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24 May 2006 : Column 488WH—continued
David Taylor (North-West Leicestershire) (Lab/Co-op): Although I do not agree with all the hon. Gentleman’s preliminary comments, does he agree that one of the problems is that the market has, in a sense, been created the wrong way round? It does not give PCTs sufficient powers or resources and does not allow them to be big enough to be comparable in power to acute hospitals. Where acute hospital trusts have had problems, they have, in their enfeebled position,
transferred financial pressures into areas over which they have more control, such as community hospitals. Perhaps the Government have now addressed that by allowing larger PCTs to emerge, similar to the one that has always been present in North-West Leicestershire, which is more comparable to the acute hospitals in the area. Does the hon. Gentleman agree?
Peter Viggers: I do agree. PCTs have been required to pay so much of their budget to hospital trusts that it has been difficult for them to develop the community facilities that are needed.
I would describe some of the difficulties in the national health service as tactical problems, which derive from the Government’s obsession with micro-management. Let me give three examples of that micro-management in the setting of targets. A cancer specialist was sitting in her consultation room, when a manager burst in and said, “You must see the woman in the waiting room immediately.” The cancer specialist said, “I cannot possibly see her. She hasn’t been referred to me by a GP. I haven’t got her notes. She has not been given any tests. It would be absolutely pointless for me to see her.” The manager said, “You must see her immediately. She’s been booked in. Every minute that she sits there runs against our averages. You must see her now.” I can vouch for the truth of that story because I am married to the doctor in question.
I can also vouch for the truth of my second example, although I will spare the blushes of the person involved. I went to see a hospital manager, who told me, “I know, Mr. Viggers, that you have not received the service that you need from this hospital group, but I can assure you that the situation will change. We have doubled the size of our complaints department and put three new people in the public relations department, so I am sure that you will get a much better service in future.” People simply do not understand.
I can vouch for the truth of the third example, as well. An accident and emergency unit had to meet its targets and set a period in which to do so. For weeks in advance and for weeks afterwards, there was distortion and difficulty and the unit was all over the place, but it met its targets during the relevant period. The important thing, however, is not meeting the target, but giving a good service.
Let me also give an example of the manner in which the Government have messed around with primary care trusts. In my area, we had Gosport primary care trust, Fareham primary care trust and East Hampshire primary care trust. Then Fareham and Gosport were merged. Then, in an incredible move, it was decided that the two primary care trusts should share management facilities with another primary care trust. Then both were merged with East Hampshire. Now there is to be a merger for the whole of Hampshire. That is very bad management.
I also have serious reservations about the PFI process. I was in the Treasury as a Parliamentary Private Secretary many years ago when the PFI process was first thought up. The point then was to bring private sector skills into the public sector. Now,
however, the Government use the PFI process to get borrowing off balance sheet. It is a notable fact that about £2 of borrowing is off balance sheet compared with every £1 on balance sheet. That is very worrying.
Another point is that the contractor who takes the risk under a PFI scheme is in the private sector—he is there to make money, not to lose money. Therefore, in assessing the risk over the 30 years or whatever the period is, he has to assume the worst from his point of view. Almost by definition, that means that the price will be at the higher rather than the lower end of the range. It would take a great deal of skill to make up for that higher price.
David Taylor: Hearing “PFI” triggers in me a sort of Pavlovian response. Does the hon. Gentleman agree that, despite all the wonderful things that the present Government have done in the NHS in the last nine years—I mean that seriously—the PFI is a blemish on that record? It is prohibitive in cost, flawed in concept and intolerable in consequence for taxpayers and the patients and staff in the NHS. More traditional and conventional forms of financing would have avoided some of the difficulties that the hon. Gentleman is illustrating so effectively.
Peter Viggers: Although I am spiritually in tune with some of the criticism made by the hon. Gentleman, I have to say that the PFI inevitably has some disadvantages. I remember attending a meeting addressed by Sir John Bourn, the head of the National Audit Office. He pointed out that contractors who had undertaken PFI arrangements over the past 30 years had done so before the invention and use of the MRI scanner, which blew all the estimates sideways. None of us knows how medical technology will evolve in the next 30 years, so it is impossible to take a clear and firm view about the next 30 years. There is much to be said for PFI schemes if they are properly administered, but they need to be reviewed every five years or so.
Mr. Christopher Fraser (South-West Norfolk) (Con): Does my hon. Friend agree that if cottage hospitals such as Swaffham and Thetford in my constituency are to continue their excellent work, Government funding must take into account their position in relation to county hospitals? In Norfolk, the Queen Elizabeth hospital in King’s Lynn, the Norfolk and Norwich hospital and others used by constituents in my area face a shortfall in funding. That has a profound effect on the services that they deliver and in turn puts more pressure on the cottage hospitals that serve the same community.
