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Charlotte Atkins (Staffordshire, Moorlands) (Lab): In the past week, north Staffordshire communities have been left reeling by the extent of the proposed redundancies at the University Hospital of North Staffordshire Trust, which is one of 18 NHS trusts currently receiving extra support from the turnaround team to help recover its financial balance. In order to bridge the £30 million gap between income and expenditure and start to repay some of the debt, the trust plans to save around £43 million over the next two years. That is a tough task, but the new interim chief executive Anthony Sumara is probably the person to do it.
About 70 per cent. of the trust's annual expenditure goes on pay, so it is clear that jobs must go, but the prospect of 1,000 jobs going has sent shock waves throughout north Staffordshire. Anyone with extensive experience of the hospital in the past couple of yearssadly, I have had that experienceknows that it was badly managed.
The hon. Gentleman may laugh, but if he had spent as much time in the hospital as I have,
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he would know that that was the case. The management task was not helped by dilapidated buildings on two very separate sites, but there is no excuse for weak management that has left patients waiting weeks for tests, with appointments cancelled and delayed.
Mr. Stuart: I made a noise when the hon. Lady blamed NHS managers, because that is all we hear from Ministers. The problem is systemic, and Ministersnot chief executives or civil servantsmust take responsibility for the state of the NHS. The hon. Lady's constituents and others will see thousands of jobs go, and they will not think it acceptable to blame the situation on poor management when those managers are appointed through the centralised system set up by this Government.
Charlotte Atkins: I totally disagree with the hon. Gentleman, given my personal experience. While the failed previous chief executive has escaped to a plumb nursing job in the Department of Health, is it right that patients and staff should suffer cuts as a result of poor past management? Valuable and committed staff are being sacrificed to recoup the losses generated by past poor management.
There is scope for greater efficiency. For instance, a hip replacement normally means a five-day hospital stay, and if in North Staffordshire that involves an 11-day stay, it does not take rocket science to recognise that the hospital is bound to make a loss. Unless such stays are reduced to the average for other trusts, the hospital is bound to get itself into difficulties. Improvements can and will be made by examining the use of theatres and out-patient services, rationalising the split site arrangements, using new technologies and reviewing back-office functions, but the impression remains that existing staff are paying the price for management failures that were not of their making.
I have received numerous letterssimilar letters have appeared in the press, toopraising the friendliness and professionalism, and the caring and hard-working nature, of the staff, and I want them to be looked after. There is a plan to employ many of the people who currently occupy the 1,000 jobs in the community that are due to go, because the trend is towards community care rather than basing care on an acute hospital. I want to see a package on the scale of the Rover package to help those staff either retrain or enter other jobs in the health service. The community in north Staffordshire is very deprived, and we cannot sustain 1,000 job losses without extra help.
Martin Horwood (Cheltenham) (LD):
Like north Staffordshire, Gloucestershire is reeling from the revealed scale of the cutsin our case, funding cuts of £20 million for the foundation trust and saving plans across the three PCTs of £30 million. Will the hon. Lady
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accept that at least part of the cause of the abruptness and scale of the cuts, which have left both our counties reeling, is the fact that they have occurred shortly before the start of the coming financial year? The funding formulae and mechanisms imposed by the Department of Health must therefore be largely to blame.
Charlotte Atkins: Those are short-term issues. I appreciate that the slide cannot continue in acute hospitals and PCTs, and a line must be drawn to deal with those deficits, which should be dealt with in a relatively short periodobviously, on occasions, with transitional help.
The big issue in north Staffordshire is the rebirth of the University Hospital of North Staffordshirethe fit for the future project. The project faces some paring down, which is in keeping with the move towards community health resources rather than relying on the acute trust. It is nevertheless vital that the project goes ahead, to reduce the glaring health inequalities in north Staffordshire and help to regenerate the local economy. Despite the hospital deficit, that project must go ahead, because any uncertainty will create real problems.
It is important that the Department should consider transitional funding, if it is necessary to get the hospital off the ground. The locality needs a new hospital, because we have possibly the most dilapidated hospital buildings anywhere in the country, so replacing them is a priority. The lack of investment in hospitals in the past is demonstrated by the fact that we are stuck with such appalling buildings, which should be replaced quickly. I want the hospital to work much more closely with PCTs, the ambulance trust and community staff.
The Secretary of State has pointed out that deficits generally occur in wealthier areas, which are frequently bailed out by more deprived areas. That is not the case in north Staffordshire, which has significant deficits, which must be sorted out, not only in the hospital but in the PCTs. I welcome the greater transparency that is now involved. In the past, Staffordshire has frequently bailed out Shropshire. It has all been done very much under wraps. The loan has of course eventually been repaid, although no interest has been paid. Now it is clear that my own Staffordshire Moorlands primary care trust will be borrowing money, but will be paying interest that the lender will receive. What is happening is clear for all to see.
Mark Pritchard (The Wrekin) (Con): My constituents in Shropshire would be aghast by the hon. Lady's last comment that Staffordshire has bailed out Shropshire. It is some sort of a bail-out when the Shropshire health economy is facing a £38 million deficit, meaning cuts to local hospital services.
Paying off the deficit is going to be very tough for Staffordshire Moorlands PCT. It will not just mean stripping out inefficiencies; there are bound to be service cuts. However, I have great faith in my PCT's leadership, who will ensure that they work closely with the community to ensure that the cuts that they have to introduce will have the least possible impact on patients.
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I very much support the Secretary of State's statement about reducing unplanned emergency admissions and saving the NHS money. My PCT has embraced that enthusiasticallyfor instance, through the anti-falls programme, but particularly by using community matrons to intervene in the community to pre-empt unplanned emergency admissions. The PCT has saved about £0.5 million by such investment in community provision. However, the avoidance of emergency admissions now attracts half the funding that it did previously, so from a financial point of view there is less incentive to invest in community provision and it is less cost-effective to do so. That will hardly encourage best practice, as the Secretary of State wants to do, and it will undermine future investment made by my PCT in preventive measures such as the anti-falls programme and the employment of health visitors and suchlike.
Similarly, we have an ambulance service in Staffordshire which, through its superior training of paramedics and community first responders, prevents huge numbers of admissions to hospital by treating people at home. That is better for the patient and saves millions of pounds for the NHS, and it does not crowd out elective surgery at the hospital. Yet that ambulance service is threatened with merger, involving a dilution of staff skills and a reduction in their service standards. If we are serious about increasing and improving out-of-hospital care, we have to reward PCTs and ambulance trusts that are excelling in those fields. We should not merge them with other organisations that do not share their focus and delivery.
I hope that when we come to the end of the public consultation on Wednesday 22 March, the strategic health authority and the Secretary of State will listen to the overwhelming response of people in north Staffordshire who say that they want to create a local north Staffordshire PCT and do not want a gigantic Staffordshire-wide trust. They also want an independent ambulance service working within the west midlands that would act as an exemplar to other ambulance services and help to create far better ambulance services country-wide.
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