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3.40 pm
Mr. Michael Mates (East Hampshire) (Con): It is often what happens to individuals, rather than what happens to institutions, that tells us when something is going badly wrong. Over the past two years, I have read with mounting disbelief letters from my constituents about the NHS in Hampshire. In case after case, they complain that they cannot get the treatment that they need. They tell me that national policies, such as cancer treatment within four weeks of diagnosis or the provision of services in community hospitals, are not being delivered on the ground.
When I take up these problems with the relevant authorities, I am sent from one to another, on a bewildering journey around an amazing merry-go-round of bureaucracies, none of whom seems to be wholly responsible for what has happened. Is it the hospital trust that is responsible, or the primary care trust, or the National Institute for Health and Clinical Excellence—or even, perhaps, the ambulance service? The space between the various bodies is not so much a gap as a swamp into which my queries sink into boggy depths, with all too often no satisfactory explanation for what has gone wrong.
Let me say something else—by way of light relief, perhaps. The new Hampshire strategic health authority started on 1 October. Its chief executive was the chief executive of one of the major trusts in the county; he has moved up the ladder, as so often happens in such situations, and I do not knock him for that. However, when I wrote to him about a problem at the beginning of September, he replied—very promptly—that he could not help me until 1 October because he did not exist until then. Such bureaucratic problems make a bad situation even worse.
Only yesterday, I received a letter from a constituent whose wife was diagnosed with a brain tumour on 9 June at Queen Alexandra hospital in Portsmouth, and it is that that has prompted me to take part in a health debate, which I do only very infrequently. Despite continuing pressure from her husband and her GP, no treatment began within the target time of four
weeks. Indeed, they had to wait nine weeks for treatment at the other hospital in Portsmouth, St. Mary’s. During the intervening period, her condition deteriorated, so that in the end radiotherapy treatment was too much for her to bear and had to be stopped. She died six weeks later.
Why did she not receive treatment within the stated time? I shall seek an explanation from the two hospitals involved. One of the things that my constituent simply cannot believe is that it takes two weeks for medical records to travel the two miles from one hospital to the other, because they are sent by second-class post.
But it is not just in headline grabbing areas such as cancer treatment that the NHS has problems. The Government say that they are committed to community hospitals, but both of the community hospitals in my constituency have experienced significant service reductions at a time when, as everybody agrees, the NHS budget has been expanding. At the Alton community hospital, the Inwood ward was closed for many months. Happily, it will now reopen. At Petersfield hospital, the Grange maternity suite was closed at two weeks’ notice because of staff shortages, and it has stayed closed for 16 months. Happily, that is also now reopening. But how could the planning go so awry that those closures were necessary in the first place?
The trouble is that the NHS—particularly in Hampshire—is suffering from a stop-go policy. Sudden staff shortages or budget crises cause the withdrawal of a service. That sets off an understandable public row. Health service managers promise to reopen the facility, but are vague about when that will happen. After many months—often over a year—it is necessary to launch a recruitment drive to find the staff to run the service so that it can be reopened. Meanwhile, other parts of the NHS are making people redundant. The facility then reopens, but often—as at Petersfield—with a reduction in services.
That stop-go approach is deeply debilitating. It undermines morale in the NHS, wastes resources as facilities have to be closed and then reopened, and, worst of all, it bewilders patients. It is the most vulnerable patients who suffer from the closure of community hospital facilities, as they are the ones who are unable to travel to the nearest district general hospital.
This mismanagement—that is what it is—results from the total absence of stability within the service, as my right hon. and hon. Friends, whose knowledge is greater than mine, have mentioned. When my right hon. Friend the Leader of the Opposition spoke about taking politicians out of the NHS, he did not mean for us to walk away from our ultimate responsibility to provide health care; he meant that the constant chopping and changing brought about by the pressure of party politics has to stop.
