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The Minister of State, Department of Health (Ms Rosie Winterton): Wandsworth primary care trust, which covers Tooting, has 174 NHS dentists and received £269,000 in access money. Patient registrations in the area have increased by 2.8 per cent. in the past year. The benefits of the new dental contracts will be available to all practices in Tooting from April 2006.
Mr. Khan: I thank my hon. Friend for her answer. In the context of the scaremongering and selective amnesia that we have witnessed today and in recent months, will she comment on the fact that last week I opened a dental practice in my constituencythe 119, on Mitcham lanewhich has state-of-the-art equipment partly funded by the PCT, fantastic dentists and staff and is able, willing and keen to take on more NHS patients?
Ms Winterton: I am very glad that my hon. Friend is taking an interest in dentistry in his area and that a new practice has opened there. That is a great tribute to the hard work of his local PCT and others in ensuring proper provision. As I understand it, one difficulty in his area is getting people to register, and one of the new schemes that the PCT is examining is concerned with getting more people on to the books. As he says, there is absolutely no shortage of dentists in his area. In a sense, the problem there is the opposite of that faced by other areas: getting people on to the books.
The Secretary of State for Health (Ms Patricia Hewitt): For most hospital trusts, payment by results applies only to elective admissions. We are introducing the new tariffs gradually, over a four-year period, so that national health service organisations can get used to the new system. By 2008, payment by results will apply to the vast majority of acute services.
Mr. Illsley: I am grateful to my right hon. Friend for that response, but as she is probably aware, some NHS hospitalsin my area, for exampleare competing with independent treatment centres, where payment for an operation is based on tariff-plus, so the independent sector gets more money for an operation. That competition, plus payment by results, is putting downward pressure on the hospital to reduce costs. That is welcome in terms of reducing waiting times but is causing pressure on the NHS hospitals, who are competing, to an extent, on an uneven playing field with the private sector centres. Will my right hon. Friend take that into account in the future roll-out of payment by results and try to bring in a more even payments system as between the NHS hospitals and the independent sector treatment centres?
Ms Hewitt: I entirely agree that treatment centres, both independent and NHS, are helping to get the waiting times down, which is of huge benefit to patients in my hon. Friend's constituency and in many other parts of the country. Like him, I want to see a level playing field for all providers to the NHS. In the case of the independent sector treatment centres, a premium was paid in wave one to bring new providers into the NHS, but also to recognise that they were having to make new capital investment that was not required within the NHS itself. Overall, our foundation trusts and independent sector treatment centres in south Yorkshire and elsewhere are doing a superb job for NHS patients. We want that improvement to continue and it will undoubtedly do so next year with the introduction of patient choice of at least four hospitals, which will start in January.
Steve Webb (Northavon) (LD): Under payment by results and the market that the Secretary of State is creating in health, does she envisage that the number of local district general hospitals will decline in the NHS over the medium term?
I envisage more care being delivered in community hospitals, health centres and so ona theme to which we will return in next month's White Paperand hospitals giving better and faster care to patients who need in-patient treatment. That will be supported by payment by results, which is essential both for patient choice and to ensure that we get the best value for the enormous sums of money that we are putting into the NHS.
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Mr. Jim Cunningham (Coventry, South) (Lab): How will the deficit at Walsgrave hospital in Coventry be handled by payment by results, given that the hospital has been asked to reduce its budget by another 2.5 per cent.?
Ms Hewitt: For the first time, payment by results will ensure that we know how much is being spent, on what treatments, at what cost and with what value for money in different parts of the NHS. Under the historic system of funding, extremely efficient hospitals could get no reward at all and, indeed, could have any surplus taken away to cover the deficit in some other part of the NHS that might have been much less efficient or was overspending on its patients. That was unsatisfactory. Payment by results is an essential part of improving the service that we are able to offer to patients and, by giving people more choice of hospitals, as we will be doing from next month, we will continue to ensure that the NHS brings down waiting times and gives people better, faster care.
John Penrose (Weston-super-Mare) (Con): Does the Secretary of State accept that the gradual introduction of payment by results puts highly efficient hospitals such as my own in Weston-super-Mare at a comparative disadvantage? Such hospitals would gain more cash, perhaps to repay financial deficits rather faster, if they were allowed to have payment by results across the whole range of services that they currently offer.
Ms Hewitt: It is perfectly true that hospitals in that position would benefit if payment by results were rolled out in the course of one year rather than four. It is not possible to do that for the reasons that I have described, but I want to stress that the overall deficit in the NHS in the last financial year was less than half of 1 per cent. and that the vast majority of NHS organisations are not only improving services, but living within the enormously increased budgets that we have been able to give them. Payment by results will help us to ensure that all hospitals are delivering the best possible value for money and that the minority of organisations that have a deficit get those deficits under control.
Mr. Neil Gerrard (Walthamstow) (Lab): Have final decisions been made about which specialisms will not be included in the payment by results regime? The regime gives hospitals a guaranteed income, but what steps can be taken to ensure that they do not neglect treatments that are not included in payment by results?
My hon. Friend raises an extremely important matter. We have excluded certain specialist procedures, high-cost drugs and medical devices from the payment by results regime so that they can continue to be paid for and commissioned separately. We are also ensuring that the tariff for other specialist activity is topped up, so that hospitals that undertake the most complex specialist activity are properly recognised and rewarded for their work. That continues, to the benefit of patients.
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The Minister of State, Department of Health (Jane Kennedy): Chelmsford PCT reported a deficit of £7.1 million for 200405, and forecast a deficit of £11.2 million for 200506 at month six. Simultaneously, however, it improved its performance, from being zero-star rated in 2004 to being two-star rated in 2005a very good result indeed.
Jane Kennedy: Chelmsford PCT is currently being assessed by a turnaround team. When that has concluded its work, we will have a better idea of what the causes of the deficit are. However, Chelmsford appears to be an interesting place
Jane Kennedy: The hon. Gentleman may not like my answer, but it is the one that he is going to get. I was about to say that Chelmsford is an interesting place. It returns the hon. Gentleman to Parliament, and it was the location for the film "The Fourth Protocol", starring Pierce Brosnan. The House may also be interested to learn that the strategic health authority serving that constituency had 849 general practitioners in 1997, but that it has 1,010 in 2005. I shall describe one thing that the PCT is doing to address the deficits: its rapid assessment unit is developing an admission-avoidance service, which will save £869,000. The underlying principle, however, has always been that patient safety
Those are not my words, but those used by the Secretary of State in her evidence to the Health Committee on 6 December. Does that not prove that the Government's resource-allocation formula takes too much money away from those parts of the country, to the extent that they are no longer able to maintain the level of front-line services?
In this financial year, Chelmsford will achieve cost reductions of almost £3 million. It will do so according to a planbased on the principle that patient safety and mission-critical services will not be cutthat is being followed in all savings proposals. It is possible
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to manage finances well and achieve improvements in services. For example, the rapid assessment unit is, in essence, a primary-care based team. It filters people arriving at the accident and emergency department, and determines whether they can be discharged into the community once they have been diagnosed. That is better for patients, allows the hospital to treat sick people, and saves £869,000.
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