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1 Mar 2006 : Column 133WH—continued

NHS (North Northamptonshire)

Mr. Peter Bone (Wellingborough) (Con): I am pleased to be under your chairmanship, Mr. Chope, for this debate on an issue that is extremely important in my constituency. I am also grateful to Mr. Speaker for allowing the debate, and I hope that he recovers quickly and is back in the House as soon as possible. I thank the Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint), for attending, and I hope that she will be able to address the issues that I raise.

I note that my hon. Friend the Member for Kettering (Mr. Hollobone) is here; he has concerns about health care in north Northamptonshire, too. He and I have been raising local health care issues since we entered Parliament last May. In Wellingborough, health care has become the No. 1 issue to local people, as identified by my "listening to Wellingborough and Rushden" campaign. I note today that my excellent local newspaper, the Evening Telegraph, has a story about the health service with the headline "Crisis Point".

Back in the autumn of 2005, my hon. Friend the Member for Kettering and I wrote to the Secretary of State for Health requesting a meeting so that local health care problems could be discussed. I do not request meetings with Ministers lightly; in fact, it is only the second such request that I have made. I was eventually given an appointment with the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), on 1 December 2005. However, a few days before, the meeting was cancelled with no explanation. After hearing nothing from her regarding an alternative date, I contacted the Department of Health to say that my hon. Friend the Member for Kettering and I still desperately needed a meeting with the Minister. I was given an appointment for today, 1 March, which was in three months' time, but—lo and behold—a few a days ago that meeting was cancelled, too. I heard on Monday that it has been rescheduled for 19 April. Trying to get an appointment with the Minister is like trying to get an operation in a NHS hospital: one is never quite sure when it will be, and there is always a strong chance that it will be cancelled at the last minute.

My constituents, the people of Wellingborough, have been misled. The Government promised them something that they did not deliver. Last year, they promised that no one would wait more than six months for a NHS in-patient operation. Well, the Government misled the House. One of my constituents, whose operation was cancelled recently, has been forced to wait well over six months. I have a statement from Northamptonshire Heartlands primary care trust, saying that it cannot meet the Government guarantee. I also have a written answer to a parliamentary question, which I received two weeks ago. It confirms that scores of patients are waiting more than six months for an NHS in-patient operation.

We are only two months into 2006, and the Government have not kept their promise. Let me make it clear that the Government could never have kept it: the six-month guarantee was never feasible without
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massive extra resources for certain primary care trusts and hospital trusts. It is not that the guarantee went wrong; it was never possible to meet it. The guarantee has more to do with spin doctors than real doctors. The reason why the Government have not kept their promise to my constituents is lack of funding, pure and simple. For far too long, the Government have underfunded my local hospital—Kettering general hospital—as well as the Northamptonshire Heartlands primary care trust. Health care in general in my constituency is underfunded compared to other parts of the country.

I pay enormous tribute to the doctors, nurses and staff of Kettering general hospital; they do a superb job treating patients in difficult circumstances. I praise them for their excellent work. They often carry out additional work, for which they are not paid, to ensure that patients do not suffer. If it was not for them, local health care in my constituency would collapse.

The Government cannot claim that Kettering general hospital is inefficient and wastes money. The Government have a national formula for funding hospitals, allegedly so that there is no inequality for funding across the country, yet the funding is only 85 per cent. of what Kettering general hospital should get. It has a hospital budget of £119 million, which means a shortfall of £21 million. Because of that, it has one of the    lowest nurse-to-patient ratios, yet under the Department of Health's standards, it comes in the top quartile for efficiency. It is a well run hospital, and I pay tribute to its professional managers and administrators for achieving what they do, but they are being asked to do it with £21 million being held back—£21 million that, by the Government's own standards, the hospital should have.

