Patrick Hall (Bedford) (Lab): When I was first elected to represent Bedford and Kempston in 1997, a regular feature of my postbag then and for some years thereafter was people asking for help because of the consequences of excessive hospital waitingthe pain, the living in distress and the time off work. Many people were driven to the private sector. If that goes too far, it undermines the principles of the NHS. That is the way it was nine years ago. Today, I hardly ever have such a case brought to me by a constituent. People acknowledge that there has been a real improvement in waiting times. The Conservative party must hope for a national collective outbreak of amnesia on this point if it is to make progress with its claim to be the true party of the NHS.
The Government have even more ambitions than their achievement so far. The plan is that, by the end of 2008, the overall maximum wait in the NHS will be 18 weeks. That is from GP to operation, including diagnostics, and that has never been attempted before. In practice, for many interventions, that will mean an in-patient treatment wait of seven or eight weeks, which will truly revolutionise the NHS.
Kitty Ussher (Burnley) (Lab): Does my hon. Friend agree that, under this Government, not only will the waiting time become a maximum of a mere 18 weeks, but that in the Conservative years it was 18 months?
The other aspect of modernisation and improvement of the health service is the switch to primary and community careaccessing health care more at local GP surgeries, local clinics and enhanced pharmacies, and treating people in the home if possible.
I acknowledge the investment in the NHS and the move towards community services, but
the problem is that acute services cannot be operated directly in the community; they need decent sized hospitals that are relatively close to where people live. One consequence of concentrating on specialist hospitals alone is that, in rural areas such as mine, one ends up with the situation such as that at Westmorland general hospital where the medical emergency admissions may soon be shut down because of the drive for the best. The best is becoming the enemy of the good enough. Does the hon. Gentleman accept that we need to ensure that we have safe services that are close enough to people for them to get there in time to survive and be stabilised when they have conditions such as heart attacks?
Patrick Hall: I did not follow that entirely, but yes, of course, we want a better NHS, if that is what the hon. Gentleman said. If we have more services in the community, that will free up the acute sector to enable it to treat more people more quickly. If people have to go to hospital, they want the prospect of safe treatment without having to wait too long and as locally as possible, although that depends on the nature of the operation that they face.
Not enough has been said about the plans to modernise the NHS. It has not been sufficiently reported. It involves change and change can be difficult, but it is a good news story which, when I discuss it with NHS staff and constituents, is one that they can broadly sign up to, even if it goes under the peculiar term of reconfiguration.
But the context has dramatically changed in recent months, and that context arises from the consequences in Bedford of the Bedford Hospital NHS Trusts £11.8 million deficit. I do not have time to go into why there is that deficit, but it is combined with the Governments decision this year to address the NHSs overall deficit of the last financial year by top-slicing the budgets to PCTs, and the two together have created real pressures. They are short-term financial pressures, but they could lead to up to 200 redundancies at Bedford hospital, although the figure is likely to be significantly less. Nevertheless, it is worrying, and damaging to staff morale, and it will slow up the development of the consequential primary care services that will be needed if there is to be a shift to some extent from acute to primary. Such uncertainty is bad for staff morale and the public do not understand what is happening. They know that there have been improvements and that there is a lot more money year in, year out, but they face difficulties such as they have not experienced for years. That situation provides fertile ground for others to increase peoples fears by telling scare stories. In the case of Bedford hospital, the scare stories were started by the Liberal Democrats in The Daily Telegraph on 14 September. The scare tactic involved saying that Bedford hospital is scheduled for closurea Bedford hospital consultant went on the record to make that point and Bedford and Kempston Conservative party is circulating a leaflet reinforcing the fear of the threat of closure. Let me make my position clear. I totally support Bedford district general hospital as a viable district general hospital. The hospital is not at risk from closure, and it is wholly wrong to whip up fears that it is.
