Ms Hewitt: If a local trust has been overspending or running up a deficit, it will need to make decisionsin some cases, they will be difficult onesin order to get itself back into balance. The hon. Gentleman talks about honesty, but we have still had no answer, honest or otherwise, on the question of patient passports.
Ann Winterton : Can the Secretary of State really sleep at night? She talks of deficits and the reasons for them, yet the Central Cheshire NHS primary care trust will not fund Herceptin, while every other neighbouring trust has done so
Tony Baldry (Banbury) (Con): On a point of order, Madam Deputy Speaker. When I was a Parliamentary Private Secretary, it was a point of privilege. The behaviour of the Secretary of State's PPS this afternoon has been disgraceful.
Ms Hewitt: The hon. Member for Congleton (Ann Winterton) makes an important point about Herceptin. As she will know, I have already taken steps to ensure that testing facilities for HER2 will be available across the NHS in England, and for NICE to speed up dramatically its evaluation not only of Herceptin but of other drugs coming through the system. I have also made it clear that primary care trusts should not deny Herceptin, where it has been recommended by a clinician for an individual patient, purely on grounds of funding.
In every strategic health authority, and for every deficit trust, a recovery plan is in place. Where the challenge is greatestwhere the deficit is largestthe health authority and the trusts have been given more time to sort out the problem, together with transparent financial help from the NHS bank and other NHS organisations. For the organisations with the worst deficits, turnaround teams have gone in to help, not simply to consider the finances but, crucially, to make sure that the trust meets its waiting time and other targets and to help it to deliver the best possible patient care, together with the best possible value for money.
This point is at the heart of the debate. Good patient care and sound financial management are not two things between which any part of the NHS can choose. Good patient care and sound financial management go hand in hand.
Mark Pritchard : I am grateful to the Secretary of State for giving way. I am flattered, and I am glad that I parted my hair in the way that I did this morningclearly, it works. On that point of financial mismanagement, how does she respond to the independent financial inquiry into the financial mismanagement and series of corporate failings of the Shrewsbury and Telford NHS Hospital Trust? Does she not feel a sense of responsibility, given that her office appointed the chairman, who has now resigned, the chief executive, who has resigned, and the deputy chief executive, who has gone? Does she not feel that she needs to make a statement to my constituents?
Several hon. Members have made the point about extraordinary advances in medical techniques. As a result, patients do not need to stay in hospital for as long as they used to. Sometimes, they do not need to go to hospital at all. Indeed, as the admirable Mr. Fieldman told me in Newham this morning, a patient needing a gall bladder operation who in the past would have had to spend at least 10 days in hospital can now have the operation done during an overnight stay, or in some instances as a day case. The best of our NHS hospitals are among the best in the world and we should be proud of them. However, not all our hospitals are achieving the besttoo many are not even achieving the average.
Ms Hewitt: No, I will not give way. I want to make a point. [Interruption.] This is directly relevant to the point made by the hon. Member for South Cambridgeshire. He made great play of hospital beds, but completely failed to focus on outcomes or the impact of new medical techniques.
One strategic health authority compared the lengths of hospital stay for patients with broken hips in the seven NHS hospitals in its area. Two kept patients in for about 20 days, below the NHS average of 25. The other five kept patients for longer than the average. In one case, the average length of stay was 38 days. Those five hospitals had the worst outcomes. The health authority calculated that if all the hospitals simply achieved the NHS average with all their patients, that one area alone would need 400 fewer acute beds.
Mr. Bone : The Secretary of State mentioned speed and good patient care. Does she agree that the two may not go together? As she knows, last week I raised the case of a constituent who gave birth at 4.30 am and was thrown out of the hospital at 9 am because of a lack of beds. Is that what the Secretary of State means by speed and good patient care?
Ms Hewitt: My point is that thanks to the extraordinary advances in medical techniques, anaesthetics and so on, it is now possible to do on a day-case basis what used to require in-patient care. It is possible to do in a few days what used to require a patient to stay in hospital for many days. It is possible to do outside hospitals what used to require in-patient treatment.
It is true that, compared with the position when I had my two children some 20 years ago, the average length of stay for women having babies is now very short, and
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most women want to get home as quickly as possible. That may not apply to the case cited by the hon. Gentleman, but generally speaking it is true.
Senior surgeons and leading GPs say that between 40 and 50 per cent. of out-patient appointmentson a conservative estimatein acute hospitals could and should be dealt with by community hospitals, health centres or even large GP surgeries with equally good health outcomes, more convenience for patients and better value for money for taxpayers. That, of course, means fewer beds and fewer facilities in acute hospitals.
Although there are outstanding examples of best practice throughout the NHS, there is not yet the value for money throughout the NHS that the taxpayers whom we have asked to pay higher contributions are absolutely entitled to expect.
Richard Younger-Ross: Yes, one has been trying for a little time to catch the Secretary of State's eye. She spoke of good health care. Does she agree that recovery is better when patients are transferred from general to community hospitals? It is the community hospital beds that are at risk at the moment because of financial deficits in the primary care trusts. If we can keep those beds in place, in hospitals such as the Moretonhampstead in my constituency, we can free up bed space in the district general hospitals.