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Mr. Adrian Bailey (West Bromwich, West) (Lab/Co-op): In a debate that concentrates on estimates and figures, it is inevitable that there is an emphasis on difficult funding areas. However, when we rightly examine such areas, it is important that we do not lose sight of the bigger picture: far from being in crisis, for the fifth year running, our health service is treating more people, reducing waiting lists and improving patient care. Funding has increased from £34 billion in 1997 and it is projected that it will be £92 billion in 2007–08. Yes, there are problems, but when a £70 billion budget—the current budget—is delivered by 600 separate units, the chances of keeping each unit in financial equilibrium are slim. We must also consider the situation in the context of dramatic changes to the way in which we deliver health care and the implementation of new contracts. Such difficult and perhaps destabilising issues have caused problems, but we have an NHS funding deficit that is a tiny proportion of the whole budget and considerably less than that in 1997, when there was a much smaller NHS budget.
The hon. Member for Beverley and Holderness (Mr. Stuart) threw out statistics on productivity that were laced with individual anecdotes. I, too, would like to compare what the NHS is like for people in my area with how it was a few years ago. My GP surgery, which is just down the road from me, has almost doubled in size. There has been a huge increase in the provision of GPs and support staff, and throughput. The surgery now has a training centre.
I look at the two acute hospitals in my area. Russells Hall in Dudley has almost doubled in size and Sandwell hospital has a new accident and emergency department. I had personal experience of the A and E department at Russells Hall last week, when I suffered the occupational hazard of all politicians. When inserting a leaflet through a door, I was met by a quiet, yet vicious dog that not only refused to enjoy the wisdom of my leaflet, but proceeded to try to chew off the ends of my fingers. I was in and out of the accident and emergency unit at my local hospital in just over an hour. When I compare the waiting times that I experienced a few years back—
Mr. Stewart Jackson (Peterborough) (Con): Will the hon. Gentleman give way?
Mr. Bailey: I will not give way, because I am short of time and other hon. Members wish to speak.
We have seen a huge improvement, but I wish to take up a couple of issues. My hon. Friend the Member for Dartford (Dr. Stoate) mentioned deficits and the way in
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which some hospitals were managed. My local PCT has a small deficit and it puts it down almost entirely to the increase in accident and emergency admissions in hospitals, especially a huge increase in short-stay admissions as a result. I cannot believe that so many more people are having accidents or other emergencies that require short-stay admissions. There must be a problem with the management of the health care caseload in the area, which must be examined to ensure that funding meets provision more accurately than it does at present.
I reinforce the comments made by others about top-slicing. My own local area has a history of underfunding and health problems. On all the indices, such as cancer rates, coronary heart disease, infant mortality and life expectancy, my area performs poorly, which is why it is one of the so-called spearhead PCTs. We were enthusiastic about the extra funding from the Government to address those problems, but the SHA's top-slicing arrangements mean that all the benefits that could have accrued from that extra money might be lost. I ask the Minister to ensure that the process that will be used to bring overspending trusts back into line does not penalise those PCTs in the most deprived areas. Otherwise, the whole thrust of Government policy will be blunted.
There are problems, but they have been created in the context of an expanding health service, which is driven by people's higher aspirations. We need to deal with the problems, but we should not lose sight of the fundamental truth that the NHS is not in crisis. It is delivering a much better service for many more people than it has done historically.
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Mr. David Amess (Southend, West) (Con): I was very interested in the various points made by the right hon. Member for Rother Valley (Mr. Barron), and I know that, as the Chairman of the Health Committee, he will ensure that it scrutinises carefully how the NHS is managed and the money is spent.
Although the hon. Member for Wyre Forest (Dr. Taylor) says that he is non-party political, I agreed with every word of his speech on this occasion. The NHS faces one of its biggest overspends since 1948. Many trusts and PCTs are now faced with stark options—to meet the Government's targets and create large deficits or adopt cost cutting and contractions to come in on budget.
I am fortunate enough to represent a constituency with a PCT that has managed to break even every year since its inception, and a hospital trust that has been able to carry forward large surpluses in the present financial year. However, I appreciate that I am in a minority of Members in that respect, and I have listened carefully to what others have said about local deficits. I feel for them, and their attempts to address the issue.
