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Mr. John Baron (Billericay) (Con):
We all agree that better community services are needed, but how can the hon. Lady square her comments with the fact that community hospitals are being closed by the Government, the number of district nurses is in decline,
and one in 10 birth centres are apparently close to being closed? That is not a sign of a Government who are willing to commit greater resources to community provision of health care.
Dr. Blackman-Woods: I hope that the hon. Gentleman accepts that the situation varies across the country and has a great deal to do with how effectively resources are managed. I will give him an example. The acute trust in Durham is considering how it can reduce some of the acute services where there is overcapacity and shift those resources towards primary care services. I hope that that will lead to better treatment services in local communities—that is what has to happen. It is a difficult decision, and I have had to argue for it locally because the local press and opposition are trying to make out that that means cuts. It does not; it is about planning for the future and reconfiguring according to need. We on the Labour Benches have started a very important debate.
Given that the Conservatives called today’s debate, I thought that I would look at their website to see what policies they are producing to address the issues. I consulted “The Wellbeing of the Nation”, a public service improvement policy group publication from autumn 2006. I hope that that is recent enough for Conservative Members. The first thing that I discovered was
“Policy-makers—of all parties”
“have too often fallen into the trap of implying that employment in the professions is ‘just another job’. We believe this approach fatally undervalues”
the professions working in the health service. That may be the Conservatives’ belief, but it is most certainly not the belief of those on the Labour Benches. We have always valued people who work in the national health service, and I pay tribute to those who do so in my constituency.
I also looked at the Leader of the Opposition’s weblog, where he tells us about news of the health service and that reorganisation in the health service must stop, with which I agree with him—we need a period of stability. However, the very first point in the document says:
“Are the present structures within the clinical professions capable of performing the roles..? If not”
should they be amended? It continues:
“Are the present structures within the NHS capable of performing the roles envisaged...in this partnership?”
If not, it asks, should there be amendments?
Conservative Members are not even addressing the challenges that they are setting for themselves. I would like to hear from them how they will achieve the move from acute to primary services. How will they deal with rising expectations? How will they keep the NHS safe if they commission from the independent sector? We have heard it acknowledged this afternoon that all services could be commissioned from the independent sector. How would the NHS be safe with them? My constituents know from their experience that the NHS is safe with us, not with the Conservative party.
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. It is too late to invoke the short speech rule, but may I suggest to hon. Members, about 10 of whom would like to catch my eye, that they operate on the basis that the rule was invoked, in which case the tariff would be about five or six minutes per speech?
5.40 pm
Mr. Graham Stuart (Beverley and Holderness) (Con): It is my good fortune to have you in the Chair making that announcement just as I rise to speak, Mr. Deputy Speaker.
I have enjoyed today’s debate. Thoughtful speeches have been made by hon. Members on both sides of the House. Some Labour Members have not read an entirely Labour party-oriented script, but have examined some of the issues and problems. That is surely what we all should be doing. As Conservative Members have said, a consensus is emerging on the way forward for the NHS—a consensus on making the best use of the resources that we have. The hon. Member for Bedford (Patrick Hall) in particular picked up on the present financial shortcomings.
The Labour Government inherited the most powerful economy in Europe—an economy that had been transformed by the Conservatives after years of socialist failure. As Labour Members are fully aware, this country had become the fourth most competitive economy in the world. Labour’s sick man of Europe had been converted from a basket-case into a model envied and, indeed, copied in equal amounts by others.
David Taylor (North-West Leicestershire) (Lab/Co-op): Will the hon. Gentleman give way?
Kitty Ussher: Will the hon. Gentleman give way?
Mr. Stuart: No—I have only five minutes and hon. Members are stretching credulity if they think I will give way.
There is more to life than economics, however, and the British people wanted world-class public services, not just a world-class economy. Labour’s victory in 1997 was achieved on the basis that a Labour Government would accept Conservative economic prescriptions but use that economic strength to make our education and health systems world class, too. As my right hon. Friend the Member for Charnwood (Mr. Dorrell) said, it is greatly to the Labour party’s credit that it reflected public opinion and the public’s desire for world-class public services—a desire for spending to increase to the European average. The measures taken at that time were opposed by the Conservatives, but my party has listened to the British people and recognised the need to change, and it is doing so.
There has been a doubling—not a trebling, as one hon. Member said—of spending on the NHS in real terms since Labour came to power. Sadly, however, outputs and the outcomes for patients have not matched the massive increases in resources. In the 1997 manifesto, Labour promised to be
“wise spenders, not big spenders”,
but Ministers admit—even the Secretary of State has done so, albeit not today in her rather weak speech, which did not match the strength of many Labour Members’ contributions—that outputs have not increased in line with increases in resources.
