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By the new year, the Secretary of State had blocked Barts and the London’s private finance initiative bid.
The net result was a 20 per cent. reduction in the number of beds and £35 million wasted on the delay.
John Mann (Bassetlaw) (Lab): A few minutes ago, the hon. Gentleman said that hospital trusts had overspent in the hope that a Labour Government would bail them out—a statement that Hansard will record. Should Governments bail out a hospital trust that overspends?
Mr. Lansley: And Bassetlaw went Conservative. The answer to the hon. Gentleman’s question is no. Ministers know that because I have written an article in the Health Service Journal on precisely that point. There should be a change in Government policy. If a hospital restores itself to recurrent financial balance, with prospective financial stability, and can meet the authorisation criteria to become a foundation hospital, the Government should be prepared to turn past deficits into public dividend capital for a new foundation hospital. That is not a bail-out—the interest still has to be paid on the PDC.
The Government are preparing to do the opposite of their own policy, however. Their policy is not to bail out hospitals—I have heard the Secretary of State say it—so why are they creating a £1.5 billion strategic health authority reserve? What is its purpose? It is for a bail-out. There will be the most enormous bail-out this year and it will transfer the problems of deficits from one set of trusts to every trust.
Only last week, Louis Appleby, the national director for mental health, said that mental health trusts the length of the country were cutting services not because they were in deficit but because other trusts were in deficit. A mental health trust in my constituency has to make savings of £2.5 million this year, not because it is in deficit, but because its PCT is. The national director said that was a disgrace, and he is right.
Mr. Henry Bellingham (North-West Norfolk) (Con): Bailing a hospital out is one thing, but adding injury to that is another thing altogether. Is my hon. Friend aware that Queen Elizabeth hospital in my constituency is in a recovery plan? It has built up a large deficit. Staff are working hard to pull it around, yet the Government have imposed a 10 per cent. usage charge, which will add £1 million to the problem. Is not that wrong in principle?
Mr. Lansley: Yes. If hospitals were genuinely free and given the opportunity to behave in a businesslike way, they would be able to make different arrangements for their financing needs. Indeed, some PCTs are doing just that; things are getting so desperate in the NHS that a PCT in my constituency has borrowed £2.5 million from the local authority. However, I must make progress because we have only reached the new year.
In January, the Secretary of State’s operating framework for 2006-07 said that new guidance on PFI would be published, with the effect of cutting the PFI programme by a third. The guidance never appeared and it is reported that it has gone into limbo, and nobody with a PFI project in prospect knows what will happen. The same document stated that in this financial year
“for the system as a whole we expect to recover any overspend from 2005/6 and we are planning for a surplus.”
It said that individual NHS bodies should plan both to achieve in-year balance and recover 2005-06 deficits.
On 12 April, the Secretary of State for Health sent me a letter in response to my inquiries. She said that the objective has changed:
“All organisations are overspending to show improvement during 2006-7, and by the end of the year everyone should have monthly income covering monthly expenditure.”
What kind of financial balance is that? It happens to coincide with the 12th month of the financial year. The Government’s policy has completely changed. They did not tell the House about it; it emerged from a letter written to me. The policy is no longer to achieve financial balance in 2006-07—it may not even be to do so in 2007-08. We simply do not know what is the Government’s policy to restore NHS finances.
Tom Levitt: Will the hon. Gentleman give way?
Mr. Lansley: No, I have given way.
In January, the White Paper proposed a new gimmick for the NHS. Hon. Members will remember that the Secretary of State said that we would all have German-style polyclinics. The problem is that we have a third fewer doctors than Germany has. Germany does not have our system of GPs. We do not have community specialists to anything like the extent Germany has them. The Secretary of State’s self-styled vision of care closer to home will not work if health visitor numbers are down 2 per cent. on 1997 and if the number of district nurses is down by 14 per cent. compared with 1997. Of course, despite her U-turn on community hospitals, the NHS has not listened to her. Community hospitals are still being closed, because of PCT deficits. Hospitals are being subject to cuts on the assumption that patients will be treated closer to home, yet the community hospitals, intermediate beds and community nursing staff required to do exactly that are being cut as well.