The important issues are more difficult. The serious issues facing Bedford district general hospital are
managing the four-year financial recovery plan to eliminate the hospitals debt, changing the shape of local NHS services to improve them for the long term and ensuring that those two tasks are carried out while maintaining a full range of services, particularly the 24-hour accident and emergency service. Those are the challenges in Bedford, and they clearly worry my constituents. We are not helped by fears being whipped up unnecessarily, which goes on day in, day out in my constituency.
There are real problems that we must face up to, so what should we do? First, when changes are prepared and published, there should be a three-month statutory consultation process with which people are urged by all parties to engage on the basis of facts and a measured and informed debate rather than on the basis of scare tactics.
Secondly, the Government must examine RAB, the resource accounting and budgeting financial management system that now applies across central Government. The principles of RAB have supposedly been applied to NHS trusts across the country, which means that, if a trust reports a deficit in one year, its income is reduced by that amount in the following year. That is a double whammy, which is unfair and guaranteed to make a difficult situation worse. Furthermore, the in-year deficit is reported to the balance sheet reserve and carried forward cumulatively. Bedford hospital trust reported an income and expenditure deficit of £8.48 million in 2004-05, and Bedford PCT passed on a reduction in its service level agreement income of that amount in the following year as a result of RAB. However, because that reduction would have devastated the hospital, which would not have been able to pay many of its staff, the trust was permitted to borrow that sum from the strategic health authority. That cash borrowing, which did not appear in the accounts in the normal way, was interest-free, and the sum was to be paid back in the following year. In 2005-06, the in-year deficit was reduced by the trust to £3.41 million, which under RAB should have led to a cut in its income of that same amount in this financial year, but that did not happen, because a deal was done with the SHA.
I hope that Ministers look carefully at the Audit Commissions review of the NHS financial management and accounting regime, which contains a clear and powerful critique of RAB and the labyrinthine system of complex financial devices which dominates, and has always dominated, the NHS. It calls for an end to RAB being applied to the NHS and for a system of much greater clarity and transparency. What is happening to Bedford hospital reinforces the message from the Audit Commission. In one year, RAB was applied, but cash borrowing was allowed to cover the cut, and then it was not applied in the next year.
Some might say that we muddled through and that the situation is okay, but I disagree, because the system is bizarre and confusing, and it perpetuates a culture within the NHS that is not businesslike. If RAB were not applied to the NHS, as proposed by the Audit Commission, which has also made suggestions for improvements, Bedford hospital and other trusts with deficits would still have to address their deficits. We are not talking about just wiping deficits clean and
pretending that they do not exist, but at least we could then build on a system that enables clear planning, openness and transparency which more people than just the finance director could understand. The NHS needs that important development, so that it is not just left to the finance director to understand the finances, and so that all elements of a hospital, for example, contribute to financial efficiency.
It is also important to get rid of RAB so that we abolish its cumulative balance sheet feature. That element might not appear to matter, but it will from April next year when the capital funding regime is due to change and an NHS trusts ability to borrow will partly be judged by the state of the balance sheet. Under RAB, while Bedford Hospital NHS Trust should eliminate its deficit within four years, the balance sheet will show the deficit for eight years. That is a wholly ridiculous situation.
Thirdly, we should continue to close the gap between what the health economy in Bedfordshire gets and what it should get in terms of its capitationthe system known as fair funding. Year on year, in Bedfordshire, despite Conservative claims that somehow money is being robbed from Bedfordshire in order to over-fund the north of England, this Labour Government are closing the gap with regard to fair funding. We need, however, to continue that process.
Patrick Hall: I am not going to not say something just because some Conservatives may agree with me. Sometimes, it is important to unite on issues in the national interest. I am speaking up for my health economy and my hospital, and I do not mind at all if Conservatives wish to support me in that. We need stability, because there has been too much structural change. Some welcome reforms, such as practice-based commissioning, the choose-and-book system and payment by results, are about to be introduced, but it is all happening at once. Whatever we do in reform and in government, there are still only 24 hours in the day, and sometimes things get a little too much.
