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9 May 2006 : Column 61WH—continued
1.15 pm
The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Mr. Ben Bradshaw): I congratulate my hon. Friend the Member for Sherwood (Paddy Tipping) on securing the debate. He rightly pointed out the timeliness of it, and had he not suggested in his closing remarks that we should consider the debate as the final contribution to the Government’s consultation on the review of their waste strategy, I would have made the same suggestion. He got that in just in time. I have a great deal of sympathy with the five points that he went through and assure him that we will consider them carefully and respond to them as part of the review process.
Like my hon. Friend, I am an enthusiastic home composter. I am fortunate enough to have a garden, which helps. There are some challenges, as I am sure that he will realise, in some parts of the country where that is not always so easy, but compost makes a great contribution to the paucity of London clay when it comes to growing flowers. The debate is an appropriate title for national composting week.
As my hon. Friend also rightly pointed out, we will have to up our game significantly in the next few years if we are to meet the demanding landfill targets, although he was also correct to point out that local authorities and individuals—this is about partnership—have done extremely well in recent years in increasing the amount that we recycle and compost.
We have trebled recycling in this country since Labour came to power in 1997. My hon. Friend’s local authority in Nottinghamshire has done extremely well. I had the figures to hand—I seem to have mislaid them—but I think that it was up by 30 percentage points for recycling and composting. In doing so, it has easily exceeded its targets, so many congratulations to those involved. Just before the debate, my hon. Friend handed me an invitation, hot off the press, from Nottinghamshire county council to celebrate the signing of its new contract. I would be delighted to do so if I am still in post, and my diary commitments allow.
As my hon. Friend rightly pointed out, one of the big challenges that we face in getting our response to the consultation on the waste review right is the financial framework. He talked about planning and funding, which are major obstacles to providing the infrastructure that we will need, as the Government realise. As I am sure he is aware, we changed the planning guidance about a year ago and are still considering how successful that has been in creating a better climate on the ground for the provision of major infrastructure. I hear from the industry that that has not made as much difference as they would have liked, but clearly we will want to
revisit the subject of planning. I will take his point about the parallel processes that have to be gone through to get a biodigester up and running. That seems odd to me.
My hon. Friend also kindly reminded hon. Members that concerns were raised with me by the community composting organisations in the voluntary sector about the proposed level of new fees under the licensing system. I intervened and we are currently reviewing that, and I hope that we will have something to say about it later in the summer that will make it easier for them to enter the market. I am determined that there should be an enhanced role for the community and voluntary sector—we say that explicitly in the review of our waste strategy—not just because it is doing good work on the ground and we think that it has the potential to do more but because it has a special educative function. It involves local communities in an important practice.
The point that my hon. Friend made about education and following best practice is extremely important. My own local authority in Devon had a successful campaign over recent years to encourage people to home compost. As a result, composting rates have risen considerably. As has been said, performance across the country is patchy. Some local authorities, such as my hon. Friend’s, are doing extremely well, whereas others have not done so well, and there are historic reasons for that.
One of the most important things that we need to achieve in our response to the review of our waste policy is getting the framework right. There is no doubt that there are some perverse incentives in how the current targets are set. The weight-based targets have, to a certain extent, boosted composting, because, like the rush for gas, in many local authorities there has been a rush for green waste collection. While green waste collection is a good thing to do, it has also, in some cases, been favoured by local authorities because it is an easy, quick and cheap way of getting their weight, recycling and composting figures up.
There are also challenges in respect of markets. My hon. Friend rightly pointed to the excellent work that WRAP has done in recent years, and will continue to do, to improve and grow markets. I am heartened by the general level of consensus that there has been during the review of waste policy about what needs to happen. It has involved a range of people, from the industry and political parties to green groups. If there are no markets for the stuff, things will not happen and will not be sustainable.
