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The third reason why we have achieved improved outcomes is, yes, reform and change: doing things in a better way than we have done them before. We can all debate the individual issues in particular constituencies, and it is right that we keep the pressure on to make sure that we get it right in our own areas. I
support the efforts of my hon. Friend the Member for Pendle (Mr. Prentice) in that regard, and I will join him tomorrow to ensure that we get our local overview and scrutiny committee to refer to national Government the decision to downgrade Burnley general hospital A and E.
My question to the Opposition is this. You say that you oppose reconfigurations. Let me put this to you. What would you do if that reconfiguration was leading to better value for money for the taxpayer?
What would Opposition Members do if changes in technology and in the way that services are delivered and hospitals run meant that more people were likely to survive? If new technology meant that it was possible to visit people in their own homes and give them the care that they need there, hypothetically speaking there would therefore be fewer beds locally. Would they oppose that, as they have said they would?
We have achieved better outcomes for our constituents throughout the country, and longer life expectancy and better mortality rates, particularly in respect of cancer and heart disease. We will continue to achieve that by investment, by putting up taxesthe Conservatives opposed thatby setting the clear targets that they also oppose and say they would scrap, and by reform, which we clearly need to get right.
I look forward to the Conservative Front-Bench spokespersons contribution, because the public have some questions that need to be answered. I am grateful for this opportunity to put those questions, and I think that the public will see through, as I do, the attempt of Conservative Members
Steve Webb: Will the hon. Lady clarify her position on the important decision being taken in her constituency about local accident and emergency services? Who should make it? Local people or somebody in Westminster?
Kitty Ussher: On the whole, it is right for local trust managers to make decisions in their local area, but it is extremely important that the democratic system be made to work, so that where there are serious concerns about whether something is right the decision is referred to national Government and the Secretary of State. That is very much what I hope will happen. I would support other overview and scrutiny committees that took that view.
We are seeing a callous attempt from the Opposition to try to hoodwink the public that they care about an institution that the public rightly hold dear. We have
heard nothing today to make us believe that the Opposition have policies that could make the serious and sustained difference that Labour members and our Government have been making for more than a decade. I look forward to hearing the Oppositions response to the debate because I do not think they have answers to the questions we are posing.
Dr. Richard Taylor (Wyre Forest) (Ind): I have been looking forward to this moment for a long time. I shall start by offering advicefreely given and well meantto the Government and in the second part of my speech I shall offer advice to the Government and to the Tory Opposition.
First, what does service development mean? To me, it means improving and updating the service for the good of the patient: not for managers, not for staff, not for politicians, but for the patient. In the past 25 years, 28 reforms of the health service have been carried out by Governments of both colours. They were well described as debilitating changes by the hon. Member for Pendle (Mr. Prentice), and they were decried by the hon. Member for Bedford (Patrick Hall) and by the right hon. and learned Member for Rushcliffe (Mr. Clarke), so I shall not spend much time on them.
The crucial thing is hospital reconfiguration, which obviously strikes fear in the heart of many MPs because of what happened in Kidderminster so long ago. If anyone knows how not to set about reconfiguring hospitals it is me, so I offered the benefit of my advice to the chief executive of the NHS, whom I know vaguely. I thought that I would receive no reply, but this morning I had a letter from him saying that he would like to arrange a meeting. So it seems that he wants to take my advice, which is superb. Perhaps the Government realise that as an Independent I am not automatically against them all the time and that sometimes I can help.
There are signs that the Government are beginning to remember the lessons they have learned since Kidderminster. We have heard much about overview and scrutiny committees today and a little about the independent reconfiguration panel, the crucial body set up by the Government to ensure independence in the reconfiguration process and to take it out of the political arena. It is essential that they use the panel.
The Governments record so far is pretty abysmal. Until March, there had been eight referrals from OSCs to the Secretary of State, but only one to the panel. Yesterday, other members of the all-party local hospitals group and I met the chair of the IRPa tough, no-nonsense GP from Nottinghamwhom I would back as thoroughly independent. We heard several things. Perhaps the Governments record is improving slightlythere have been 18 referrals to the Secretary of State and four have got through to the IRP. Furthermore, we heard that the panel has the promise of money so that it can expand to cope with the work as it comes in. The Government have realised the importance of that and in this day, when there appears to be no money for anything, there appears to be money for this absolutely vital panel. I hope against hope that we now have the proof that the Government are beginning to listen and to realise that using the
independent reconfiguration panel will take the politics out of it all. It is no good having the Government tsar for emergency services come up with an independent review. With all respect to the Government tsar, he is paid by the Government and cannot really provide an independent view, yet having such a view is crucial.
with patients and the public, and with staff, needs to begin right at the outsetbefore minds have been made up about how services could or should change.
developing options for change with people, not for them.
