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“22 patients spend the night on trolleys. A&E unit closes its doors. Patients diverted to Queen Mary’s in Roehampton which is earmarked for closure”.
That was under the Conservative Government. In 2006, no patients were waiting on trolleys for hours on end. There was a maximum wait in accident and emergency of just four hours. That is a turnaround. It is a target that the Conservative party said could never be met and should never be set. It is another example of what the Conservative party describes as Government interference. However, it is a target that NHS staff—more of them than ever before—are delivering. There is a new hospital to be built at Queen Mary’s in addition to 81 new hospitals since 1997, and there are many more to come.
Daniel Kawczynski: The title of the debate relates to management of the NHS. Does the Secretary of State agree that promises given by the Government should be fulfilled? One was that when hospitals merged, their debts would be wiped out. Ministers in the right hon. Lady’s Department have confirmed that that is the case. However, when Shrewsbury merged with Telford the existing £3 million debt was not wiped out and was instead brought forward. Will the right hon. Lady look into that, because it is causing terrible problems for my hospital?
Ms Hewitt: The hon. Gentleman and I have discussed that matter before. He needs to accept, as do other hon. Members, that these so-called historic deficits are simply previous years of overspending. All too often, that overspending has been matched by underspending in far poorer parts of the country. The hon. Gentleman must face the fact that if a deficit is to be wiped out in one organisation, the money must come from somewhere else.
Mr. Crispin Blunt (Reigate) (Con): The right hon. Lady knows that the Surrey and Sussex trust has suffered the most disgraceful political interference and
has not been allowed to manage its own affairs. The deficit has been about £10 million a year to keep Crawley hospital open as a full functioning hospital. Her Department approved the reform plans put forward by the trust, but then placed a moratorium upon them. It is to be hoped that the local managers will be given the opportunity to manage. There have been five years of political interference in the interests of the Labour party. This is an absolute disgrace, and the right hon. Lady should apologise.
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. Interventions should be interventions, not speeches.
Ms Hewitt: No doubt the hon. Gentleman would like to tell the House and the people of Crawley that his proposal is to close all facilities at Crawley hospital and sell it off for luxury housing or something else. I believe, and the people of Crawley believe, that there should be a community hospital in Crawley. That is exactly the plan that the local primary care trust is working on.
Mr. Blunt: Will the right hon. Lady give way?
Ms Hewitt: No, I will not. I wish that the hon. Member for Reigate (Mr. Blunt) had acknowledged that in the East Surrey PCT, where more than 600 people used to wait more than 13 weeks for their first out-patient appointment, there are no patients now waiting for such an appointment. There used to be more than 500 people—in fact, there were once more than 1,000 people—waiting more than six months for an operation, but now no one waits for an operation for more than six months. That is turnaround.
Ms Hewitt: I wish to make progress.
We know very well how much more there is to do, because we created the NHS in the teeth of Conservative opposition, and we believe in it. We know, too, that we need investment and renewal to meet the growing needs of an ageing population, to exploit all advances in medical knowledge, to match the scale of rising expectation, and to match our ambitions for the health service. That is why we made the difficult decision to ask people to pay higher contributions to fund record investment in the NHS—money that the Opposition voted against.
Mr. Owen Paterson (North Shropshire) (Con): On higher contributions, two patients with early-stage breast cancer in the Royal Shrewsbury hospital receive Herceptin. That treatment is funded by the British taxpayer, but those patients have paid taxes all their lives and I wish them luck. Someone with early-stage breast cancer who has a Shropshire address must find £47,000 on top of all the taxes that they and their family have paid throughout their life, or they face the prospect of dying. Will the Secretary of State meet some of those ladies? I wrote to her three times in the past month, but she would not reply. Thanks to the prompting of the previous Leader of the House and a written question, I received a reply from the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), but she did not answer the question. Will the Secretary of State meet those ladies?
