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“My daughter is one of hundreds of newly qualified physiotherapists unable to get a job because of the crisis in the NHS...My local hospital has a waiting list of 10 months to see a physiotherapist.”
Somebody writes from Norwich that of 96 students leaving physiotherapy training only five found jobs. A letter from Lincolnshire states:
“Not one student from Nottingham (which is a centre of excellence for physiotherapy) has been able to find employment as a physiotherapist in the NHS. This abysmal situation appears to be directly due to the budget deficits across the NHS.”
I have a question for the Secretary of State, because a practical issue is involved. In Scotland, as she knows, the Scottish NHS guarantees nurses and physiotherapists a year of employment following their graduation. Will she say that the same thing will happen in England?
Ms Dawn Butler (Brent, South) (Lab): I agree that we should be honest about the debate. Part of the reason why death rates for cancer and heart disease are falling is that our Government have set targets—[Hon. Members: “Ah.”]—Yes, targets. There is faster treatment: 99 per cent. of people diagnosed with cancer receive treatment within four weeks of diagnosis. Will the hon. Gentleman tell us whether his policies will reflect that or whether their NHS plan stands for no honest solution from the Opposition?
Mr. Lansley: I am sorry that the hon. Lady was clearly not even listening to what I was saying. As yet, there is no discernible change in the trend reduction in deaths from cancer, even as a consequence of the additional investment in the NHS cancer plan. We might wish it otherwise, but that is the case. The fact that death rates continue to go down is much to be welcomed, but it has much more to do with things such as the reduction of smoking, as well as with the quality of service. When we compare our cancer death rates to those in other countries, we see that early identification of tumours will be absolutely instrumental in their further reduction. The cancer plan said that there needed to be awareness of symptoms and up-front investment for prevention, but that has not happened.
Mr. Edward Leigh (Gainsborough) (Con): Ultimately the question is one of money and value for money. If we are to have more local control and accountability, can my hon. Friend give the House an assurance that, through Parliament’s Committees—especially the Health Committee and the Public Accounts Committee—we will still be able to follow the money? Ultimately, the House must remain responsible for all public money spent.
Mr. Lansley:
I am grateful to my hon. Friend, who properly defends that important interest. Nothing we
have said would deflect from it. The service would be publicly funded, where propriety and value-for-money considerations would remain the responsibility of the inspection bodies throughout the process, all the way down to the point where GPs exercise commissioning responsibilities. It needs to be so, because the service uses public money.
Mr. Lansley: I do not want to take more than about half an hour, as many Members want to speak.
Deficits do not affect only trainees; they have a direct impact on existing specialists. A report suggests that, by December, 61 cardio-thoracic surgeons will be without a consultant appointment in the NHS. I am advised that 37 ear, nose and throat specialists do not have posts at present. The Royal College of Anaesthetists tells me that whereas in previous years there have almost always been about 30 advertisements a month for new anaesthetist posts—last year there were 31 in July and 29 in August—only 17 were advertised in July this year and only four in August. The president of the royal college rightly says that a great number of people in other countries are looking for anaesthetists. My concern is that if we make life difficult for too long, they will go; we will lose the specialists we need.
The Government should note that the British Orthopaedic Association has already told them that the average retirement age of orthopaedic surgeons has gone down by three years over the past seven years. Such is the extent to which we are losing services.
Anne Milton (Guildford) (Con): To go back to my hon. Friend’s comments about physiotherapists, does he agree that with the Government’s drive for more people to be looked after at home and closer to their homes, physiotherapy services, and physiotherapists, are absolutely crucial to ensure well-being and treatment, especially of an older population?
Mr. Lansley: My hon. Friend is absolutely right. The situation for stroke patients, for example, is utterly depressing. Even if they are able to secure early and intensive rehabilitation, sometimes treatment cannot be followed up to maximise their chances of recovery, owing to the lack of physiotherapists in post. We must have more physiotherapists. The Government said that we needed more physiotherapists and that there would be 60 per cent. more. People went into the profession as a result. A physiotherapist told me: “I knew what was intended so I went into the course. Now there are no jobs.” That is a deeply depressing fact; it is a cruel irony played on people who took up such courses.
Mr. Lansley: I really should try to reach the end of my speech.
John Bercow (Buckingham) (Con): Will my hon. Friend be generous?
Not only have we lost specialist posts but training budgets are being cut. The Secretary of State might like to tell us whether it is the case that, as reported, training budgets across the country will be cut by 10 per cent. this year. She might like to consider the example of Leicester, where the strategic health authority says that it will cut £52 million from the training budget. The University Hospitals of Leicester NHS Trust told Leicester university that it will cut clinical academic funding by 20 per cent. That will mean the loss of 15 per cent. of the medical school staff, who spend more than half their time treating patients. Some of the senior staff, who are integral to the trust’s delivery of service, will be lost.
