Some Opposition Members have unfairly described Government Members as complacent. We know about the difficult circumstances in which people live, because we see those people in our surgeries and in the streets.
Meg Hillier: The hon. Gentleman keeps intervening from a sedentary position and I am taking up time that might have been given to other hon. Members by responding to him. He would be shocked to see how people live in my constituency and the difficulties that they face in accessing services.
The PCT is continuing to invest in mental health year on year. We need more talking therapies at GP surgeries and more preventive work. Employment support is also important, because only 21 per cent. of people with mental health problems are in employment, which is a shocking indictment that we need to examine across Government. I recently met clients at Hackney Mind, who discussed the need to have time to get back into workmost of them want to get off incapacity benefit or ill-health benefit and back into work.
I have mentioned that Hackney PCT and our foundation hospital, the Homerton, have good financial management. Last year, however, Hackney PCT had to passport its underspend to overspending PCTs in other parts of London, where average male life expectancy is a couple of years greater than that in Hackney. To our consternation in Hackney, on top of losing that surplus, which could have been invested in the services that I have highlighted, the PCT has been asked to give still more money to trusts that do not balance their books in the short term. I shall make no bones about itwe in Hackney are very angry about that.
Why can budgets not be balanced elsewhere when they can be balanced in Hackney, which faces enormous health challenges? The Secretary of State for Health has promised me in a written answer that that cash will be returned, and I ask Ministers to underline that guarantee. We in Hackney do not want to go to the barricadeswe want the money backbut we are becoming cross about subsidising organisations that are less well financially managed. I am interested to know what further action Ministers are taking to ensure that good financial management is a prerequisite for any PCT or foundation hospital.
Anne Milton (Guildford) (Con): I share the disbelief and incredulity expressed by many of my hon. Friends when they listen to Labour Members. At times, it feels like we are living in parallel universes. The truth of the matter is that we are both right. Many constituencies represented by Labour Members are getting considerable funds, which means that those constituents and the doctors and nurses involved are very happy, but constituencies represented by Conservative Members are not getting such good funding.
A lot of research has been conducted on the funding formula, and it indicates that the formula is not as fair
as it should be. Conservative Front Benchers have introduced the possibility of separating funding for disease and funding for public health, which would allow us to have an impact on health inequalities. Despite the protestations of Labour Members, who go on and on about health inequalities, and despite the huge increases in investment, health inequalities are getting bigger. The situation has got no betterit is absurd.
In my constituency, the Royal Surrey County hospital, by the Governments standards, is an example of excellence. It employs 2,300 staff, including 280 doctors, 800 nurses and midwives and a multitude of therapists and scientific and support staff. It is a success story both in the care that it delivers to patientswith a top-performing accident and emergency department, waiting times for surgery met, 100 per cent. compliance with cancer waiting times and the joint lowest mortality rates in Englandand in the way that it develops its staff. It offers outstanding development opportunities for its staff, with 96 per cent. receiving training. The focus on staff welfare is demonstrated by the job satisfaction experienced by staff. As my hon. Friend the Member for Mid-Sussex (Mr. Soames) commented, however, the strategic health authority is undergoing a review of acute services.
Mr. Jeremy Hunt (South-West Surrey) (Con): Is my hon. Friend concerned that the SHAs review seems to have been fixed before it has even started, given the comments by the chief executive of Frimley Park hospital suggesting that there is a shortlist of hospitals, and that the Royal Surrey has already been designated as one of a shortlist of two hospitals in Surrey that are likely to be closed?
Anne Milton: My hon. Friend is right. There is huge cynicism about the consultation exercise. Proposals were meant to appear in the middle of August. That was then put off until the middle of September, and then late October. We now hear that the proposals will not come forward until the beginning of December. As the debate is about the work force and how we look after and value them, it is appalling that the Government can sit back and let such exercises go on and on while staff face huge uncertainty about their jobs.
Let me say to those on the Government Front Bench: we are not making this up. The Royal College of Nursing is not making it up. The British Medical Association is not making it up. It is true, it is real, and I challenge any of them to come down to Guildford to a public meeting and listen to clinical staff. Jobs and acute services are going and the future of the Royal Surrey County hospital, along with that of other hospitals in Surrey, hangs in the balance, because we do not have adequate funding.
Mr. Humfrey Malins (Woking) (Con): My hon. Friend will know that St. Peters hospital at Chertsey is also under threat. It provides a vital service to Woking constituents, is well placed geographically and has a wealth of experience. Does she agree that, were we properly funded, none of Surreys great hospitals need close at all?
The Government can act now and stop this. The way that I see it, hospital staff, the public and the Government are on a collision course, which is starting in Surrey and Sussex. The new chief executive of the NHS made it absolutely clear that he wants to see 60 acute trusts close. He wants more care delivered in peoples homes, and that aim and vision is not inappropriate but, as ever, the closures will happen before the investment is put in. In a place such as Surrey, and for my constituents in Guildford, travelling times to accident and emergency could increase to as much as 70 minutes.
