That this House notes the current financial crisis and associated job losses, ward and bed closures and service reductions in the NHS; believes that these are consequences primarily of the failures of management at the Department of Health; further notes the Secretary of State for Healths denial of responsibility for this situation and her failure to recognise the realities within the NHS; sees a lack of leadership within the Department of Health; and, in addition to turnaround teams in NHS Trusts, calls on the Government to appoint a turnaround team to the Department of Health.
With all the difficulties that the Government have experienced, it is good to see, in the first line of their amendment, that they still have a sense of humour. I welcome new Ministers to the Department of Health. I bid farewell, although I do not think that they are present, to the right hon. Member for Liverpool, Wavertree (Jane Kennedy) and the hon. Member for Birmingham, Hodge Hill (Mr. Byrne), who have gone in different directions. Although we have not agreed on policies, we have always enjoyed good personal relations. I thank them for the tasks that they performed at the Department of Health.
I welcome the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham) and the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis) to their posts, but I warn them that it is not a happy ship. The Secretary of State has lost the confidence of hard-working NHS staff. She and her team have lost the trust of the British people to manage the NHS effectively. The public want value for money, and they want an NHS that is given the freedom and responsibility to deliver quality services for them. Instead, the Secretary of State and her team have created confusion, instability and inefficiency. The Government, by the same measure that they apply to NHS trusts, are failing. The time has come for them to put a turnaround team into the Department of Health, just as they have imposed such teams on NHS trusts. That is the purpose of the motion.
In May last year, when the Secretary of State took up her job, she said that she would listen to patients and staff. She visited five hospitals in five weeks, and then for eight months failed to visit any hospital outside London at all. Is it any wonder that she lives on a different planet from the staff of the NHS? When she says that it is the best year ever for the NHS, they say, Has she any idea of whats going on? [Hon. Members: Who says that?] The NHS staff say that. They have said it loud and clear.
NHS staff know that patients who could be treated sooner are waiting nearly six months before having their operations. They know that patients are waiting
many months for diagnostic tests. They know that waits for audiology tests and for curative radiotherapy have lengthened. They know that hospital infections are as bad as ever; that the obsession with targets has cost millions and distorted patient care; that there are fewer district nurses and health visitors to deliver care closer to home; that despite that, beds are being closed, job vacancies frozen and jobs cut in local hospitals; that newly trained nurses and physiotherapists cannot find jobs; that the number of managers has doubled while financial management remains poor; that key new screening programmes are being delayed; that public health targets are being missed; that health inequalities are widening; and that there is utter confusion over further NHS reorganisation.
Mr. Barron: The simple answer is yes, as far as patients are concerned. Can the hon. Gentleman tell us, though, what patient satisfaction ratios say about the situation in the NHS that he is describing?
Mr. Lansley: Every year, the NHS should improve. Every year, the NHS receives high satisfaction ratings from patients who are treated by NHS staff. That is precisely the point. NHS staff know that millions of patients are indeed receiving excellent care and treatment. They know that new treatments and new ways of working can do much more for patients. They know, for examplethe Government mention it in their amendmentthat the use of statins and stents can reduce the number of deaths from coronary heart disease.
Mr. Lansley: I will tell the hon. Gentleman this before I give way to him: NHS staff know that, far too often their achievements are in spite of Government interference, not because of it. They are angry when the Secretary of State claims credit for their successes, while presiding over an incompetent administration without which NHS staff would be free to achieve so much more.
Dr. Stoate: The hon. Gentleman tells us that the NHS should improve every year, and I agree with him. Can he tell me how long a patient in whom a GP diagnosed suspected cancer would have had to wait to see a consultant specialist in 1997, compared to the maximum of two weeks for which such a patient would have to wait now?
Mr. Lansley: I can certainly tell the hon. Gentleman what the Government think. The Secretary of State has reported to the Cabinet that she expects to miss her cancer waiting targets. I can tell the hon. Gentleman [Interruption.] If he cares to listen, I will tell him. The waiting time for curative radiotherapy has lengthened under this Government. [Interruption.] Radiotherapy is a cancer treatment. This is what happens with Government targets: instead of targeting the whole
patient experience, the Government target only the time before the first treatment. Subsequent treatment is not targeted at all.
The way in which, for years, the Government targeted urgent referralsthe Secretary of State knows this, even if the Prime Minister did notcaused immense damage in distinguishing between urgent and routine referrals. The hon. Member for Dartford (Dr. Stoate), for all his knowledge of the NHS, fails to note thatdeliberately or otherwisewhenever he talks about the two-week period of referral to a consultant.
Tony Baldry (Banbury) (Con): Do not the interventions from Labour Members demonstrate that they, and the Government, are living in a parallel universe? There is more bad news to come. Next week, the Oxford Radcliffe Hospitals NHS Trust will have to announce the number of frozen jobs and job losses that will be necessary to offset £33 million of enforced cuts. People in Oxfordshire are really angry. When they look at the Governments website they see that the trust is one of the best-performing, most cost-effective trusts in the NHS, and they cannot understand why more jobs must be lost.