Ms Hewitt: The hon. Gentleman knows that treatment for women with breast cancer is faster and better than it was under the Opposition. He knows very well—he should know—that death rates from breast cancer have fallen faster in this country than in almost every other country. He knows, too, that as Herceptin has not been licensed or evaluated for treatment of early-stage breast cancer, those difficult decisions must be made by the local NHS. However, we have speeded up evaluation by the National Institute for Health and Clinical Excellence and independent experts—not by Ministers—to ensure that treatments for NHS patients are available everywhere.
Mr. John Redwood (Wokingham) (Con): One of the right hon. Lady’s reforms could be very helpful, as it proposes to use more private treatment centres offering specialist services to provide high-quality fast treatment. How far will that extend, and how many treatments will there be in, for example, two years’ time?
Ms Hewitt: As the right hon. Gentleman knows very well, we have indeed used independent sector treatment centres, just as we have used spare capacity in the private sector to ensure that NHS patients receive the fastest possible care, all of it free at the point of need. The ISTC programme will continue, and I estimate that when we complete wave 2, about 10 per cent. of elective treatments will be carried out in the independent sector, all of that free at the point of need.
Ms Hewitt: I am afraid I wish to make progress.
Mr. William Cash (Stone) (Con): On a point of order, Mr. Deputy Speaker. The Secretary of State will know that when a petition is presented to Parliament it is usual for the Government Department and the Minister responsible to reply. I presented a petition on the loss of thousands of jobs in Staffordshire, but I did not receive a reply. I have presented thousands of letters to the Minister—
Mr. Deputy Speaker: Order. I suspect that that is a point of debate disguised as a point of order, however skilfully, or otherwise. The hon. Gentleman should seek an opportunity to catch my eye so that he can make his point in a different way, and not as a point of order.
Ms Hewitt: We are making record investment in the NHS, above all in our staff. We have 330,000 more NHS staff than we had in 1997. We have 85,000 more nurses, 10,500 more consultants and more than 32,000 more doctors and hospital dentists. We have more staff delivering faster and better care for more patients than ever before.
But renewing the NHS after nearly 20 years of underfunding and neglect by the Conservatives was never going to be easy. That is why I want to tackle head on the financial difficulties that have arisen. The majority of hospitals and primary care trusts are improving patient care, hitting the targets that we have set, and employing more staff and paying them better than ever before, which the hon. Member for South Cambridgeshire seems to oppose, and they are doing all that within their budget.
John Bercow (Buckingham) (Con): In an Adjournment debate on the Floor of the House on 25 April, the then Under-Secretary of State for Health, now the Minister for Policing, Security and Community Safety told me that he would need to “consider what action to take” in response to the threatened closure that I highlighted of the Nuffield speech and language unit, a centre of excellence for 35 years, providing for children with some of the most severe speech and language disorders. Can the right hon. Lady, free of party politics, tell the House what she will do to safeguard that vital national resource? If it is lost, it will not come back.
Ms Hewitt: I will write directly to the hon. Gentleman on that matter.
Although a majority of NHS organisations are making all the improvements I have outlined within their increased budget, a minority are overspending, and some very seriously. Because of that, in the financial year just ended, the NHS as a whole will have overspent by around 1 per cent. of its total budget. That cannot continue, particularly in the 7 per cent.—just 7 per cent., or about 40 organisations—that account for more than 50 per cent. of the deficit.
Mr. Charles Walker (Broxbourne) (Con): The Hertfordshire Partnership NHS Trust, which deals with mental health, has never been in deficit since 2001. It provides an excellent service and has never overspent, yet this year it has been asked to cut its budget by £5.2 million. Can the Secretary of State tell me why it is being asked to cut its budget, when it has always operated within its financial parameters?
Ms Hewitt: I shall come to that point in a little more detail in a moment.
The problem with the minority of organisations that are overspending, including many across Bedfordshire and Hertfordshire, is that those problems have an impact on other parts of the NHS, including the mental health trust to which the hon. Gentleman refers, which have been living within their budget.