My hon. Friend raised an issue about the Olympics. If he thinks it a good idea, I shall write to the Minister responsible for the Olympics pointing out the importance of the sort of infrastructure that he described. His comments about the Olympics touched on another important point—the importance of procurement generally, not just in Government but across industry. He will be aware that we set up the sustainable procurement taskforce under Sir Neville Simms shortly after the previous election. It is about to report, and I think that it will have some important things to say about the importance of procurement policy in driving up the demand for recycled products. I know that that is not strictly to do with compost, but it is in the broader sense of the term; if we could drive up
the demand for recycled products, that would give a boost to recycling and composting.
I have described the framework. I abandoned my notes, because I felt that my hon. Friend’s speech warranted that. I accept the points that both he and my hon. Friend the Member for Ipswich (Chris Mole) made about the highly precautionary nature of the animal by-products regulation. I am acutely aware of that matter. I remember a ridiculous case—I think it was in south Wales—a year or so ago in which local authorities said that they could not accept teabags as part of composting because of the animal by-products regulation. There is always a danger of overreacting.
As was kindly acknowledged, one can understand the adoption of a highly precautionary approach in the aftermath of foot and mouth. Such an approach is right. Not simply because of the composting issue but because I have a desire to be proportionate generally in Government and as a Minister, I am always asking my officials to push the case in Europe for the issue to be reviewed. As we understand more about the level of danger and so on, there might be an opportunity for scaling back, which would be helpful in terms of the current restrictions on composting.
I shall give the ball park figures for what has been invested through WRAP and the waste minimisation and recycling fund. We invested £294 million over the three years to 2005-06. WRAP has done much important work trying to develop markets for compost, which includes the development of a recognised standard for good quality, green waste compost. Another advantage of creating more markets for that sort of compost is that it will take the pressure off peat; it is a win-win situation if we can preserve the peat bogs and encourage the reuse of valuable material.
As my hon. Friend the Member for Sherwood said, we are considering waste as a resource. If he has read the consultation document on our waste policy, he will I am sure have digested the fact that we want to move away from waste being treated as waste; we want to manage it as a resource. As a result, our waste policy will fit more closely with our general policy on sustainable production and consumption.
Mr. Mike Hancock (in the Chair): Order. We move to the next debate.
NHS Services (East Sussex)
1.26 pm
Norman Baker (Lewes) (LD): It is good to see you in the Chair, Mr. Hancock, and I am grateful for the opportunity to start the debate three or four minutes early—and I thank the Under-Secretary of State for Environment, Food and Rural Affairs, the hon. Member for Exeter (Mr. Bradshaw), as well for his help in that.
Of course, this subject is very important to my constituents. The Minister—I am glad to see that she is still with us after the reshuffle—will know that when opinion polls are taken, people say that the quality of the health service is at the top of their list of priorities. To be fair, the Government have put money into the health service over the years, and they have also managed to cut waiting lists; I want to recognise the good before turning to what may be a problem.
This is a time of uncertainty. We are seeing reorganisation in the health service in East Sussex that may be necessary to some extent—for instance, there is tremendous pressure on accident and emergency departments—but I hope that the Minister recognises that it can create uncertainty and divert people’s efforts away from delivering front-line services to considering bureaucratic structures. For example, she will know of moves to change the structure of the strategic health authority to make it a south-east authority, and of the proposal to merge primary care trusts in my patch. The mental health trust is coming together, and the ambulance service looks as if it will be larger than Sussex. All those trusts—only the acute trust will be left untouched—will be going through yet another cycle of reorganisation. I wonder how many more there will be. I have been an MP for only nine years, but the health service seems to have been in permanent revolution during that time. That is not sensible for the people involved in the health service or for my constituents or patients generally. We will also have payment by results, which will have interesting consequences.
Let me refer in parenthesis to the economic position of Lewes. The town is at the centre of my constituency; it is a relatively small town, but it benefits from a large degree of white-collar work, which allows it to continue to prosper. Much of that work is based on the health service. The town houses the headquarters of the local PCT and the ambulance trust, other health bodies have links with it and the county council is based there. It would be most unfortunate if, as a consequence of reorganisation, health service jobs were lost to the town. I hope that when the Minister is considering such reorganisations and possible changes to the location of headquarters, she will bear in mind the importance of maintaining a white-collar base in Lewes.
