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Ms Sally Keeble (Northampton, North) (Lab): I am sorry that I was not here earlier. I am grateful to have been called because there are difficulties in the health service in my area and I appreciate the opportunity to make a contribution. Like everybody else, I welcome all the extra funding that has gone into my local health services. I welcome the extra staff, the extra services, the proposals for a new acute hospital and the proposals for a new mental health hospital.
I also welcome the new services and greater access that are available. For example, NHS Direct means that we do not even have to go to a GP because we can phone up for advice. Like many people, I have used the service in situations such as when one is anxious about a child late at night. I also welcome the shorter time taken in accident and emergency. We can now go in with a kid with an injury who can see a nurse, have an X-ray and be out within a couple of hours, which is phenomenal.
While all that is happening, however, there are cuts to services because of deficits. We need a real understanding of what is happening. Our acute trust is in deficit for particular reasons, but not because it has been hugely incompetent. The financial management of the hospital has improved greatly, but it has experienced difficulties. Our PCT is in deficit, which has led to the mental health trust being made to take some of the strain.
The kind of cuts that we have experienced include stopping all IVF treatment on the NHS, which puts it back to being subject to a postcode lottery, which is something against which I and others have campaigned for a long time. I think that the same thing has happened elsewhere. Several treatments have been cut, including some that are not so minor. There are proposals to cut all talking therapies in the mental health services and to cut access to certain drugs on NHS prescriptions.
Although I will not take up my full time, Mr. Deputy Speaker, I must tell my right hon. Friend the Secretary
of State that while I, like others, welcome the big pictureI think that it is wonderfula lot of people will focus on whether they can get the treatment that they want at the time that they want it. One might say that that is a little picture, but it is their picture and it is important to them, and that is why some of the cuts and the ways in which the deficits have been managed have been painful.
Some will judge the situation on their perception of their job security, given that the NHS is a huge employer. Its staff also use its service, and it is really important that those involved in service design take the staff with them, but that has not happened, especially locally. We sometimes talk about service development as though it is about only new services and more money, but some aspects of it are intensely painful. For example, it is about moving services not only from the hospital to the community but, in my area, from the hospice to the community. Changes in palliative care mean that people want to die at home, but that might result in cuts in services at a hospice in which people might have seen their friends or family die and for which they might have raised funds. The process of change can thus be difficult.
The Conservative partys focus on staff development is completely hypocritical. One of the big arguments about funding is that all the extra money that has gone to the NHS has not been properly spent. Yes, a lot of it has been spent on pay risesquite rightly soand that has of course affected the productivity figures. The pay increases have not been small. In London and the south-east during the 1990s, when I was chair of a community health council, the contract staff who cleaned hospitals in the NHS were on £2 an hour. The increase in salary up to the minimum wage and beyond affects the unit cost of all work done in hospitals.
It is also not true that deficits are something new. When I was first selected as a candidate in Northampton, the local health authority was faced with deficits in the financial year 1995-96 because it had overspent. It took the decision to keep the following years spending on services the same and to hold reviews to deal with the funding problems. It simply carried out deficit budgeting, as it is known in local government, and rolled the deficit on. Deficits in the NHS are thus not new; what has changed is the way with which they are dealt.
If the public ever fell for the Conservative partys blandishments about the NHS, they would live bitterly to regret it. There is no doubt that ours is the party that has always delivered for the NHS, and that is what got many of us into politics. I remind my right hon. Friend the Secretary of State, however, that we must not just make change, but manage change. We must take the public with us and we must recognise that treatments that might seem minor to us are major to the people at the receiving end. It is important that peoples experience of the NHS is that they receive the treatment that they want, that they can talk through the process and that they can see clearly that the NHS is safe in Labours hands.
Mr. Crispin Blunt (Reigate) (Con):
May I say what a pleasure it is to see the Secretary of State grace the end
of the debate in such sartorially elegant fashion? I wish that I could be as gallant about what she has done to hospital provision in my Reigate constituency, but I am afraid that I cannot.
