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I have referred that catalogue of incompetence and bad practice to the Comptroller and Auditor General, who, alas, cannot take it any further, but he has referred me to his excellent report on financial failings in the NHS. What I hope that the Secretary of State will understand is that we in Sussex think that her Department seems rather like the American Administration: apparently, at the same time, dysfunctional and fragile and unable to admit or
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unwilling ever to see—let alone to correct—the obvious mistakes that are being made in their name.

The constant reorganisations of the past few years may create for the Government an illusion of progress and reform, but in practice what has often happened in the recent past is that it has produced confusion, uncertainty, gross inefficiency, very serious staff demoralisation in excellent hospitals and, above all, a lack of a coherent sense of direction by managers.

Our area is expected to accommodate 41,000 new houses in the next 20 years; our local infrastructure is woeful. I have drawn to the House’s attention on many occasions the infrastructure deficit in my constituency, yet with all the added pressure for existing and future growth it is clear that the PCT plans to downgrade the Princess Royal hospital by removing the accident and emergency department altogether, although I was assured by a Minister at the Department of Health on the Floor of the House a year ago that there was no question of that happening. Indeed, the “Best Care, Best Place” consultation document said that both the Royal Sussex County and the Princess Royal hospitals will keep their A and E departments. Those assurances turn out not to be worth the paper that they were written on.

Brighton, where the A and E department is to be removed in totality, is hopelessly inaccessible by road. Its hospitals simply cannot cope with the load that is being placed on them, with patients constantly being referred back to the Princess Royal hospital. Gatwick airport is only 15 miles away, and there is always the possibility of a major catastrophe. In times of conflict, the Princess Royal hospital would be needed as a casualty clearing station. There is a major and very busy motorway on the doorstep, combined with very high housing and population growth.

This weekend, I hope that thousands of people will march in Haywards Heath in an all-party campaign to support the Princess Royal, to draw the attention of Ministers to the fact that we cannot allow our services to be downgraded, because that is not safe, and to complain about the instability of the service provided to local people. Although I agree with my right hon. and learned Friend the Member for Rushcliffe that there have been many changes for the better and that excellent changes are afoot to move services into the local community, interfering with the fundamental infrastructure of the health service in the way that is being done is a fatal mistake.

4.5 pm

Mr. Bob Blizzard (Waveney) (Lab): One of our greatest human failings is our lack of memory. I fear that today and in the weeks ahead the Conservatives will try to play on that by hoping that people will forget what the national health service was like in 1997. I would like to remind the House of what it was like in my area. Like everywhere else, we had long waits for elective treatment—18 months was the norm and, as we have heard, it could have been anything up to two years. The biggest change in the health service over the past 10 years is shown by the fact that nobody in my constituency now waits more than six months.

Going to accident and emergency in 1997 was really unpleasant. One could expect a long wait in crowded
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conditions in an environment that was miserable rather than comfortable. The second biggest change that we have seen is that today one can go to a completely modernised accident and emergency unit that is not crowded and one can be treated in under four hours. My hospital achieves that for 98 per cent. of patients.

They were chaotic times back then. The first national trust to go out of business was in my area. The Anglian Harbours NHS Trust, a community services trust, did not just have a deficit, but crashed and went out of business. Local NHS managers had to pick up the mess. Lowestoft community hospital was threatened with closure and, yes, we marched up and down the streets to save it, and we managed to under this Labour Government.

Mental health care was a complete failure in my area, with appalling Victorian and inconvenient in-patient facilities. Community mental health services were thin on the ground so that when I and my hon. Friend the Member for Great Yarmouth (Mr. Wright) were elected, we decided to march off to the Secretary of State to get something done. Thankfully, the regional health authority accepted our case and put matters right.

