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12 July 2006 : Column 482WHcontinued
Mr. O'Brien: My hon. Friend is correct. Anybody with any management experience would know that that is precisely the case.
I am delighted to inform hon. Members that the hon. Member for Watford (Claire Ward) has had a baby. I congratulate her on behalf of the Conservatives. That is the best excuse for not attending a debate. However, there is no excuse for the hon. Member for Stevenage (Barbara Follett), who has not had a baby.
The savings that I have mentioned, which are equivalent to 8,000 nurses a year, are so high risk that the SHA has told the Department of Health that it requires a control total of £99 million, but expects that downward pressure will be applied to the control total requested by the SHA. With that cash squeeze, it is unsurprising that the SHA area is resorting to drastic measures. In 2006-07, the SHA is reducing education places by 12 per cent. on the previous yeara total of 122 placesand is looking to shed 1,100 whole-time equivalents. In addition, underspends are not being returned and the primary care trusts are required to deliver 3.5 per cent. in cash-releasing efficiency savings. Cuts to mental health services were ably described with deep concern by my hon. Friend the Member for North-East Hertfordshire (Mr. Heald). We are also talking about cuts in podiatry, a transfer of thrombolysis services and cuts to sexual health services. My hon. Friend the Member for St. Albans (Anne Main) also cited a long list of services knowledgeably, robustly and compassionately.
The situation is so bad in the west Hertfordshire quadrant that the auditor issued a public interest report in April 2006, which highlighted the apparent weaknesses in the arrangements established by the PCTs to ensure effective financial governance and the poor financial information being presented to the board. The auditors also highlighted the adverse impact of the considerable uncertainty caused by NHS restructuring. Most of all, the auditors report shows that Ministers have failed in their duty to oversee our NHS, as my right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) ably illustrated in his contribution.
This crisis did not happen overnight. For example, the West Hertfordshire Hospitals NHS Trusts deficit grew from £4.6 million in 2003-04 to £14.6 million in 2004-05 and £43.2 million in 2005-06. In both 2003-04 and 2004-05, the Audit Commissions relationship manager for the SHA reported on the weaknesses in financial management and the structural issues contributing to the poor financial standing of all bodies in the Bedfordshire and Hertfordshire SHA area.
Furthermore, the public interest report constitutes one of the 20 referrals in 2006 of NHS bodies to the Secretary of State under section 19 of the Audit Commission Act 1998. There were seven referrals in 2005, two in 2004 and none in 2003. This is a worsening picture. In addition, auditors posted 93 qualifications on the accounts last yearaccounting for the doubling in the forecast NHS deficit for 2004-0553 in the previous year and none in any year before that.
The problem of NHS deficits has not suddenly appeared; it has been allowed to worsen because of the failings in the Department of Health and among its Ministers. My hon. Friend the Member for Hertford
and Stortford (Mr. Prisk) quoted the Secretary of State talking about the best year ever. He also observed rightly that reorganisations are often the Governments only retreat to try to escape accountability and blame others. Above all, failed managers are being recycled, thereby demoralising the best, who move on and out. We have a downward spiral of morale and performance.
Despite the financial difficulties, it is unacceptable that the former SHA area should be forced to make cuts to front-line patient services to find cash, especially where such cuts are driven by financial rather than clinical needs.
Regarding the West Hertfordshire Hospitals NHS Trust, we have heard about the scaling down of services at Hemel Hempstead and the building of an independent sector treatment centre there. My hon. Friend the Member for Hemel Hempstead (Mike Penning) eloquently described how the argument for the introduction of the treatment centre puts the cart before the horse. That is no way to manage our NHS.
Does the Minister find it acceptable that most of a relatively new hospital should be demolished and turned into a housing estate because it is surplus to requirements? Acute and emergency services are to be centralised at Watford general. Can the Minister guarantee that that will in no way affect patient care? The trust has announced upwards of 700 job losses and 878 bed cuts. East and North Hertfordshire NHS Trust, which has to save £69 million over three years, is set to lose 100 jobs and 1,055 beds, as described in a passionate and sincere speech by my hon. Friend the Member for North-East Hertfordshire. In addition, services are being decimated at the QEII hospital in Welwyn.
Part of the difficulty for hospitals has been the financial pressure put on them by primary care trusts, although it is the organisations that do not have payment by results, such as the mental health trusts, that are most at risk from cuts in front-line services by the eight Hertfordshire PCTs, all of which are in deficit. The effect on, for instance, Potters Bar community hospital was rightly and graphically described by my hon. Friend the Member for Hertsmere (Mr. Clappison). Two sites are being forced into one as a solution.
Above all, as my hon. Friend and others rightly highlighted, this leads to a serious collapse in trust in the Minister and the ministerial team, because of what they have said about community hospitals. There was, rightly, a huge outcry when confidence was undermined by the various messages that appeared to be coming out of the Government, but then the Secretary of State corrected that impression at the Dispatch Box. As my hon. Friend said, surely this is the time to step in and stop the permanent loss of services to his constituency.