Peter Viggers: My hon. Friend is an assiduous campaigner on behalf of his local hospitals and he makes a fair point on behalf of his constituents, for which I thank him.
On a strategic basis, because there will always be unlimited demand for medical care, a mechanism is needed to govern its use. The present Government will never be able to get that right: their commitment is to central control, including central control of spending, which will always hamper them. The Government ranks are notably short of business skills and
experience and notably full of those who have only spent rather than ever earned money. Conservative principles will be to seek harmonious arrangements with the national health service and an integration of the private sector. We need to choose good managers and then to trust them.
As it is, we have a cash crisis. The health services in Hampshire overspent by £80 million in the year before the election, and we are told by Sir Ian Carruthers that after adjustments they will need to recover some £160 million, preferably during the current year. That leads to intolerable pressures and the closure of hospitals. At present, there are about 350 community hospitals and 80 or 90 are under threat.
That brings me to January 2006 and the document “Our health, our care, our say: a new direction for community services”. I am sure that I and my hon. Friends would support many of the principles that are articulated in it. To quote a statement from that document:
“Some community hospitals are currently under threat of closure... we are clear that community facilities should not be lost in response to short-term budgetary pressures”.
“We will...invite interested PCTs...to bid for capital support”—
2.46 pm
Sitting suspended for a Division in the House.
3 pm
Peter Viggers: To continue my quotation from “Our health, our care, our say”:
“We will further invite interested PCTs...to bid for capital support... This will provide the opportunity to create many new community hospitals”.
I very much welcome that, and I would like to fold in another reference to the armed forces, which I mentioned earlier.
In 1998, the Government decided to sever the link between armed forces personnel and the armed forces medical services, so that instead of persons in the Army, Navy and Air force automatically being treated by Army, Navy and Air Force doctors, nurses and paramedicals, they are now given initial primary care at the front by their own personnel and then shipped back, after which they are reliant on the national health service. There is therefore no necessary link between armed forces personnel and those who are injured, which can have some extremely disadvantageous effects.
To cite an example from a newspaper on Sunday, a reservist who had severe spinal injuries was given a walking stick and told to find his way to his own general practitioner. He has had nine operations on his back, which is still causing him extreme difficulty. That has happened because although personnel in the regular armed forces have priority in the national health service, reservists do not.
3.1 pm
Sitting suspended for a Division in the House.
3.16 pm
Peter Viggers: I was pointing out that armed service personnel are no longer treated within the armed forces but are treated within the national health service, where they are supposed to receive priority. There are two problems with that. First, reservists, when they are dismissed from active service, do not get priority. Secondly, there is no point in having priority if there is no service to have priority within. I specifically cite mental health services. A significant number of service personnel, particularly reservists who have served in Iraq, are suffering from post-traumatic stress disorder but there are no facilities within the national health service to treat them and the only residential unit has closed. Within the Hampshire Partnerships NHS Trust, which treats mental health patients in the south of Hampshire, there were no new consultations at all for many months last year. For both those reasons, I maintain that the present arrangement is not satisfactory. I know that service chiefs are seriously worried about the medical provision for armed services personnel.
There is such a difference between the Americans’ attitude and ours. In America, the attitude is, “If we put our boys and girls in harm’s way, we will do anything to put them right if they are injured.” The attitude in the British armed forces is that if someone is injured, facilities are available in the national health service and one must go and seek them. It is not satisfactory and service chiefs are worried.
There is a model that we could develop. The Aldershot centre for health is a partnership between the Army and Blackwater Valley and Hart primary care trust. It provides excellent facilities, including GP practices and nursing teams, health promotion, diagnostics, counselling services, and drug and alcohol teams. It also has an Army medical reception ward, general practice and psychiatric services, and a standing medical ward. That is the kind of facility that I believe should be used as a model for the constituency hospital of Haslar in Gosport.
I tabled a question last week asking the Secretary of State
“whether his Department has assessed the Aldershot Centre for Health as a model which could be followed at The Royal Hospital Haslar.”
Rather encouragingly, the Ministry of Defence states that it
“will be assessing options for innovative partnerships...particularly in the light of NHS developments and future military basing. However, it would be premature”—
“to model another facility on the Aldershot Centre for Health until the functional success of the project has been evaluatedand any lessons have been identified.”—[Official Report,17 May 2006; Vol. 446, c. 958W.]
I hope that the Ministry of Defence and the Department of Health will work together and, even now, find a way ahead for the Royal hospital Haslar.
John Bercow (in the Chair): Order. If there are no further Divisions, the debate will conclude at 4.30 pm. It might help hon. Members if I explain that I intend to call the first of the Front-Bench speakers at or close to 4 o’clock. Right hon. and hon. Members will be ableto do the arithmetic for themselves, and if they tailortheir contributions accordingly it will be possible to maximise the number of Back-Bench contributors.