The Government have a good strategic policy for the national health service, which is one of the reasons that Labour got elected in 1997 and has been re-elected twice. We have an exciting vision for the national health service that does not just end now but continues for the decades ahead. At the moment, however, it is to be delivered by a wholly inadequate financial management system, which is undermining delivery and urgently needs reform. I urge my right hon. and hon. Friends on the Front Bench to take on that point with seriousness.
Mr. Simon Burns (West Chelmsford) (Con):
I listened carefully to the speech by the Secretary of State for Health. The sheer horror of the situation suddenly came to me when I realised that either she is living in cloud cuckoo land or she is in a total state of denial about what is going on in the real world beyond
this Chamber. Like all Members, the Secretary of State has constituents and, I presume, receives correspondence every day from them and the wider public because of her public role. I am amazed that she seems to think that everything is going well in the NHS and that there are no problems.
Equally, it is fatuous for hon. Members, Ministers and others simply to refuse to accept that the previous Government did good things in the health service. Since 1997, this Government have also done good things for the health service. As my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) rightly said, there is a growing consensus in this Chamber and the country over the national health servicea consensus to which I have adhered from the first day I entered this Housethat we should have a first-class health service, based on free access for those eligible to use it and paid for by taxes, except for those areas on the fringes that, historically, have not been free at the point of use, such as prescription charges.
If we work from that basis, we have a golden opportunityespecially given the revenue that the Treasury has been able to glean in the past 10 years because of the economic situation that resulted from the difficult task on which my right hon. and learned Friend embarked on in the mid-1990s and the record amounts of money that the Government have put in, which it would be foolish not to acknowledgeto introduce fundamental reforms to ensure that we get value for money from our investment and that patient care improves. There have been improvements in the health service in the past 10 years, but there are also some significant problems. Because of the lack of structural reforms to improve productivity, we have returned to short-term thinking to try to address the emerging problems.
My constituency has a fantastic local hospital in Broomfield hospital, which has an excellent management team and a first-class, hard-working and dedicated staff. I pay tribute to them, but there are problems because the money that has been made available in record amounts by the Government is not reaching front-line services at the level and in the scope that we would expect. Chelmsford PCT has a deficit of £13 million. To try to overcome that problem, as it has been told to do, two intermediate care wards have been closed completely, so there is now a gap in intermediate care that will have a knock-on effect on the local hospital and, potentially, delayed discharges will begin to escalate again.
We also have a problem with the hospital trust. Some 200 jobs will be lost or not replaced to meet its financial deficit. We also have a nurse training school at the Anglia Ruskin university. Four or five years ago, the Department of Health was trawling the third world for nurses to work in our health service because it was short of nurses. More and more people were encouraged to train as nurses and investment was made in their training, but now that they have those nursing skills there are very few jobs for them. That is a terrible waste of investment, their talents and their potential contribution to improving and enhancing the national health service.
I wish to raise another issue that illustrates the problems of the NHS. Before the last general election, the Mid Essex Hospital Services NHS Trust came up
with a brilliant PFI scheme worth £180 million. Chelmsford has two hospitalsBroomfield hospital, which is an old tuberculosis hospital that has been modernised and is now state of the art, and St. Johns hospital, which was built in Victorian times and is way past its sell-by date. Contrary to what the Secretary of State saidit did not fit her agendathere are Conservative Members who support hospital closures when they see the logic behind them. From the outset, I have supported the closure of St. Johns hospital, as have the medical staff and my constituents, because the services were to be moved four miles to the Broomfield hospital site. That is the right thing to do when the building is outdated.