Somebody said that there have been seven reorganisations of NHS bureaucracy since 1997, but I make it 10. I am not trying to dismiss the value of managers—good managers save lives by making the best use of inevitably limited resources—but it is no good Ministers trying to pretend that constant changes in management and structures do not adversely affect patients, because they do. An estimated £320 million is being spent on the current reorganisation of PCTs, and
many of my constituents want to know why that money is not being spent on patient care.
Another constituent of mine has kidney cancer, and his consultant at Southampton general hospital wants to treat him with a new drug called Sunitinib. Clinical trials of the drug have been conducted for about six months and it has proved extraordinarily effective, to the extent that another of my constituents—a 38-year-old woman—is back home with her family. Yet before the trials began, it was thought that she had only weeks to live.
My constituent’s kidney cancer was diagnosed two days after the trials officially ended, and although the treatment has been proven to be highly effective, it is not available any more, the argument being that it has not been approved by NICE. Indeed, according to a written answer in June from the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), the Department of Health is still deciding whether to refer the drug to NICE for consideration. When I asked about this, Lord Warner replied that it was for hospitals and PCTs to decide whether to prescribe new treatments. He went further, saying that
“PCTs cannot refuse to fund drugs simply because NICE guidance is not available”.
“should not refuse to fund treatment solely on the grounds of cost but should consider all the circumstances before making a decision.”
So what is the problem? The drug is the treatment of choice of the consultant, who is thrilled with the success of the trials. It is available, but it is not allowed to be prescribed and my constituent cannot have it.
The reality is that health rationing is going on all over Britain, and it is a complete lottery as to whether a particular treatment is available in a particular area. That does not add up to a national health service. I do not doubt the personal commitment of Ministers to solving some of the problems, but they do not seem to recognise that it is their making constant changes, the expansion in the number of managers and the obsession with targets that is denying patients the choice that they should properly have. If the focus of the national health service should be on anything, it should be on nothing more than patient care.
3.48 pm
Mr. Ian Austin (Dudley, North) (Lab):
I want to thank the Opposition for calling this debate, although the picture of the NHS painted by the hon. Member for South Cambridgeshire (Mr. Lansley) is not one that my constituents would recognise. Investment has doubled nationally since 1997, and it will treble by 2008. There are 32,000 more doctors and 85,000 more nurses, and by 2010 there will be 100 new hospitals. As you know only too well, Madam Deputy Speaker, my constituency has a brand new hospital that is treating more of your and my constituents more quickly than ever before. The real reason, however, why I welcome today’s debate is that it gives us the opportunity to show that when it comes to the NHS work force and service development, the only party that can be trusted
is ours. Whatever they may say in their motion on today’s Order Paper, the Opposition still do not believe in the NHS.
Last week, we were told by the Leader of the Opposition how much he now cares about the health service. This remarkable conversion follows earlier eye-catching statements in which he said, for example, that he is not a Thatcherite and that he now cares about poverty. He and his party have chosen “change to win” as their slogan, because they know that their brand was discredited and distrusted and associated with the failures and betrayals of the past. That is why they are trying to show that they now care about issues such as the NHS, on which they have never been trusted before. They might be doing a decent job on public relations, but they face much stricter tests—vague claims about intent are not enough. I am not one of those people who say that the Tories believe in nothing and that they have no policies—quite the reverse. It is because of their beliefs and values that they cannot be trusted with the health service.
The Opposition motion says that they want more staff, but the Leader of the Opposition says that the investment to pay for them is “fiscal irresponsibility”. He has committed his party to the so-called proceeds of growth rule, which—whatever the Tories say—commits their party to cuts, year in, year out. As my right hon. Friend the Secretary of State said earlier, if the Tories were in power this year, the new rule would mean expenditure at a slower rate of growth than under the Government’s plans. This year, the difference between the Opposition’s plans and the Government’s plans would be £17 billion, and it would be bigger in the future.
NHS expenditure is almost a fifth of total managed expenditure, so a £17 billion cut in public spending applied across the board would mean cuts to the NHS of at least £3 billion this year—[ Interruption.] The Tories may not like it—
Mr. Graham Stuart: Will the hon. Gentleman give way?