To be fair to the Government, in 2002, they introduced the GP returner scheme and 550 GPs used it, but the money has disappeared. In 2006-07, there will be no money for the scheme; it is disappearing across the country.
Rob Marris (Wolverhampton, South-West) (Lab): Will the hon. Gentleman give way?
I want to mention one more important issue. The problem is not just deficits. In April 2004, Members may recall that we warned the Government about the impact of the European working time directive. I shall not rehearse all the arguments, but it was clear that if the Government did not secure an amendment to the directive there would be serious consequences for services. The Government claimed that would not be the case. The right hon. Member for Barrow and Furness (Mr. Hutton), now the Secretary of State for Work and Pensions, said that they would maintain access to services despite the working time directive. But what has happened?
I shall quote from a document about changing maternity and paediatric services produced by the Manchester SHA. Manchester itself—not the whole north-west—is a good example, as it is not generally driven by deficits and ended last year with a health economy in surplus. The document states:
“Staffing pressures on the 13 units providing in-patient care are getting worse. Already children’s wards and maternity units have to close on occasions because there are not enough staff to cover them safely. We will not be able to staff all these units by 2009 when the European Working Time Directive becomes law and doctors are not allowed to work the hours they currently work. This is already resulting in units being closed frequently. In 2002 there were over 200 closures to the admission of children and young people across 13 hospitals, due to either a shortage of doctors or a shortage of specialist nurses.”
If the Government had done what they said would do, they would have secured an amendment to the directive. Their replies to me make it clear that they tried to do so when they held the presidency. They took the matter to the Employment Council in December 2005 but they failed, and they have not attempted to do anything since. They must do something.
Will the Government do what Lord Hunt—then a Health Minister—said he would do on 4 March 2003? He said that if there were difficulties, the further extension of the working time directive, due in 2009, could be deferred until 2012 and that instead of a 48-hour week, it would be possible to go up to 52 hours. Will the Secretary of State do that?
Mr. Lansley: No, I am not giving way, as I am moving towards my conclusion, but before I do so, I want to be fair to the Government. We are talking about work force planning and because I wanted to understand the Government’s approach towards it, I looked at their evidence submitted to the Health Committee, which is currently investigating the matter. Here it is. The Government say that there is now “a streamlined framework” for work force planning. There are workforce directorates within strategic health authorities and they work with the social partnership forum, with the workforce programme board, with the national workforce group, with the workforce review team, with NHS national workforce projects, with Skills for Health and with NHS employers. There is even a diagram to explain it all—and all that is supposed to be the “streamlined” framework! Whatever it is, it is certainly not yet streamlined enough. We need a much better system because out there in the NHS, staff have no idea what the work force plans look like, as even now, posts are being cut.
The staff of the NHS are, as we have said, its greatest asset. They work miracles daily and we need them to be motivated and inspired, but at the moment they are demoralised. The Secretary of State has gone from her “best year ever” in May to a “very difficult year” by September. NHS staff are seeing a feast turn into a famine. They see promises of expansion turn into cutbacks and they see the advertising campaigns of three or four years ago to recruit new nurses and therapists turning into the cruel irony of people leaving training unable to pursue their vocations and find jobs. They see sham consultations over service reconfigurations driven by short-term financial expedients.
The staff also note how the effects of the European working time directive are dressed up to suggest that services have to be shut down because they are deemed unsafe. Frankly, that is a slur on NHS staff. People are working across the country to save their local NHS services. Labour Members should not decry that as a Tory conspiracy; it is happening because people are angry about the loss of their local NHS services. They do not want to block changes, but they want them to be guided by evidence and to take account of needs for accessible services.
The new chief executive of the NHS says that more than one in four of district general hospitals have to be downgraded. He then tells us, in an interview in The Guardian, that he “understands the politics” of it. Well, we do not need an NHS chief executive who understands politics, but one who is focused on patients. We need a chief executive who is not spending all his time trying to work out what Ministers want him to do, but assessing what is in the best interests of patients and the NHS. We need an NHS free of the Secretary of State and the chairman of the Labour party sitting down with their advisers, trying to decide which hospitals to close.
I am an optimist. I believe in the NHS and I believe in what NHS staff can achieve, but they can do so only if we give them the framework, the resources and the freedom to deliver. That is our objective, so I commend the motion to the House.