In particular, I want to talk about the impact of the job cuts in Sussex that are fast coming down the track. I said at the start of my speech that I recognise that the Government have put more money into the health service—they have—and the Chancellor has put in more money than ever before. It is therefore difficult to understand the reason for the headlines in my local papers. One headline in The Argus says “200 jobs cut to save the NHS £8 million”, and another says, “NHS in jobs crisis”. One in the Mid Sussex Times says “325 jobs to
go at hospitals”. Across the acute trusts in particular, we are seeing large-scale redundancies. For instance, the 325 redundancies at the Brighton and Sussex University Hospitals trust comprise 7 per cent. of the work force. The 250 jobs that are to go in Eastbourne at the East Sussex Hospitals trust form 5 per cent. of the work force.
By any standard, those are huge cuts. More than that, they will be random cuts, because the trusts are sensibly working on the basis of trying to avoid redundancies and allowing for natural wastage. Of course, that means that the cuts will come in haphazard fashion according to when people happen to leave—they may, in fact, be in the wrong places. There is no guarantee of a straightforward, sensible and clinical—in both senses of the word—approach to what happens. Instead, the job cuts will fall rather randomly. That will have an effect on front-line services.
It is not difficult to gainsay the suggestion that with7 per cent. of the work force going within a year, there will be no impact on front-line services. Clearly there will be an impact. Will the Minister explain how—I genuinely do not understand—when the health service has more money than ever, job cuts of such a magnitude are being made in our trusts? It is not a matter of one trust that has been badly managed. Trusts across Sussex, as referred to in my local paper, are affected.
The cuts are having other unwelcome consequences. I spoke last night to Dr. Andrews, the chairman ofthe East Sussex Hospitals trust local negotiating committee. He told me that things are moving to a stage at which even the most basic drugs are running out in hospitals, including antibiotics. Those are not expensive drugs, but basic drugs. He tells me that hospital doctors scout around for alternatives that can be used to treat patients, but which are often not the most desirable in clinical terms, and are often more expensive; they are just what happens to be there. The cash-flow problems of the hospital are now leading to wastage, with secondary clinical decisions sometimes being made which, although I am not saying that they are wrong, are not necessarily the doctors’ first choice. More money is spent in an attempt to save money, which is counterproductive.
Experienced staff are being replaced with less experienced staff—we have of course seen that happen in schools—because they come cheaper, being further down the grading scale. However, by definition they do not have the knowledge and detailed experience that is necessary for our hospitals. The consequence is that we have less experienced staff.
All those developments are very worrying to people in my constituency. With respect to the Brighton and Sussex University Hospitals trust—the one with the biggest deficit and the biggest problem—I am happy to concede that a part of the process may have been limitations in previous management decision making. I am happy to accept that that has been a part of the process if the Minister wants to argue the point. However, now that a turnaround team has been sent in by the Department, the trust’s historic debt, which is significant at £10 million, should be wiped off, provided that the trust can agree with the Department of Health and the turnaround team a process for going forward that will prevent further debt from mounting up.
That seems to me to be a compromise. If the trust is expected to deal with the historic debt as well as with the accumulating debt, the consequences for patients will be severe. Wiping out the old debt seems a way to bring some intellectual and financial rigour into the process while recognising that there will be a significant downside for patients if things are allowed to continue as they are.
That is not to say that money is not wasted in the health service. I particularly object to large pay-offs being made to individuals for reasons that are not entirely clear. I draw to the Minister’s attention the case of the former chief executive of the East Sussex Hospitals trust, Annette Sergeant, who was given special leave on 21 June 2005. She left the trust on 16 October 2005, officially
“to pursue new career opportunities”
in the health service. I do not know the ins and outs of that decision, but if Annette Sergeant was doing a good job why was she elbowed out of the trust? If she was not doing a good job, why was she given a big pay-off and found another job in the NHS? Neither outcome seems to make sense. She was either up to the job or she was not. Will the Minister confirm that Annette Sergeant received a pay-off in excess of £250,000 to leave the trust before taking up another job in the health service? How can that decision be justified in relation to public expenditure?
