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12 July 2006 : Column 476WH—continued
“Nurses are scared, upset and demoralised—they feel like they’ve worked flat out to deliver Government targets and this is their reward.”
With all those developments affecting the NHS in east Hertfordshire, hon. Members will see immediately how hollow the Secretary of State’s words sound to my constituents.
Part of the problem is the Government’s obsession with reorganisation. I have been a Member of Parliament for five years, and in that time the Government have restructured, de-merged, re-merged and reorganised the ambulance trust at least once and the PCTs twice. The new strategic health authority will be in its third incarnation—I thought that only Dr. Who could change his form so often. The whole structure of health care in Hertfordshire seems to be up for grabs. Chairs are delicately moved around, but nothing is done about the service. Reorganising and restructuring will make no difference if the fundamentals are not dealt with.
That leads me to my principal point. In Hertfordshire, the truth is that patients are not getting their fair share. NHS spending per person in Hertfordshire is just 90 per cent. of the average for England. On last year’s figures, the shortfall is £69 per person, which means that my constituency lost out by £5.2 million last year. For the county, it is £69 million in one year. Of course, it does not stop there. England itself is a poor relation when compared, for example, with Scotland. On last year’s figures, patients in Hertfordshire got only £614 per person, but Scottish patients received £855 per person. That is a gap of £241 per person or, in my constituency alone, £18 million in one year. It is an iniquity, which will appal many people, and to which I hope the Minister will respond.
Mr. Heald: Does my hon. Friend agree that it is also odd that people in the Secretary of State’s constituency get £1,306 per head, whereas people covered by the PCT that we share get £1,057 per head? Again, the first figure is 30 per cent. higher.
Mr. Prisk: I think that that leads quite accurately to the central point that concerns us all. We simply seek our fair share. We do not want better treatment, but we certainly do not want worse. Whatever the apparent wealth of our areas, whether that is measured by house prices or incomes, the truth is that an elderly person’s worry in Hertfordshire about whether they have cancer is as important as it would be if they lived in any other part of the country. That is the iniquity that we are dealing with today. I hope that the Minister will have the courage not to hide behind the usual platitudes that we hear from her boss, but to tell us the truth, and give us the assurances, that our constituents seek.
3.21 pm
Mike Penning (Hemel Hempstead) (Con):
I congratulate my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) on obtaining the
debate, and my right hon. and hon. Friends who represent Hertfordshire constituencies on showing the House and our constituents how much we care about their health care.
The national health service was created as a level playing field. It was there for all those who needed health care and could not afford to pay for it. On the estates where I grew up in north London, the hospital was the focal point of the community, because that was where people could go when they needed help. Many people in the areas of north London where I was brought up moved out to Hemel Hempstead in the 1950s, to the wonderful new town with its gardens, hospital and college, and all the facilities that they perhaps struggled to get before.
A wonderful acute general hospital was built in Hemel Hempstead in the 1950s. Smaller hospitals were closed and the full acute hospital was created. It fought for 30 years, under different Governments, to find out whether it was safe and would remain. Eventually, 10 or 12 years ago, it was concluded that it should be left alone, and investment was put into it, which meant huge amounts of money, under Conservative and Labour Administrations. A brand new stroke unit was built; huge investments were made in the cardiac unit; and a maternity unit was built up, which then closed, after which a new birthing unit opened—no one quite understood why, but there was an election in the middle, so perhaps we may assume that that had something to do with it. That hospital is a facility that is there to be used.
Great Ormond Street hospital was there to deal with the need for specialist care for children, and people who needed specialist cancer care could go elsewhere. My wife is presently visiting the Royal London hospital, because it has the best haematology department, whose services she needs. That is not what we are asking for in Hemel Hempstead. What we wanted, and what we have, is an acute hospital.
I shall probably be the last hon. Member to speak in the debate before the Front-Bench spokesmen make their speeches, and that is right, because what is happening is terminal for Hemel Hempstead. The acute hospital will go. If the trust gets its way, next spring it will send the bulldozers in to Hemel Hempstead hospital. It will become a housing estate. If we are lucky, I am told, we shall have an independent sector treatment centre—a surgery centre for elective surgery. I have plainly said that I do not want an ISTC. We have three theatres and an elective surgery unit. We have five theatres at St. Albans, doing the job now.