Mr. Mark Lancaster (North-East Milton Keynes) (Con): My hon. Friend is aware that, only today, a hospital that he visited two years ago—the Fraser Day hospital in Newport Pagnell—has been announced for closure. That is a desperate blow for the city of Milton Keynes, whose people are reliant on the hospital for intermediate care. Does he understand my constituents’ concern that we have an ever-expanding city in Milton Keynes but an ever-shrinking health care service?
Mr. Lansley: I recall visiting the Fraser Day hospital. For a growing city, with a capacity-constrained hospital, the importance of the intermediate care facilities in the community or the support that could be given to patients who are discharged is terribly important. The Secretary of State is always talking about preventing readmission to hospital and reducing the length of bed stay. That cannot happen while the services that my hon. Friend describes are being shut down. It is a disgrace.
By February, things had got worse. The home oxygen service collapsed on 1 February: the first day of the new contract—of course, helpfully scheduled for the middle of the flu season. On 6 February, the latest
figures on MRSA showed no further progress. On Valentine’s day, the Secretary of State plumbed new depths when she told the “Today” programme that she would vote to exempt clubs from a smoking ban but did the opposite in the afternoon.
Mr. Lansley: She did . [ Interruption. ]
On 22 February, the Department withdrew the NHS tariff on the basis that it had underlying errors. Hon. Members might wonder what sort of underlying technical errors they might be. They were really complicated things: the Department was supposed to take £140 million from patient transport, but it only took £140. Things like that happened. So the NHS did not get its tariff until 10 working days before the start of the new financial year.
It became clear in February and March, too, that the Government’s legislative programme had collapsed. The new Leader of the House is here, and I welcome him to his post. I am sure that he will be interested to know that the Department of Health was given the benefit of three measures in this legislative programme, but the policy on the Health Bill collapsed and the Government had to do a U-turn, the NHS Redress Bill has been radically changed in the Lords from the Government’s original proposals and the draft Mental Health Bill has been abandoned. We simply do not know when the Government’s new and, I hope, better proposals will arrive.
In March, the trauma got worse. Deficits turned to disasters. On 7 March, Sir Nigel Crisp resigned. The chief executive took responsibility for the problems of the previous months—what a pity Ministers did not.
Dr. Doug Naysmith (Bristol, North-West) (Lab/Co-op): The hon. Gentleman makes great play of deficits in the NHS. How does he explain the fact that the great majority of trusts and PCTs in every part of the country, including the south, have no deficits?
Mr. Lansley: The hon. Gentleman does not yet know how many hospital trusts had deficits last year. Certainly, more PCTs had deficits last year than the year before. It might be true that more hospitals had deficits last year than the year before, and more might do so this year. As I made clear earlier, we have gone from six to seven to 12 to 21 strategic health authorities that, in the total health economy, have a deficit. We are not talking about an isolated instance. If those deficits were being disguised in the past by brokerage from surpluses elsewhere, there would not now be a system-wide deficit—there would still be surpluses to offset the deficits. The point is that very few such surpluses are being created to mask such deficits. The Government will have to create surpluses by the expedient of cutting money from primary care trusts, which will cause a great number of problems in the hon. Gentleman’s constituency.
On 22 March, the Chancellor’s Budget ignored the NHS. There were job losses at the Royal Free hospital and the University Hospital of North Staffordshire, and many other hospitals followed. The total list of job losses to date is more than 13,000—it is 13,700. On
30 March, the Health Service Journal disclosed that central Department of Health budgets are overcommitted because Ministers have been making commitments without understanding the financial consequences. Delays on programmes such as the bowel cancer screening programme are the result.
In April, there was the issue of dentistry. On 1 April, there was the new contract—a shambles, as it was called by the British Dental Association. Some 10 per cent. of dentists have left the NHS and 1 million fewer patients have NHS dentists. Patients who do have NHS dentists are paying a third more in total for the cost of their NHS dentistry as a consequence.