Of course, restoring the NHS to financial balance entails difficult decisions. Nobody wants redundancies, and every hospital and primary care trust will do everything that it can to avoid making a staff member, particularly a front-line clinical member of staff, redundant. Behind almost every story on redundancies, every scare-mongering headline and every figure that the hon. Member for South Cambridgeshire uses—he did it again this afternoon—is a hospital that is sensibly cutting back on temporary staff from expensive private agencies, like West Hertfordshire Hospitals Trust. It has a deficit of £28 million and an agency bill of £17 million, and it is going to get that down.
Mr. Shailesh Vara (North-West Cambridgeshire) (Con): The Secretary of State speaks of temporary staff not being replaced. What about permanent staff who are leaving and not being replaced in the various institutions?
Ms Hewitt: The hon. Gentleman must decide whether he wants hospitals to become more efficient and effective, and whether he wants more day case surgery, more patients looked after in the community and more emergency admissions avoided, or will he
stand in the way of change and progress, and refuse to support hospitals making difficult but right decisions?
Mr. Lansley: If it is all about agency staff, will the right hon. Lady explain why, over the last two years, the proportion of the NHS pay bill spent on agency staff has declined at the same time as the deficits have ballooned? If it is all about treating patients closer to home, why are intermediate care beds being closed and why are there fewer district nurses and health visitors? Why are these objectives—they are not new to the Secretary of State, as they started with the right hon. Member for Holborn and St. Pancras (Frank Dobson) in 1998—not being fulfilled?
Ms Hewitt: Of course spending on agency staff has started to go down, but it has not gone down enough. Does the hon. Gentleman really think that the Barking, Havering and Redbridge hospital, for example, should not reduce its £34 million bill for temporary and agency staff? Does he really think that the Royal Free hospital, which he mentioned, should not reduce its agency bill or reorganise its wards and the use of its permanent staff to give patients more effective care with better value for money?
Let me provide another example. South Tees hospitals trust has already reduced staff by 300 as it has become more effective, and with just three compulsory redundancies. While it did so, the number of people waiting more than six months for treatment fell from more than 470 to zero. Sandwell and West Birmingham hospitals trust has already cut its costs by £10 million, the equivalent of 200 jobs, but with only one compulsory redundancy. The number of people waiting more than six months for treatment in that trust fell from 23 to zero.
Mr. Andrew Tyrie (Chichester) (Con): The right hon. Lady seems to be portraying the whole of the deficit problem as if it were the fault of the hospitals. My constituency has one of the most efficient hospitals in the country and, if it were paid at the full tariff, it would be in surplus. It is in substantial deficit, even though it was viewed as the third best hospital in the country and the best in the south-east last year. Indeed, it has been in the top 40 hospitals in every one of the last six years. It is the only hospital in the country to achieve such a record, but guess what is happening? It is being cut back sharply, so what possible logic can there be in any system of health delivery that does that to such a successful institution?
Ms Hewitt: We expect every hospital, right across the NHS, to go on becoming more effective and efficient and to go on using all the extraordinary advances in medical technology that enable them to do so. In each area of the country that receives fair funding for its population we expect the NHS to deliver the best possible care for all patients—outside as well as within hospitals—within their allocated budgets.
John Pugh (Southport) (LD): Is the Secretary of State seriously suggesting that all the deficits can be wiped out without cutting back on any clinical activity?
Ms Hewitt: What I am suggesting, as is confirmed by virtually every hospital chief executive and clinical director to whom I have spoken, is that as more day-case surgery is done, patients can be treated better and faster with fewer acute beds and therefore fewer staff in certain jobs. That is not worse care for patients, but better care for patients and better value for money.
Kali Mountford: I am somewhat surprised to see the Opposition in today’s debate blocking the reform that is so badly needed. Opposition Members used to talk in the past about the reforms that needed to be made to secure value for money. My right hon. Friend has pointed out some very good examples of where change has taken place with minimum disruption. It is important to assure people working in the NHS about their futures and their ability to deliver the best possible service to our population. Will my right hon. Friend share her information with all trusts, so that those experiencing change can do the best they possibly can with it?