If the Government are arguing that the job losses and deficits throughout the country that are having to be compensated for are simply the result of poor local management, let them look at the audit reports of the County Durham and Darlington NHS Trust, in the Prime Ministers own constituency. They show that it has a good management that is working hard to deliver, but the Governments mismanagement of NHS finances has caused it serious problems.
I want to make it clear to the House that this is not just a recent problem; there has been a catalogue of failures under the Secretary of States stewardship. In July, the NHS chief executive sent out instructions for strategic health authority and primary care trust reconfiguration, which, he said, were in line with the Governments policy of separating commissioning from the provider role. By November, however, the Secretary of State was apologising for that and making it completely unclear whether PCTs would be provider bodies.
Judy Mallaber (Amber Valley) (Lab): The Secretary of State dealt with that issue, and as a result of discussions, considerable changes were made. I recently had a mammogram, and although I would normally be quite calm about it, I was very scared because one of my staff had recently been diagnosed with breast cancer. However, within two weeks she was in hospital, having the operation that she needed. She is also diabetic, and the treatment that she received was impeccable: the hospital ensured that the treatments for her diabetes and for her breast cancer were in harmony. Does the hon. Gentleman accept that although there are occasional failings, many people are getting far better treatment than they used to get? In any system, there will be
Mr. Lansley: Thank you, Mr. Speaker. I do not live in a parallel universe. In the world that I live in, NHS staff deliver excellent care to the great majority of patients, but they also work in hospitals that are experiencing job losses. In the world that I live in, the consequences of deficits are getting worse, and although urgent referrals for cancer treatment are being seen within two weeks, some people are waiting much too long. The Government do not even measure the wait for many diagnostic tests; however, the information that they are just starting to gather shows that people are waiting six months or longer for basic diagnostic tests.
Kali Mountford (Colne Valley) (Lab): I am grateful to the hon. Gentleman for giving way at this point. He talks about NHS funding, but can he tell us who would benefit most from his own rule of providing funding only from the proceeds of growth: patients or staff? Has he made it clear to the country that that would mean cuts for the NHS?
Mr. Lansley: When the hon. Lady understands that parties in all parts of the House are talking about future increases in resources for the NHS, and that the Chancellor of the Exchequer is in no way certain about what NHS resources will look like beyond 2008, we can have that debate. She does not know how much this Labour Government plan to spend beyond 2008. All that I know is that between now and 2008, the Government will have to deal with the immense deficits that are cutting back the resources available to front-line services. That is a consequence of mismanagement.
Philip Davies (Shipley) (Con): Would my hon. Friend like to remind the hon. Member for Colne Valley (Kali Mountford) that during last weeks local elections, a Save Huddersfield NHS candidate won in her constituency? Does my hon. Friend agree that all cannot be well, therefore, in the NHS in the hon. Ladys constituency?
Mr. Lansley: I thank my hon. Friend for that intervention, which illustrates a lesson that the Government need to learn. The map of deficits throughout the NHS shows that three years ago six strategic health authorities were in deficit; that two years ago the figure was seven; that a year ago the figure was 12; and that last year the figure was 21. The Secretary of State told the Health Committee that this problem was confined to the healthiest and wealthiest parts of the country, but it is not; it is a systemic problem right across the country.
In July the Secretary of State said that the 2003-04 NHS deficit would be £140 million. Weeks later, the then NHS chief executive said that it was in fact £250 million. In August the Secretary of State had to reveal that the key health inequalities of life expectancy and infant mortalityboth targeted by the Governmenthad widened. In September thousands of doctors were found by the BMA to be unable to find training posts. Junior doctors see training budgets being cut and a future severe shortage in the training posts available to them to fulfil their vocation.
In October the Secretary of State said that primary care trusts should not refuse to provide Herceptin for early-stage breast cancer. By February her Department was telling the High Court that Swindon primary care trusts refusal to do so was not incompatible with Government policy. Also in October, the Secretary of State told the House that there was enough flu vaccine, but by November it emerged that she had confused UK-wide supplies with the at-risk groups in England only. On avian flu, she promised the House that she would have contracts with suppliers for items such as face masks and gloves. Those contracts have not yet been tendered for.
In November, when we had a debate on the subject of NHS deficits, the Secretary of State told the House that the Government would reduce the NHS deficit this year compared with last year. We told the House that despite unprecedented resources, the trusts were in deficit to the tune of £600 million last year2004-05and predicted deficits approaching £1 billion for 2005-06.
Tom Levitt (High Peak) (Lab): It is worth bearing in mind the fact that the hon. Gentleman and his party have voted against extra money for the NHS on every occasion. Is it a fact that the general deficit for the NHS for the year just gone was around 1 per cent., and in 1996-97 it was 1.5 per cent.? Deficits under this Government have been lower than under the Tories.
Mr. Lansley: It is a fact that in the year of the 1997 general election NHS bodies started spending money virtually without constraint, in the expectation that a Labour Government would bail them out. My right hon. Friend the Member for Charnwood (Mr. Dorrell) might recall that. The hon. Gentleman is also right to say that the deficit for the year just gone probably will be about 1 per cent. of NHS resources. However, the NHS is a body that is voted a certain sum of money by Parliament, and for it to spend more than that is serious. In my book, several hundred million pounds is very serious.
