John Pugh (Southport) (LD): It seems an eternity since this debate began. It is customary in such debates for Opposition Members to identify problems and blame the Government for them, and for the Government to identify successes and take the credit; for the Government to gloss over problems, and for the Opposition to ignore the successes; and for the cup to be seen as half empty by one side, and as half full by the other. What is missing is the perception that successes and failures are often intimately related.
I want to return to the substance of the debate. I have no reason to believe that civil servants or Ministers in the Department of Health are any stupider, less efficient or less caring than their counterparts elsewhereat least I hope that they are not. I think that the fault lies
with a mistaken ideology based on flawed thinking and a false prospectus. I am sorry to say that that ideology seems to be shared by ranks of dubious advisers and think tanks, as well as the official Opposition and, sadly, the Prime Minister. That is what the Department of Health and Ministers have to contend with.
That false ideology is at the root of the problem, and it is possible that it will be the cause of this Governments ultimate downfall. It is an ideology dreamed up by people who do not understand what the NHS is. As I understand it, the NHS is the vehicle by which wethe healthy, the taxpayersentitle the sick and infirm to a standard of care that they simply could not afford by themselves. The NHS is a provider of entitlements and a moral enterprise. It is not a business, but nor is it a fairy godmother to satisfy every whim and ill.
However, just as the sick are entitled to care, so the taxpayer is entitled to value for money, and to see that the money invested is well spent. We all welcome the new investment, and we all want value for money, which leads us to the mantra about investment and reform that the Government recite again and againalthough the word reform should be a synonym for beneficial change, and not just for change itself. Moreover, not every change is a reform, and there is certainly something wrong with permanent reform that is too fast and too frequent, and which is ill-managed and incapable of being withstood by the organisation to which it is applied. That is what is called chaos.
Mao Tse Tung thought that revolution was a good thing, but discovered eventually that permanent revolution was not such a good thing, as it led to destitution and chaos. We have almost got to that stage in the NHS, caused by well-motivated but mistaken attempts to secure value for money.
In the early phase of this Government we had a target and inspection regime that in itself was not bad: setting targets and having inspections is one way to encourage a degree of efficiency in a public service. Gradually, however, it was recognised that the service could be distorted by performance indicators that caused silly things to be done, such as taking the wheels off trolleys so that they could be called beds. Moreover, targets could be politically driven. They were micromanaged and run to satisfy inspectors, and they were neither sufficiently focused nor alert enough to patients needs or clinical priorities.
That approach has not been abandoned altogether: it is still around, being implicit in the contracts for dentists and GPs whereby activity is to be rewarded. In some ways the process has become more sophisticated and works a little more harmlessly than in the past. Now we simply have a new, more dominant model of reform; in the absence of another description I shall call it the market model. It seems to be widely accepted on both sides of the House, although not by me, and consists of turning our NHS institutions into autonomous trading units, increasing competition and importing concepts of consumer choice from private enterprise. Its rationale is relatively easy to understand: such models are supposed to encourage efficiency in the private sector, so, it is argued, they will necessarily encourage it in the public sector. It is believed that the
model will eventually shake out waste and inefficiency in the NHS, which of course we are all against.
There are fears about the model, however. The fear that it will accentuate health inequality has been voiced in the debate. There is also the fear that the model will bring unpredictability, and the fear, which should dog Labour Members, that it will bring the collapse of much-needed services and district general hospitals. The reason for those fear is that markets do not deliver entitlements, and the NHS is not a market.
To deliver the complex entitlements that the NHS offers, it needs to operate seamlessly. There must be strong clinical networks spanning many agencies, co-operating and not trading with one another. The NHS needs strong partnership arrangements and good integration. I offer a practical example from my own neck of the woods, where there have been long-standing problems with childrens services, which were to be ameliorated, in part, by co-operation between Alder Hey, the PCT and the acute trust to establish good and better clinical networks. That clinical networkthe solutionhas been blown apart, because the organisations concerned have acute individual financial needs and problems that they need to address separately rather than co-operatively.
I have another example. My local GPs have told me that they want to work co-operatively, to co-provide and fund new secondary care facilities, but they dare not because there are so many uncertainties about the effects of the choose and book system. The GPs might set up something for which there turned out to be no predictable demand, so their investment would go to waste.
Even if we concede that there is any merit in that dotty market modeland I do not think that we shouldwe must admit that the NHS is a strange marketplace. After all, what market has its costs and tariffs invented, varied, tweaked and tweaked again by civil servants on an irregular and unpredictable basis? What market rewards providers in one area more than in another, not by market circumstances but by Government decree? I am referring to the market forces factor, which may be subject to considerable debate at a later stage. What businesswhether Tesco or any otherforces its newer branches, as the NHS forces hospitals, to bear the capital costs of newer buildings, so that it costs more to treat people in newer hospitals, which trade at a loss and are then charged 10 per cent. on their overdraft? The word trade is horrible in this context, but we are forced to use it.