At the end of January 2006, Northamptonshire Heartlands primary care trust, which covers my constituency and Kettering general hospital's catchment area, announced that it was cutting £720,000—nearly three quarters of £1 million—from the planned budget of Kettering general hospital. As a result, Kettering said that it would have to cancel or postpone more than 2,800 out-patient appointments, 200 ear, nose and throat operations and 370 gynaecology operations. In addition, the hospital has had to close one gynaecology ward and theatre, reduce the number of beds on another ward, and redeploy doctors and nurses to work in others areas of the hospital.

Transferring gynaecology nurses to other wards, in areas in which they are not trained, can only be to the detriments of patients' health. What a totally unacceptable situation. We have the doctors, nurses and staff, the wards and operating theatres, and patients in desperate need of an operation, yet operations cannot be carried because the accountants will not allow it. All that does is to push the problem into the next financial year and the whole sorry cycle of events starts again—Ministers, civil servants and accountants deciding when people in my constituency who are in pain and in need of an operation can have an operation.

Let us examine what the Government's promise to the people of this country was. Last November, the Prime Minister stated in Prime Minister's questions that, from the end of that month, for patients awaiting an NHS in-patient operation

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That was a guarantee to sick people that they would not have to wait more than six months. On 1 December 2005, I pointed out in the House that 437 people in my constituency were waiting more than six months, as recorded in column 401 of the Official Report. In fact, only five hospitals out of 205 in the whole country had more people waiting longer than six months for an NHS operation than Kettering general hospital did.

I wrote to the Prime Minister and the Secretary of State on that point and was advised that the maximum six-month wait for operations was to come into effect on 31 December 2005, not on 30 November 2005—a change in policy in fewer than 24 hours. The Secretary of State also wrote to me in a letter of 7 December that

In a parliamentary answer to me given on 14 February 2006, the Minister for Health said:

However, on the very same day I received another parliamentary answer, from the Minister of State, Department of Health, the right hon. Member for Liverpool, Wavertree (Jane Kennedy), who stated that scores of patients were waiting longer than six months for in-patient admission at the end of December 2005. The answer also referred me to the Department's website, for detailed figures by hospital trust. They showed that some patients were waiting more than 12 months for their operation. So much for the Prime Minister's six-month guarantee.

I was amazed that, out of the numbers of patients mentioned in the parliamentary answer, Kettering general hospital NHS trust was shown as having none waiting more than six months. I know that at least one patient has been waiting more than six months, so how many more have been waiting more than six months but not been disclosed? Getting an accurate figure from the Department is almost like pulling teeth.

On 14 July 2005, my constituent, Mrs. Michelle Baddock, received a letter from the hospital informing her of her in-patient operation, which was to take place on 1 February 2006, which by my calculations is more than six months. So how on earth can I receive a parliamentary answer stating that there were no patients at Kettering general hospital waiting more than six months for an operation when I have that example?

Of course, that is not the worst of it. Mrs. Baddock was admitted to hospital on 1 February 2006; but, after her pre-op, after being marked up for surgery and after being told to gown up to be ready to go down to theatre at 1 pm, she was told at 5 pm that the doctors would not be operating. Instead of pushing the operation back to the next day, which one might think would be the sensible thing, considering she that was completely ready for the operation, she was sent home. Having taken up Mrs. Baddock's case, I discover that her operation was scheduled for this week, some eight months after she was originally told that she needed the operation. I have here an unreserved apology from Kettering general hospital NHS trust to Mrs. Baddock.
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In the same parliamentary answer that I received from the right hon. Member for Liverpool, Wavertree, she stated:

That is good news, but in the very next paragraph she says that

We cannot have the Prime Minster and the Secretary of State giving us an assurance of a guaranteed maximum waiting time and then telling us that they are meeting that guarantee, only to find that the facts are massively inconsistent with their claims. We then have two parliamentary answers totally contradicting one another on the same day and we have a Department's website giving the wrong facts.

