists in Wales.
1.42 pm
Mr. David Jones (Clwyd, West) (Con): The failure of the NHS in Wales can be exemplified by the experience of a constituent of mine. Mrs. June Derry is a well known town councillor in Ruthin. She is 73 years old, has worked hard all her life, paid her taxes and national insurance contributions, and over the past few years has developed leg pain. On 8 August last year, she was referred to a consultant at her local centre of excellence for orthopaedic surgery, which is the Robert Jones and Agnes Hunt orthopaedic hospital in Gobowen, which is just across the border in Shropshire. She was told that she needed a knee replacement operation. When she asked how long the surgery would take, she was told that because she came from Wales she would have to wait for 18 months. If, however, she had come from England, she would have had to wait for only 17 weeks.
Knowing that this debate was to take place, I spoke to Mrs. Derry yesterday evening. She told me that she was still awaiting that hospital treatment some 12 months later. As yet, she has received no indication of
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when the operation will take place, but she is in considerable and worsening pain. What is annoying her more than the pain, however, is the knowledge that if she lived just on the other side of Offa's dyke, she would have received her treatment six months ago. She made a simple point to me that the Minister could perhaps comment on. She said, "I pay my taxes and I have paid my national insurance contributions at precisely the same rate as a patient from England. Why, therefore, do I have to wait five times as long for treatment?" That is a simple question, which a lot of patients in Wales are asking. The answer, as we all know, is because of the Assembly Government's utter failure on health.
I request that the Minister telephone Cardiff after this important though short debate and speak to the First Minister and to the Health and Social Services Minister to inform them—as if they do not know already—of the strength of feeling in Wales about the failure on health. He should tell them clearly that, on health, they and the Assembly are drinking in the last-chance saloon. Frankly, it would be wrong to allow political dogma to take precedence over patient care, but that is what is happening in Wales.
1.45 pm
The Parliamentary Under-Secretary of State for Wales (Nick Ainger) : May I begin by congratulating the hon. Member for Monmouth (David T.C. Davies) on securing the debate?
The Welsh Assembly Government are committed to establishing not just an illness service, to which many Members have referred, but a true national health service that promotes and creates good health and prevents ill health at source. I welcome this opportunity to explain the Assembly's work in introducing the changes needed in the health service in Wales to meet the challenges of the 21st century.
The Assembly Government have made important progress towards building an NHS and social care services that provide high-quality care that is fashioned to meet the individual needs of patients. For example, 190,000 more people attended hospital via out-patients and accident and emergency departments in 2003–04 than in 1996–97. The hon. Gentleman will be aware of innovative developments in the delivery of health care in his constituency. For example, the operation of Chepstow hospital is unique in Wales, in that it contains both primary and secondary facilities: two GP practices are based alongside the trust's acute facilities. The hospital features highly in the Monmouthshire local health board plans for the future development of health care services in the wider pan-Gwent review of health care provision.
As in other parts of Wales, the NHS in the hon. Gentleman's constituency is being refocused on the needs of patients. This year, £4.3 billion will be spent on health in Wales, almost double what was spent the last time his party was in office. In their last year, the Tories spent £640 per person in Wales. By 2007–08, it will be more than £1,800.
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David T.C. Davies : I did not dispute the increase in spending—some 40 per cent.—for the Welsh health budget. My point is that the money is not being used efficiently or effectively. Those are not my words; they are in the Audit Commission's report.
Nick Ainger : The Audit Commission also referred to innovations. It is accepted that more improvement is needed and that, in order to get improvement, there must be investment. The Welsh health service under the Tories was certainly starved of investment.
In the eight-year period from 1999, real-terms investment in health in Wales will rise by 4.8 per cent. a year. By 2007–08, it will be £5.5 billion. The budget for hospital buildings and equipment, an issue raised by the hon. Member for Carmarthen, East and Dinefwr (Adam Price), will rise from £120 million in 2004–05 to £309 million in 2007–08. I believe that that addresses the issue of capital spending.
As part of the Assembly's vision for providing better health care for the people of Wales, there will be better designed, better delivered services in key priority areas including cancer, coronary heart disease and chronic diseases. The priorities recognise the higher incidence of such diseases in Wales than elsewhere in the UK, a point that was not made by Opposition Members.
Ambitious new targets have been established to cut waiting times for cancer patients, and trusts in Wales are required to report monthly to the Assembly to ensure that the targets are met. Waiting times for cardiac surgery have also decreased. From April this year, no patient will wait longer than eight months for cardiac surgery, and the Assembly Government will ensure that, by 31 March next year, no patient waits longer than six months. Likewise, from May this year, no patient will wait longer than six months for an angiogram. By 31 March next year, the target will be four months.
One of the top priorities that the Assembly has focused on in the past 12 months is reducing long waits in Wales. An extra £32 million has been given to the NHS to help meet targets in this financial year.
Mr. David Jones : The Minister talks about reduced waiting times and waiting lists, but is not it the case that in the two months between March and May, the number of patients waiting more than 12 months for in-patient treatment increased by more than 1,100?
Nick Ainger : There might well be differences month on month, but the overall trend in Wales, as in England, is that waiting times are falling for patients. That is the important point.
The key manifesto commitment for the Assembly Government is that they will ensure that, by 2009, no one will wait more than 26 weeks from GP referral to treatment. To ensure progress towards that target, they have pledged that, by 2007, no one will wait more than 39 weeks.
Adam Price : In the 2001 general election manifesto, Labour promised to build 10 new hospitals in Wales by 2010. How much closer are we to that target?