Mr. Graham Stuart: Will the hon. Gentleman turn his mind to looking ahead? As my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) said, if we looked back, we would see significant improvements in any 10-year period such as the 81 new hospitals that were built under the last Conservative Government. Will the hon. Gentleman follow the example of the hon. Member for Pendle (Mr. Prentice) who looked at the difficulties, which does not mean denying that improvements and benefits can be found? Looking at the problems and concerns today about the failure of productivity would help us to get a better deal for patients. After the hon. Member for Dudley, North (Mr. Austin), we have yet another party political rant based on the memories of what happened 10 years ago, and that is an entire waste of time. The hon. Member for Waveney (Mr. Blizzard) should focus on tomorrow and the issues that we face today and try to make a difference not just to his party.

Mr. Blizzard: If we want to understand the future, we have to understand the past.

We thought of going to the then Secretary of State, my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson), because he had already intervened in the East Anglian Ambulance NHS Trust, which habitually failed to achieve its target response times. That trust delivered last year the fastest response times in the history of East Anglia.

All the trusts at that time found difficulty recruiting staff because pay was low and the NHS was just not attractive. That was the dismal picture of the Tory NHS that we endured for 18 years. We had reorganisations too and I will declare an interest: my wife works for the health service and she was reorganised and reorganised again. Sadly, she has been reorganised a few more times since this Government came to power, but one of the worst things the previous Government did was split the Great Yarmouth and
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Waveney district health authority and the natural health economy that shares the same hospital. I am delighted that the Secretary of State put that back together again in the recent PCT reconfiguration.

The transformation today is so great that if I had promised what we have today in 1997, I probably would not have been believed. The cornerstone of our local health service is our general hospital, the James Paget. So much investment has taken place in the hospital that I have no time to list it all. We have had our share of the extra doctors and nurses, a new accident and emergency unit, as I have said, new theatres, intensive care units, maternity units, pathology facilities, eye units, new renal stations, scanners, digital X-ray, and most recently a new emergency admissions and discharge unit, which is helping to make the hospital far more efficient and to treat more people.

Mr. Simon Burns (West Chelmsford) (Con): I am interested to hear the hon. Gentleman outlining all the investment in his hospital, but would he tell the House of his concerns at the east of England strategic health authority review, which has just begun, and comment on rumours that his hospital might face closure or cuts?

Mr. Blizzard: If the rumours are being spread by Conservative Members, they will be very disappointed—

Mr. Burns: Will the hon. Gentleman give way?

Mr. Blizzard: No; I have given way twice. I am absolutely confident that our hospital will remain a first-class district general, and I will not accept scare stories spread in this House.

The hospital is high quality because it has met every target set for it ahead of time: 100 per cent. of people do not wait six months or more; 100 per cent. of cancer patients are seen in two weeks; 100 per cent. of those diagnosed with cancer are treated in one month; and 98 per cent. of people who turn up at A and E are seen in under four hours. My local hospital has got to grips with MRSA: last year it saw 300,000 patients and had 41 cases. It has had only 14 cases in the past seven months, but it wants to do better. Even its food was given a 98 per cent. satisfaction rate among patients in a recent national survey. That is why the hospital has been a three-star trust for successive years, why it has had no deficit for 2005-06—in fact it had a surplus—and why in August this year it became a foundation trust hospital, joining the other 47 in the country.

I have been calling it the James Paget hospital, but its new name is the James Paget University hospital, because it is now part of the new medical school that was established at the university of East Anglia, which has done so much for the health service in our area, bringing new, young medics whom we can recruit when they qualify.

This year will be a challenge for the hospital, but it is having to make no redundancies and I am increasingly hopeful that all the trainee nurses will get jobs. In another recent national survey, on staff satisfaction, the hospital came 10th among 200 surveyed.

That is a great performance and it has been aided by innovation. I told the House last year about the work
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of orthopaedic surgeon Mr. John Petri, who carries out dual operating and so has no waiting list. He moves between two theatres and two teams. If hon. Members want to do something for their local health service today, they should ask their hospitals why their orthopaedic surgeons are not carrying out dual operating and getting waiting lists down.