Most worrying is the fact that the services are being closed down without hope of substitutes. Both the private finance initiative rebuild at Watford and the PFI super-hospital at Hatfield seem to be frozen. The latter has already been downgraded and there is no indication that either will ever arrive.
Auditors have highlighted problems with financial management in the Hertfordshire area, but the struggle
in that area is symptomatic of an NHS that has been centrally mismanaged. The fact that deficits are arising in places such as Bedfordshire and Hertfordshire, Thames Valley and Surrey and Sussexthe areas that are hardest done by in the resource allocationreflects the fact that those areas are becoming too underfunded. Constant central restructuring has contributed to the difficulties, as has the scandalous political meddling in the PFI programmes, such as the one at Hatfield, laid bare in the powerful speech of my hon. Friend the Member for Welwyn Hatfield (Grant Shapps).
However much the Secretary of State and her Ministers may dislike the south-east and middle-income Britain, is there any credible effort that the Minister can make in her speech now to start rebuilding the trust between them and the people of Hertfordshire, represented so passionately and ably by my right hon. and hon. Friends? Do this Government govern for all or just for the reducing number of Labour voters in this country? Will the Minister now commit to a simple ministerial dutyfairness to alland correct here today the deep, damaging unfairness that has been done to the people of Hertfordshires health under Labour?
The Minister of State, Department of Health (Ms Rosie Winterton): I, too, congratulate the hon. Member for South-West Hertfordshire (Mr. Gauke) on securing the debate. It will not be possible for me to address every point that has been made. I hope that right hon. and hon. Members understand that. I should also say that I am meeting the hon. Member for Broxbourne (Mr. Walker) next week to discuss specific issues relating to mental health, and, as I understand it, the hon. Member for Hemel Hempstead (Mike Penning) as well. On behalf of the Lord Commissioner of Her Majestys Treasury, my hon. Friend the Member for Watford (Claire Ward), I thank all hon. Members for their congratulations on the birth of her baby. I will pass those congratulations on to her.
I should like to deal with some of the issues by making general comments about the situation in Hertfordshire and the approach that the Government believe needs to be taken to sort out what is a very difficult situation. I am grateful to all right hon. and hon. Members who have paid tribute to the hard work of the staff in the local NHS, who have contributed to the real improvements that have taken place in recent years, such as the cuts in waiting lists and the improvements in general health outcomes. Those are real changes, of which the staff are proud. I am proud to be part of a Government who have helped to bring about those changes, but there is no doubt that they could not have taken place without, first, the hard work and dedication of NHS staff.
Secondly, the changes could not have taken place without the increased investment that has gone into the NHS. I believe that there is actually quite a lot of political consensus on the fact that investment in the NHS has increased from some £33 billion in 1997 and will increase to some £92 billion in 2007-08. The combination of increased investment and the changes
that have been made because of the work of NHS staff has led to real improvements in health care.
Hertfordshire has been a beneficiary. Whatever is said at the moment, there is no doubt that there have been increases in resources. A number of hon. Members mentioned the funding formula. It is true that PCTs in Hertfordshire receive less funding per person than the national average, but that is because a formula has been put together to address the health needs of an area. That means that in some of the more deprived areas there are higher levels of funding. I would be amazed if the Conservative party was saying that it wanted to adopt a policy whereby it ignored the fact that some areas have greater health needs than others and that therefore it would reverse the efforts made to tackle health inequalities.
The hon. Member for Hemel Hempstead talked about the establishment of the NHS, which was about providing equal access to health care throughout the country. Inevitably, that means that in some areas there are higher levels of funding, but that does not mean that PCTs cannot target funding within their overall area to tackle health inequalities. That is why the Government have put a lot of emphasis on tackling health inequalities. No matter what we say, right hon. and hon. Members in this room know that a boy born in Manchester, for example, is likely to die eight years earlier than someone born in, I think, Dorset.
Grant Shapps: I appreciate what the Minister is saying about health inequalities, but surely the way to tackle inequalities is not to drag down an area where, in the past, the position may have been better, by closing down important services such as cancer care, maternity and accident and emergency services. That seems to be the approach that the Minister is taking.
Ms Rosie Winterton: No, that is not the approach that I am taking. The approach that I am taking is to challenge the assertion that has been made by the Conservative party that it is wrong to channel funding into areas where there are greater health inequalities. I am challenging that belief because it would be completely the wrong approach to the NHS. The new formula takes account of the impact of deprivation on health need in ways that were not possible before. It also considers unmet need. In certain areas, there may be peoplefor example, people from ethnic minorities and socio-economically deprived groupswho are not receiving health care services to the same level as others. If the Conservative party decides to reverse that approach, it will reverse everything that we have been doing to tackle health inequalities.
Mike Penning: I do not think that anyone here is saying that everyone in every area should get identical funding. We want a level playing field in relation to the areas that the Minister has described, such as Manchester, where people die earlier. In our part of the worldthe debate is about Hertfordshiremore people are living longer, and that costs the NHS more. When people get old, they get ill and need health care, no matter where in the country they live.