The debate has been characterised by a remarkable contrast. A number of Government Members have said how splendid things are in their constituency and how cross they are about the prospect of their budgets being put at risk so that deficits can be dealt withdeficits that, by a remarkable coincidence, seem to be in trusts represented by Conservative Members. It is beyond belief that all the incompetent NHS managers have ended up in Conservative constituencies, while all the brilliant managers have somehow ended up in Labour constituencies. The principal acute trust in my constituencySurrey and Sussex Healthcare NHS Trustis about to appoint its seventh chief executive since 1997. It may be the sixth chief executiveI may be one out, as it is easy to lose count.
I shall speak in strong support of the proposals that my right hon. Friend the Member for Witney (Mr. Cameron) and my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) made about the independence of the health service. The speech of the hon. Member for Waveney (Mr. Blizzard) was instructive. He wanted the ability to interfere politically in the provision of health care in his constituency. What happened in my constituency is nothing short of a disgrace. On 19 December last year, the Secretary of State overturned a recommendation for a new hospital in Sutton in favour of a new hospital at St. Helier, at the explicit request of her hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) solely on the basis of evidence provided by the hon. Lady.
Earlier in our debate, the Secretary of State told us that she took that decision on the basis of health inequalities. The only problem with that explanation is that she received advice that directly contradicts that explanation from her own adviser on the NHS in London, Dr. Sue Atkinson, on health inequalities and the merits of that decision. Dr. Atkinsons advice to the Secretary of State was unequivocal:
I recommend that you should therefore accept the judgment of the local NHS on the location of the Critical Care Hospital...to be at Sutton.
The hon. Member for Wyre Forest (Dr. Taylor) made the point that decisions in which the Secretary of State had intervened had not been referred to the independent reconfiguration panel, and nor was the decision in my area. I have to tell the hon. Gentleman that there is a case for independent review when the Secretary of State intends to overrule the decision of the local health community. If the Secretary of State is minded to accept a recommendationin this case, the unanimous decision of the local medical establishment that a new hospital at Sutton was the right decisionI do not think that there is a case for the Secretary of State to go to the independent reconfiguration panel.
The Secretary of States decision was so outrageous that Reigate and Banstead borough council and Surrey county council decided, having taken counsels advice, to seek judicial review of that decision because it was unreasonable. The first stage of the process was complete, a case to answer was identified and a court date had been set, but on 16 August the Secretary of
State reversed her decision, pending another review. That is one of the cover-ups that always goes on when there has been political interference. That case was direct political interference in the interests of the Labour party in Mitcham and Morden: I can say that because the Government have form, as the same thing happened at the southern end of my constituency. I notice that the hon. Member for Crawley (Laura Moffatt) is present. We have had this debate on numerous occasions and I will not repeat it now, except to say that one month before the 2001 general election, the Secretary of State directly interfered, at the request of the hon. Member for Crawley, to affect a decision in the political interests of the Labour party in Crawley.
The hon. Lady has defended herself, saying that she will go on intervening to defend her constituents interests. I know, as well as she does, that what she did was not in the interests of her constituents or of all the people who were being provided with acute hospital care in the area. It was not the right decision, and it has taken another four or five years for Crawley hospital to be extracted from the provision of acute care by the acute hospital trust. I am delighted that it is now the responsibility of the hon. Ladys local primary care trust, and it is now out of the hair of the managers who are trying to provide acute hospital care.
Laura Moffatt (Crawley) (Lab): It probably is right that the hon. Gentleman give way, so that I can give the House my account, rather than his account of what he thinks I was doing. I will continue to campaign, and the hon. Gentleman should be very careful because we need to be very guarded about his interference, using his local authority to promote the idea of legal challenge.
Mr. Blunt: In 2001, the hon. Lady enjoyed the benefit of that political interference, and in the 2005 general election she enjoyed the biggest swing in the country against a Labour candidate. The people of Crawley rumbled her and she was very nearly replaced as their Member in this Househer majority was only 32 votes.
