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I have first-hand knowledge of the commitment of this Government to confronting and dealing with health inequalities. Earlier this year, more than 250 people from two council wards in the south of my constituency braved a freezing February evening to attend a small celebration that I hosted to thank the Secretary of State for Health for saving and agreeing to rebuild their local
general hospital, St. Helier. They wanted to thank her for listening to their concerns. Many of them were elderly or infirm, and they have suffered for years as a result of inequalities in the health service. They wanted to celebrate because they were so delighted that, in order to tackle health inequalities, an earlier decision by some in the health establishment about where to locate their new hospital had been overruled.
Siobhain McDonagh: I will not give way.
As I have said, my constituency is one of the most disadvantaged in our strategic health authority’s catchment area, with some of the greatest health needs, yet when the axe had to fall throughout the ’80s and early ’90s it was my constituency that suffered most. In the past few months, we have uncovered secret plans by the local health authority dating back to the mid-1990s. It proposed to shut St. Helier, but thankfully was unable to do so before Labour came to power.
St. Helier hospital is not in my constituency—it is in a Liberal Democrat constituency—but it serves half of my constituents. The health establishment has for many years scorned Mitcham and Morden. Even now, despite many complaints from me, no one who lives in my constituency is on any NHS board, either of a primary care trust or a hospital trust. So I should not have been surprised when St. Helier came under threat again more recently, when the administrators decided that they wanted to remove critical services from the hospital. It was saved only following the intervention of my right hon. Friend the Secretary of State for Health.
Those administrators argued that the site of the main hospital—the critical care hospital—was not important, as the community hospitals would take most of the people who normally go to hospitals. A public consultation was conducted, and it soon became clear that the main issue would be where to put the new critical care hospital, which would house the area’s accident and emergency unit, and acute services such as maternity and obstetrics.
My view is that the people who need critical care services the most are those who are most disadvantaged and have the worst health. There is a strong link between social disadvantage and the need for emergency services and health needs such as low birth weight and teenage pregnancy. The bulk of the population live near St. Helier, and the vast majority of those with the greatest health needs live there. They are those with the lowest life expectancy, those who experience the most emergency admissions, the highest levels of child accidents, the lowest levels of good health and the most long-term illnesses. They also include those with the most babies with low birth weight, the least access to primary care, the lowest incomes and the least access to cars. The area also has the largest black and ethnic minority population. For all those reasons, I felt that having the critical care hospital at St. Helier was the best way to reduce health inequalities. The public consultation seemed to agree— [ Interruption.]
Madam Deputy Speaker (Sylvia Heal): Order. There is far too much noise in the Chamber.
Siobhain McDonagh: Madam Deputy Speaker, the Conservatives do not like to hear the truth, but I will continue with this speech and I will not be abused— [ Interruption.]
Madam Deputy Speaker: Order. The hon. Lady has made it clear that she is not going to give way. That is her prerogative.
Siobhain McDonagh: Thank you, Madam Deputy Speaker.
The public consultation seemed to agree with my views. Although fewer people from disadvantaged areas take part in public consultations, and although my own surveys were repeatedly ignored, St. Helier emerged as the top choice among the public for the location of the critical care hospital. However, last January, local NHS managers voted to overturn the views of the residents, and to build a new critical care hospital in Belmont, a very well-to-do suburb in Surrey, instead. They did so despite the fact that the health establishment initially gave St. Helier a 7 per cent. higher score than Belmont in its original assessments. That decision would have meant that St. Helier would lose its accident and emergency, maternity and other critical care services.
Belmont is one of the wealthiest areas in the country, and the people living close to it have a high life expectancy, good access to health care and high levels of private health care. The area around St. Helier has the greatest health needs in the whole catchment area, and the people living there have up to 10 years less life expectancy. They are also the least likely to have a car and the most likely to need to go to hospital. The whole catchment area can reach St. Helier well within the critical “golden hour” that our health experts agree is crucial to survival. Indeed, more people can get to St. Helier within 20 minutes than to Belmont, and St. Helier has far better public transport services than Belmont. St. Helier was the preferred choice of all the MPs in Sutton, Merton and Wandsworth, and of Sutton and Merton councils.
Given the harm that would be done in terms of health inequalities if Belmont was the location of the new critical care hospital, rather than St. Helier, Merton council called in the decision. Even the health establishment admitted that if the Belmont site was chosen, people living in seven of the 10 most deprived postcodes in the region would have to travel further than they do at the moment.
I was delighted, therefore, when the Government demonstrated once and for all to the whole NHS that health inequalities really do matter, and when the Secretary of State backed St. Helier too. She was brave to do that, because she must have been under a lot of pressure from the health establishment, and the decision must have been very close. She came down firmly on the side of reducing health inequalities. She decided that it was the patients who mattered most, and showed for all to see that reducing health inequalities was the Government’s top priority.