It is also true that between 1997 and 2002 there were no system-wide deficits in the NHS, but hospital trusts in England finished the year before last with an accumulated deficit of some £300 million. They finished 2004-05 with a deficit of some £600 million, and they will have finished the last financial year with a deficit of some £1.1 billion. The hon. Gentleman and many other Labour Members will be wondering why strategic health authorities are cutting a third of their additional allocation to primary care trusts this year to hold the sum as a reserve. It is because they need some
£1.5 billion this financial year to bail out the accumulated deficits and the underlying deficits that hospitals are experiencing.
Mr. Clifton-Brown: The situation is worse than my hon. Friend has told the House, because hospitals have to find a further £1.5 billion for the 2 per cent. efficiency savings, taking the black hole in the NHS to more than £3 billion. Is it not inevitable that many more hospitals and jobs will be lost in the NHS?
Mr. Lansley: My hon. Friend will understand that I do not accept that the requirement for NHS trusts to deliver efficiency savings is a black hole. If they are asked, albeit rather arbitrarily, to increase efficiency savings from 1.7 per cent. for the previous year to 2.5 per cent. this year, that constitutes an effort to try to deliver greater efficiency, although it has not been accompanied by any measures to help it to happen. What many staff of NHS trusts object to is that the tariff is being manipulated at the same time, so that last year they had a 7.1 per cent. uplift for pay, prices and costs, and a 5.3 per cent. increase in tariff. This year they will have a 6.5 per cent. uplift for pay, prices and costs but only a 1.5 per cent. increase in tariff. That is why hospitals in many parts of the country find that they have no alternative. Their PCTs will not send them any more patients, and say that there is a limited financial envelope for their activity. The tariff being paid does not reflect the costs that the Government have imposed.
Daniel Kawczynski (Shrewsbury and Atcham) (Con): The present NHS deficits are a major issue, but senior members of my hospital in Shrewsbury came to see me as early as autumn 2004 to tell me that they were facing huge deficits in the future. They were told to keep quiet because a general election was in the offing and the Government did not want the matter raised.
Mr. Lansley: I visited that hospital with my hon. Friend and can vouch for the fact that those problems were emerging at that time, but we do not need to speculate about how the Government were trying to cover things up in the run-up to the election. The present Secretary of State for Work and Pensions was a health Minister before that election, and in March 2005 he said, Dont worry about it. At this time of year theyre always predicting deficits and it always turns out all right. After the election, the red ink was all over the books.
Mr. John Redwood (Wokingham) (Con): Does my hon. Friend agree that the PCTs deficits have been made much worse by the ham-fisted and badly negotiated central contracts with professionals, which have had unforeseen consequences for the amount of money involved? If the Government had negotiated a better deal for the professionals and the taxpayer, we would not have so much of a problem.
Mr. Lansley: I am very interested that my right hon. Friend should raise that point, as I want to deal with what happened in respect of pay and contracts in December. When the pay review bodies reported, the Prime Minister said that he was proud to be paying NHS staff more, but Labour Members will recall that the Secretary of State met those bodies in December. Although the Department of Health had stated in
September that it accepted a pay rise of 2.5 per cent. for NHS staff, she wanted the pay increases for nurses and doctors to be reduced to 2 per cent. and 1 per cent., respectively.
We do not believe that the assimilation costs of recently negotiated pay modernisation should be taken into account in setting the level of the basic uplift for future years. These costs were part of the negotiated agreement and should have been taken into account during the negotiations rather than clawed back at a later date.
In other words, the pay review bodies were saying, Dont come to us asking us to cut future pay settlements because you got the figures on your contracts wrong. The cost of the contracts miscalculation is now £600 million.
a combination of rushed implementation, a serious underestimate of existing consultant workloads and a lack of national guidance has made it difficult for hospitals to use the contract to bring about improvements for patients.
Ann Coffey: I want to return to what the hon. Gentleman said about payment by results [ Interruption. ] I have been trying to intervene for some time on that point. I heard his criticism of the Governments scheme, but does his party support the introduction of a national tariff? If not, what changes would it make?
Mr. Lansley: I have always made it clear that we support payment by results and a national tariff, but the hon. Lady asks an interesting question. In the three months leading up to the end of the last financial year, the tariff could have been amended in a way that would have assisted the NHS dramatically. In December last year, some hospitals had capacity. However, the PCTs that were running out of money told hospitals to delay treating patients until the end of the six-month waiting time, with the result that operating theatres and staff sat idle. Why could not the national tariff be amended to allow hospitals and their local PCTs to agree marginal pricing arrangements? When we debated the 2003 legislation in Committee, we argued for such flexibility, as my right hon. Friend the Member for North-West Hampshire (Sir George Young) will confirm, but the right hon. Member for Barrow and Furness (Mr. Hutton) and the Government resisted it. We asked whether, if a hospital could offer marginal capacity at a marginal price, the NHS should be able to buy it. The answer was No. That is ridiculous and damaging, but that was the Governments policy.