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18 Oct 2006 : Column 289WH—continued
An all-party committee, Save Hospital Services, was formed under the chairmanship of Steve Cohen, the editor of Bucks Free Press, to fight the proposals. I acknowledge the work of all those who served on the committee, as I did. It is invidious to name names, but
I want to single out Dave Parsons for the exceptional amount of time and trouble that he dedicated to the committee’s work.
Our concerns were graphically illustrated by a letter that arrived in my post last October. It states:
“People think that there is still a fully functioning accident and emergency department here”—
that is, in Wycombe. The letter continues:
“Clearly, this is untrue...Major trauma and sick medical/surgical patients are receiving sub-optimal care and lives are being put at risk. This is a major clinical governance issue. There needs to be a serious revision of the current management of emergency patient care.”
The authors of the letter were the entire anaesthesia department at Wycombe hospital. The Minister is aware that it is extremely unusual for a whole department to sign a letter that uses such stark and graphic language.
On the same day, the minutes of the 12 September meeting of the medical advisory committee of the Buckinghamshire Hospitals NHS Trust also arrived on my desk. Andrew Kirk, the then medical director of the trust, is quoted as saying:
“The system is fragile and there is a need to redress the position...There is also the future service change for women and children, which it is considered can make the situation worse.”
I asked the trust to appoint an independent outsider to examine those claims immediately. It finally consented to do so in February. During the summer, its chairman and chief executive resigned, shortly before the report into the outbreak of clostridium difficile at Stoke Mandeville, which cost more than 41 lives and which I am sure my hon. Friend the Member for Aylesbury will mention later.
Last week, I received a letter from Alan Bedford, the interim chief executive of the trust, which states:
“We still believe that the SHS model is the right model for now. However, it is complex, there are some risks involved”—
I believe that this is the first time the trust has been so candid about risk—
“and as you know the health community is substantially in difficulty financially.”
The letter also confirmed that middle-grade doctors are now providing support 24/7 as a result of the independent review of A and E at Wycombe. I quote:
“We have agreed to do this to ensure that both our A&Es come up to the required standard.”
This confirms that the anaesthetists’ concerns were reasonable, despite the assurances that we received at the time about A and E.
In respect of “Shaping Health Services”, we are, in effect, in no man’s land. We do not know whether children’s and maternity services will be moved to Stoke Mandeville. We do not know the future of what remains of A and E at Wycombe. We do not know who the permanent management team of the trust will be. Indeed, my hon. Friends and I do not know the full future of our local hospitals at Amersham, Stoke Mandeville and Wycombe, or of community hospitals such as Marlow cottage hospital in my constituency.
We do know that the deficit problem that was previously the responsibility of the hospital trust is now the responsibility of the primary care trust. The latest estimate of the PCT’s deficit is £15.2 million, compared with a control deficit of £7.1 million, and the
PCT is seeking immediate cuts of £3.5 million. It is worth noting that £15.2 million is only an estimate, as far as I can see, and that a definitive figure will be known only when the figures for the final period of the former smaller PCTs in Buckinghamshire are known.
The £3.5 million cuts are only the start. The new PCT’s total savings target is more than £31 million. Consequently, it has developed a three-stage financial turnaround programme to achieve it. Details are vague at present, but it is clear that the trust is looking for savings in, inter alia, hospital referrals, prescribing, services for older people and mental health provision. I shall return to the matter later, but I pause to note that a falling deficit in one part of the local health economy tends to worsen a rising deficit in another part of it. For example, what would the scale of the effect on the hospital trust’s finances be if fewer patients were referred to Wycombe and Stoke Mandeville by the new PCT?
I shall now probe what I believe are the five main themes woven through this tale of deficits and, alas, closures. First, there is transport. Buckinghamshire is a narrowly drawn county with few major north-south connections and a considerable rural hinterland, particularly in the north. At the time of “Shaping Health Services”, we were told that a blue-light ambulance journey from Wycombe to Stoke Mandeville could be done in roughly half an hour and that the ambulance service could take the strain, but anyone who has travelled on the A4010, which is not a modernised road, and who is familiar with local traffic, particularly during school-run hours, knows that the half-an-hour estimate simply is—let me put it this way—unreliable. Anyone who has noted that, during the last year, the number of emergency calls to local ambulances has risen sharply by more than one fifth, on average—in the Wycombe area, by 21 per cent.—knows that the service may not be able to take the strain, and certainly would not be able to do so in the event of, say, a flu epidemic or major terror incident.