Mr. Jeremy Hunt (South-West Surrey) (Con): Is my hon. Friend aware what a grim month April was in my constituency? The PCT decided to close Milford hospital. The Government claim to be listening to members of the public, but they chose an option that 94 per cent. of survey respondents opposed.
Mr. Lansley: I am grateful to my hon. Friend. The truth is that there are Labour Members who know that, all across the country, such consultations have too often been a sham. It is a disgrace that the public have been deluded into believing that NHS organisations are genuinely listening to them, whereas in fact those organisations are being dictated to by the Department of Health.
The Government promised that every single patient referral from a GP would be booked through the choose and book system by the end of December 2005. The latest figure, in April 2006, is about 10 per cent. On electronic prescribing, the Government’s target was for 50 per cent. of prescriptions to be electronically filled by December 2005. In February 2006, the figure was 1.8 per cent. Confidence in the NHS IT programme continues to fall. The latest disclosure is that an NHS care records service, which was intended to be up and running in 2005, has been put back—no date is now offered—and will have to be piloted. People who know about such programmes have said that user involvement and piloting the systems would have been the right way to proceed in the first place.
If there are Members from Scotland and Wales present, they will understand that the NHS care records service in the Government’s connecting for health programme is not currently compatible in relation to England, Scotland and Wales. That will be fun at the Countess of Chester hospital and the Royal Shrewsbury hospital.
Siobhain McDonagh (Mitcham and Morden) (Lab): I agree that all too often the NHS does not listen to the public in consultations. In my own area, in the case of Epsom and St. Helier University Hospitals NHS Trust, it took the Secretary of State to take account of local people—rather than the health bodies—and to agree that the critical care hospital was to be at St. Helier.
Mr. Lansley: The question of whether the Secretary of State acted wisely or even reasonably in relation to that matter will be tested soon. We will come back to that question in due course.
I am afraid that we arrived at the point in April when the latest statistics added insult to injury for NHS staff. The work force census showed that the number of managers had doubled since 1997. In the last year for which the figures were gathered, the number of administrators went up by 11,000—while the number of nurses went up by 6,000. That is in the teeth of all the Government’s claims to want to cut the bureaucracy of the NHS. That is not happening at all. On the basis of all that, on 23 April, the Secretary of State called it “the best year ever”. I never want to be around when she thinks that things are going wrong.
The Prime Minister has retained the services of the Secretary of State at the Department of Health, apparently to push forward NHS reforms. If the Prime Minister believes that, he is living in the parallel universe that the Secretary of State inhabits. Conservative Members believe that reform is essential, but that even more so is leadership and competence. The Government’s combination of arrogance and incompetence is a recipe for disaster.
Every aspect of desirable reform is being undermined by the actions of Health Ministers. Patients should have choice, but PCTs, through referral management centres, are controlling and subverting choice. Patients need a voice, but after scrapping community health councils, the Government are going to abandon patients forums and have no idea what to put in their place. GPs need real GP budgets, but the Government’s plans do not offer them the incentives to reinvest their savings or give them the power to negotiate contracts with providers. The Government talk about local decision making, but that is being abandoned because the SHAs are top-slicing PCT budgets and controlling the growth money for the NHS for this year.
Progress towards foundation hospitals is being delayed and their freedoms are still severely limited. National standards need to be set through the National Institute for Health and Clinical Excellence, but the guidelines are not being implemented and the postcode lottery goes on. The independent and voluntary sectors have no clarity on their future involvement in the NHS. The second wave contracts are being scaled back, and the wave 1 contracts cost 11.2 per cent. more than the NHS price. As independent sector treatment centres are guaranteed payments whether or not they do the work, they are bringing the system of independent contracting into disrepute.