It is essential that we stop this party political interference in the management of health. My hon. Friend the Member for Hammersmith and Fulham (Mr. Hands) has been surprised to discover that Ravenscourt hospital, which was saved three years ago, is suddenly now being closed by this Government. Why? What has changed? The political party representing the constituency of Hammersmith and Fulham is the only thing that has changed.
We must move to a system that our constituents can have confidence in, in which the money being spent clearly reflects health needs. I absolutely commend the splitting of public health provision to address directly the issues of health inequalities. The acute provisionthe critical care provisionshould then be done on a properly assessed basis. Haste the day that we can get to that point and take the corruption of party politics out of the provision of health care in this country.
Grant Shapps (Welwyn Hatfield) (Con):
I am grateful to be speaking at the end of what has been a very interesting debate, characterised by Labour Members
telling us that everything is well, and Opposition Members pointing out problems. As ever, the truth probably lies somewhere in between. However, the specific subject of the debate is staff cuts and the surrounding financial environment, on which I wish to touch briefly.
There are many different ways in which the constraints on the health service are impacting on the way that it is run. I am very pleased that the Secretary of State is in her seat, so that I can mention one of them. Sterilisation of instruments is increasingly being centralised and as that is happening, operations are being cancelled, which is decreasing the efficiency of the health service. Next Monday, a report will be published showing a 21 per cent. increase in the number of operations cancelled, purely as a result of the centralisation of sterilisation of instruments used in operations.
I have a letter from a constituent who said that last week, she was in the Queen Elizabeth II hospital in Welwyn Garden City waiting for her operation. She came in the day before, so she used a hospital bed, in which she was put up overnight. A high-dependency bed was booked for her the day after her operation. She spent the entire day in the waiting roomthe anteroom, as she calls itawaiting surgery, only to be told that the operating implements were dirty and that no more could be obtained in time.
It was not only my constituents operation that was cancelled that day; 10 others were also cancelled. Surely it cannot be longit has probably already happened in the QEII hospital and elsewhere where centralisation is taking placebefore somebody is on the operating table and is cut open, only for it to be found that an instrument of a different size or nature is required to finish the task. I know that that happens in operationsI once had my clavicle operated on, and exactly that happened. If no instruments are available, the person has to be sewn back together and told to come back another day. I tell the Secretary of State that that is an unacceptable situation, which is a direct consequence of the financial crisis that we are experiencing.
Another fact, sourced through a freedom of information request, is that there has been a 40 per cent. increase in the number of operations cancelled merely for administrative reasons, because, for example, the operating theatre had not been booked or the patients notes not senteven because the patient had not been told that the operation would be taking place. In a period of only three years, a 40 per cent. increase in cancelled operations for such reasons is of real concern.
I would appreciate the Secretary of State taking this point on board: 640 operations are cancelled every day, simply due to administrative cock-up640 throughout the NHS. That is a huge figure. On Monday, I shall be supplying her with the figures, so that she can see for herself. They have been obtained from all the hospital trusts through the freedom of information procedure, and I shall be interested to know what action the right hon. Lady intends to take.
Time is short, so I shall conclude by mentioning Hatfield hospital. The Secretary of State will be aware
that her predecessor visited Hatfield before the election when a Health Minister held my seat with a dodgy majority. The then Secretary of State for Health promised us a £0.5 billion new private finance initiative hospital at Hatfield. What happened? When I defeated the incumbent Labour Health Minister, the plan for that hospital disappeared [Interruption.] If I am wrong I shall be interested to hear the Secretary of States response.
Not only has that shiny new £0.5 billion hospital plan gone, but the existing Queen Elizabeth II hospital in Welwyn Garden City, which is supposed to support all the present population plus an expanded population, because we are told that we need to build tens of thousands of new homes, is being chopped away bit by bit. We are about to lose A and E, maternity, paediatrics and much more besides. That simply does not add up. I ask the Secretary of State to respond when she has the opportunity and I hope that she will take these matters more seriously than some of her Back Benchers, who have been laughing them off all afternoon.