That is the situation in my local hospital. It has new buildings and good clinical outcomes. It has a deficit, but it is cursed by the strange way in which capital charges weigh on it, and by dotty perverse solutions dreamt up by accountants who can see only financial solutions rather than clinical ones.
Tom Levitt: The hon. Gentleman is answering his own question when he asks what sort of market and competition the NHS is. It is clearly not a private sector market with private sector competition, so his parallels do not seem to be taking him anywhere. Is he really saying that choice is such a bad thing, and that if an elderly lady were offered a hip operation either in her local hospital or in a hospital near where her daughter lives, she should not be allowed to choose the latter?
John Pugh: I am saying that the fundamental job of the NHS, as established by Aneurin Bevan, Beveridge and so on, is to deliver entitlements. People are entitled to a degree of choice, but entitlement must come first. If the choice regime leads to things being unavailable that were previously available, entitlements are lost and disappear.
At present, we have a strange, perverse, hybrid market; we have a muddle, with mixed messages from the Government. Worse still, there is the potential for mayhemthat should put fear into Labour Members. It is not too late for the Department of Health to turn round and be sensibly pragmatic, which we will all support; to consult and inspire the NHS work force, which it has clearly failed to do so far; to proceed on an evidence-led basis, which it has not done so far; and to listen. But that would mean the Department of Health and the Labour party taking on the crazed ideologues who buzz around No. 10. Not to fight that battle is, ultimately, to betray the NHS, and the nation.
The topic for debate is the management of the NHS by the Department of Health. Thank goodness the NHS is managed not by private business, as the Opposition would prefer, but by the Department of Health. I am not a dinosaur and I have no problem about the use of spare capacity in private hospitals. The hon. Member for Shipley (Philip Davies) will know what I am talking about, because the Yorkshire Clinic is near my house. The clinic is pleasant and I have attended it from time to time for minor diagnostic procedures, paid for by my health centre because my appointments were for 8 oclock on Sunday mornings. I did not mind that, because my treatment took place at times when the clinic would otherwise have been unused.
In the main, however, acute health provision must remain free at the point of use for all anddare I say it?from cradle to grave, as is the case at the wonderful Airedale general hospital at Eastburn in my constituency. Airedale hospital is the biggest employer in my constituency; it is much loved and appreciated by patients from Settle in the north to Bingley in the south.
Airedale hospital also serves Pendle on the other side of the Pennines, the constituency of my hon. Friend the Member for Pendle (Mr. Prentice), as well as the leafy suburbs of Leeds in the east, including magnificent Ilkley, and its moor, in my constituency. The air ambulance helicopter is crucial for carrying patients, including potholers, climbers and walkers in the dales, to Airedales accident and emergency department. It is a hugely popular and life-saving facility. However, I live in Shipley, four miles outside my Keighley constituency, in the constituency of the hon. Member for Shipley, so I am in the catchment
area for the Bradford Royal infirmary, which I use, but I want to describe various aspects of the NHS that I know something about.
Following the death of my second husband, John, from cancer 18 months ago, I appreciate the choices available for cancer patients. John could choose from ward 15, the oncology ward at the BRI; palliative care at home, with the support of the hospice at home team; or hospice care at Sue Ryder Manorlands at Oxenhope in my constituency or the Marie Curie hospice in Bradford. It was extremely important for our family to be able to discuss, around Johns bed, how we should choose palliative care for the end of his life. It was a very positive experience.
I shall soon be an in-patient at the BRI. Being a coward, I am not looking forward to the experience one bit, but at least I know that when I go into hospital it is for necessary surgery, not because a gynaecologist wants to make money out of me. I do not have to think about how many bits of cotton wool will be used, and I do not have to worry about something going wrong. I know that if it did, I would be transferred to another part of the hospital for appropriate treatment.
On the subject of dentists and other things, I have two moans: yes, there are not enough NHS dentists, and yes, there are too many changes in the NHS. So let us now concentrate, consolidate and stop change for the sake of change. I want to mention to my hon. Friend the MinisterI wonder whether he will touch on thisthat there are possibly too many elderly people, and I consider myself to be one of them, at 66, but I am not sure what we do about it. It is wonderful that we are living longer, but we must consider a bit more carefully where we will go when we get to the point of needing help.
Mr. Philip Dunne (Ludlow) (Con): On the subject of the elderly and where we should put themI think that that was the point that the hon. Lady was just getting toI hope that she will agree that what should not happen to the elderly and some of the most vulnerable in our society, the mentally ill, is what happened yesterday as a result of the decision made by Shropshire County PCT to close, at Ludlow community hospital, the only ward for the elderly mentally infirm available in my entire constituency, as a direct result of financial cuts. There is no clinical or patient need to close it, because the patients will be transferred to the only remaining Victorian asylum operating in England. The decision was taken purely for financial reasonsthe result of the Governments mismanagement of the NHS.
Mrs. Cryer: Perhaps my hon. Friend the Minister will address the hon. Gentlemans comments, but I cannot; I do not know anything about it. Of course, yes, we must consider the care of the elderly very carefully.