The exact configuration must be determined locally by clinicians, ambulance staff and patients.
clinicians, ambulance staff and patients,
Steve Webb: As ever, the hon. Gentleman is making a thoughtful contribution. May I take him back to the independent reconfiguration panel? Does he accept that it is very much a second-best world, whereby local people who have a problem can go for the mercy of the Secretary of State, who may or not appeal to a group of people who were not elected in the first place? Is not that less satisfying than what he referred to previously: local people taking local decisions?
Dr. Taylor: I am grateful for that, because it allows me the opportunity to clarify what the independent reconfiguration panel is now doing. Because it has been used so little by the Secretary of State, it is putting itself forward as an advice service early on in the process, before an issue goes to formal consultation, thereby bringing together parties from both sides in order to broker a compromise. Time and again, compromise will prove essential.
To clarify my position, I reluctantly have to accept that we cannot keep every acute district general hospital doing everything in every town. The European working time directive, changes in practice, the move to primary care and the existence of financial deficits make that impossible. However, I will never accept that what happened at Kidderminster was right or should ever happen anywhere else. As hon. Members will know, we lost everything that makes an acute hospital an acute hospital. We lost in-patient medicine, in-patient surgery and hence, of course, the accident and emergency department.
Things have changed tremendously since 2000, when that happened. At that time, one could not maintain acute medicine without retaining all of emergency surgery. Now, it is accepted that even if emergency surgery is lost, it is possible to keep acute medicineadmissions for heart attacks, strokes, pneumonias,
bread-and-butter emergencies and so forth. It is now well understood that in any A and E department, the bulk of emergencies requiring admission are medical and not surgical. In Keeping the NHS Local, the Government produced some models of the downgrading of hospitals that are far less severe than what happened at Kidderminster and that have been accepted by local people. One need mention only Hexham and Bishop Auckland, where emergency medicine was kept, even though emergency surgery was lost. They were able to keep what are called urgent care centres, which are a jolly sight better than the minor injuries unit that is all that Kidderminster has left.
My plea to the Government is to use the independent reconfiguration panel and, as an aside, to standardise what is meant by emergency departments in our acute hospitals, as was done in the Northern Ireland acute services review of June 2001.
My second piece, which I must rush through, is that morale among the work force is absolutely desperately low, not only because of continued change, because of fears about jobs and partly because of deficits, but because of the rush to privatisation. It has suddenly come to me what the Conservative party and the Labour Government regard as privatisation, and it is not the same as what most of us who worked in the NHS and most other people think. To the Government and the Conservative party, so long as the patient does not pay, we have a national health service.
People who work in the NHS and the bulk of the patients to whom I talk have a high regard for uniformity of provisionat least, in the acute hospital service, if not across the whole NHS. I absolutely take the comments of many hon. Members on both sides of the House who have pointed out the hefty involvement of the private sector. Uniformity of provision was what Bevan produced. By introducing common pay scales right across the whole country, he immediately made it just as satisfactory for the best doctors and nurses to work out in the country as in London. By privatising some of the providers, we are risking a great deal of the real good that is in the NHS, and that will be one of the battle grounds in the future.
I do not believe that we should have an independent body running the NHSthat should be left to clinical and managerial staff close to the patients on the groundand that is why I am so glad that the Healthcare Commission is assessing not only how to fulfil targets, but how to assess outcomes. I cannot wait to read the comments that will come out in the next 24 hours or so.
I have looked at a large number of hospitals, and the crucial thing is the standard of the medical director and of the chief nursing officer. If they are of the right calibre and are prepared to get out and about to see what is going on, they can pull up the standard of care. The posts of those whom the Healthcare Commission decides are sub-standard should be examined very closely.
I have run out of time. I believe that the rush to privatisation might even galvanise people who did not have a previous political interest to take up the sword, rather as I have done, on the issue of abnormal, unwise hospital downgradings.
