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(a) the Committee shall take questions under Standing Order No. 110 (Northern Ireland Grand Committee (questions for oral answer)), and shall then consider the matter and the legislative proposal referred to it under paragraph (1) above;
(c) at the conclusion of those proceedings, a motion for the adjournment of the Committee may be made by a Minister of the Crown, pursuant to paragraph (5) of Standing Order No. 116 (Northern Ireland Grand Committee (sittings)).[Mr. Heppell.]
Rob Marris (Wolverhampton, South-West) (Lab): I present a petition that is one of a series instigated by the Isitfair campaign on council tax. Mr. Donald Morris of Wolverhampton has worked tirelessly to collect the signatures for it, and it has been signed by 1,416 people in Wolverhampton, South-West.
Year on year, the above-inflation increases in Council Tax are causing hardship to many and take no account of ability to pay. They further declare that the proposed property revaluation and rebanding exercise will make an already flawed system even worse. The Petitioners request that the House vote to replace the council tax with a fair and equitable tax that, without recourse to any supplementary benefit, takes into account ability to pay from disposable income, such a tax to be based on a system that is free from any geographically or politically motivated discrimination, and that clearly identifies the fiscal and managerial responsibilities of all involved parties.
I want to focus on the Queen Elizabeth hospital in my constituency, and on the West Norfolk primary care trust, and to examine the underfunding of the PCT and the accumulated debt of the hospital, which currently stands at £11 million. I shall also consider the penal usage charge that is being applied to the deficit, which is no more than a fine or penalty. Last July, the chairman and the chief executive of the Queen Elizabeth hospital trust resigned because of the funding problems the trust was facing. That led to what can only be described as a very serious situation.
I shall start by outlining the wider background to this case. As I have time to do so, I shall go into a little more detail than I would otherwise have done. I returned to the House in 2001 and one of my immediate observations was that I was getting many more letters about the NHS than I did when I was an MP in a previous incarnation up to 1997. That was partly because the expectations of my constituents have been raised, especially by the Government going on and on about all the extra money that is going into the NHS. People are more demanding now and expect higher standards. The majority of the complaints are not against staff but against the system and the administration of the NHS.
All MPs have heard their fair share of local NHS stories, but nothing gives rise to greater anger than cancelled operations. I have here a letter from a constituent and I am afraid that it is by no means unique. This constituent was diagnosed with kidney stones on his right and left sides on 20 February 2004. He had to wait until 10 May for a hospital appointment with a consultant. He then had an operation planned for 24 May 2005, nearly a year later. That operation was cancelled and postponed until 27 May, then cancelled and postponed until 3 June, then cancelled and postponed until 23 June, and then cancelled again. There are many reasons why those operations were cancelled, but my constituent's sense of anger and betrayal must be seen to be believed. To understand it properly, one must examine the correspondence. I am afraid that that case, which I mention because it is probably the worst of the pile of local NHS cases that I currently have, is by no means unique. There have been many other similar ones. It is not necessarily the fault of the staff but of the system breaking down.
What is happening? The money that the Government are putting into the local NHS is simply not getting through to patient care. I had a long talk with a well-known local consultant earlier today. He said:
He went on to say that if the extra money going into the NHS actually got through to patient care, we really would have a first-class local NHS. As the Minister will
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be aware, that is borne out by the recent National Audit Office report, which concluded that productivity in the NHS across the country
Another cause of some of the problems in my local health service is the primary care trust structure, which does not help at all. As my hon. Friends who represent Norfolk know, we had a Norfolk health authority until about eight years ago, which has been replaced by a large number of local PCTs that are inherently bureaucratic and top-heavy on management, hugely duplicate management layers and are expensive. To the Government's credit, they have belatedly seen the light and are effectively going back to the old system, with one PCT for Norfolk. Let us consider the waste and accumulated extra costs of those eight years and the inevitable destruction as the PCT system is overhauled, streamlined and reformed.
I want to consider the historic underfunding of the health service in west Norfolk. The Queen Elizabeth hospital has fallen behind the other Norfolk hospital trusts. Over the past four years, the average annual compound growth rate for the Norfolk and Norwich university hospital has been 13.2 per cent., that for James Paget, a similarly sized hospital trust covering the eastern end of the county, has been 10.7 per cent., and that for the Queen Elizabeth hospital has been 7.4 per cent.