One cannot talk, as the Prime Minister does, about a patient-focused service that is locally delivered when at the same time the NHS is controlled by an overbearing bureaucracy and politically dictated targets. The team at the Department of Health knows neither what NHS reforms are actually needed, nor how to deliver them. No one in the NHS can say what the destination of reform is. Who will be commissioning services in the future? Will PCTs be both commissioning and providing services? Who will set the tariff? How will financial control be enforced? Will the independent sector have a long-term commitment and the opportunity to supply services to the NHS? What happens to failing hospitals? The team does not know, and the Government will not give, or simply do not know, the answer to any of those questions.
The time has come for a turnaround and a new team at the Department of Health. Ministers should be removed from their interference in the NHS. If we cannot immediately get a new Government, let us at least have a team brought in that is empowered to deliver NHS reform and the long-term stability that the NHS so badly needs. Such reform should reflect the principles of equity, choice, competition and independence for which we have argued.
Most of all, the NHS needs leadership. Professor Halligan, who was deputy chief medical officer of the Department of Health until last year, said that the NHS has
“a leadership void, which has caused it to lose its way”.
He describes the service as “rudderless”. Tellingly, he adds that it is
“extraordinary, the gap between highly motivated frontline staff and the systematic dysfunctionality in which they operate”.
At the risk of using an unparliamentary expression, the situation is what the Health Service Journal describes as a “total cock-up”. Only days ago, the outgoing director of human resources at the Department of Health, Andrew Foster, who is one of the most senior NHS officials, said:
“It’s been almost tangible over the last 15 months, the growing sense of dislocation between the NHS and the Department of Health and a growing lack of confidence in the leadership of the Department”.
Even those working most closely with the Secretary of State express their lack of confidence. NHS staff did so in loud and clear terms. We have no confidence in her stewardship of the Department. It is time for a turnaround. It is time for Conservative policies and, frankly, it ought to be time for a Conservative Government who are committed to a NHS that is energised and equipped to deliver. It is time for change, and I commend the motion to the House.
4.34 pm
The Secretary of State for Health (Ms Patricia Hewitt): I beg to move, to leave out from “House” to the end of the Question, and to add instead thereof:
“recognises the effective leadership given by the Department of Health in managing the NHS; acknowledges that the majority of NHS organisations are living within their budget and providing patients with better services; welcomes the turnaround in the NHS since 1997 as a result of the dedication and commitment of staff, backed by the Government’s programme of investment and reform; congratulates the Government for trebling investment in the NHS by 2008 compared with 1997; welcomes the recruitment of more than 300,000 extra staff in the NHS since 1997 including 85,000 more nurses; notes that waiting lists are now at their lowest since records began with over 370,000 fewer patients waiting for an operation than in March 1997; further welcomes the fact that all patients can now expect to wait no longer than six months for their operation and that 98 per cent. of patients are now seen, treated or admitted within four hours in accident and emergency departments; and applauds the NHS for saving more lives than ever before. Including 43,000 more people saved from cancer and 87,000 saved from coronary heart disease.”
I am delighted to start by welcoming to their posts the Minister of State, Department of Health, my hon. Friend the Member for Leigh (Andy Burnham), on his promotion, I congratulate him and the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis). I take the opportunity to thank my right hon. Friend the
Member for Liverpool, Wavertree (Jane Kennedy) for the work that she has done, especially in securing the new private finance initiative for Barts, the Royal London, St. Helens and the new private finance initiative building programme for Birmingham. I congratulate the new Minister for Policing, Security and Community Safety, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne), on his promotion to the Home Office.
The hon. Member for South Cambridgeshire (Mr. Lansley) spent the past 40 minutes telling us about everything that he thinks he is wrong with the national health service. A year ago, he was telling people that he believed in the patients’ passport—taking money out of the NHS to put into private care. He says now that he has changed his mind and that he really believes in the NHS. Four years ago, he voted against more money for the NHS. Now he and his right hon. and hon. Friends keep demanding more money for the NHS. He and his right hon. Friend the Member for Witney (Mr. Cameron) have turned round their positions so often that the public no longer know what the Conservative party believes in.
Let me tell the hon. Member for South Cambridgeshire what we have done about turnaround in the NHS. In 1996, I have one cutting from one day. It reads:
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