I mentioned that there is no reconfiguration of the acute trusts in the sense of changes to boundaries, but the Minister will know about the document produced by the Surrey and Sussex strategic health authority, “Creating an NHS fit for the future”. That document sets out some sensible analysis. By the way, Candy Morris is a very competent person to lead that organisation; I am impressed by her. However, the consequences of some decisions may well be very unwelcome for local communities. The decisions cannot simply be rushed through. In particular, there is a suggestion, as the Minister will be aware, that the hospitals in Sussex and Surrey, which by and large are all equal acute trusts with equal A and E facilities, will in effect become part of a two-tier system, with some hospitals having more A and E facilities than others.
There is particular concern in the eastern part of my constituency that Eastbourne district general hospital will be downgraded, may lose some of its A and E facilities and will probably lose its maternity unit. There is concern that because the East Sussex Hospitals trust runs both Eastbourne and Hastings, some procedures will be delivered in Eastbourne and some in Hastings. That is not satisfactory.
As local GPs have said, the key issue about core services is that they want key emergency cover, both medical and surgical, at both hospitals, not at one site. I do not believe that surgical emergencies should go to Hastings if they arise in Seaford or Polegate in my constituency. There is also a question about whether that saves any money. I am not sure that it does and it certainly creates problems of its own. The transport implications are significant. I understand that the ambulance trust has written to express concern about the idea that people from, say, Seaford, Polegate or Eastbourne will have to travel to the hospital in Hastings for a particular sort of care. The distance between Eastbourne and Hastings is significant and the
road system will not impress the ambulance service trying to get there. It is a single-carriageway road with many bottlenecks along it. The idea that because a trust happens to cover a particular geographical area, its services can be spread out so that only one centre deals with a particular function, seems to me to be inherently flawed, but it appears central to the logic of the strategic health authority paper.
We have already had some indication that services will be reduced at Eastbourne. My colleague in Eastbourne, Stephen Lloyd, who stood as a candidate at the last general election, fought to prevent cuts in children’s services when they were first mooted. The instinct of the trust throughout has been to deny that services are about to be cut or removed, only for that to be confirmed subsequently. It now seems likely that the maternity department at Eastbourne will be removed and that mothers will be expected to go to Hastings. Almost 4,000 children were born in the trust area last year, so assuming that it is a case of half each, 2,000 people will be expected to go from Eastbourne or, even worse, from Seaford or Polegate—even further away—to Hastings to give birth. That is unacceptable.
The hon. Member for Eastbourne (Mr. Waterson), who cannot be here today, is also concerned about the matter. Indeed, I think it is fair to say that the concern is shared by all East Sussex MPs, including—I do not want to misrepresent him—the hon. Member for Hastings and Rye (Michael Jabez Foster), who is one of the Minister’s colleagues. I think that he, too, is concerned about some of the proposals. It would therefore be helpful if the Minister gave precise details of the timetable for any proposed changes, where they are in the system at the moment and what form of consultation will take place on them, with specific reference to the East Sussex Hospitals trust and how those issues dovetail with the strategic health authority document.
May I remind the Minister that there is an issue about patient transport, particularly from rural areas such as Seaford in my constituency, if people are to be expected to get to Hastings? In a written answer from one of her colleagues on 8 November 2004 to a question that I asked, the Government stated:
“The principle which should apply is that each patient should be able to reach hospital in a reasonable time and in reasonable comfort, without detriment to their medical condition”.
However, the answer also stated:
“A clinical need for treatment does not imply a medical need for transport.”—[Official Report, 8 November 2004; Vol. 426,c. 543W.]
I accept that as a statement of fact. However, I am concerned—I hope that the Minister will recognise this point—that as facilities move further and further away from patients in particular cases, the distance, time taken to travel, need for transport and cost all become greater. All those are downsides in terms of patient care that I am sure the Minister does not want.
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