We have heard a great deal about acute hospital performance. In the six years to 1997, the number of hospital treatments in the NHS increased by 26 per cent. Productivity was improving sharply during the 1990s. [ Interruption. ] If the hon. Member for North Durham (Mr. Jones) will allow me, I am trying to address the root of the problem. There is a consensus about the broad approach, and we as a Parliament and as politicians need to work together to find a way forward. In the six years after 1997, however, there was only a 14 per cent. increase in hospital treatments, and according to the Office for National Statistics, productivity in the NHS has fallen by up to 1.3 per cent. each year since 1997.
Labour Members can take credit for the massively increased expenditure on the NHS, and there have been improvements in standards as a result of that investment; those points are valid and they deserve to be made. However, falling productivity means that that expenditure has not brought value for money for the UK public. The Secretary of State for Health said earlier this year:
“For all the extra money, all the extra staff and extra patients treated, NHS productivity has remained almost unmoved.”
The truth is that it has moved: NHS productivity has fallen under Labour. That is the central problem.
I and many of my colleagues broadly support the vision set out in the White Paper at the beginning of this year. It is the disconnection between that vision and the reality on the ground that we are discussing today. Ways must be found to address the problem of falling productivity that has been recorded under the Government and to overcome it. I hope the Government will be able to make improvements. Although that will be less politically advantageous to us at the next election, I hope there will be serious productivity improvements by then.
Mr. Stuart: I will not take any interventions, after the words of the Deputy Speaker.
If the Government had merely maintained the progress—admittedly, with much lower resources—of the last Conservative Administration, 1.4 million more people would have received hospital treatment under the Labour Government. Waiting lists, instead of being massaged, would have been banished. The hon. Member for Bedford described the financial arrangements of the NHS as bizarre, confusing and damaging and said that the resource accounting and budgeting must be sorted out.
Labour has failed because it has not delivered value for money. For all the billions that have been spent, 1 million people still remain on waiting lists, which none of us in the House wants to see. Health inequalities have been mentioned several times. I do not want to be rude to Labour Members, but there seems to be a certain level of complacency about the fact that health inequalities are at their widest since Victorian
times and 10 community hospitals have closed in the first six months of this year alone. [Interruption.]
The debate is very much about staff. My colleagues are urging me on. I thought they were urging me on in my speech, but I now realise that they are urging me to stop so that they can speak, so I shall conclude, in deference to them, with a letter that was delivered to the Prime Minister two days ago. It is signed by the general secretary of the Royal College of Nursing, the chief executive of Diabetes UK, the chief executive of the National Rheumatoid Arthritis Society, the chief executive of the MS Trust and the executive director of Incontact—who, I hope Labour Members will accept, are not a group of Tory stooges trying to make political advantage for its own sake. The letter states:
“Now the very people who have delivered your reforms are among the thousands of NHS staff who are at risk of redundancy. A culture of fear and uncertainty has permeated the health service. Nursing staff are worried about their futures and have become increasingly concerned about the safety and welfare of their patients, whom we believe are at serious risk from the actions which Trusts in deficit are taking to save money.”
That is the position that we are in. We all need to work together to sort it out. Moves to stop the meddling from the centre and to provide an independent board for the NHS—the prescription proposed by the Conservative party—will make the difference. We will work with the Government while they remain in office to try and improve the NHS. I hope all sides will work together on it.
5.47 pm
Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): This has been a rather surreal afternoon, perhaps because it is nearly six hours since I came into the Chamber and I have not had lunch. It was odd for me to sit opposite the right hon. and learned Member for Rushcliffe (Mr. Clarke), who is no longer in his seat. It seems not that long ago—a little longer than I would like to admit—that I was studying him and his Government at A-level. During parts of the debate, one could be forgiven for thinking that we were living in the 1970s and 1980s.
But reality bites, and in my constituency, reality bites about what has happened in the NHS since the Government have been in power—the rapid investment. I shall respond briefly to the comments of the hon. Member for Beverley and Holderness (Mr. Stuart). Perhaps he does not understand the basic economic principle that if one pays people what they are worth, which is more than they were being paid in 1997, productivity will indeed go down. We still need to do more, but he does not seem to have grasped that. On health inequalities, he is rude about all of us, but he is wrong. There is no complacency among Labour Members about health inequalities. I have little time, but I shall touch on some of those health inequalities in Hackney.
Hackney’s health services are being transformed under the Government. One leading local health professional said:
“The NHS has done fantastically well under this Government and any current concerns must be couched within this context.”