But the hon. Gentleman cannot have it both ways. He talks about a level playing field, but
there will always have to be some way of allocating funding. It has long been proved that in areas of deprivation where health needs are higher and there are inequalities, there is a need for greater funding.
Ms Winterton: I need to move on, because I have only five minutes left, and I want to address some of the other points that were made. If there is time, I will come back to this point.
Overall, no matter what is said, the amount being received in Hertfordshire has grown enormously in recent years. It received £135 million in 2002-03, £151 million in 2003-04, and £165 million the year afterand that is just the Watford and Three Rivers primary care trust. Those are enormous increases in the allocated funds.
Mr. Prisk: I am grateful to the Minister for giving way. She is very generous. She says that it is not possible to adjust the figures so that they could be, broadly speaking, at 100 per cent., yet, according to a written answer that she gave to a question from my hon. Friend the Member for Hertsmere (Mr. Clappison), that is exactly what the Government did in the financial year 2001-02, when the figure was 103 per cent. Why has that not been possible in subsequent years?
Ms Winterton: The hon. Gentleman well knows that the point that I was making was that if the Conservatives are saying that they want to reverse the idea of targeting funding into certain areas[Interruption.] The figures were given. It was said that in Doncaster, Central, the figures are something like £1,300 per head, whereas in other constituencies it may be lower. That is to reflect the deprivation.
Mr. Heald: That is the point. Will the Minister give way on that?
Mr. Mike Hancock (in the Chair): Order. Let the Minister have some time to speak.
Ms Winterton: I need to move on, because the point that I want to come to
Mr. Stephen O'Brien: They are all Labour constituencies.
Ms Winterton: Actually, it is about where there is deprivation. It is quite wrong to suggest that the way to deal with health inequalities is to remove the ability to target areas with high levels of deprivation. [Interruption.]
Mr. Mike Hancock (in the Chair): Order. Everyone listened with great tolerance and understanding when others were speaking. Let the Minister be heard in the same way.
Ms Winterton: I do not think that they like it, Mr. Hancock.
It is true that deficits have built up in Hertfordshire over several years, but Opposition Members are, in a sense, suggesting that we should ignore that position and that it will somehow go away. That would be quite the wrong approach. We need to look at how services are delivered. The worst thing for staff, patients and services such as mental health services would be to continue such a process. If the Conservatives were to adopt a policy of ignoring those deficits and making no effort to deal with them, that would not do patients or staff any good. We need to say, This is the problem that we are facing; we should look at this in the light of the extra resources that have gone in. The Department can give help through sending specialist teams in to work with local trusts.
I have visited a number of hospitals in the areaunfortunately, I am no longer the Minister with responsibility for Hertfordshire, but I would be more than happy to go back there to look at the mental health servicesand people have told me that there have been difficulties with managing the finances over a number of years. We need to consider that. There are ways in which the strategic health authority and the Department can work with areas such as Hertfordshire to ensure that some of the changes that need to be made are made with the minimum of disruption to staff and patient services
Mr. Mike Hancock (in the Chair): Order. I must bring the debate to an end. I thank all those Members who worked wondrously well to allow everybody to speak, and I thank Members for the courteous way in which they listened to the Minister, most of the time.
Greg Mulholland (Leeds, North-West) (LD): Let me start by saying what a pleasure it is to have you in the Chair, Mr. Hancock. There was a slight diary confusion in my office about the start time of the debate, and I probably broke the record for getting here from Norman Shaw South. Perhaps we can look into having a record for that run: I did it in about two and a half minutes. [Interruption.]
Mr. Mike Hancock (in the Chair): Order. Members of the public are not permitted to walk through the Chamber.
Greg Mulholland: I am very pleased to have secured the debate, and to have this opportunity to raise this increasingly important issue in the Chamber. As I have already made clear to the Minister, I wish to focus specifically on the practice in which a number of disreputable companies and individuals around the country are engaged: the misrepresentation and mis-selling of greenfield land, which is becoming a critical issue in many rural and semi-rural areas. Before I expand on that, I want to make it clear that my purpose today is to ensure that after the debate the Minister and the Government will agree to work with me and MPs from all parties who are also concerned to address this issue. I shall make some suggestions later as to how that could be achieved.
Let me define precisely the relevant issues. In broad terms, land banking is simply the practice of purchasing undeveloped land for future developments or resale. That investment often comes in the form of land investment companies or partnerships buying land, subdividing it and then encouraging secondary investors to buy individual plots. If the land value increases, the investment companies gain a high return, and the secondary investors also benefit. In the vast majority of cases, for the value of the land to increase substantially a change of use must be accorded to the land, which means that local councils must grant permission for it to be developed. If it is green belt land, there needs to be a change in status.
For those of us with rural and semi-rural land in our areas, this is a highly contentious issue. It is particularly worrying that there appear still to be individuals and partnerships buying up large areas of undeveloped green belt land and deliberately suggesting, or at least giving the impression, that permission for that land to be developed is likelyoften, they give the impression that it is very likely, or a done dealwhen that is far from the truth. I have an example from my own constituency which illustrates how that practice works. It is how I came across the issue in the first place.
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