I wrote to the Secretary of State on 15 February urging her to come to the House to make a statement correcting the misleading impression that had been given. Would you believe it, Mr. Chope, the Department rang my office yesterday and stated that, owing to an administrative error, it had lost my letter? The Government obviously have something to hide. I am unable to get a meeting with the Minister, the Department loses my letter—why do the Government not just come clean?

One of the many problems with the Government's guarantee of a maximum six-month wait is that many people are having to wait longer. Patients who may have had to wait a few weeks are having their operations pushed back to five and a half months to try to squeeze everyone in. That sounds all right, but let me highlight what it means in practical terms.

In the autumn of 2005 my constituent, Miss Michelle Major, was told that she needed a hysterectomy. Several doctors recommended that she should have a hysterectomy, owing to the constant pain and other symptoms she had been suffering. On three occasions, the pain and bleeding had become so bad that she had been rushed to the hospital's A and E unit. Each time that happened she was sent away without seeing a consultant and just given a prescription for painkillers. Why is Miss Major unable to have the operation that she so desperately needs? Once again, the reason is funding. Kettering general hospital has the doctors and staff to perform the operation, but it has had to close one of its gynaecology wards. Miss Major was originally given an operation date of 8 March, but that was cancelled. As of yesterday, she had not been notified of when she will have an operation.

That is the crux of the problem with the Government's six-month waiting guarantee. More people are having to wait longer than they would have done for serious operations such as Miss Major's. I want a fairer share of Government funding to go to the Northamptonshire Heartlands primary care trust. I also want an emergency funding package for Kettering general hospital, so that it can carry out the operations needed and not have to close wards or transfer staff to areas in which they are not trained.

The Government may quote their rhetoric time and time again, but the rhetoric has got the people in my constituency nowhere. I am fed up with Government spin. I want guarantees and action. Can the Minister
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guarantee patient and staff safety by transferring gynaecology nurses to work in other wards? Does she not agree that it is ludicrous for wards at Kettering general hospital to be closed when waiting lists are growing? Does she not agree that it is absurd to deny patients operations for financial reasons rather than clinical ones?

If a patient's operation is postponed or cancelled, their condition is likely to get worse, therefore requiring more treatment. Have the Government not learned that by pushing problems into the next financial year, those problems do not go away? They grow and grow. I want the Government to admit that they have failed to deliver on their promise of a six-month waiting guarantee, and I want them to apologise for misleading those of my constituents, and the other people throughout the country, who have had to wait more than six months for an operation.

From the facts that I have given today, it is clear that we are in desperate need of a community hospital in Wellingborough. Kettering general hospital is already full to capacity, and yet Northamptonshire's population is growing ever larger as it has been decreed one of the Deputy Prime Minister's areas for major growth. Over the next few years, 167,000 extra homes will be built in Northamptonshire, yet our local hospital cannot cope with the current levels of demand. We desperately need local facilities in Wellingborough; that would reduce the burden on Kettering general hospital and provide a service to local people. I hope that the Minister can give my constituents some hope in respect of this matter.

4.30 pm

Mr. Philip Hollobone (Kettering) (Con): I congratulate my hon. Friend the Member for Wellingborough (Mr. Bone) on securing this debate on such an important topic, and I thank the Minister for allowing me to say a few words in support of my parliamentary colleague.

I, too, wish to thank all the hard-working medical, administrative and ancillary staff at Kettering general hospital, and those who are involved in all the other NHS functions in our local area. Of course, our local GPs and dentists are also feeling the strain of the lack of NHS funding from central Government. In my constituency, all the local GP lists are closed. Local people are not able to go to the GP of their choice; they have to be allocated to them by the local health authority. So far as dentistry in the Kettering constituency is concerned, 7,000 local people have been thrown off NHS dental lists over the past three years and now have to go private, and I suspect that many thousands more will go down the same route as a result of the new dental contracts that are now being introduced.