The future is bright for my local district hospital. As a foundation trust and a self-governing hospital, it has £40 million to invest over the next five years on ward upgrades, to enable it to exercise even better infection control, and on upgrades of patient facilities too. Its aim is to be a full district general hospital of high quality. That is what local people want and I am confident that that is what it will remain.

Tim Farron (Westmorland and Lonsdale) (LD): Will the hon. Gentleman way?

Mr. Blizzard: No. I have taken two interventions and I get no more extra time.

The purpose of my telling the House about the hospital is that the James Paget hospital shows that a well run NHS hospital can operate within the finances available to it, meet all its targets and deliver quality services without any deficits.

I do not have time to go into so much detail on primary care and community services, but suffice it to say that Waveney primary care trust set out its own “care closer to home” approach before the Government paper, so we see an important role for our community hospitals. The Lowestoft hospital, which faced closure, has had a major overhaul with massive investment, and I welcome the Government’s announcement of £700 million more across the country and hope that some of it will come our way.

Many of my constituents in the western part of the area are served by All Hallows hospital. It belongs to a charitable trust and has provided services for many years for elderly NHS patients in my constituency and in south Norfolk. A problem arises, however, when two neighbouring trusts do not move in the same direction, and we have such a problem at the moment with South Norfolk PCT, which is talking about reducing the number of contracts. If it does that, there will be a knock-on effect in my constituency, where the local trust wants to go in another direction, so I hope that we will see greater co-ordination. With practice-based commissioning, I know that local people will want to choose that hospital and that GPs will want to send them there, so with that type of commissioning and the new payments system, we hope we have a future.

As I said, the best thing to happen to primary care in my constituency was the formation again in the recent reconfiguration of a Great Yarmouth and Waveney PCT. That organisation can focus on commissioning the health services that are right for our local area based on local need, working closely with local GPs to serve local people, maintaining that relationship with the local hospital, and getting the funding appropriate to our needs. In mental health, we have brand-new facilities for in-patients. The ambulance service has turned itself around completely, as I said, and I expect it to get a good rating from the Healthcare Commission tomorrow.


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What has made the difference since 1997? Obviously, the increased funding, which the Conservatives opposed, has made a great deal of difference, but the other element that has made a difference is targets. The Opposition criticise targets, but if life was so good without targets, why was the NHS such a mess in 1997? I admire medical professionals; I work closely with them and I know that they are dedicated, but they need co-ordination and direction. I do not think that we can simply leave them alone to get on with it.

That raises the question: what is the role of politicians in the NHS? I attended a meeting in Manchester where a gentleman from the British Medical Association kept referring to politicians “meddling” in the NHS. Well, my constituents expect me to meddle in the NHS—they elected me to meddle in the NHS. Every month some of them write to me asking me to meddle in the NHS, and the people who ask me to meddle the most are BMA members—local doctors. They ask me to lobby Ministers to get things done, and sometimes—quite regularly, in fact—it works. If politicians do not involve themselves in that way, people will ask what is the point of voting for them and turnout will fall even lower.

I do not want to hand over the NHS to an independent board. I do not believe that it would be independent or be seen to be independent. Politicians would still get the blame for things that go wrong, but they would have no power to deal with them. I wonder what an independent board would become under the Conservatives. I worry that it would float away in the direction of charges, self-pay, patients’ passports, vouchers and all the other principles that we have often heard stated by Conservative Members.

I think that the NHS is safest in politicians’ hands because the British people, who cherish the NHS, will punish those politicians who do not look after it, as they did the Conservatives in 1997. Politicians know that. That is why we are committed to the NHS and why the Conservatives just pretend to be. The Conservatives and their newspapers are trying to present a picture of an NHS that is falling apart, but the NHS Confederation has just published a report, “Lost in translation”, which points out that when people who have been in hospital are asked about the experience, they say that they had good treatment. Some of them think they were lucky, but they were not lucky; they just voted Labour three times and they now have a Labour NHS.