Dr. Roberta Blackman-Woods (City of Durham) (Lab): This is an important time for the NHSchange is never easy or straightforwardand I should like to think that the Conservative party had called this debate to help us with our deliberations and to engage constructively in a discussion about the future of the NHS. After listening to much of what has been said today, however, I fear that the debate is simply opportunistic and an attempt to exploit some of the difficulties and challenges that are associated with change.
Figures that were published by the Department of Health earlier this week show that health inequalities still exist and that health outcomes for people in the north are still poorer than in the south. In the north-east, where my constituency is located, life expectancy is lower than in other areas of the country and people are still dying prematurely from cancer and circulatory diseases. Although there have clearly been huge improvements in the NHS, they have not been good enough. It is important to note that Labour Members recognise that improvements must still be made, and a number of Department of Health documents, which I will talk about later, recognise that fact and set out a strategy to address those needs.
We need better diagnostics and quicker treatment. People need to be not only more aware of lifestyle facts, but to act on them. We need greater community support for lifestyle changes, because some of the communities that we are talking about are extremely vulnerable, with very vulnerable people living in them, and they need support to make changes.
We also need a much greater availability of a range of low cost sport and leisure services and, to this end, I am disappointed that the Liberal Democrat council in Durham has chosen to build its new swimming poolwe all applaud it for doing thatin the most affluent area of the city and ignored the deprived ex-mining villages. That will not help us to reduce the health inequality gap.
Although challenges remain for constituencies such as mine, I want to recognise the improvement in local services. We have a new hospital in Durham and it is doing extremely well at meeting the Governments targets. The figure is 100 per cent. for all out-patient services and it is 100 per cent. for more than half of in-patient services. Things are getting better for the people I represent. We are now close to an 18-week waiting list for all services.
We should also note in passing that the quality of information that we now have about what is happening in our local hospitals and GP practices is excellent and enables us to see what is going wrong in a way that certainly never happened under the previous Government. A Conservative Member said that there was greater anxiety now about what was happening in the health service, but I dispute that not only because things are much better, but because there would have been huge anxiety under the previous Government if people had actually known what was happening to health services.
In terms of service development in Durham, we have the new hospital and new mental health services, which have not been mentioned much in the debate. Such
services are critical but, in Durham under the previous Government, they were left to languish in an old Victorian hospital with no investment whatever. We are now getting a new mental health facility with acute and community-based services. Our PCT reconfiguration will also help to deliver partnership working with the local authority across a range of services.
I also want, however, to refer to some of the challenges that remain. In Durham and other areas, the Government have recognised that we need a shift to more community-based services. Many more people want to have services at home or in their local community if that is at all possible. I pay tribute to the Government for producing three documents that address some of these issues. They are Health Challenge England, which was published earlier this week and gives detailed information on health inequalities and the problems that still need to be tackled; Our health, our care, our say: a new direction for community services, which looks at involving local people in making decisions about their community; and Choosing Health. Those documents are important because they help us to look at challenges resulting from demographic and technological changes and from what is happening to consumer awareness and consumer demand.
The documents also consider several professional issues and that leads to a key point. Money needs to be directed at reducing inequalities in health and that means directing money to the areas where it is most needed. I have sat on these Benches for many debates and many Question Times listening to Conservative Members trying to defend primary care trusts that have not lived within their budgets and that seek to obtain subsidies from areas such as the one that I represent where there are poor health outcomes.
Grant Shapps: Will the hon. Lady not concede that whether a primary care trust does or does not meet its target is at least in part due to the amount of money that it was given in the first place? It is conceivably possible that the guidelines that work that out are unfair in many ways.
Dr. Blackman-Woods: Perhaps the hon. Gentleman would look at the primary care trust in Durham, which has enormous health challenges, as I outlined, yet manages to live within its budgetso it is possible. To return to my point, difficult decisions have to be made and if health inequalities are to be addressed, money has to be directed towards areas that need it most and that have the poorest health outcomes.
We also need a degree of local commissioningthat is also addressed in the documentsso that local factors can be addressed. We need greater local delivery and accountability, and we are having discussions about how that can best be achieved. That is critical for constituencies such as mine where there are remote, sometimes isolated ex-mining villages that need local services.
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