Finally, I wish to emphasise the point about the growth in population in Kettering and Wellingborough. Under the Office of the Deputy Prime Minister house building expansion plans, the population of the local area is likely to increase by at least a third in the next 15 years. Therefore, we will need a third more dentists, a third more GPs, a third more nurses, a third more doctors, a third more spaces to park the car at Kettering general hospital, and so the list goes on. But the point is that we do not have enough of those resources now; we
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do not currently have enough personnel of that kind. Unless the Government realise the seriousness of this issue, local people will find that the local NHS in Kettering and Wellingborough simply will not deliver the world-class service that we have all come to expect, and that we all pay for.

4.33 pm

The Parliamentary Under-Secretary of State for Health (Caroline Flint) : I congratulate the hon. Member for Wellingborough (Mr. Bone) on securing this Adjournment debate, and I welcome the presence of the hon. Member for Kettering (Mr. Hollobone).

Let me begin by saying something about the recent debate about health inequalities. I took a great number of interventions in my opening speech, and in closing I was left with less time than my Opposition counterpart. Although I was aware that the hon. Member for Wellingborough was present for the debate, my perception was that he was not present for all of it. When I did not take his intervention during the small amount of time I had for my closing speech, I made that point, and I think he was rather offended. I apologise for any offence caused, but I was present for the entire three hours, and it was my perception that the hon. Gentleman was not there for all that time. I hope that that has cleared that matter up to everybody's satisfaction.

Both of the hon. Gentlemen make important points, but what they leave out of their analysis of this situation is a frank discussion of the state of play in relation to waiting times and resourcing for the NHS prior—I am sorry to say—to my Government being elected in 1997. I am sure that the hon. Gentlemen will shrug their shoulders and say, "Well, what's that got to do with where we are today?" I think that the facts speak for themselves and I shall go into detail about that. For instance, we can compare the number of people who were waiting in those days, with those waiting today, or the number of doctors and nurses we have today, compared with the situation before 1997.

Of course, the NHS stands still for no one. People's expectations have changed as new drugs and technologies are used and become more commonplace, even during my lifetime. I can remember when hip operations were seen as a novel idea. It is fair to say that, although it is not commonplace for people to have such operations, it is now a pretty commonplace procedure. That is an important context in which to place these issues. It is undoubtedly the case that the Government are responsible for record levels of investment. The amount of money spent on the NHS has risen to about £60 billion from £34 billion in 1997, and it will go up to more than £90 billion in 2008. That represents a decade of significant investment in the NHS and a period of record investment in health services for the people of England, which applies to both hospital services and the development of services outside of hospital, too.

It is not just a question of putting money in; the process has to be accompanied by reform to ensure that we deliver a more efficient health service. During my time in this job during the past eight months, I have been surprised and worried in different respects by visits to certain hospitals and primary care trusts during which I
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have seen how money is spent very well in some places, delivering better services for better value, but in some places—dare I say it—they could do better.

One of the aspects of the NHS the Government have to consider is best practice in order to see why certain places have better outcomes in their hospitals or in the community when compared with others. There are clear issues to discuss concerning the financing of the NHS and to be fair to my Government, we have shone a light on what has been a historical legacy of a smoke-and-mirrors approach to NHS funding in the past, where creative accountancy created debts going from one financial year to another. By shining that light, we have taken a risk because we have exposed historical funding anomalies that have to be put right.

We have also exposed underfunding in certain areas. This is certainly the case for the PCT area of the hon. Member for Wellingborough and, I think, for the hon. Member for Kettering. It is similar to the case of my own area in Doncaster where historically there has been underfunding compared with other areas where, when we have looked at what is necessary for the needs of the area, we have found overfunding. That is why a number of Health Secretaries have looked at how we can enable areas that have been historically underfunded to reach their target point of funding, work which has been continued by the work of my right hon. Friend the Secretary of State. I hope the hon. Member for Wellingborough agrees that in reaching that point we have to bring areas that have been overfunded to a level point, in order to bring the others up.

