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I would like to deal with the effect on my constituency of the massive investment that has been put into it over the last few years, particularly in respect of the Hull and East Yorkshire NHS hospitals trust, an acute trust. About £6 million has been invested in the creation of the Hull and East Yorkshire eye hospital and £35 million has been put into the building of the Hull and East Yorkshire women and childrens hospital, which opened two years ago. Plans are afootthe first contractors are
on siteto build a £45 million cardiac and elective surgical facility at the Castle Hill hospital site, and £60 million is available for a new oncology centre at Castle Hill. Several other smaller capital developments are either planned or already in progress. My constituents are really seeing the benefits of massive investment in the NHS in Hull and east Yorkshire.
My area in Hull is rated ninth out of the 354 local authorities and districts in the country in respect of disadvantage and deprivation: health care is thus a key issue for us. I was very pleased that the Hull York medical school came to the Hull university site a few years ago, which meant that we were training doctors who would, we hoped, decide to make their careers in the Hull and East Riding area. We put in a bid for a new dental school, but it was unfortunately not successful. I remain hopeful of another round and another strong bid from the Hull York site, which should be viewed favourably by the Government.
I want to finish with a few comments on some recent visits that I have made. The first was to the East Yorkshire eye hospital. I encountered a fabulous NHS staff team there, including a consultant who told me that, from the day he sees someone who needs a cataract operation, he can be operating nine days later. I believe that that is phenomenal when we think that a few years ago, people in Hull and elsewhere had to face months of misery before having a cataract operation. Nine days is brilliant and something to be very proud of.
We should also pay tribute to the flexible way in which NHS staff now work. It was interesting to hear from the hon. Member for Wyre Forest (Dr. Taylor) about what I thought was a rather old-fashioned way of demarcating doctors, nurses, matrons and so forth. What I felt was so refreshing when I visited the eye hospital was the fact that the consultant, the nurses and the administrators worked incredibly well together to ensure that the patient experience was the best possible. It was a real team, which recognised the importance of working as a team. There was no pulling rank in the sense that the consultant had considerable experience while others did not: they operated as a team, which demonstrates the way forward.
I would like to say a few words about the Hull and East Yorkshire women and childrens hospital, which provides midwifery-led care. We also have the Jubilee birth centre, which is totally midwife led, but the costs are quite high. We have to think about costs and the type of facilities that we provide to expectant parents.
Sandra Gidley: The hon. Lady mentioned the cost of the midwife-led centre, but there is a body of opinion that clearly demonstrates that the wider cost benefits are often not taken into account. The key benefit of a midwife-led unit is the one-to-one care, which means that there are fewer interventions. That is simply not taken into consideration when we look at the issue from a purely accounting perspective. Does she agree that that should be taken into account as well?
Ms Johnson: That is probably right. When I visited the Jubilee birth centre, I was rather taken aback when told the cost of each birth in comparison with having a baby at the women and childrens hospital. It was
because it was midwife led and no consultants or doctors were there to deal with any emergencies. Women then had to be put into an ambulance and taken back to the centre of Hull. There are many important issues there.
When the Jubilee centre was being designed, I suspect that management was not thinking sufficiently clearly. There are two sites in Hullone in central Hull, the other in East Riding. It is now believed that elective surgery and planned occurrences such as having a baby should be carried out on the site outside Hull and that the acute hospital should deal with accident and emergency and provide urgent treatment that cannot be arranged in advance. The issue involves management and thinking about what will be most effective for people in a particular area. Ten years ago, such issues would not have been thought through as well as they are today, and I know that todays plans involve splitting off elective care from A and E and the acute sector.
Finally, I want to mention the PCTs in Hull, which are spearhead PCTs because we have some of the worst deprivation in the country. I am very pleased about the reconfiguration of the PCTs. At the moment, we have East Hull PCT and West Hull PCT, but we will have one PCT for Hull, which is sensible because it will be coterminous with the local authority. Furthermore, the local authority and the PCTs are already working together on the public health agenda: a public health director has been jointly appointed; work is going on in our schools to encourage healthy eating among young children; free swimming has been provided for young children; and smoking cessation groups are working particularly well.
Overall, I am very proud of the political investment that we have made in the NHS. We are kidding ourselves as politicians if we do not recognise that health is intensely political for the most disadvantaged people, such as my constituents.
The people of Basingstoke are proud of their health care professionals: we are proud that we have one of the top 40 hospitals in the country; we are proud that we have world leaders in bowel and liver cancer in North Hampshire hospital; and we are very proud of the Ark, which is a medical research and learning centre located at the hospital. We have a team of dedicated professionals, who do a very good job.
In response to my questions about the future of health care in my constituency, the Minister usually blames people on the ground for our problemsin my part of the world, the health care crisis is real. I think that the origins of the problem lie not with the people who work in my constituency, but with the Department of Health, which needs to take a long, hard look at its own management before pointing at people who live in north Hampshire.