3.19 pm
Mr. David Drew (Stroud) (Lab/Co-op): I take careful note of what you say, Mr. Bercow. I will keep my remarks as brief as possible.
I congratulate the hon. Member for Gosport (Peter Viggers). I, like him, want to talk about local problems. That is the best way to approach the difficult debate on how we can save our community hospitals and enhance our community services. I have a series of questions for my hon. Friend the Minister that relates largely to how “Our health, our care, our say” is to be implemented, about which the hon. Gentleman spoke.
I am the fortunate possessor of a document that was sent to all strategic health authority chief executives and directors of performance. It is a public document, so I am in no way leaking information, and it is entitled “Moving care closer to home”. It takes up two sides of paper, which is wonderful, because the issue does not need to be spelled out any more clearly, and it highlights community hospitals. I shall read two paragraphs from it:
“In many parts of the country, community hospitals are an important part of the strategy of moving care closer to home. This vision for the future of community hospitals was set out in chapter 6 of the White Paper and the new generation of community hospitals could be either new or refurbished existing facilities. Further guidance will be available in the summer.”
It would be nice to hear from the Minister when that further guidance will come. The letter goes on:
“Where reconfiguration proposals of existing community hospitals relate to facilities that are clinically not viable, or which local people do not want to use, or which cannot economically be raised to modern standards, then local reconfiguration is right but we need to ensure that all such proposals are consistent with the long term strategy of the White Paper to move care closer to patients’ homes. This is why the White Paper makes a commitment that”—
“‘PCTs taking current decisions about the future of community hospitals will be required to demonstrate to their SHA that they have consulted locally and have considered options such as developing new pathways, new partnerships and new ownership possibilities. SHAs will then test PCT community hospital proposals against the principles of this White Paper.’ (para 6.43)”
That is an important mechanism for primary care trusts, and in Gloucestershire all the trusts are facing cuts as a result of problems that I would argue are not of our making. [Interruption.] Well, that is not entirely true of my own primary care trust; I shall be very careful. However, I have always argued that it was wrong to create three primary care trusts in Gloucestershire; there should have been two, and we are now moving to one. Cotswold and Vale primary care trust—my local PCT, which I share with the hon. Member for Cotswold (Mr. Clifton-Brown)—was created with a deficit. That deficit has not got any worse; the problem is that we are in the strategic health authority from hell, and I look at the hon. Member for
Northavon (Steve Webb) as I say that. It is continually overspent, and I could share some of my problems with the hon. Member for Westbury (Dr. Murrison) as well.
It is because of those problems that Gloucestershire, which has largely kept in balance, is being penalised. It is being asked to make good some of the problems of the strategic health authority and to come into balance very quickly. There is an argument going on—and I shall advance it with the Secretary of State—about how quickly we are expected to get into balance. That is a key debate, but I shall not say much more about that now. In my area, there is a proposal to shut Berkeley hospital. That proposal has been round the circuit before, but it is being eagerly progressed now.
Dr. Andrew Murrison (Westbury) (Con): I have been following the story closely in the Stroud News and Journal and read the hon. Gentleman’s remarks assiduously. I am sure that he is as confused as I am about whether his trust is required to balance the books in-year or over three years, because there appears to be conflicting advice coming from his hon. Friends on the Front Bench. Has he considered that, particularly in the context of Stroud maternity hospital?
Mr. Drew: Absolutely; I shall come to Stroud maternity hospital in a minute, because I want that clarified. I have certainly made it clear to my right hon. Friend the Secretary of State that there is confusion about the difference between being brought into balance this year, and being brought into balance while dealing with historical problems, of which there are some in Gloucestershire, although they are nothing compared with those elsewhere in the strategic health authority. That is part of the debate.
Shutting Berkeley in the south of my constituency and trying to relocate those facilities would be a highly dangerous path to take. I can see Berkeley being shut but there still being no money available to create new facilities in the Cam and Dursley area. I want to maintain Berkeley hospital. I am willing to look at the argument for a community hospital with a changed series of objectives. Berkeley hospital has done that well over the past decade and more but, for a population of 50,000 people, we cannot shut a facility until we open something else. I accept that Berkeley serves a smaller proportion of the population in the southern part of my constituency, but it can still fulfil a number of key objectives. If Berkeley were to close tomorrow, that would cause dramatic pressure elsewhere, on Stroud general hospital and, again, the acute facilities.
The cuts are being driven forward at a relentless rate—we are talking signed, sealed and delivered in five weeks, which is abhorrent. People cannot consult and come up with alternatives in that time. I intend to bring forward alternatives and we will test the model.
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