There is no question but that the pressures in west Norfolk have been exacerbated by a big increase in the population of over-65sa 23 per cent. increase over the past eight yearswho, of course, have more complex medical conditions. There is also a growing population in west Norfolk. In 1997, the population of west Norfolk, which covers the whole of my constituency and a lot of the constituency of my hon. Friend the Member for South-West Norfolk (Mr. Fraser), as defined by the NHS guidelines, was 205,000. In 2005, that had increased to 222,000. Furthermore, in 1997, emergency admissions to the Queen Elizabeth hospital were 3,700, whereas in 2005, that figure is predicted to be 8,700. Of course, there are more cars on the roads and more accidents as a consequence. There is also a failure of primary care, with many of my constituents gong to accident and emergency rather than having their problems sorted out in a local surgery.
The Queen Elizabeth hospital, however, is doing what it does best: treating patients, many more of them, and providing high standards of health care. But because it is treating more patients and achieving better throughput than ever before, it has a debt of £11 million, the consequences of which I will consider in more detail.
The West Norfolk primary care trust has been seriously underfunded for a number of years. This year, it is receiving £15 million less than the target set by the Department of Health's Advisory Committee on Resource Allocation. Even though the Minister, Lord Warner, has promised in a letter that future
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increases will be above the national norm, that will still leave the PCT with a deficit of £7.3 million for 2008. I ask the Minister to comment on what his ministerial colleague, Lord Warner, has said, as he will have plenty of time to do so in his wind-up.
Let us examine the consequences of that deficit. First, we had the resignations of the chairman and chief executive of the trust in July. I do not know whether having the two key guys resigning is unique, but they were under real pressure, felt completely boxed in by the funding crisis and believed that they had to stand down. It was highly regrettable that they did, because in some ways it made matters worse On the other hand, we now have a clean slate to move forward.
There have been ward closures. As the Minister will know, because, obviously, he has done his homework, the Elm and Denver wardsboth surgery wardshave been amalgamated, and the West Dereham and West Newton wards, both of which were involved with the care of the elderly, have been merged. We have lost 57 beds, and the Queen Elizabeth hospital's beds per thousand of population ratio was already one of the lowest in the region. There have been no redundancies, but there will be a freeze on recruitment, and there is bound to be an effect on patient care.
I am sure that the management of the hospital, to whom I spoke this morning, and the Minister will say that the impact on patient care will be minimal. Closing 57 beds, however, is not good news. The consultants to whom I have spoken are very concerned. They tell me that it will inevitably mean shorter stays, more pressure on patients and staff, a possible dilution of nursing care, and possibly even an impact on waiting lists. In addition, the Arthur Levin day surgery unit will be forced to close for six weeks, adding to pressure on patients. The funding of replacement equipment and repairs to equipment will also be on a very tight budget.
How do the Government react to all that? A number of letters have come through to me, including one from Lord Warner, who explained in some detail about what was going on and the PCT allocations. He admits that the Department of Health's Advisory Committee on Resource Allocation predicts that the West Norfolk PCT will still be 3.5 per cent., or more than £7 million under target by 200708, but what impact will the reorganisation of the PCTs have on that prediction? The noble Lord went on to say that all is under control, because more is going into the health service. It is the usual storymore and more money is going in, so we should not be complaining and there should not be problems.
I wrote to the Prime Minister. He does not always reply to Back Benchers who are not Privy Councillors. He does not necessarily always reply to people who have had a spat with him at Prime Minister's questions, as I have, but to be fair to him he wrote me a very nice letter, which began "Dear Henry" and ended "yours, Tony" and which I appreciated. Again, I had the standard line about how much more money is going into the health service and how the position overall is very bright. He also said that the changes taking place locally
"will mean that the management will need to make tough decisions but, I am sure you will agree, the provision of high-quality healthcare, which meets the needs of local population, will at no stage be compromised."
Of course I am grateful to Ministers for coming back to me and telling me what is going on. I appreciate that no Minister wants dissatisfied MPs on their own Benches or on the Opposition Benches. Ministers want to do their level best to get all this right. However, the Minister who will reply to the debate must appreciate that we must do our best for our constituents.