We are dealing with services and people, and a big bang approach could have caused a huge number of problems. I shall go into a little more detail about that, but I am pleased to say that we are gradually moving up. The hon. Gentleman's areas have benefited during the past three years from a steady movement towards their target, and there have been increases that were larger than the national average in the spend available for PCTs to plan their services locally.

Alongside that investment, we have seen important reform and that dynamic has to continue. We have also delivered extra staff and shorter waiting times. I am sure that the hon. Gentleman would agree that in the area that he represents, the big killer diseases caused by cardiovascular disease and cancer have been considerably dealt with and challenged. That is one of the reasons we are seeing people's overall life expectancy improving, although there are issues of health equality upon which we have to bear down even further. There has been a 47 per cent. increase in the number of consultants since 1997 and although I take on board the point made by the hon. Member for Kettering, there are now more GPs in the NHS than ever before, as is also the case for qualified nurses.

For the people of Northamptonshire, it comes down to the fact that there are 100 more GPs, more than 280 consultants, more than 1,500 more nurses and midwives and more than 1,400 more health care assistants in the Leicestershire, Northamptonshire and Rutland strategic health authority area than in 1997. If there are issues in more localised areas, the PCTs must address
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them, as they do in my area of Doncaster, attracting and recruiting professionals to work in our local health economies.

In terms of health and inequalities, one problem that was highlighted in our recent White Paper, was that our poorest areas are least well served by GPs. We must look into that. I say to GPs who may be listening to this debate, "Come and use your training for some of those most challenging communities that desperately need your expertise, professionalism and support. In those areas, there is the biggest challenge and the most satisfaction, because you can make a real impact."

The NHS plan sets out the direction of NHS reform, and we are half way through it. Local health economies will have to make some difficult decisions if we are to provide an NHS that can meet the needs of patients in the 21st century. I am sure that that the PCTs in the hon. Gentlemen's areas take that to heart, and that that is why they are considering the issues of operations and services.

Again, there is a judgment to make. We have always said that in all finance decisions, clinical issues and priorities must be taken into account. That should be set against the services that people were getting in those areas 10 and 20 years ago. They have been substantially improved. It is a sign of our success that people do not remember the long, one or two-year waits for treatment that they used to have, because, let us face it, why worry about what happened five years ago? They are concerned about what is happening today.

The waiting list issue was raised by the hon. Member for Wellingborough, and I shall ensure that my right hon. Friend sees his contribution about the cancellation of appointments. I assure him that there was no conspiracy. There was certainly a—I do not want to use an un-parliamentary expression—but there was no conspiracy. The hon. Gentleman acknowledged that his constituent Mrs. Baddock has received an apology. I understand also that on 27 February, she received her operation.

I have looked into the case, because it is a constituent concern, and to be honest, in an open way and in good faith, it was an administrative error that was caused locally. I do not want to get into a blame game about that, but several issues did not serve Mrs. Baddock well. There was no manipulation of waiting times, and there was no local or national conspiracy to try to hide situations in which people had said that six-month waiting times were being met when they were not. The trust has confirmed that it was an isolated case and that it continues to meet the national waiting time targets.

We are addressing issues about those targets. The six-month target came into effect at the end of December. Before that, it was a nine-month target, so on 1 December or 14 December, there were people who had been waiting six months, but that was based on the old nine-month target. Therefore, the two answers to the parliamentary questions to which the hon. Gentleman referred were both right in their own sense. One referred to how many people were waiting more than six months before we reached 31 December, and the other answered the question about the situation on 31 December.
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There are some issues about the way in which the figures are collected, but counting the number of waiters at the end of a period is the method that the Department of Health has used to measure waiting times for more than 20 years. The reason why we continue with that is to be consistent.

Mr. Christopher Chope (in the Chair): Order. We must move on to the next debate.

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