As I understand it from the evidence given to the Select Committee on Health, on which I have the honour and privilege to sit, the rules for ISTCs are that they are not permitted to create a demand; an ISTC is supposed only to replace something that is missing. What is happening in our part of Hertfordshire is that a demand for an ISTC is being created by knocking down a hospital and five theatres, an out-patient department and an elective surgery department at St. Albans. We must ask why.
Several of my hon. Friends have discussed the fairness of the funding formula. I think that it is unfair that the Minister has been picked on for the fact that
her constituents receive more than mine, because there are some constituencies, such as Sedgefield, where people get £300 to £400 more per head than my constituents. I do not know why. Evidence was given to the Health Committee about that last week—by the way, we in my constituency got about £960 per head of population last year, rising to about £983 this year; some constituencies get as much as £1,600 per head. That is shameful when it is to be hoped that patients will, in the end, be treated similarly for the same ailments and problems.
I have a problem in Hemel Hempstead because, as a London overspill town, it has areas of serious social and economic deprivation. That is not just because of the Buncefield disaster—after which the hospital’s emergency services did fantastically well in treating the injured; God forbid that the hospital should not have been there, which would have meant going to the emergency centre at Watford. Perhaps some of those people would not be alive now, because two people were very seriously ill after the explosion.
What would it take to clear the deficit and to decide, “We do not need to do this”? The chief executive, in the presence of my hon. Friend the Member for South-West Hertfordshire, said that the closures would not take place if there was no financial problem. What is happening is not reconfiguration; it is cuts. We are trying to get more out of less. It is that simple. We will move all acute services to Watford; we will not go ahead with the promised private finance initiative building; we shall put in portable buildings. Eventually we dragged from the chief executive the truth about the life expectancy of those buildings. It was 40 years—instead of the promised new hospital.
The residents of Watford, Welwyn and Hatfield, St. Albans and other parts of the country were duped. They were made promises that there was no intention of keeping. The funding formula problem—the deficit—has existed for years. Ministers in Select Committee and chief executives of other trusts have argued that the problem is one of management. The managers are not doing their jobs properly. How can that be, when the trust has been changed three times, the PCTs have been changed and the whole of the strategic health authority has been changed? They cannot all be bad, surely. Surely there must be one good manager somewhere in the NHS, because, clearly, they do not have such a problem in other areas. There is clear evidence, however, that areas without so many problems get a lot more money.
I want to close by explaining exactly what will happen to the Hemel Hempstead hospital. We have a full acute hospital with out-patients, elective surgery and, most importantly, as was explained earlier, the acute blue-light facilities, for those who need them. There are 250,000 people relying on the accident and emergency unit at that hospital. It is proposed that all of that should go by next Easter. The whole site will be up for redevelopment. I know that, because I was lucky enough to find out that the trust had had meetings with my local council asking what it could build on the site; I know, because eventually at the Select Committee I dragged from the chief executive the information that the land and facilities will be surplus to requirements. Surplus to requirements? It is a general hospital, which people rely on!
Lives are at risk. I am conscious of the need to leave time for the Minister’s response, but we are not playing a numbers game. We are not saying that some people are nasty and some are good. We are talking about ordinary people, who deserve the NHS that was created many years ago as a level playing field. Watford is in the premier league; it is a fantastic result. The Saracens are doing very well. Hon. Members might like to try going down the A41 from Hemel Hempstead at any time without a blue light. I drove blue-light emergency vehicles and I know how difficult it is. They will not get there. The Government are putting lives at risk.
My hon. Friend the Member for Welwyn Hatfield (Grant Shapps) invited the Minister to visit the hospital in his constituency. I shall not do that, because thousands of my constituents have invited the Secretary of State, but she is too busy. I asked to see her diary and she was too busy to show me that, too. It is a disgrace, and lives will be lost.
3.29 pm
Dr. John Pugh (Southport) (LD): I congratulate not only the hon. Member for South-West Hertfordshire (Mr. Gauke) but all hon. Members who have spoken so emphatically about their fears for their services. I shall not comment in detail on the local circumstances—I defer to their greater knowledge on that subject—but I shall make some general remarks, as the issues affecting Hertfordshire emphasise some familiar themes and common problems that occur elsewhere.