This is the Secretary of State who has seen a fantastic growth in the NHS, a dramatic reduction in waiting times, and a significant increase in the number of staff and the amount that they are paid. She is the Secretary
of State whose policies have uncovered modest overspends in some hospital trusts, and established the need for them to improve their efficiency while spending the extra money that the Government have given them. She is also the Secretary of State who has put tackling health inequalities firmly at the top of the political agenda. I back the Government’s amendment.
7.29 pm
Dr. Richard Taylor (Wyre Forest) (Ind): I welcome the Minister of State, the hon. Member for Leigh (Andy Burnham)—I and other hon. Members welcomed his presence on the Select Committee on Health, so I am delighted to see him in his new job. I hope that he will be able to see through this afternoon’s fog to the real state of the national health service. A visitor from outer space would think that Opposition and Labour Members were talking about different health services, and I am sure that the truth is somewhere between their portrayals.
Everyone agrees that all NHS staff are striving to do their best for patients. I resent very much the suggestion that the demonstration at the Royal College of Nursing conference was orchestrated. Many people whom I have known well for years feel strongly that they cannot keep up the current quality of care. There have been instances of only one trained member of nursing staff being present on a large ward, of patients being unable to find a member of nursing staff to help them, of relatives feeding patients because there are not enough nurses to do it and of relatives looking for a doctor who does not have time to talk to them. Therefore, while there are many improvements, which I acknowledge, there are still tremendous problems.
Dr. Stoate: The hon. Gentleman says that he does not think that what happened at the RCN meeting was in any way orchestrated, but does he think that it is pure coincidence that 100 people turned up with identical T-shirts and sat in the front row?
Dr. Taylor: I take that point.
The debate is about management of the NHS, so I shall refer first to reforms. In 2002-03, the Health Committee’s report inquiring into foundation trusts started with a table quoted from the Journal of the Royal Society of Medicine, which listed the reforms that had taken place between 1982 and 2003 under Governments of different colours. There were 12 reorganisations between 1982 and 1997, another six between 1997 and 2003, and since then, as panic has set in, there have been at least 10 more—practice-based commissioning, payment by results, “Agenda for Change”, new contracts, reorganisation of trusts, independent sector treatment centres, out-of-hours care, the computer program, the primary care White Paper and the abolition of the Commission for Patient and Public Involvement in Health. The NHS is supposed to be patient-led, but none of those has come up from the bottom; they are all top-down.
For example, by and large, independent sector treatment centres are against local wishes. I have just received a letter from one of my ex-housemen, who is now a professor of magnetic resonance imaging. In respect of independent sector scanners, he wrote:
“I am not aware of any attempt at all to evaluate whether or not the NHS could have provided this extra capacity. Many NHS MR systems are under-utilised owing to either revenue or staff shortages.”
“There was no consultation locally on Wave 1—it was presented as a ‘fait accompli’”
In relation to primary care trust mergers, everyone in my area is against the loss of their own PCT for their own part of the county. That has been made clear at all levels, and any movement on the matter is most unlikely. I have heard other Members make similar comments this afternoon. PCT mergers are not in accordance with local wishes; they are top-down.
The abolition of the Commission for Patient and Public Involvement in Health will have a devastating effect on local forums, removing the very bodies that could communicate the patients’ and public’s needs and wishes. Abolishing the CPPIH two years after its institution does not strike me as good management. Equally, abolishing PCTs just two to three years after inception, just as they are beginning to work, does not seem to me to be good management.
The Government-inspired reforms, especially their number and top-down nature, lead to problems. The person who wrote the article listing the number of reforms from 1982 to 2003, quoted in the Health Committee report that I mentioned, wrote subsequently that
“perpetual reform is very costly, both in terms of the time and effort invested by managers and other NHS staff, and in terms of the financial costs of establishing the physical fabric of new organisations and of meeting the redundancy or retirement costs of displaced staff. It can create a significant diversion of time and effort from the focus on delivering improvements to patient care, and, crucially, may promote a cynical attitude to innovation and change in the NHS”.
The Health Committee report on the merger of primary care trusts followed up that theme. In our summary, we wrote;
“It is clear that the impact of proposed reconfigurations on PCTs’ day to day functions, including clinical services, will be substantial—it takes on average eighteen months for organisations to ‘recover’ after restructuring and to bring their performance back to its previous level.”
“After the immediate disruption of reorganisation, it is thought to take a further 18 months for the benefits to emerge—a total of three years from the initial reforms. Thus, just as the benefits of PCTs (established in 2002) are about to be realised, the Government has decided to restructure them.”
The Government attempt to justify the NHS deficits on the basis that they only affect a minority of trusts. In relation to the 2005-06 deficits, that seems to be the case. What we desperately need to know—I am pleased that the Health Committee will undertake an inquiry about this in future, as we might then find out the real scale of the deficit—is what savings all trusts across the country must make to be in balance by the end of 2006-07. That will give us some idea of the true deficit.
