Nick Herbert (Arundel and South Downs) (Con): The Secretary of State gave the clear impression that the deficits described by other Opposition Members do not matter. She said that they affected only a small minority of trusts, but all four acute trusts serving my constituents in Arundel and South Downs are in deficit. The Brighton and Sussex University Hospitals Trust has a deficit of £7.5 million, and that will double by April. The St. Richard's hospital in the south-west of my constituency serves my constituents in the Royal West Sussex Trust and has a cumulative deficit of £20 million, and rising. The Surrey and Sussex Healthcare Trust has been referred to already and has a deficit of £29 million, while the Worthing and Southlands Hospitals Trust has a deficit of £5 million, which is forecast to rise to £13 million by March. That represents a total deficit of more than £60 million, and rising, in the acute trusts in West Sussex alonehardly a chimera.
That deficit affects the trusts' creditors; it is not merely a paper deficit. Ministers will know that many of the trusts are unable to meet their bills, and that means that creditors, including those in the private sector, are being made to wait for payment.
The Secretary of State said that a recovery plan was in place. What does that plan entail in West Sussex? In Worthing and Southlands, it means that two wards will be shut. In the Royal West Sussex Trust, one rehabilitation ward is to be shut, with the consequence that patients are being transferred to Arundel community hospital. That hospital is being told that it can treat fewer local patients than would otherwise be the case.
In 1932, people in Arundel supported the building of the hospital by public subscription. The bricks were paid for by everyone contributing sixpence each to the
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building fund. Local people have contributed every year to ensure their community hospital's preservation, and they feel very aggrieved that, in effect, it will be taken away from them.
In the Brighton and Sussex University Hospitals Trust, accident and emergency services and major trauma services are being transferred from the Princess Royal hospital in Haywards Heath to the Royal Sussex hospital in Brighton. Again, that is strongly against the wishes of people in the local community.
Is it not clear, therefore, that the recovery plan really amounts to a closure plan? However, when the Secretary of State says that trusts are not being efficient enough, that is to ignore that the St. Richard's hospital in my constituency is one of the most efficient in the country. It is among the top 15 per cent. of NHS trusts nationally, and has accumulated two of the three possible stars in the Healthcare Commission ratings, yet the Government say that it is not efficient. The truth is its efficiency is being penalised by the deficit that it should not be running up.
The Secretary of State said that deficits were rising in spite of higher resources, but the point is that, in effect, those resources are not available. The King's Fund has pointed out that 73 per cent. of spending increases are being absorbed in cost pressures. Professor Nick Bosanquet of Imperial College has said the samethat 70 per cent. of annual spending rises are being absorbed by inflation.
The Government have fuelled inflationary pressures in the NHS, and made it less possible for trusts to meet their bills. That is not merely due to an increase in existing salary costs as a result of "Agenda for Change" and the new consultant contract: it is because the future spending commitments taken on by the Government are not properly accounted for. They include the PFI schemes, the new primary care contract that is being introduced, and the fact that more staff will be taken on.
Professor Bosanquet has estimated that, in five years, the additional costs will amount to £10 billion a year. That will be funded from within existing NHS budgets, at a time when the increase in spending will be slowing down. By then, our health funding will be nearing French levels. It will account for 10 or 11 per cent. of gross domestic product, but the NHS will face a French-style financial crisis.
Hospital managers have no control over those costs, which in effect are being imposed on them. In a national system, they have no way to vary the costs, and the possibility that they might be able to has been taken away. The right hon. Member for Darlington (Mr. Milburn) proposed the introduction of foundation hospitals, but that innovation never saw the light of day.
There will, of course, be less in the way of resources for health care if the money being put in is not matched by output. The Treasury's initial measure of NHS productivity showed that it fell by a staggering 15 to 20 per cent. between 1997 and 2003. The Office for
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National Statistics was told to recalculate the measure, but even its revised figures show that productivity has been falling by as much as 1 per cent. a year since 1997.
Falling productivity means that the NHS needs more resources just to stand still. One reason for that fall in productivity is that there has been an increase in non-productive activity. For example, the latest ONS figures, published last month, show that the number of managers in the NHS in England is increasing three times as fast as the number of clinical staffthat is, doctors and nurses.
The problem is not that more money has not been put in, but that the money has been put in ahead of reform and consequently dissipated. Higher spending has simply fuelled higher costs. The national problems are exacerbated in West Sussex, where our population is rising, and relatively elderly. As Opposition Members have pointed out, the NHS funding formula discriminates against the south-east.
Dr. Andrew Murrison (Westbury) (Con): We have a had a good debate, with 13 contributions from Back Benchers, almost all of which have been good and which, in their own way, have had something to add to the debate. However, I have to say that the debate has been rather better supported by Conservative Members than by Labour Members.
The debate started with a contribution from the hon. Member for Romsey (Sandra Gidley), although it was a pity that we did not hear from the hon. Member for Northavon (Steve Webb), especially as he has Thornbury hospital in his constituency. It is a community hospital near Bristol, and I would have thought that the hon. Gentleman might have liked to talk a little about it.
The hon. Member for Crawley (Laura Moffatt) gave us a revisionist romp through the NHS, although my recollection of working in the NHS is rather different from hers. My hon. Friend the Member for Eastbourne (Mr. Waterson) talked about the effect of deficits in an area with an elderly population and needs that may surprise Labour Members. The hon. Member for Wirral, West (Stephen Hesford) did not mention the closure of wards 6 and 7 of Victoria Central hospital, despite being prompted by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) in his opening remarks. My hon. Friend the Member for Banbury (Tony Baldry) talked about the outsourcing of resources and NHS reorganisation, including the fact that it may act as a distraction to achieving a reasonable balance sheet and to achieving for patients.