One reaction from this Government has upset me deeply. Far from writing off the debt, which, as I have illustrated, is no fault of the hospital or its staff, the Government have imposed the usage charge. I am concerned about that. The Government have said that, by March next year, the deficit of the hospital will be £11 million. They are imposing a usage fee on that of 10 per cent., making a total of £1.1 million. They are adding another £500,000, so the total amount is £1.6 million. The hospital will also have to pay 10 per cent. interest if it borrows any money. That seems completely ridiculous. It is unfair. In fact, it is penal.
If the hospital went to a high street bank as a thoroughly reputable, solid organisation, it would surely secure a commercial lending rate of perhaps 1 or 2 per cent. over base. It could go into the eurobond market and borrow at under 4 per cent. but the Government say that, if it borrows money from HMG, it has to pay 10 per cent. interest and it cannot borrow from anyone else. Furthermore, if it has a deficit, it has to pay the 10 per cent. usage charge.
Is there a hidden agenda to penalise some NHS unit and trusts? Is there a hidden agenda even to make some of them fail completely? Surely that is the logical conclusion of that system. I hope that the Minister will answer those points.
As for morale at the hospital, the situation is altogether different. Although precarious, the situation is looking more robust than might otherwise be expected. The staff at the hospital are working very hard in extremely difficult circumstances. I praise them for all they have done to keep everything going and to keep the whole system moving forward. I also praise their professionalism. The hospital has met its access targets, particularly on A and E and outpatients. It has a recovery plan in place, which I am sure the Minister will tell us about, up to March 2008, but there is a feeling of uncertainty. Every successful organisation needs to recruit new people. It needs a flow of new ideas. One of my concerns with the freeze on recruitment that I mentioned is on the nursing front.
"My job is to educate students wishing to undertake a career in the Nursing Profession. We have a cohort of students that are just about to qualify and have been told by the clinical staff that they will probably not be offered jobs. Many of these students are mature, with families and are settled in the area, so would find it difficult to either move or to travel long distances to work."
"I am currently a student nurse at the hospital due to qualify in the next few weeks, and am more than a bit concerned at the situation I may be facing due to the hospital's financial decision to make cut backs. At the present it is very uncertain if the hospital will be able to offer myself and my colleagues any hope of there being any vacancies for us."
As I said, new blood is essential for any organisation to rejuvenate and to build morale. I am concerned about that. I am concerned about retention, too. If morale is good, one can innovate and modernise.
Morale has been good up to now. That is why a lot has been achieved on the modernisation programme. I do not want to be negative because the staff at the hospital keep writing to me, telling me and telephoning me to say that a lot is going on with paramedics' extended roles, the spinal clinic and the hip and knee clinic, and that the pre-admission clinics are going well. A lot is happening on the diabetic and community nurses link, on the haematology front and with the new critical care system, which won a national award. A lot is happening on the digital radiology front. I could go on.
The staff have done a great deal in engaging charities. For the day surgery unit, £3.4 million was raised. For the resonance imaging scanner, £750,000 was raised. The Macmillan unit raised £500,000. The paediatric day centre raised £500,000. Those initiatives require engagement, high morale and motivation. They require a sense of belief in the mission and in the future. I am concerned that all that could come unstuck unless something is done.
Does the Minister recognise how precarious the situation is? Does he agree that the Queen Elizabeth hospital and west Norfolk have been underfunded? Does he agree that there is a structural problem at the heart of the funding mechanism that fails to recognise all the key factors in west Norfolk? Is there any chance of the Minister writing off some of this debt? If not, will he look again at the usage charge, which is wholly iniquitous? All it will do is make a bad situation worse. It is penalising staff who are giving their all to try to retrieve the situation and working professionally with dedication and motivation. If the usage charge is not reviewed urgently, anger and resentment will grow.
Those words were well chosen. He did not say that it will be a disaster because he knows and trusts the staff at the hospital, who live in my constituency, that of my hon. Friend the Member for South-West Norfolk and that of the hon. Member for North Norfolk (Norman Lamb). The consultant knows how dedicated staff are, but they feel let down. There is an opportunity now for the Minister to tell us what he can do, to show that he has listened to their concerns and to give us some good news.
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