The financial crisis in north Hampshire is real, but the problem runs deeper and stems from management practices in the Department of Health. Unless those problems are addressed, we will continue to pump
taxpayers money into a structurally dysfunctional organisation. What is structurally dysfunctional about the Department of Health or, using language that the Government understand, where does the systemic failure lie? In too many cases, there is no link between the central strategies followed by the Department of Health and what is delivered on the ground. The Government are trying to micro-manage from Whitehall, but they do not take responsibility when things start to unravel on the ground in our constituencies, and we have heard many examples of that today. I follow my hon. Friend the Member for Guildford (Anne Milton) in hoping that Ministers are listening to the problems, which are real.
I shall give the House two brief examples. A key plank of Department of Health strategy is to move patients from being treated in an acute setting in hospital to being treated in the community. We have been told that that strategy reflects the patients desire to be treated closer to home. In my experience, most patients want to be treated in the most appropriate place, which should be down to doctors, but we have been told to follow that strategy in order to reduce referrals to secondary care and to control the financial situation. GPs in my constituency have acted responsibly and organised themselves to take the challenge seriously and to examine delivering services in GP surgeries which have historically been delivered in hospital. However, we have no community hospitals in my constituency.
We have identified at least four surgeries that need a lot of investment, possibly even new accommodation, in order to be able to increase services of the kind that the Government are talking about. Staff at our doctors surgeries are working in intolerable conditions, which I could go through in detail if time allowed. Despite the Governments strategy of trying to take people out of acute services and into our community, there is simply no money available from the primary care trust for any new doctors surgeries to fulfil either the strategy of trying to increase the services that are available through surgeries or the demands of the many thousands of new people who are moving to Basingstoke every single year.
Our GPs have had problems with regard to the Departments accounting practices, which are beyond me. As a simple person who has been in business for about 17 years, I find that the way in which the Department tries to put together accounting practices is for the benefit of nobody but itself. When doctors look at creative ways of trying to improve services for their patients, financial limitations, in the shape of accounting procedures, are put in their way. That is deplorable.
As I said, a key plank of the Departments strategy is to move more patients from being treated in an acute setting in hospital to being treated in the community, but there is no money to invest to make it become a reality. It needs to take a long, hard look at that short-termism, which is destabilising the long-term robustness of the community health service in my constituency.
That level of dysfunction does not end there; it extends to departmental announcements that have no way of being delivered on the ground. One example that will have led to similar problems for many other
hon. Members is that of IVF treatment. When the Departmentindeed, the then Secretary of State, who is now Home Secretaryannounced that by 1 April 2005 all hospitals would be able to provide at least one cycle of IVF treatment, that built up the hopes of a great many of our constituents. It received good media coverage for thatjust before a general election, I seem to recallbut the reality is that health care providers in our constituencies cannot provide that service on the ground. There was no more money to deliver, and the result was a great deal of distress and pain for people who deserve better. It does not seem to matter much to the Department whether the headline matches the reality.
Mr. Andrew Pelling (Croydon, Central) (Con): I am pleased to be able to speak in this debate to raise concerns about what is happening in my very well regarded hospital trustthe Mayday trust. It recently benefited from significant investment in the capital of its building, but now faces a £6.8 million overspend that is described by the departing chief executive as a significant financial problem. Indeed, it is a problem that will also be worrying staff, as it is expected that several rounds of reductions in posts, and some redundancies, will have an adverse effect on the performance of this excellent trust.
I listened closely to what the hon. Member for Keighley (Mrs. Cryer) said about supporting the elderly, because the Mayday trust has found it necessary to close down a ward that was dedicated to such support. In times of financial difficulty, inappropriate decisions are often made whereby services are in effect forced to transfer to other parts of the public sector, often to areas where the eventual cost of care will be greater than it would have been for the authority that has been trying to transfer it to others.
I am also worried about the distorting effects of centrally set targets on my local primary care trust. Croydon PCT found it necessary, in its desire to match a Government short-term target for the completion of operations, to pay over the odds for evening and weekend operations. The PCTs director of commissioning said:
We geared up to achieve a target, now we have got where we have to go and we dont need that extra capacity.
I am not going to pretend that we wouldnt wish we had more money but having reached the target if we keep spending at this rate we are going to overspend.
Ministers will be pleased to know that the PCT was keen to live within its means. However, it found it necessary to spend an extra £500,000 because of its desire to meet a short-term target, which would later lead to an overall reduction in services to my constituents.
I am also worried about the future of an important investment that was made in the walk-in centre in Croydon. Estimates show that it has been successful in serving 32,000 visitors a year. It is an important service, especially when we bear in mind that it deals with many unregistered people, often migrants from Lunar house. That nurse-led service, which relied on support from
doctors, now finds that, despite the good investment that has been made, it is no longer able to afford doctor support.
Those are examples of permanent damage and inefficient public investment in the health service, which can happen when one is confronted by short-term crises in investment and the ineffective application of centrally set targets.
Stephen Hammond (Wimbledon) (Con): I want to make two brief points. First, I welcome the two new Ministersthe hon. Members for Leigh (Andy Burnham) and for Bury, South (Mr. Lewis)to their posts and wish them success. I have sat through the long debate, in which we had, with one notable exception, thought-provoking, valid contributions of quality.