The hon. Member for Colne Valley (Kali Mountford) made some thoughtful points about maternity services, if I can say so without flattering her too much. That theme was taken up by my hon. Friend the Member for Fareham (Mr. Hoban), who talked about Blackbrook
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maternity hospital, which has a special place in my heart because it is where my fifth and final daughter was born five years ago
My hon. Friend the Member for New Forest, East (Dr. Lewis) gave us some helpful campaigning tips on how to secure the future of one's community hospital and, having visited his area, I hope that his forceful local campaign will ultimately be successful. I am sure that it will. The hon. Member for Wyre Forest (Dr. Taylor) was as sage as ever and reminded the House that Ministers have recently applied their micro-management of the NHS to reinstate GP Saturday morning surgeries. He also reminded us that it was the Labour party that removed them in the first place.
The hon. Member for Sutton and Cheam (Mr. Burstow) expressed concern about Sir Nigel Crisp's announcement last week that he will hold back powers from PCTs at strategic health authority levelconcerns that we share. My hon. Friend the Member for Boston and Skegness (Mark Simmonds) will lead a delegation from SkegnessI hope that the Minister will meet itin support of his community hospitals. My hon. Friend the Member for Peterborough (Mr. Jackson) talked powerfully about the effects of PCT deficits in his area and the causes of them. Finally, my hon. Friend the Member for Arundel and South Downs (Nick Herbert) discussed his concerns about service cuts in his constituency and the underlying reasons for them, which are familiar to all of us who face that problem.
Nobody disputes the Government's good intentions and they certainly put our constituents' money where their mouth is. However, health outcomes have improved only marginally since 1997 and have, in some instances, declined. International comparisons of mortality and morbidity are unflattering to the UK and output, according to the Office for National Statistics, has fallen.
The Secretary of State wants views on health outside hospital to inform a White Paper, which we understand will be delayed, although we will probably get it at some time in the new year. In the meantime, I wonder what the outcome was of last month's faintly sinister and highly selective deliberative exercise, "Your Health, Your Care, Your Say". The Department must surely by now have some feedback, so perhaps the Minister can share it with us. We understand that the 1,000 or so participants in that jamboree said that they wanted services closer to their communities. Well, there's a surprise. One did not need to spend more than £1 million to discover that. I could have told the Government that for free from what I hear day in and day out in my constituency. Doubtless, we will hear other startlingly obvious revelations with an extraordinary price tag. I resent that spending, because the apparent £1 million cost of the exercise in Birmingham is approximately the sum necessary to keep my community hospitals, which are threatened with closure, open for a year.
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That brings me neatly on to one of the main consequences of PCT deficits that has been raised today. It was the subject of a well attended meeting upstairs this morning and the mission of CHANT or Community Hospitals Acting Nationally Together. I confess that that is a tortured acronymfor which we are indebted to my hon. Friend the Member for Beverley and Holderness (Mr. Stuart), who is heavily bandaged at presentbut it grows on one. I hope that it will appeal to the Minister and I am sure that she will hear more of it in coming weeks.
There are four community hospitals in my own constituencyBradford on Avon, Trowbridge, Warminster and Westbury. The quality that they and 400 like them provide is undisputed. The cost per case treated is capable of manipulation, but the best evidence that we have suggests that community hospitals are highly competitive. They are characterised by strong local support, local fundraising and of course by leagues of friends that have over the years provided the NHS with substantial subsidies.
Community hospitals also have a dedicated work forcepeople who are expert in what they do and are pleased to serve at the less glamorous margin of our health care system, secure in the knowledge that their largely unsung work is contributing massively to the well-being of their community. Any large organisation must base itself around its skilled work force and Ministers must not assume that those wonderful people will relocate to the nearest district general hospital or shiny new independent sector treatment centre if their hospital is closed down. As community hospitals close, it is likely that many will simply be lost to the NHS altogether.
Despite all the virtues of community hospitals, Ministers do not have a clue how many community hospitals there are, or where they are. I know that because I have asked them. Nor do Ministers know how many are under threat, so we have been forced to conduct our own research. It appears that more than 90 community hospitals are under threat and the figure could be higher. What is moreand this is the crucial pointthere appears to be a strong correlation between PCT deficits and community hospital closures.
Many of the PCTs in trouble serve small towns and villages, and we know from the Government's research that they are relatively underfunded. That puts to bed the notion that shutting community hospitals is all about improving health services. It is not: it is all about dealing with Government-inspired deficits, especially in parts of the country with which Ministers have little sympathy. However, care in community hospitals is as cheap as chips compared with similar treatment in a district general hospital. Closing them would surely cost more, as patients default to other providers.
The trouble is that the same Secretary of State who is comfortable using her long screwdriver to micro-manage the NHSas shown by her insistence last week that PCTs reinstate out-of-hours GP covertold me when we met a few days ago that hospital closures are entirely a matter for local decision making. Other hon. Members tell me that they have had a similar response and that the Secretary of State is adept at interpreting the comments of local overview and scrutiny
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committees in a way that creates a pretence of local accountability. Faced with deficits that are largely not of their making, trust chief executives scratch around trying to square away their little bit of NHS budget as they are legally obliged to do, and naturally they light upon community hospitals. The cost of closure to the wider health care economy, including social services and acute units, let alone patients and carers, is of secondary importance and the person in overall commandI hope that the Secretary of State is listeningis unwilling to take charge.
The Secretary of State was pleased to wave a copy of her party's election manifesto at me when we met the other day to discuss community hospitals, especially those in my constituency. The manifesto contains a clear and unambiguous commitment to community hospitals, but PCT deficits are closing them down. We are entitled to ask when the Secretary of State's action will match the rhetoric.