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The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne):
May I congratulate the hon. Member for North-West Norfolk (Mr. Bellingham) on securing this Adjournment debate on health services in and around his constituency? He takes a keen interest in health matters in Norfolk, and has recently raised health services in his constituency in parliamentary correspondence, to which the Minister of State, my hon. Friend the Member for Doncaster, Central
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(Ms Winterton), has already replied. He raised the issue with the Prime Minister, and we debated the financial deficit at the Queen Elizabeth hospital at Health questions last Tuesday. I welcome his balanced view of progress and matters that need to be addressed, and I hope that I can address almost all his concerns this evening along with those expressed by the hon. Members for North Norfolk (Norman Lamb) and for South-West Norfolk (Mr. Fraser). If I fail to do so adequately, I hope that they will allow me to write to them to fill in the gaps.
I very much welcome the credit that the hon. Gentlemen gave front-line national health service staff who work in and around their constituencies. They are right that they make the world of difference for many people. Indeed, in some cases, it is literally the difference between life and death. Before I turn to the crucial matters raised this evening, I should be grateful if the House permitted me to set the scene.
The hon. Member for North-West Norfolk said that the Government bang on about the additional resources that have gone into the NHS, but we do so because we are very proud of them and the scale of the increase bears a little repetition. Funding of the NHS has increased from £35 billion in 1997–98 to nearly £70 billion in 2004–05, and is set to increase to £92 billion. That is an increase of enormous magnitude. Indeed, if the NHS were a national economy, it would be the 33rd largest in the world and about the size of Portugal. The extra money has brought extra staff, shorter waiting times and enormous advances against big killer diseases. The number of consultants is up by nearly 9,500. The number of registrar group doctors is up by 2,200 on last year alone. The number of GPs has increased by more than 4,000 since 1997. There are more qualified nurses working in the NHS than ever before—an increase of nearly 80,000 since 1997.
As a result, NHS waiting times have fallen massively. The number of people waiting more than 13 weeks for an out-patient appointment has fallen from an enormous and scandalous 340,000 in 1997 to just 35,000 in June last year. In-patient waiting times are also showing enormous improvements. The number of people receiving treatment in hospital has increased by 750,000 to more than 5.5 million and the total number of people waiting has fallen by a quarter.
The result is that lives have been saved. The cancer mortality rate in England has fallen by some 12 per cent. since 1995–97. Mortality for circulatory disease in England has fallen by a massive 27 per cent. But this debate is about the future, not the past. Our stance on health care in Norfolk is shaped by our ambition to cut the waiting times from the scandal of a year and a half that we inherited in 1997 to eighteen weeks. That is no empty promise, because it is backed by resources.
Hon. Members talked about funding and the distance from target in their constituencies. In 1997, there were enormous gaps between actual funding and the correct level. In February this year, my right hon. Friend the Secretary of State did an enormous amount to correct that. For the latest allocations round for PCTs, covering the next two years to 2007–08, we have decided to move PCTs more quickly towards their fair share of funds. In 2003–04, some PCTs were as much as 22 per cent. under target. By more aggressively accelerating the funding of
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those furthest away from target, we will change that over the next few years. In fact, by 2007–08, no PCT will be more than 3.5 per cent. below its fair share.
Hon. Members will, I am sure, admit that such increases have significant effects for Norfolk. For example, North Norfolk PCT will receive an allocation of £143 million—a cash increase of nearly £25 million or 20 per cent. over the next two years. West Norfolk PCT will receive substantial additional funding, representing cash increases of nearly £44 million or more than 25 per cent. over the next two years. That will leave the West Norfolk PCT about 3.5 per cent. under target, but that is a substantial correction to the wild extremes of 1997.
The increases will mean big changes on the ground in Norfolk. The PCTs recently approved the outline case for Cromer hospital, which will see it become the best equipped local hospital serving a rural area. Intermediate care strategies will mean that care is provided closer to home.
Norman Lamb: The Minister rightly points to the approval in principle at strategic health authority level for Cromer hospital. That is extremely good news. However, there is a concern that because the strategic health authority contributes more than its fair share to the total deficit of the NHS, the whole project could be threatened by the financial situation. Will the Minister give an assurance that that will not happen? As he says, it is an exciting project and it must proceed.
Mr. Byrne: I hope that I can give the hon. Gentleman an even better reassurance. Funding for his local SHA will rise by about £700 million over the next two or three years, so in the context of a clear manifesto ambition to deliver services that are much more in line with local community needs, taking local community views much more closely into account and, above all, cutting waiting times to just 18 weeks, ambition and money together are the best assurance I can give.
The hon. Member for North-West Norfolk mentioned many unacceptable cases of poor NHS treatment for his constituents. I hope that he would agree that they are, by and large, the exception. The latest figures show that death rates from coronary heart disease and cancer in north Norfolk have fallen by about 20 per cent. and just over 3 per cent. respectively since 1997. That is in no small part due to the extra 5,000 nurses, 827 doctors and 256 GPs across the SHA area. Investment is being made to develop local health services and build new facilities where they are needed. Those initiatives are already delivering real benefits to patients.
The hon. Gentleman mentioned red tape, but I am sure that he would accept that management costs are lower as a percentage of NHS spending than in 1997. Managers are needed in the health service. The NHS treats 1 million people every 36 hours and is required to prepare for every contingency, from the possibility of pandemic flu to the London bombings in July, so it needs good planners and good managers. Sometimes, we do not give them the credit they deserve.
Mr. Bellingham:
I do not want to get into a long debate about management and bureaucracy, but as there is to be a reorganisation of PCTs in Norfolk does
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the Minister accept that there is significant duplication of management in PCTs that cover quite small areas? For example, in my area there are finance managers, communications directors and other people doing management jobs, while just over the border in the constituency of my hon. Friend the Member for South-West Norfolk there is duplication of many of those aspects of management. That must be improved, but what will be the impact of that reorganisation on the funding targets that the Minister has just set out?
Mr. Byrne: The hon. Gentleman makes an extremely important point. Our manifesto was clear not just about the need to keep a tight handle on bureaucratic costs; we set a clear target of cutting £250 million-worth of administrative costs to put back into front-line care. The more important issue is how we ensure that local PCTs are the strongest possible commissioners of health services on behalf of their local communities. We will not be a country where waiting times for medical treatment are only 18 weeks unless there is strong local commissioning. I think that the hon. Gentleman was involved in consultation about the proposed reorganisation of his local PCT. I understand that proposals are now with the Department and I hope that he will stay involved in the debate as it unfolds.
The hon. Member for North Norfolk talked of the need for a stable structure. I second that.
It is against the background that I have set out that we must view the situation at Queen Elizabeth hospital, with which I want to deal in a little more detail. As hon. Members know, the reported deficit was £3.1 million in 2004–05 and it is forecast to rise to £11 million at the end of the current financial year. That deficit exists not because the Government have under-invested in health care services, but because each year for several years the trust has reported a small overspend yet failed to tackle the issue head-on. The broader strategic point I want to make to the House is that as we are about to pump another £22 billion into the NHS we must have health managers who are able to balance the books.
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