The NHS has to live within its means and the long-term solutions are, as always, to maximise productivity and ensure that extra spending brings worthwhile returns. However, it is not just for NHS managers to address those issues. As several of my hon. Friends have already said, the Government have a responsibility to ensure that their target-setting agenda does not force health organisations into debt, and that bureaucratic
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changes, such as the transition to payment by results, do not increase the financial uncertainties faced by many trusts and authorities.
Why is the national health service in financial difficulty? There are various reasons, and I do not for one moment blame the Government for all of them. The Government have done good things, but I challenge them on others—for instance, the difficulties due to the extra costs of increasing staff, the tough targets, the culture of transparency, hospital rebuilding programmes and payment by results.
I am sure that the Minister of State, the right hon. Member for Liverpool, Wavertree (Jane Kennedy), who will respond to the debate, is enjoying every minute of it so I do not ask her to respond now to the matter that I am about to raise, but perhaps she could write to me. In 2004, Southend Hospital NHS Trust applied for foundation trust status on the basis that it would be able to remain part of the NHS, working under NHS traditions, providing treatment free at the point of delivery, and would also be able to involve more local people, hospital staff and volunteers in service delivery, but with greater freedom in the funding of health care. However, the application was turned down and, as the trust reported on 27 February, Southend hospital's hope of being licensed as an NHS foundation trust on 1 April 2006 received yet another disappointing setback.
Like five other hospital trusts that were set to gain approval from the regulatory body, Monitor, Southend was told that there were a number of "underlying errors" in the new payment by results tariff issued by the Department of Health. That really depressed the staff. The chief executive of Southend hospital, David Brackenbury, described the unwelcome news as
"frustrating for everyone who has been involved in the extensive preparations necessary to become established as an NHS Foundation Trust . . . Furthermore, this delay in receiving the tariff will cause us considerable problems in setting our budgets".
I could say much more, but I am sure that the Minister has got the message, and I would be grateful if she would write to me.
Why do some hospitals manage to come in on budget while others fall into serious debt? Some hospitals and PCTs are managed better than others—I will not say much better. However, some suffer from much larger systemic problems, such as being in an area with a large number of hospitals, resulting in too many bureaucrats and too much administration and duplication of diagnostic facilities.
Southend does not suffer those systemic difficulties, as it is a small unitary authority that collaborates well with other PCTs in Essex. I am delighted to tell the Minister that for the third year running, Southend Hospital NHS Trust has achieved the top, three-star, status—a significant achievement. Furthermore, it succeeded in meeting both its financial and waiting time targets, so the Minister will understand my point about the disappointment caused by the statement about the hospital's foundation trust application. The hospital's achievements are solely down to the hard-working staff, who have risen to the extra challenges presented by the Government's target-setting agenda, while managing to balance the books.
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As several Members have said, changing the structure of PCTs has caused some disquiet; it has certainly done so in Essex. Is the reorganisation of PCTs about cost saving or improved service delivery? The Government have identified efficiency savings of 15 per cent. Had cost savings not formed part of the criteria, organisations could have had considerable flexibility to tailor reconfigurations closely to local need. Linking the reforms to cost savings at a time when many PCTs are already managing deficits means that many SHAs will have no option but to reduce the number of PCTs. Such a reduction in the number of organisations would release £250 million of NHS money, but in some PCTs the push to save costs has overridden other considerations, such as maintaining local engagement. I hope that that is not what the Government intended.
The Secretary of State announced last week that she is willing to accept full responsibility for the financial circumstances in which the NHS finds itself, and she has pledged to go ahead with market-based reforms and be judged on their success. That has been accompanied by the news that hundreds of jobs are likely to be axed—we have already heard about the announcement by the University Hospital of North Staffordshire NHS Trust that 1,000 jobs are to be cut from its 7,000-strong work force. The Secretary of State accepts that there will be more turbulence, more disquiet and more criticism, but believes that measures to improve efficiency could be made without jeopardising patient care. However, the departure of Sir Nigel Crisp smacks of his being fingered as the fall guy for the problems. The Minister of State should say more about that.
The hon. Member for Wyre Forest (Dr. Taylor) talked about proposals to ease the cash crisis by cutting the number of emergency hospital admissions for chronic illnesses, but I wonder whether that is a sensible move. The Royal College of Nursing has acknowledged that many people with chronic conditions could be treated in the community rather than admitted to emergency units, but points out that that would require extra funding to pay for the nurses, which would still take resources, so it is not necessarily the cheaper alternative that the Government are seeking. The Government should reconsider that idea very carefully.
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