My first point is a macro point. No hon. Member wants the NHS to be out of financial balance. However, the Governments macro reality is that they are spending £96 billion on the NHS, whereas my micro reality is that my local acute hospital and my PCT are in deficit. The Governments macro reality is that, as the Secretary of State said, the financial problems are always created by the trusts. That is not so. The bulk of my constituents in Wimbledon look to St. Georges as their acute hospital, which is in the constituency of the hon. Member for Tooting (Mr. Khan). I have spoken to the financial director, Mr. Colin Gentile, and the turnaround team has done a good job. However, one of the problems that exacerbated the deficit was the inability of the Department of Health to get its tariffs correct in the first place. Although the Government say that the problems are always caused by the trusts, that is not the case.
Secondly, let me consider the local point. The hon. Member for Mitcham and Morden (Siobhain McDonagh), who is no longer in her place, made an ill-tempered contribution, in which she allowed no interventions. Her constituency is next to mine and we share a borough council and a health reality. The health reality that she portrayed was not that that some of us experience. Yes, several improvements have taken place at Sutton and Merton PCT but she should also have said that it has deficits. Some are due to overspending, which it needs to put right, but others, as in the case of St. Georges healthcare trust, are due to a problem about which it could do nothing. An arbitration settlement from three years ago hit it. Community practice nurses, the district nursing service and the home health visiting service are consequently being cut. The White Paper states that community health provision should not be cut as a result of short-term budgetary issues. I ask Ministers to think about that.
The hon. Member for Mitcham and Morden also spoke a lot about the Better Healthcare Closer to Home project, and about her supposedly great victory in retaining St. Helier hospital. St. Helier was never going to be closed: it was either going to be a local care centre or an acute care trust. She misrepresented the situation several times, and I look forward to reading Hansard carefully tomorrow and, I hope, making some points of order and asking for some corrections.
The overwhelming point is that, although the Secretary of State granted the hospital a reprieve as an acute care trust, she failed to consider what would happen to the local care trusts. As a result of that decision, the whole Better Healthcare Closer to Home project has now gone into abeyance, and the business case has been distorted. My constituents in Wimbledon, who want to see excellent local primary care delivered through the local care hospital, can no longer be certain that that will happen, either in the given time scale or at all. I am seeking reassurance from the Ministers that it will happen.
James Brokenshire (Hornchurch) (Con): This is a timely debate, given the considerable uncertainty in the national health service, both nationally and in my local area. My local acute trust has overspent by £24 million, which means that it will have to make considerable savings. There is no doubt about that. Some of the reasons for the overspend are quite interesting. The trust talks about an overspend from the last financial year, as well as about money that needs to be spent over the next year in order to meet Government targets and to comply with other financial pressures. Therein lies the message.
Health trusts have tried hard to meet the various targets that the Government have set. They have had to reduce waiting times and perform a certain number of operations and procedures, for example, in order to meet those targets. The problem is that, in doing so, they have overspent. It is a bit rich of Ministers to point the finger at health trust bosses who have done their bidding and performed the tasks that they were asked to perform, and who are now being threatened with the sack because they have overspent. The Government cannot have it both ways, and it is absurd that they appear to want to take that position.
It is likely that 190 beds will be lost in the hospital sector in my local health community. That is partly due to relocation to a new hospital site funded by a public-private partnership. I welcome the creation of the new health facilities, provided that they are used effectively and properly. My concern, however, is that that is not going to happen, because efficienciessuch as those relating to the use of theatre timethat need to be put in place now have not been followed through properly.
In the Secretary of States opening speech, she commented on the fact that my local hospital trust was going to make savings from the temporary agency staff budget. That might be quite clear, but she appeared to pass over the issue on the ground that that meant that there would be no loss of clinical staff on the front line. I simply do not accept that. While those savings are part of the recovery plan that the health trust is putting in place, it seems clear to me that the jobs of permanent front-line staff will be threatened.
I hope we will not have to make any more reductions in staff650 is a large number and will help to make substantial savings, but I cannot guarantee that there will not be further reductions next year.
We are talking about problems that are being experienced now, but I perceive that there will be significant problems next year, as we suddenly realise that the necessary
savings cannot be made and that more pressures are being brought to bear. As the chief executive of my health trust is suggesting, more job savings on the front line might be needed. Locally, there is considerable uncertainty. The local health economy faces a number of challenges, which the professionals, nurses and doctors are working extremely hard to meet, but the threats are there.
We are constantly told that what is going on is all down to local decision making. Therefore, the Government are in some way off the hook. However, I draw the Ministers attention to the fact that PCTs and other health bodies must adhere to the framework set by the Department of Health. Priorities set from the centre must be adhered to, spending levels must be followed and increases in spending cannot be applied elsewhere. The suggestion that it is all about local decision making and local management misses the point. It is about central direction, the priorities set by Government and failures from the centre. The localities must deal with that, but the problems are caused by the centre.
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