The hon. Gentleman originally drew to our attention two problems. One was the problem of underfunding, which seems to affect all services across the piece, and the other was the problem of hospital reconfiguration, with the hospital trusts having substantial deficits, in excess of £20 million. The Government’s response to deficits is usually that trusts should get a grip and balance the books, which of course always travels with a presupposition that we already have a fair formula across areas and even within areas, between institutions. However, I see no evidence that we have yet arrived at that state.
There is also another common phenomenon in Hertfordshire, which is that of a number of smallish hospitals in clusters, with pressures on all services.
Mike Penning: I do not think that the hon. Gentleman has been to my part of Hertfordshire, but we do not have a small hospital. The Watford general hospital is not a small hospital and neither is the QEII hospital. They are massive acute hospitals, not little community hospitals, as he is describing them.
Dr. Pugh: I was not suggesting that they were community hospitals, but the descriptions are relative, and we could compare them with St. Thomas’ hospital over the river from here.
I am familiar with the scenario, because I come from an area where there are two hospitals that I would describe as relatively small in NHS terms and that are separated by the sort of distance that separates some of the Hertfordshire hospitals. I am fairly familiar with the problem—I know that hospitals belong to distinct communities, I know that travel between them is rarely ideal and I know that there is strong community
resistance to changes in local hospitals. I also know that when change takes place, there is an unconvincing process of local consultation that satisfies nobody and buys nobody off.
There are usually two drivers for reconfiguration. A clinical driver to do with the concentration of expertise is usually cited in evidence, and there is usually a financial driver. The financial drivers on hospitals involve not only deficits but other things, such as the working time directive and the junior doctors’ contract, which put additional pressures on hospitals in all areas. None the less, people in Hertfordshire are quite justified in fearing reconfiguration, because reconfiguration and all that it evokes has a pretty poor reputation across the NHS.
Looking at the SHA consultation on reconfiguration in 2003 from an external point of view, I thought that an attempt was being made—although probably not a successful one—to give everybody a little piece of the action or to satisfy everybody, if I may put it like that. Clearly that effort failed and was replaced by something much more unacceptable. In my neck of the woods, with two hospitals separated by the same sort of distance as between Watford and Hemel Hempstead, we have already lost obstetrics and paediatrics in Southport.
Anne Main: The hon. Gentleman talks about the same distance as between Watford and Hemel Hempstead, but would he agree that the Minister should ensure that if any service is to be moved to Watford, the road configuration should be altered—which is exactly what we were promised—before any development of the hospital takes place? Perhaps the Minister knows better than I do, but I have yet to see any details of that road configuration or that road investment.
Mr. Mike Hancock (in the Chair): Order. That sounds like another speech.
Dr. Pugh: That is absolutely the point that I would re-emphasise, as similar problems are faced in many areas. In my neck of the woods, where two hospitals are owned by the same trust, the road is an issue and travel is the one thing that is most ignored.
I was not surprised to find, on looking into the matter, that the offer that was originally made in the 2003 consultation has been further downgraded. At one stage there was talk of having a birthing unit in Hemel Hempstead and using it to spread good practice elsewhere, but I understand that that is now unlikely to happen. As the hon. Member for Hemel Hempstead (Mike Penning) said, the best that will happen is that an ISTC will emerge. That is a common pattern in different places, with the same meaningless consultation forming a backdrop. Scrutiny and review sections of councils debate things, but the financial position continues to deteriorate.
We can anticipate the Government’s response, which is also fairly familiar. In most such debates, the Government will say that people ought not to be wedded to bricks and mortar, that services can be delivered in the community and—to a lesser extent—in secondary care, that institutions have to co-operate,
that clinical networks have to be delivered and that people will travel for the best possible service.