Ms Hewitt: My hon. Friend is right. That is exactly what we are doing through the Modernisation Agency and the NHS institute for improvement. As staff change jobs, and particularly as more services move from hospitals and into the community, we need to support those staff, particularly where they need to change their skills.
Let me give the House an example of exactly how the NHS is making those changes in Dudley, where I recently met several of its patients. One is Ron Lane, a gentleman in his 70s who has severe heart disease. He told me that his community nurse now gives him tests and treatment in a couple of hours in his own home that just two years ago used to require an emergency admission and several days in hospital. He told me that his quality of life has been transformed thanks to those community nurses. In just 12 months, thanks to the NHS community nurses in Dudley, 120 patients like Mr. Lane have had more than 500 fewer admissions to hospital.
The new acute hospital in Dudley has fewer beds than the old hospital. It needs fewer staff in many of those jobs, and the local NHS is underspending on its hospital budget, so it has more money to put into other improvements for other patients, which provides better care for patients and better value for money. The reforms that we are making, which the hon. Member for South Cambridgeshire has said that he supports but has also attacked, and the changes that we are making, with stronger commissioning from GP practices and primary care trusts, will give every part of the NHS the incentive to do what Dudley and many other places are already doing.
Mr. Stephen Dorrell (Charnwood) (Con): Given what the Secretary of State has just said about the importance of shifting services towards the community, will she take this opportunity to clear up a major policy mix-up for which her Department is responsible? Last July, she announced that it was her policy for PCTs to divest themselves of responsibility for service delivery. Is that still her policy?
Ms Hewitt: I made it absolutely clear to the House last autumn and again in the White Paper that primary care trusts, as well as having a stronger commissioning role, will continue to employ staff in the community and to provide services. That is a matter for them and for their patients and users, and there is no requirement for them to divest.
Tom Levitt (High Peak) (Lab): I can confirm that the Secretary of State gave me that answer on 25 October. Will my right hon. Friend confirm that when Labour entered office, one of the problems that we had to address was that areas in which health needs were greatest were, relatively speaking, underfunded compared with more affluent areas? We have been addressing that problem, and it would be wrong to continue a system where health surpluses in areas of high health treatment need were subsidising more affluent areas, which was the case in the past.
Ms Hewitt: My hon. Friend is absolutely right. When we reviewed the funding formula a couple of years ago, we found that some of the poorest areas in the country with the worst health problems were anything up to 20 per cent. below their target funding, while other healthier and wealthier areas were between 15 and 25 per cent. above their target funding, and we are changing that situation. In the old NHS, over-spending in one place was simply compensated for by underspending elsewhere. As my hon. Friend said, that was not only unfair, but utterly ineffective, because overspending areas had no incentive to put their houses in order. Our changes and reforms have not created those problems, they have revealed them, and now they are helping to correct them.
Ms Hewitt: I shall give way to the hon. Member for Strangford (Mrs. Robinson).
Mr. Simon Burns (West Chelmsford) (Con): She has only just come in.
Mrs. Iris Robinson (Strangford) (DUP): I am grateful to the Secretary of State for giving way; as my hon. Friend has indicated, I have just arrived from Northern Ireland. Will the Secretary of State indicate the lessons that she has learned following her reception at a recent meeting by angry nurses and union staff, who say that the NHS is in a mess? This is the third term of new Labour, so can they all be wrong?
Ms Hewitt: I rather regret giving way to the hon. Lady now, but there we are.
Ms Hewitt: I will make a little progress, if I may.
The point about fair funding is absolutely central. Because we have promised to give people in every part of the country the best possible care, we are reforming the way in which the NHS is run so that every hospital takes responsibility for organising the best care within its budget. We will not expect others to bail them out.
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