I have thoroughly welcomed the extra money that has gone into the NHS, but the Health Committee has heard some worrying facts about what happened to the extra £6.6 billion this year. Nearly half has gone on pay rises and other expected things, but much of the other half has gone on uncosted or inaccurately costed contracts, PFI costs, independent sector costs, the computer system and the pharmacy contract. At that stage, there has been mismanagement of the vast amount of extra money that has gone in.
With regard to the private finance initiative, would people now allow a PFI contract to be written with a clause stating that if bed occupancy goes above 90 per cent, there would be extra payment? Before the changes removing the need for some hospital beds, not all of which have taken place, as the hon. Member for Dartford (Dr. Stoate) mentioned, initial PFIs were made with fewer beds. Allowing a contract to have a penalty clause for occupancy levels that would inevitably be reached was inexcusable. During one meeting of the Health Committee, we tried to find out from top civil servants how widespread the practice was. The civil servants promised to send a note because they could not answer at the time, but I think we are still waiting for that note.
There is another sad aspect of the private finance initiative. Forecasts were made of its unaffordability, and my own trust has now admitted that approximately £7 million of its deficit of nearly £30 million is owing to the PFI.
We should also ask what managers in any concern other than the health service would allow independent-sector treatment centres a fixed contract for a guaranteed number of cases, to be paid for within a fixed time regardless of whether they have been dealt with, while at the same time NHS treatment centres struggle to make ends meet? That strikes me as a little odd, and it strikes me as poor management.
Another thing that worries me, and worries many people in the NHS is who would go fast and furious down the road to privatisation when there is so much opposition from health workers of all kinds? The fact of resistance is proved by the appearance of the group called “Keep Our NHS Public”, which has been joined by a good many junior doctors.
Some expenses resulting from Government rulings on top-down management seem to me fairly ridiculous. They may be controversial and I may be wrong, but I want to mention them. Clinical risk managers, for instance, are senior nurses who have been taken away from their jobs looking after patients in order to manage risk. Has there been any study of their value for money? The same question could be asked about quality managers. As for the plethora of “modern matrons”, that is really just another name for the departmental nursing officers whom we have had for years and years.
The typical image of a matron is that of the archetypal figure in a smart uniform who sails around a hospital and puts the fear of death into all the nurses and doctors. That one person can do more in terms of risk, quality and the standard of care than any number of highly paid modern matrons. If I were looking for savings, rather than getting rid of practising, working nurses on the wards I would get rid of risk managers and quality managers. I would return the modern matrons to their jobs as nursing officers and bring back “the matron” who is not bothered by management or the reforms that she must introduce, but is purely and simply concerned with quality.
Ms Diana R. Johnson: The hon. Gentleman’s comments seem to relate to a very rigid and old-fashioned method of hospital management, which, as I am sure we all recognise, involved severe problems.
Would not a more flexible approach, featuring the use of different skills by different professionals, be preferable to that?
Dr. Taylor: The problem with having worked for the health service for even longer than the hon. Member for Dartford is remembering bits of it that worked and bits that did not. We have got rid of some of the bits that did not work, but one bit that did work was that leading figure, the single matron who kept an eye on all that was going on. She was far better than the modern matrons.
Anne Milton: I am sure the hon. Gentleman agrees that it is a shame that people use the term “old-fashioned”. As one who worked in the NHS as a nurse for 25 years, I remember the matronly figure with fondness, but also—and I think that this is what the hon. Gentleman is talking about—as a figure personifying visible management, standards and a climate in which patients were given the best possible care, and a figure of whom everyone was in fear as she passed.
Dr. Taylor: Absolutely. Matron’s ward round was seen as an event, and everything had to be just right. I think that some things in the past are worth remembering.
Another economy could be made. Every week the Health Service Journal provides two, three or four glossy brochures giving details of courses. The cost of a one-day course is £440.63, even for health service employees. That money comes from a health service fund. There are other ways of training people, and I think that the number of people we lose when they go on those terribly expensive courses is distinctly excessive.
There are many examples of the Department’s making a mess of management. Perhaps there are examples of local bad management, but I wonder whether those involved have been given much of a chance. My plea is this: give the NHS a period of stability, stop the reforms for the moment and do not produce any new reforms just yet, and allow the NHS time to get into balance. It is impossible to be in balance within 12 months when some 15 per cent. of the budget must be saved.
If reconfigurations are necessary, the Government have established a mechanism to make them—politically, at least—acceptable: the independent reconfiguration panel. The case cited by the hon. Member for Mitcham and Morden (Siobhain McDonagh) was not referred to the panel. If it had been, it could have been seen to have been handled without political considerations.
If I were looking for savings, I would also sack some of the advisers. Prince Charles is often derided and some people do not think much of him, but some Members may recall that extracts from his diary featured in The Times on 23 February. One of them referred thus to the Government:
“They then take decisions based on market research and focus groups, on the papers produced by political advisers and civil servants none of whom will have ever experienced what it is they are taking decisions about.”
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