4.18 pm

Dr. John Pugh (Southport) (LD): I shall be brief, because much of my thunder has been stolen by the hon. Member for Pendle (Mr. Prentice). I could not better his critique of what is going wrong in the health service.

The main focus of the debate is on NHS planning, or the lack of it. NHS planning is in danger of becoming an oxymoron, like “journalistic balance”. Although it is not my habit, I can best illustrate that point using events in my constituency, where we have the usual litany of modern NHS ills, especially in the acute sector. Only this week, we had another ward closure; this summer, we had ward closures, cutbacks and redundancies, not only among support staff, but on the
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clinical side. All year there has been anxiety about deficits and disputes about their cause and the solution to them. We have seen plenty of management consultants, plenty of hassle and plenty of controversy. Despite all that controversy and hassle, the staff have got on and delivered an exemplary service, but the word “planning” has no place in their world that they can understand. One can plan only when one properly understands the environment in which one is working, and there is no evidence over the past 10 years in my constituency that anybody has been able to do that.

Ten years ago my local trust, which controls two hospitals, tried to deliver a plan—not a very good plan, but it was based on allegedly clinical criteria. It was based on the demands of the medical profession for safety, clinical standards, training capacity and so on. It was deeply flawed. It had children who had suffered any kind of trauma or accident by-passing a fully fledged casualty department, and it was not acceptable to the people of my constituency. It was supposedly and unconvincingly based on the latest recommendations from the royal colleges, but it was at least coupled with a substantial new build investment programme.

However, even before the quoted medical advice had changed and before the plans were allowed to settle down, they were all thrown into the melting pot by the unexpected implications of junior doctors’ hours and changed conditions and the European working time directive, none of which hospital managers could do a great deal about. Just as that was heading for a settled outcome, payment by results appeared on the radar, ushering in uncertainty and further turmoil. Management consultants then proposed clinically absurd proposals at variance with all the previous proposals, and the new capital investment under payment by results became a financial millstone. The accountants—McKinsey’s, Ernst and Young and the rest—rather than the doctors appeared to be calling the shots.

That was not planning. It was reactive. It was crisis management. It is crisis management, but each crisis is internally generated. The public are left baffled and angry and the politics is messy and at times unpleasant. At the height of all this, there was a blessed moment of sanity in my constituency. The primary care trust, backed by the strategic health authority, took matters in hand, called all the parties together, sat them down and asked simply, “What do people here need? What can people fairly expect to receive?” Genuine consultation took place and for a time real solutions seemed to be in the offing. It was a model of crisis resolution.

Clinical networks were planned, sensible co-operation between all parts of the local NHS was envisaged, including specialist hospitals such as Alder Hey, and a genuinely workable road map was worked out, but then it all got parked. The PCT was abolished, the strategic health authority was abolished, the plans were sidelined, clinical networks were dropped and people were moved on. New financial goals were set overnight, management consultants from outside came in again, politics intruded again and the local NHS was
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turned upside down again. Financial considerations seemed to dominate over clinical delivery.

Like most trusts in the NHS Confederation, my trust is reciting the current mantra that so many beds and so many nursing staff may not be necessary. People cite figures showing the considerable fall in hospital occupancy over the past decade. However, they omit to tell us that the number of acute beds, as opposed to beds for maternity and the elderly infirm, has not fallen appreciably. We get flimsy clinical excuses for financially based decisions. Looking on anxiously in almost every constituency are the poor public—the citizen, whether ill or well—unable to detect the shape of future services, unsure of what awaits them, and unconvinced of the existence of even a Baldrick-like cunning plan.

As I look back over the past decade, I can detect periods when the concerns of doctors were dominant, periods when the interests of hospital administrators were dominant, and times such as the present when the voice of the accountant and the management consultant is dominant, but I have yet to experience a period in which the voice of the community and the patient is dominant, and I have yet to see an argument against it.


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