It is not only ambulances that will have to make journeys on unmodernised roads but cars containing families and, of course, patients. To travel to Stoke Mandeville from Marlow in my constituency, for example, a driver would have to negotiate High Wycombe in order to get on to the A4010 at all. Such a driver might, of course, go to Wexham Park, just north of Slough. That raises further questions about the degree of planning that has taken place not only between the two hospital trusts concerned but at strategic health authority level.
In the wake of the parts of “Shaping Health Services” that have already been implemented, will the Minister liaise with his colleagues in the Department for Transport and find out what plans it has, if any, to update the A4010 and other transport links to the north and south of the county and to what timetable? Will he guarantee that before any further structural changes are made a full reassessment of blue-light times and transport times will be made by the hospital trust and published? Will he find out, too, whether the new bus service from Wycombe to Stoke Mandeville, which is essential for patients without cars of their own, is running fully during afternoons and when the service will run at weekends?
If the Department intends Bucks county council to help to fund future transport health requirements, how is the council expected to do that when last year it found itself £15 million short of the funds that it needed to preserve the previous service levels? Finally—at least in this section—what guarantee do we have that the new strategic health authority will help to ensure that the transport plans of NHS trusts in Bucks accord with those of NHS trusts elsewhere?
Second after transport comes safety. The tale of the anaesthetists’ letter confirms that anxieties about safety and the quality of patient care are well founded. I said earlier that the trust is looking for savings in hospital referrals, prescribing, services for older people and mental health provision. I accept that some treatments that are carried out in hospitals can be done elsewhere, and that some treatments have higher priorities than others. None the less, the consequences of the PCT’s plan seem to be that some patients who might have had operations or treatments will not obtain them, that some patients who might have been prescribed drugs will not get them, that some people who might have had follow-up appointments will not have them and that some mental health patients—mental health is, of course, often the poor relation of health care—will be treated in circumstances that are not yet clear. Will the Minister guarantee that a full risk assessment—not, please, the risk description that we had in “Shaping Health Services”—will be made on the proposals that the PCT will put forward for consultation in the spring, and that local doctors and other health professionals will be full partners in the consultation?
Furthermore, can the Minister tell us what impact any cuts will have on improvements that have already been promised, such as the new sexual assault referral centre that will probably, I learned this week, be based in Aylesbury? My hon. Friend the Member for Chesham and Amersham has asked me specifically to mention the Chesham health zone, which was apparently pledged when Chesham hospital was closed. I appreciate that the Minister will say that those are local decisions, and there is some truth in that, but the NHS is a national—I scarcely need to underline that word—health service, for which Ministers have responsibility.
I want now to turn to my third theme, for which there can be no doubt whatsoever that Ministers are responsible. That theme is targets. Conservative Members tend to claim that there are too many targets, that they change too often and that they are too prescriptive, stifling local initiative and accountability. Ministers tend to reply that targets are essential to raise the quality of the service, so I want today to cite a source that is neither Opposition claim or ministerial response, namely Professor Sir Ian Kennedy’s report into the clostridium difficile tragedy at Stoke Mandeville. The report was extremely critical of the precious senior management team at Buckinghamshire Hospitals NHS Trust. Those criticisms naturally tended to grab the headlines when the report was published.
The full report is worth reading closely. On page 89, Sir Ian wrote:
“At Stoke...the increased throughput of patients needed to meet performance targets resulted in patients being moved, difficulties in isolating patients with infection and high occupancy”
rates. There is no suggestion that the trust was unique in that respect. On page 88, Sir Ian wrote:
“There is much in this report to suggest that there may be continuing tensions between the control of infection...and other national priorities”.
That sounds to my ears like a masterpiece of understatement, and suggests that the targets regime was a contributor to the disaster at Stoke. I would be grateful if the Minister told us whether the Department saw a draft of the report before it was published, whether any changes were requested and whether any were made.