However, that aspect of Government policy does not hang together with something that was cited several times in the consultation, which is the Government’s own policy of keeping the NHS local, which produced a well-known pamphlet that is much cited but rarely acted upon. That policy recognises that although people are ready to travel for specialist care, they expect to find many services locally, particularly A and E services and those that look after people with chronic conditions that involve repeated journeys to hospital. Additional travel in such cases means extra trauma. Someone who has to go further to an A and E department might not arrive with a long-lasting problem or even with a major trauma, but for someone travelling with a child to A and E who is not sure what is wrong, every extra mile is a very unpleasant experience.
People do not mind clinical networks, if that is what the Government want, but they want the clinical networks that suit them and their clinical needs. As it is, reconfiguration across the piece normally results in health authorities presenting a menu, a rather bogus form of consultation taking place and, when it is completed, people often choosing to go in unexpected directions, rather than to the hospitals to which they were expected to travel in the first place. As many hon. Members have said, the backdrop is often the need for a quick financial fix, which discredits any reconfiguration proposal whatever.
Mr. Lilley: On a point of order, Mr. Hancock. Is the hon. Gentleman’s speech in order, as it is not about Hertfordshire?
Mr. Mike Hancock (in the Chair): The hon. Member is entitled to put a view about the consultation, but I remind hon. Members that we are about to have a Division and it would be appropriate to give everyone a fair chance to speak in this debate.
Dr. Pugh: I shall finish shortly, as I said I would, although I also said that I would make some general remarks that would probably apply to Hertfordshire, as well as to other places.
If there is a mistake—as there must be—it is not beginning with community needs. The public are not stupid; they know that they cannot have everything everywhere. However, they want good quality, timely and accessible services but, as hon. Members who have voiced their opinions so far have made clear, Hertfordshire is not getting them.
3.36 pm
Mr. Stephen O'Brien (Eddisbury) (Con): I, too, congratulate my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) on securing this important and timely debate.
3.37 pm
Sitting suspended for a Division in the House.
3.52 pm
Mr. O'Brien: Having congratulated my hon. Friend on securing the debate, I also pay tribute to the measured, serious way in which he presented his overwhelming and unquestionably cogent case on behalf of his constituents, demonstrating his concern for their health and well-being.
We have heard from the massed ranks of Conservative Members of Parliament representing Hertfordshire this afternoon; eight out of nine have contributed to this debate and the ninth would have attended, but for being away necessarily on Select Committee business. It is notable that the two Labour MPs who represent Hertfordshire are absent. The Liberal Democrat spokesman, the hon. Member for Southport (Dr. Pugh), concentrated on general points because, thankfully, Hertfordshire, like Cheshire, is a Liberal Democrat-free zone.
I make no apology for focusing on the financial issues, because those lie at the heart of so many of the points that have been raised and have real effects on patients and the constituents of my right hon. and hon. Friends, as we have heard. It is right for us to debate financial issues today, because those are in the power, remit, gift, discretion, authority, responsibility, duty—whatever people want to call it—of the Minister and the Secretary of State; there is no escaping that.
Bedfordshire and Hertfordshire strategic health authority, which is now subsumed into the East of England SHA, has had to make significant savings in an attempt by the Secretary of State to mitigate the NHS deficits. In month six of 2005-06, the SHA was predicting a surplus of £18,000, which was 0.2 per cent. of its turnover. In month 12 it delivered a surplus of more than £19 million—20.7 per cent. of its turnover—which was generated by a mere £200,000 underspend on administrative budgets and enhanced by underspends on training at £3.5 million, the national programme for IT in the NHS at £3.9 million, central budgets of £6 million, a carry-over of £2.6 million from the 2004-05 underspends and an allocation from the national health service bank of £3 million.
As a total health economy across all the NHS organisations in this area, the SHA had a total deficit of £107.9 million in 2005-06. I found that figure, which breaches the SHA’s control total by £33 million, in the financial report of 20th June 2006, presented at the final board meeting of the Bedfordshire and Hertfordshire SHA before it was subsumed into the East of England SHA. The SHA has been given a control total deficit of £80 million for 2006-07, necessitating savings of £150 million, which is enough money to employ just over 8,000 nurses a year and is eye-watering by any standards.
Mr. Prisk: My hon. Friend rightly highlighted many of the financial issues, but is he concerned about the constantly changing figures coming from the Government? People working in health care keep being asked to do new things and change, which is debilitating for many of them.
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