1.23 pm
The Secretary of State for Health (Ms Patricia Hewitt): I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
“welcomes the Government’s historic investment in the NHS since 1997, trebling funding by 2008; pays tribute to the commitment of NHS staff; recognises the ongoing investment in their training and development; notes that there are now 32,000 more doctors and 85,000 more nurses, and that overall there are over 300,000 more staff working in the NHS; acknowledges that as a result of the Government’s investment and reforms and the hard work and dedication of NHS staff, virtually no-one now waits more than six months for their operation whereas in 1997, 284,000 people waited longer than six months with some patients waiting up to two years; further notes that over 99 per cent. of people with suspected cancer are now seen by a specialist within two weeks of being referred by their general practitioner, up from 63 per cent. in 1997, and that death rates from cancer and heart disease are falling faster than ever before; and further recognises the need to ensure NHS services continue to change to benefit from new medical technologies and treatments which mean more care can be delivered in local communities and people’s homes.”
Mr. Speaker, the hon. Member for South Cambridgeshire (Mr. Lansley) has spent nearly 40 minutes telling us, as he always does, what is wrong with the NHS. I want to start by congratulating the staff of the NHS—more than 1.3 million committed and dedicated men and women, many working in very difficult circumstances. There are more than 300,000 extra staff—my right hon. Friend the Prime Minister slightly understated the increase in Prime Minister’s questions—than there were in 1997. I particularly want to thank them for the improvements that they have made in looking after patients in recent years. We have seen dramatic improvements in waiting times, for example.
Andrew Gwynne (Denton and Reddish) (Lab): With additional new money, the NHS has improved dramatically. We have perhaps forgotten that in the 1990s we used to worry about the number of years that patients had to wait for treatment, whereas today we worry about the number of weeks. That is not from the Whip’s brief, as the point comes from the director of public health at Stockport primary care trust. Does my right hon. Friend recognise that that professional view represents the reality of what is happening out there?
Ms Hewitt: My hon. Friend is absolutely right: he is in touch with what is happening in his local NHS.
Ms Hewitt: I shall give way again in a few moments.
In 1997, 284,000 people were waiting more than six months—some for more than two years—whereas today almost nobody waits more than six months and the vast majority are treated far more quickly than that.
Mr. Lindsay Hoyle (Chorley) (Lab): I am sure that my right hon. Friend would want to congratulate workers at Lancashire teaching hospitals on their dedicated work in ensuring that the quality of lives in Lancashire continues to improve. Does she support the continuation of the work at those hospitals and will she ensure that it does not go to the private sector, which would put them at risk?
Ms Hewitt: I join my hon. Friend in congratulating the staff at those hospitals. As he well knows, the Government and I have supported both investment and reform from the outset, including, where it will help cut waiting times and secure even better care for NHS patients, the use of the independent sector.
Mr. Michael Fallon (Sevenoaks) (Con): While she rightly congratulates existing staff, what does the Secretary of State say to those newly qualified midwives and physiotherapists who were promised a job in the NHS only to find that they cannot get one? Why has she made such a mess of work force planning?
Ms Hewitt: We have never made promises to NHS staff that either we or the Opposition could not keep. What we are saying to newly qualified staff, some of whom are indeed struggling to find a job, is that we will do everything possible to ensure that they get one. In some parts of the country, NHS hospitals are working with other organisations to ensure that, if a permanent job is not available for newly qualified nurses and midwives, they are at least taken on temporarily so that they can continue to build their skills and contribute to the NHS.
Ms Hewitt: I want to make some progress before giving way again.
I also want to thank NHS staff for dramatic improvements—belittled, I have to say, by the hon. Member for South Cambridgeshire—in cancer care. I do not think that any of the 50,000 cancer patients who are alive today because of improvements in cancer care would want to belittle them and neither would the hon. Gentleman’s view be shared by cancer patients who have seen dramatic improvements over the last 12 months. Just 12 months ago, fewer than seven out of 10 patients with most suspected cancers could count on being seen, diagnosed and then beginning their treatment within two months. Today, nearly 95 per cent. of patients are doing so. That is the result of the incredibly hard work of staff, more money, which the Conservatives voted against, and the targets set for cancer care that the Conservatives would abolish.
Ms Dari Taylor (Stockton, South) (Lab): On that very point, I would greatly appreciate it if my right hon. Friend would keep certain facts to the forefront of the debate. In North Tees hospital, for example, 100 per cent. of all breast cancer patients are seen and treated within 62 days. That is a superb achievement, which no one in the House should ever do anything other than congratulate.
Ms Hewitt: My hon. Friend is absolutely right. It is a superb achievement when 100 per cent.—well beyond the target that we set—are being seen, diagnosed and beginning their treatment. That is one of the ways in which survival rates from cancer will be improved.
Ms Hewitt: I give way to the hon. Member for Buckingham (John Bercow).
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