My auntie died in Januaryit was just awful for meand we discovered from the post mortem examination that she had a calcified broken femur. She was in a residential home. Why did that broken femur go undiagnosed? I could not understand why she was in pain. We found out why on her death. The cause was that undiagnosed broken femur. The residential homes that are looking after elderly people are frequently not up to the job.
Mrs. Cryer: I am not sure whether that would answer the problem that I am talking about. My auntie was receiving free care, because her savings had gone down to a certain limit. I understand what my hon. Friend is talking about, but it would not have helped. I am concerned that the care must be adequate. Whether free at the point of use, or whatever, the care should be adequate.
Finally, I have been promised by the Department that the Coronation hospital at Ilkley in my constituency will not close until the services that it provides are up and running at the Springs medical centre next door. That is what I have been promised, and it is what I expect. I hope that my hon. Friend the Minister will comment on that.
Anne Milton (Guildford) (Con): It has been an extremely interesting afternoon, not only with hon. Members sliding in and out, but with unanswered questions about what we do with elderly peopleas I am approaching that place myself, I will give it some thought.
I should like to thank some hon. Members for their contributionsin particular, my hon. Friend the Member for New Forest, West (Mr. Swayne), who is not present now, and the hon. Members for Wyre Forest (Dr. Taylor) and for Dartford (Dr. Stoate), all of whom made thought-provoking contributions.
I do not think that the staff have had much mention today, and in my constituencyGuildfordgenerally speaking, patients are getting an incredible standard of care, kindness and attention from an extraordinarily hard-working work force, whom we talk about in the House often without recalling that they are at the front line, delivering care. I know that there are problems in some instances, but their dedication and commitment are outstanding, and the one thing that they would always ask of us is to try to keep the use of the NHS as a political football down to a minimum. Many hon. Members have welcomed those of this evenings contributions that have been thought-provoking and considered some of the not easy issues that we must consider.
Tom Levitt: I am sure that the hon. Ladys generous remarks about NHS staff will be appreciated throughout the country. Does she agree and will she put it on record that NHS staff get a much fairer deal on pay under this Government than they did under the previous one?
Anne Milton: I thank the hon. Gentleman. That is just what I have been talking about: it is all too easy to say, Well, five, 10, 15 or 20 years ago, it was so much worse. That is what NHS staff do not want us to talk about; they want sensible contributions. Of course, pay has gone upso it jolly well shouldbut there are issues that we must address. In 1996, pay had gone up from 1994, and so it goes back. What the public and
staff are looking for are sensible contributions, and I should like to talk a little bit about what is happening in my constituency.
My hon. Friend the Member for New Forest, West talked about perceptions. If nothing else this evening, I hope that we can bring Members on both sides of the House together, at least to recognise that what is happening in our own constituencies is not necessarily the same as what is happening in those represented by other hon. Members. Certainly, the bigger picture for Guildford and Waverley PCT is looking rather grim.
The PCT had a substantial and partly inherited deficit. Last week, to alleviate that deficit, it decided, against public opinion, to close community beds. It took that decision after many months of consultation and many hours of work by the local community. The PCT decided to close Milford hospital, which, although not in my constituency, is used by many of my constituents and is a specialist rehabilitation centre. It also decided to close beds at Cranleigh village hospital. That was one of five options that the PCT had to consider. Democracy and local opinion have been mentioned, and it is of note that 94 per cent. of local people did not want that option.
The decision was taken despite the fact that the local community in Cranleigh has raised considerable funds to rebuild Cranleigh village hospital. It was taken despite the fact that the Cranleigh village hospital trust has now been given a piece of land on which to build the hospital and despite the fact that it has planning permission to build the hospital and a partner within the project. In fact, the trust was going to build precisely what the Government would like to see: a community hospital that has flexible space, the opportunity for step-up or step-down beds and the space to perform diagnostics within the community.
By pulling the plug on the beds at Cranleigh village hospital, the PCT has put the project in jeopardy. The partners are unsure whether there is any real commitment from the NHS to buy services from the hospital. It is extremely disappointing to local residents in Cranleigh that the Government cannot see that. I share the frustration of my hon. Friend the Member for North Shropshire (Mr. Paterson), who said that he has written to the Secretary of State and to Ministers but nobody is listening. There are exceptional circumstancesCranleigh village hospital is onewhere the community have embraced some of the changes that the Government would like to see and have raised all the funds to build a new hospital, but still it seems impossible to get the attention of Ministers or the Secretary of State.
The problems have just started in the Royal Surrey County Hospital NHS Trust in my constituency, despite the fact that it has done so well on many frontsin fact, the chief executive did so well that I understand he has moved on to greater things and is now the principal policy adviser to the Secretary of State. Having been in balance, the trust is now forecasting a £15 million overspend and today it announced plans to try to counter that. I have had some reassurance that the situation is unlikely to lead to redundancies at this stage, although I think that there will be some job losses.