The PFI scheme was put together and I fully supported it. It was the centrepiece of the West Chelmsford Labour partys election campaign in 2005the Governments investment in the health service. I have to hand it to them, because it is a centrepiece that would deliver an improvement in health care. The scheme was ready, it had been validated and approved by the Essex strategic health authority, and it went to the Department of Health in October for final approval. Unfortunately, the Department could not get its act together and, having said that we would have a decision by the end of November and then by the end of the year, it had still failed to make a decision by late January. At that point, the Chancellor stepped in and said that all PFI schemes had to be revalidated, so we were back to square one.
it will have an optimistic conclusion.
an assurance that it will go ahead as quickly as possible, once the remaining issues have been sorted out.[ Official Report, 10 May 2006; Vol. 446, c. 310.]
I was grateful to the Prime Minister for that response, but it is now 11 October, and the plan has not received the go-ahead. It has also been scaled down, to a probable value of £80 million. If it finally receives approval, the hospital will have 200 fewer beds than it has now, and the outcome will not be the tremendous, state-of-the-art improvement originally envisaged.
I wrote to the Minister a month ago, and he kindly replied to me today. The trouble is, his letter says nothing in response to my real questions. If the plan fails and does not get approved, the Prime Minister will look foolish. If that happens, I will feel a bit sorry for the people who briefed him when he gave me the assurances and commitments in May. However, there will also be the knock-on effect that a significant amount of money will have to be repaid if the project falls apart and is abandoned. That money could have been invested in health care and front-line services and used to wipe out the deficits of the Chelmsford PCT and the Mid-Essex hospital trust. I think that the East of England SHA is the cause of the problem. Going to see the people there would be a waste of time, as they would tell me nothing new. The Minister must look into the matter and try and get everyone working together, as quickly as possible.
In conclusion, it would be stupid to suggest that everything is wrong with the NHS at present. It would
be equally stupid, however, to suggest that everything before 1997 was appalling. One should give credit where it is due, but Ministers and the Secretary of State must stop patronising the House. The right hon. Lady speaks to hon. Members like a know-all head teacher speaking to naughty schoolchildren. She must accept that there are significant problems with health care delivery in parts of the country, and in certain areas of medicine.
Those problems have to be addressed. I applaud the record amounts of money that the Government have made available, but that money must be channelled towards front-line service and the provision of even better health care. It must not be wasted on bureaucracy and ceaseless reform. We need stability, so that the NHS can get on with providing the finest possible care for all our constituents.
Andrew Gwynne (Denton and Reddish) (Lab): I welcome this debate, and am very pleased to be able to contribute to it. I should like to speak about the demands that the NHS faces, and to which it must respond. Demand for a mass health system is not always visible. I have many constituents in parts of Denton and Reddish who need NHS support but who do not actively seek it.
I think that that is the challenge. Of course, the NHS must respond to the demands made on it, but it must also find new ways for those demands to be made, and especially by the most dislocated and vulnerable people in Britain. The debate has moved on from being simply about quantities of investment. Stephen Watkins, the director of public health in Stockport, has written:
For several years now the Government has been investing very large sums of new money into the NHS. This money far exceeds anything that would have been dreamed of throughout the late 1970s, 1980s, or early 1990s. Those who called for UK health spending to be increased to the European average were dismissed as unrealistic dreamers. In 1996, the BMA said that £6 billion of real new investment was required for the NHS and was attacked by other health organisations for going over the top. In 1999, the Government injected £12 billion of real new recurrent money to start a process of increasing NHS spending to the European average.
With this additional money the NHS has dramatically improved.
That is not a political statement. That comes directly from the director of public health in Stockport and his 2006 public health annual report. Clearly, the level of Government spending was the argument in the 1990s. To solve the problems that the NHS may face in the future requires reform for our changing society.
The Labour Government who took office in 1945 were a response to the demands of post-war Britain. War and sacrifice, both at home and abroad, led to the most demanding British electorate since the emergence of mass suffrage. That electorate demanded that the Government provide a free and first class health service for all throughout the country, and the Labour Government responded. The British people have, of course, changed a great deal since the 1940s. They have become ever-more demandingmy constituents included. Their expectations are much higher and rightly so.