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Nick Ainger : Ten hospitals are being built or are planned. The capital budget has almost tripled in three years, and a significant part of it will be spent on constructing and completing those hospitals. Two hospitals are under construction in my constituency.
Nick Ainger: I have already given way quite generously and time is pressing.
The Assembly Government have rightly recognised that waiting times are a serious public concern. Just as in England, the Assembly Government are making important progress towards reducing waiting times. Indeed, the latest data show that half the patients admitted to hospital for an operation from a waiting list had waited only 11 weeks or less.
Last year, in-patient and day-case waits of more than 18 months were cut by more than 1,300, and waits of more than 12 months were cut by almost 8,000. That shows the progress that has been made as a result of investment.
Last year, out-patient waits of more than 18 months were cut by more than 7,000, and waits of more than 12 months reduced by almost 10,000. In the last month alone, out-patient waits of more than 18 months have reduced by 27, and waits of more than 12 months have reduced by 220. Almost 90 per cent. of accident and emergency patients are seen in under four hours.
At the end of the day, addressing waiting times and improving the health service are down to increasing the number of staff, buildings and equipment. There are more than 450 more consultants and more than 7,000 more qualified nurses in Wales than there were in 1997.
By 2010, the Assembly plans to have 525 more consultants and 175 more GPs, 6,000 extra nurses and 2,000 extra other health professionals. The Assembly has doubled the annual medical intake since 1998, and has almost 1,000 senior doctors in training for consultant posts. In addition, the total number of nurse training places commissioned in Wales increased from 3,261 in 2000–02 to 3,750 this year.
The Assembly is moving towards abolishing prescription charges by 2007, a measure that is clearly benefiting Mrs. Derry, the constituent mentioned by the hon. Member for Clwyd, West (Mr. Jones), although I accept that the problem of waiting times for patients who seek treatment and are referred to hospitals in England needs to be addressed. It is, to say the least, unfair to treat differently patients who are referred to hospitals outside Wales through the traditional commissioning process. That is an equity issue, which the Assembly will have to address.
The Assembly also aims to make NHS provision attractive for dentists. The hon. Member for Monmouth did not make that point, but it is worth making, because the hon. Member for Carmarthen, East and Dinefwr and I have similar problems in our constituencies. More investment needs to be made. The Assembly is handling the issue innovatively. As well as implementing dental initiatives, it is investing more money to ensure that more dentists are attracted to carry out NHS work.
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The reforms being introduced by the Assembly Government are in marked contrast to what happened when the party of the hon. Member for Monmouth was in power. Seventy hospitals closed in Wales under the Tories.
David T.C. Davies : The Minister should be well aware—it is accepted in the Assembly—that that figure is completely misleading. Some of those hospitals closed, some were reopened and new ones were built. He spoke earlier of 10 new hospitals in Wales. Did he mean 10 hospitals in addition to those built under the Tories? Does he not accept that some hospitals will be closed during the next few years, or have their A and E units taken away in order to make way for new hospitals?
Nick Ainger : The advice that I am given is that 70 hospitals closed between 1979 and 1997. That is a fact. One of the problems inherited by the Labour Government in 1997 was the lack of capacity—in buildings and in staff. Prescription charges increased eightfold under the Tories, whereas under Labour they are being phased out altogether.
I remind the hon. Gentleman that not so long ago we had a general election, and the Conservatives did not address the fundamental issues that any party would face if it were serious about forming a Government: how to address the problem of capacity and how to recruit staff. All that they could come up with was the expensive and wasteful health vouchers, which would have taken £1 billion a year out of the NHS to subsidise private health care. That policy would benefit those who could afford private care at the expense of the many who cannot afford it.
Devolution brings government closer to citizens, and it gives the people of Wales greater freedom to develop policies to meet their needs. Wales was the birthplace of the NHS; under devolution, Wales now has a real opportunity to take control over its own health. Devolution is about approaching priorities in a way that best suits local needs. One size does not fit all.
The health needs of the people of Wales are not the same as those of the people of England. For example, one third of all adults in Wales—800,000 people—have at least one chronic condition; and 23 per cent. of people in Wales suffer a limiting long-term condition against only 18 per cent. in England. In some areas, the problem is worse. For example, 30 per cent. of people in Merthyr Tydfil suffer such a condition. Of people aged over 65 in Wales, 34 per cent. suffer arthritis, 21 per cent. have a respiratory illness and 30 per cent. have a heart condition. The incidence of cancer among Welsh men is 10 per cent. higher than in England.
Adam Price : If that is true, why is health expenditure per head lower in Wales than in the north-east of England?
Nick Ainger : That is a decision for the Assembly. I know that the hon. Gentleman and his party have been trying to claim that it is the result of Treasury decisions made in Westminster but, under devolution, the Assembly decides how to spend the money. I have given the hon. Gentleman the figures, which show substantial
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increases, including a tripling in three years of capital expenditure. Other expenditure, too, is way above inflation. The hon. Gentleman spoke of one region of England; Wales is spending far more per head than England, but finances in England are now being targeted towards regions with health problems. No one can get away with claiming that investment in Wales is not substantially above the rate of inflation.
The hon. Member for Monmouth claims that his solution would, in effect, take responsibility for health away from the National Assembly. I do not think that
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his party leader in the Assembly agrees with that policy, nor does his health spokesman, Jonathan Morgan. The hon. Gentleman proposes the complete removal of health care from the Assembly. That shows his failure to come to terms with devolution. It would not be possible to achieve it under the Government of Wales Act 1998, as functions exercised by the Assembly can be transferred back to central Government only with the Assembly's consent. The hon. Gentleman may be a member of the National Assembly, but I do not believe that he speaks for the majority of his colleagues.
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