Mr. Austin: The hon. Gentleman can listen for a while. Let him listen to what the Leader of the Opposition said about the proceeds of growth rule this year—his words, not mine. He said:
“As that money comes in let’s share that between additional public spending and reductions in taxes. That is a dramatic difference. It would be dramatically different after five years of a Conservative Government.”
He also said that he wants to replace public services for the poor with
“a profound increase in voluntary and community support”.
It is the same old Conservative ideology: a small state and spending cuts, leaving the most vulnerable relying on charity. That is why the Tories cannot promise that they will not cut funding for the NHS.
Before the Leader of the Opposition’s conference speech last week, the Conservative party website said that it would promise:
“We will never jeopardise the NHS by cutting its funding.”
That line also appeared in the extracts released to the media before the right hon. Gentleman delivered the speech, but it did not appear in the final version or the published version.
The Tory motion claims that the NHS is being cut, but the Opposition voted against the extra funds we invested. In fact, not only did the right hon. Gentleman oppose the national insurance increase at the time, he called for a social insurance system for health care instead. The Tories cannot say that they have changed that position, because only this week the shadow Secretary of State repeated his opposition to the tax increases that paid for the improvements. Time and again, they use moderate, compassionate language to mask traditional Tory positions.
Today’s Tories claim to support the NHS, yet they run it down at every opportunity. They tell us that they believe in the health service, yet they are still committed to massive cuts. They say the NHS is underfunded, yet they vote against extra spending. It is absolutely clear that when it comes to the health service—just like everything else—they do not have even one centre-ground policy.
There is no huge secret about the so-called new Conservative party. Every speech makes it absolutely clear: the Tories may not spell out the lower taxes they want, or the precise parts of the so-called “big state” they want to cut down to size, but anyone who looks beyond the rebranding will see the same old Tories committed to the same old spending cuts. Instead of greeting their so-called changes with warm words of approval, we should expose the fact that they are not really changing anything at all. We should demonstrate that they will claim anything to win, but that they do not believe a word of it.
Grant Shapps: Much of what the hon. Gentleman says will ring hollow to my constituents and those of many Members on the Opposition Benches whose hospital services—unlike those in Dudley—are being cut, not expanded. How can the hon. Gentleman stand in the Chamber and say things that are not a reality for the whole of the country?
Mr. Austin: The reality for the whole of the country is that no one now waits longer than six months for an operation, down from 284,000 when we came to power. Ninety-nine per cent. of cancer patients are seen by a specialist within two weeks. Almost 99 per cent. of people with cancer are treated within 31 days of diagnosis, and 19 in 20 patients are seen, treated and discharged from accident and emergency departments within four hours.
Those things did not happen by chance; they happened because we set targets to achieve them. Eradicating targets, as the Opposition propose, may sound alluring, but can they imagine a patient turning up at BUPA—as they probably do—and saying, “I’ll pay the charges and sign the contract but I don’t care when you treat me, just do it in your own time. I don’t want targets, I’m not that bothered”? Of course not.
It is not possible to say that everything is perfect in every case in the modern NHS, but no one prepared to look at the issues dispassionately can fail to deny that the NHS has been transformed. Come to Dudley and a brand new, £160 million hospital can be seen with more doctors, more nurses and more other staff treating more patients more quickly than ever before. There are
new community facilities treating patients in their own homes in ways that could not have been dreamed of just a few years ago. That is not to deny that there are issues in Dudley. We have problems with car parking charges and we have a shortage of chiropodists—I hope that the Minister will help on that—but the new facilities and low waiting lists in Dudley show the improvements that extra spending and modern ways of working can bring to the NHS.
One does not have to accept my word on all that. Let me conclude by reading a letter from my constituent, Mr. Albert Williams, a 79-year-old gentleman suffering from two terminal illnesses. He wrote to the Secretary of State to say that
“the new hospital, the extra nurses and doctors and the new technologies I have seen at first hand have made a huge difference to me... The care that I have received in my home is a great example of the way the health service can treat people in the community, be visited by nurses, enabling them to live at home and free up hospital beds for other patients. Send people who spend their whole time complaining about our health service to talk to me. I can remember what people had to rely on before the NHS existed to treat people regardless of their income or ability to pay. It is our country’s greatest invention and you”,
he wrote to the Secretary of State,
“should be proud of the work your government is doing to strengthen it for the future.”