In fairness to the excellent health professionals in Hackney, South and Shoreditch and Hackney borough, I want to give just a few examples of good
service development in my constituency. I do not have time to deal with all the indicators, but hon. Members will know from previous comments that I have made in this House that Hackney has many health challenges.
We have an excellent foundation hospital in the Homerton hospital, which is ahead of the game on a number of counts, but particularly on connecting for health, the computerised IT programme. We already have a comprehensive electronic patient record service, in the vanguard of the rest of the NHS in IT innovation, and that is thanks to Government money.
We have a primary urgent care centre at the Homerton hospital and more GPs and GP surgeries than ever before—154 full-time equivalents—and their premises are constantly being improved, which was long overdue as many GPs were working from tatty terraced housing. Some still are, but we are working to improve that.
We have two walk-in centres in the borough, one in Liverpool street near my constituency and one in Hackney, North and Stoke Newington in Stamford Hill. Practice-based commissioning is advancing, with 39 practices now thinking carefully and enthusiastically about how they can use that to improve patient care, because they put patients at the centre.
Meg Hillier: No, that is a very different model. It is putting GPs in the driving seat on patient care, where most people have their first, and last, contact with the health service. It is not differential funding, and that is important to remember. There is no sweetener for people trying to take a different route and opt out of the NHS. They are working with hospital doctors to ensure closer care and for more of it to be provided at GP surgeries. For many of my constituents, just getting to the hospital, even though it is very local compared with those of many hon. Members, and having a local, safe, known environment means that there is a much greater chance of them getting the treatment that will prevent some future health inequalities. Flu jabs are well organised, with pharmacists in Hackney also providing them. It has never been easier to be immunised in Hackney.
The Homerton hospital is our local district general and for 11 years, since its inception, it has had no deficit. In fact, for most of that time it has had a surplus. Last year, it had its first small deficit but it was less than 1 per cent. Much of the talk about deficits has suggested that they are a widespread problem, but in fact only a small percentage of trusts—
Martin Horwood: Cheltenham and Tewkesbury primary care trust had also never had a deficit, but it has not saved us from the cuts. The fiction that they affect only a minority of trusts has nothing to do with the configuration of the deficits. Shared services and other factors are causing that.
Meg Hillier: If I have time, I will come to some of the issues in my local area.
This year is a more challenging one for my local hospital, largely because it is very dependent on
emergency admissions, and the tariff for that is much lower than those for other treatments. It is unusual for a hospital to have the high level of emergency work that the Homerton has. That is partly due to the nature of the area where many people still present at hospital as a first option rather than at primary care level.
Recently, I met the chief executive and she knows that times are challenging as she manages this change, but she is positive that the changes that she is making are clinically driven and are leading to innovative best practice. That is a big priority for her and her clinical team. Next year will be hard because those savings need to be found in that year, but the future is looking more stable. I have great faith that the future will be much more like the last 10 or 11 years, when the budget was balanced. It is down to good management, adjusting to change in the interests of patients, and good financial management——there and in the primary care trust, which also has always had balanced budgets——is important.
This debate is supposed to be about service development, so I want to deal now with mental health, which is a big issue in Hackney. People in Hackney are diagnosed with schizophrenia more often and admissions to hospital for schizophrenia are three times higher in Hackney than they are in England. The borough has unusually high rates of illness across the mental health spectrum. The factors are many and I do not have time today to go into them, but in terms of future service development, the Government’s focus on delivering race equality in mental health is very welcome and pertinent to Hackney, South and Shoreditch.
Of those sectioned, 44 per cent. are black men. They make up only about 5 per cent. of the total population, but that is an incredible anomaly that we need to tackle. There are good examples of what can be done, and some are not just about services in hospitals, or even in health facilities, and I want to highlight a couple.
The Hackney football team has been run for the past two years by an occupational therapist who is also an accomplished footballer. The players in the team have all suffered mental health problems. Now, all but one of them is not smoking, three have coaching badges and one has a full-time job. It is clear that that team has helped those people to get back on track and into normal life.
The 4Sight group involves users of the City and Hackney centre for mental health. Its members work with a drama group to develop plays about their experiences, which are now being used to train staff. The Government can learn from that experience with regard to the rest of the country. [ Interruption. ] I hope that hon. Members are listening and that they will take that point back to their mental health trusts.
Language and access to health services is a big issue in my constituency, and it is as important in mental health as it is in other areas. I commend Derman, which is a bilingual health advocacy service to the Kurdish and Turkish communities, to Ministers. It enables those communities to access a range of mental health services, and it helps to reduce hospital admissions and health inequalities, which I have not had time to discuss today. It is vital that we look at the differences between areas.
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