It would be awfully nice if the Secretary of State listened to me for a minute and took some notice of what is going on. Clinicians, GPs and respected hospital doctors have told me that people will die if our accident and emergency departments are closed. The chief executive of the strategic health authority has said time and again that four out of five people can be treated outside A and E, but I still await an answer from the chief executive as to whom those four out of five people are. I contend that this Government will put lives at risk if they continue in their determination to close A and E departments and to downgrade our acute trusts, which also add to the huge research base in this country.
Ms Diana R. Johnson (Kingston upon Hull, North) (Lab): Listening to the debate for the past six hours or so, I have been surprised by some of the contributions. In particular, the hon. Member for Westmorland and Lonsdale (Tim Farron) said that he wanted an NHS that was just good enough, not excellent. That is certainly not what we want.
I was also surprised to hear from the hon. Member for Beverley and Holderness (Mr. Stuart), my near neighbour, that if the Tories had got back in 1997, the huge waiting lists would have somehow disappeared into the ether. That is certainly not the general view. We needed to put the targets in place to ensure that the waiting lists were dealt with.
I am pleased to be able to make a short contribution to the debate today, because I want to say something specific about 1997. I shall not rehearse all of our fine achievements since 1997, but in those days I was a member of the Mental Health Act Commission. I was appointed by the hon. Member for West Chelmsford (Mr. Burns), and I visited very vulnerable people who had been sectioned and placed in psychiatric units in the south-east of England. I saw for myself the under-funding, the poor state of the buildings and the lack of investment, which was because mental health services were such a low priority for the Tory Government. I am very proud of what the Labour Government have achieved since 1997, especially in mental health services.
The right hon. Member for Charnwood (Mr. Dorrell) commented that he did not believe that Labour Health Ministers could talk the talk and walk the walk. I fundamentally disagree. The NHS 10-year plan showed clearly that our Health Ministers were
talking the talk and walking the walk from day one. The right hon. and learned Member for Rushcliffe (Mr. Clarke) criticised the Agenda for Change, introduced by the Labour Government, but I am proud that we dealt with the poverty pay in the lower NHS pay scales. I remember watching the news as I grew up, with nurses talking year after year about how they were not paid properly. Labour has introduced proper pay scales and rates for nurses. We have also developed the nursing profession through nurse consultants and the introduction of modern matrons. We have an enormous amount to be proud of.
Hull is one of those areas that has massive health inequalities. Listening to the debate, it struck me that several of my hon. Friends whose constituencies also have high levels of health inequalities said that their PCTS and acute trusts are managing their budgets and keeping within them, just as the Hull PCT has done. The East Riding PCTs did not keep within their budgets, but they serve a much more affluent, and therefore healthier, population than does Hull PCT. That is cause for thought.
Hull is now a spearhead PCT and receives additional funding to address some of the deep-seated inequalities, and that is only right. I challenge Opposition Members to say whether that would be part of the Tory policy on the NHS. Would they continue the additional funding for spearhead PCTs?
We have also seen massive investment in capital build in the Castle Hill hospital, which many of my constituents use. Some £65 million has been invested in a new cancer unit and £72 million in the surgical and cardiac units. The local improvement finance trust programme in Hull is providing decent community services and facilities for GPs, nurses, podiatrists and dentists. That is the right approach, and not a penny is being wasted.
I hope that my right hon. Friend the Secretary of State will look at the Orchard Park LIFT site in my constituency. It is in a very deprived part of Hull, and unfortunately there has been a huge delay in getting the new facility up and running. It is vital to the local community that we get things moving as soon as possible.
I turn now to the Hull and York medical school, the jewel in Hulls crown. It is very new but very popular, and I am proud that it is producing doctors for communities in Hull and east Yorkshire. Its students are often older than usual, and their socio-economic backgrounds are often different from those usually associated with people who go into medicine. The school is a very positive development in medical education, and provides a patient-focused approach to the training of doctors.
I hope that the Minister, when he winds up, can reassure me about the funding of the Hull and York medical school, as concerns have been expressed about the local SHA taking control of the training budget. We must make sure that enough money is available to enable the students to complete their training and stay in our region.
The NHS must adapt. It is a dynamic organisation, and we cannot afford to be static and to keep things as they are. The Opposition say that no change is necessary, but I totally disagree. The priority of
managers in the NHS is always to be looking at how the service can be developed. For example, the Hull royal infirmary accident and emergency department has been transformed by the introduction of new ways of working, a different staff mix, and a new approach based on what works best for patients.