That, Madam Deputy Speaker, is the truth about the modern NHS that the Government are building.
3.56 pm
Mr. Nicholas Soames (Mid-Sussex) (Con): First, I congratulate NHS staff in my constituency on delivering a wonderful service in a very good hospital. They are nervous and anxious about the future. I also warmly congratulate the shadow Secretary of State on the excellent way in which he moved the motion. I hope that the House listened carefully to the speeches of the two former Secretaries of State for Health, my right hon. Friend the Members for Charnwood (Mr. Dorrell) and my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), which were full of wisdom and clarity about the way ahead. I wholly agree with the picture painted by my right hon. and learned Friend the Member for Rushcliffe, who took a tremendously national view of the NHS, to which I wholly and unreservedly subscribe.
In 23 years as an MP, I have never known such anger and anxiety directed at the Government as is now being generated on national health issues. Since I became the Member for Mid-Sussex in 1997, there have been four reviews of hospital services—nothing like as many as experienced by my right hon. Friend the Member for East Hampshire (Mr. Mates)—in my constituency and local area. We have had “Modern Hospital Services for Central Sussex—A challenge for us all” in 2000, and even more ridiculous names such as “Strengthening Hospital Services in Central Sussex” in 2001 and the “Best Care, Best Place” consultation in 2004. Now, 18 months on, we have a new document that sweeps all the rest into the waste paper basket: “Creating an NHS Fit for the Future”.
Those reports were all subsequent to a document commissioned by the West Sussex health authority, which was faced in 2000 with growing fragmentation in health care provision, escalating and disproportionate
management costs and rapidly accumulating debts, which are at the nub of our present unhappy state. Matters were so serious that the Government asked Michael Taylor, then chief executive of Oxfordshire health authority, to investigate and report on West Sussex as a failing and debt-ridden health authority. His report, which was damning, set out a series of recommendations, which were by and large completely ignored by Candy Morris, who was acting chief executive of West Sussex health authority until its demise. She was also responsible for the NHS consultation documents from 2000. By an astonishing quirk of fate, she is now one of the architects of proposals about to be announced for the apparent deconstruction of the NHS in West Sussex.
Those changes will throw the NHS in Sussex into even greater turmoil than is already the case. What Taylor exposed was a series of top-heavy management structures, in expensive premises—the sort of point made by my right hon. Friend the Member for East Hampshire—involving duplication, replication and wastefulness. No one paid any attention to his warnings and this continuing, wilful mismanagement of the NHS has now led to colossal debts of well over £100 million in West Sussex.
Another important contributory factor in this debacle has been the complete failure of the independent watchdog bodies—first, the community health councils and latterly the West Sussex health scrutiny committee and joint scrutiny committee—to refer any of the proposed configurations to the Secretary of State for intervention and for her to account to Parliament directly on that managerial vandalism.
What the Secretary of State must understand is that when the “Best Care, Best Place” consultation began in November 2004—incidentally, it was a total sham, in which, again, the scrutiny committee failed to act—it was represented to all my constituents and me by the management of the strategic health authority, and most especially by the primary care trust, as the way ahead for the foreseeable future. Many of them were deeply cynical of the Government’s motive at the time, but they went along with it.
As recently as 25 May, at a meeting that I called in Burgess Hill in my constituency, the chief executive of the South East Coast strategic health authority—a newly created animal—never mentioned any of the changes that were likely to happen, even though they were being discussed at board level and elsewhere. My constituents and I feel that that amounts to a deceit, a betrayal and totally unacceptable behaviour by the management of the NHS, which has lost its way and has been party to the waste of hundreds of millions of pounds over recent years—money that could quite well have been spent on patient care.
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