Mr. James Gray (North Wiltshire) (Con): When the hon. Member for Hackney, South and Shoreditch (Meg Hillier) spoke, she was very content about the fact that her PCT was breaking even. However, she failed to mention one vital fact: every person in Hackney has £2,000 a year spent on them. In the Prime Ministers constituency, the amount is £1,300 a year and the average for England is £1,200, while in my constituency the average is only £900 a year. It is thus hardly surprising to discover that my PCT is £43 million in deficit across the SHA and that, as a result, health provision in North Wiltshire is in a deep and damaging crisis.
It was tragic to drive past Malmesbury hospital the other day and see the barriers behind which it was being demolished. It is tragic to hear that maternity services at Chippenham are so badly underfunded that there are no staff, so the services can no longer be provided. It is tragic that according to a consultation paper currently out for consideration up to seven community hospitals across the county of Wiltshire could be closed. It is tragic that the Royal United hospital in Bath, which serves my constituency, is laying off about 300 people and closing 60 beds, and that the Great Western hospital in Swindon is laying off 198 people.
When we put all those facts alongside the failure to provide dentistry and proper GP services in parts of my rural constituency, they amount to a significant crisis in health care in North Wiltshire. Whether that is the fault of the Labour party, senior managers or me, I know not, but I can tell the Secretary of State one thing in the few moments remaining for my speech: if she thinks that the NHS is having its best-ever year, I challenge her to visit North Wiltshire and see what I see in my constituency surgery every Saturday. Let her go to Malmesbury hospital, now being destroyed, to Chippenham hospital where destruction is imminent and to the seven hospitals in my area that are threatened with closure and then tell me that all is well with the health service in Wiltshire.
Mr. Stephen O'Brien (Eddisbury) (Con): After a full days debate in Opposition time, we have covered an enormous range of issues on the NHS, with particular focus on the NHS work force. I hope that the Minister of State, the hon. Member for Leigh (Andy Burnham), and I can do something novel and avoid the ritual ding-dong that tends to happen on these occasions. The Minister gets the last word, so if I refrain from the ding, it is no guarantee that he will refrain from the dong.
The temptation is to revert, as always, to the tired old slanging match of me pointing out the failures and disappointments of the Governments policies on the NHS and the Minister reading out his prepared false accusations to the effect that we want to take money out of the NHS, when we are clearly committed to precisely the opposite. My right hon. Friend the Leader of the Opposition confirmed that only two days ago when he said that all parties supported increased NHS funding. It is worth taking the risk and seeing whether the Minister will respond to the genuine concerns and worries that have been raised in our important and timely debate.
Our debate on the vital issue of our NHS work force was ably opened by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley). I am confident that I speak for the whole House when I pay tribute to all the medical professionalsthe nurses, the therapists and practitioners in our NHS. As my hon. Friend said, they do excellent work on which we all relymy family no less than any other, as we have very good reason to be eternally grateful to NHS professionals and carers.
After my hon. Friends excellent opening speech, we heard from the Chairman of the Select Committee, the right hon. Member for Rother Valley (Mr. Barron), who called for more evidence to build on some of the anecdotal points. I do not see him in his place, but he rather uncharacteristically spent his time hair splitting on the semantics of whether we are talking about posts or jobs in the NHS.
Our debate is more likely to be remembered for the outstanding contributions of two former Secretaries of State for Health, my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) and my right hon. Friend the Member for Charnwood (Mr. Dorrell). My right hon. and learned Friend the Member for Rushcliffe rightly said that there was a remarkable consensus about the partnership approach that we all adopt to supporting the NHS. He also rightly argued that, because of some of the Governments actions and despite good will, we are in danger of seeing reform being given a bad name, when we need the money and reform to ride together. He was particularly concerned about the short-term expediency forced on so many NHS organisations through financial pressures and cuts. His major point was that those factors are unlikely to lead to greater efficiencies, so productivity is damageda point strongly reinforced by my right hon. Friend the Member for Charnwood when he said that a once in a lifetime chance to reform the NHS and its productivity had been fluffed. He argued that it was important to challenge moves to take resources out of community services, which represent an easy hit for a Government attempting to correct financial incompetence.
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