Doctors and nurses at the Hull royal infirmary say that one problem is that people undergo the same diagnostic tests again and again. Putting that right will lead to more savings, but the point is that we must look at service reconfiguration and redesign to ensure that the NHS is fit for the 21st century. The matter goes beyond beds, bricks and mortar: we need to keep developing our community and LIFT facilities, and we must also look at the role played by midwives who were seconded into Sure Start childrens centres, as it is very important that the NHS is taken out into the community.
Hulls Doula project involves volunteers who work alongside midwives to give a helping hand to vulnerable mums-to-be. It is an example of how service innovation can use the talents of the voluntary sector, and an illustration of how we must think about health in its broadest context, rather than simply in terms of hospitals.
I utterly disagree with the Conservative proposal to run the public health budget separately from everything else. That is completely the wrong way to go. We need to mainstream public health into everything that we do. I am very proud that the Government have taken a bold but correct approach to smoking, and we in Hull are leading the way by making sure that all children have access to healthy food every day that they are in school. We are also encouraging children to exercise by providing free swimming facilities.
Public health provision is a long haul, and we will not see the benefits of the changes immediately. However, health inequalities will start to level out over the next 10, 20 or 30 years as we refocus on public health in a more effective way than has been the case in recent years.
Finally, the Conservatives have argued for a massive expansion of social insurance schemes, voted against Labours extra investment in the NHS, and said that the NHS should subsidise private health care. Therefore, their claims to believe that the NHS is important and that it is safe in their hands do not ring true. When the electorate look at the Tory Oppositions record, it is clear that they do not really trust them with the NHS.
Martin Horwood (Cheltenham) (LD):
I begin by declaring an interest. My wife works in my local NHS, so I must take particular care to praise the work and endless patience of local NHS staff, including those in the former Cheltenham and Tewkesbury PCT. The people there, just like their counterparts in the constituency of the hon. Member for Hackney, South and Shoreditch (Meg Hillier), did everything that the Government asked of them. They never had a deficit, with the result that the PCT was top-sliced. It was given a promise that it would get its cash back, but it has now been abolished. I hope that the new
Gloucestershire PCT will do as well and survive longer. To be fair, I would also like to praise the extra investment that has gone into the NHS, which we supported. However, I have to acknowledge that, as the right hon. and learned Member for Rushcliffe (Mr. Clarke) said, most of the reasons for the current crisis lie in the mismanagement of that extra NHS finance at a national level, including things such as the over-commitment on GP and consultant contracts.
The cuts and closures in Cheltenham are very serious. We face the loss of local adult mental health services; cuts in acute care; the decision to close a local rehabilitation hospital before any plan for providing those services elsewhere has been put in place; cuts in health visitors, community nursing, community dental services, patient transport and the prescription of drugs newly approved by the National Institute for Health and Clinical Excellence; and the loss of overnight acute in-patient child care, despite the promise one year ago that that would be saved, at least as a nurse-led unit. The consultation process that we have just been through made no difference to any of those things.
One service has been partly salvaged from the wreckage. After 15,000 signatures and 10,000 people marching through the streets of Cheltenham, St. Pauls maternity unit has been savedat least as a midwife-led unit. Let us hope that that promise sticks. However, most of our local maternity serviceprobably some 2,000 deliveries a yearwill be lost and people will have to travel to Gloucester. The Government have even had the bare-faced cheek to claim public support for that policy. The health White Paper said:
participants in the Your health, your care, your say consultation said they wanted more care provided in community settings. The majority favoured increased investment in the latter, even if this meant changing the type and scale of services provided by their local hospital.
To what extent do you support or oppose providing more services closer to home, including community hospitals, if this means that some larger hospitals concentrate on specialist services and some merge or close?
Only 15 per cent. of the people at the summit supported that in an unqualified way; 39 per cent. supported it to some extent. To find out which bits people supported, and what they were hesitating about, we have to go back to the consultation document Your health, your care, your say. Buried on page 112 of that document is the summary of the main findings of the consultation. The summary makes it clear that
Most support moving hospital services into the community
They think services will be more accessible, because they are nearer to home.
They think the Government is proposing to close hospitals via the back door.
One participant gave the example of travelling from Cheltenham to Gloucester for treatment: a one-way taxi for that journey costs £35.
That participant must be absolutely staggered by what is happening in Cheltenham. As part of the reconfiguration of services, obstetrician-led maternity care will cease, sending, as I said, some 2,000 expectant mothers on exactly the journey from Cheltenham to Gloucester that Your health, your care, your say said we would be avoiding. They will be making that journey along with their relatives and friends, the sick children going to the new overnight childrens care service in Gloucester, the mental health patients going to the new adult mental health services at Wootton Lawn in Gloucester, and many others. It is quite clear that, although Labour was elected to save the NHS, what it is delivering for my constituents and many others across the country is less choice, not more, and health care further from home, not closer to home, and it is claiming support for both, when that support never existed.