Nor can the fourth theme that emerges from circumstances in Bucks over the past few years be shunted away from the Department and from Ministers. We read a lot these days about families with chaotic lifestyles and, indeed, I presume that in the pursuit of health promotion and illness prevention the Department has an interest in reducing such lifestyles. It seems that on closer examination, however, the whole Department is in the grip of a chaotic lifestyle.
When I was first elected in 2001, Wycombe hospital had just been merged with Stoke Mandeville. Since then, the mental health trust has been formed and effectively merged with that in Oxfordshire, primary care groups have become primary care trusts, the three primary care trusts have become one and the strategic health authority has been widened so that its scope includes places as far away from High Wycombe as, say, Ventnor in the Isle of Wight. Not a single combination of chief executive and chairman is the same.
The chief executive at Wycombe hospital when I first arrived, Roy Darby, had been in place for more than 10 years. Wycombe will soon be on its third chief executive in five years—and Stoke, for that matter. Such management chaos and confusion undermines responsibility, weakens accountability, strengthens the temptation to pass the buck and makes sensible medium-term planning in our local NHS all but impossible. There must be—indeed, there is—a link between the unstable and erratic change and the fluctuations in the finances of our local NHS. In 2003-04, Wycombe PCT underspent by £536,000 and the SHA underspent by £4.2 million. In the future, can we please have only change that is built to last?
Finally, and inevitably, comes money. According to the Association of Councils of the Thames Valley Region,
“in 2007-08 PCTs in Thames Valley will in aggregate receive the lowest level of funding per crude head of population of anywhere in England. It will effectively deduct 20 per cent. of the population.”
My colleagues and I were told last week that each Bucks resident receives approximately 18 per cent. less per head of NHS spending than the average resident in England and Wales. I realise that the Minister’s response will be that Bucks is a relatively prosperous area, but that raises some important points.
In even the most prosperous areas there are, of course, pockets of poverty and deprivation. One super output area, as they are now described, in Oakridge and Castlefield in my constituency is ranked among the most deprived 25 per cent. in the country. When it
comes to housing, 12 SOAs in my constituency are among the most deprived 20 per cent. in the country and five are in the most deprived 5 per cent. In short, one way of looking at all that is that my poorer constituents are being penalised, in terms of health care funding, for living alongside richer people rather than those who happen to be as poor and deprived as themselves.
There is a wider point. NHS spending is weighted, as we have heard, towards more deprived areas, but it is claimed in some quarters that disease and illness in Britain are relatively evenly distributed. Has the Department considered rebalancing its funding so as to give greater weight to the distribution of illness and disease? What confidence can we have in present financial arrangements when we learn in Monday’s edition of The Times that
“seven times as many community hospitals have closed or are under threat in constituencies held by opposition MPs. There are 62 closed or at-risk hospitals in Conservative constituencies and...11 in Labour areas”
“The revelation comes a month after The Times disclosed that Ministers and Labour party officials held meetings to work out ways of closing hospitals without jeopardising key marginal seats.”
Many of our constituents will, I am afraid, conclude that they are effectively being punished for not voting Labour.
I accept that NHS budgets are always limited, that not all change is for the worse, and that there have been some improvements. I accept that change is always difficult. However, as our constituents look at their local NHS, they see cuts in their local hospitals, then cuts in the provision of primary care, and then the likelihood, if not the probability, of more cuts in local hospitals—in short, a descending spiral of cuts and closures that leave in their wake transport problems that have yet to be resolved and burning questions about patient safety and the quality of care. Yet all the while existing health bodies are being wiped off the map and senior managers are trooping in and out of revolving doors.
My hon. Friends and my constituents tell me that when the Conservative party was in government life was not perfect, but there seemed at least to be a measure of continuity, stability and predictability. When we were in government, new services were coming to our hospitals, not going out. The blue light now seems to be flashing above at least parts of our local NHS. We hope that the Minister will be able to provide us with some answers.
2.51 pm
Mr. David Lidington (Aylesbury) (Con): I congratulate my hon. Friend the Member for Wycombe (Mr. Goodman) on his success in obtaining this afternoon’s debate and on the measured and comprehensive way in which he introduced the subject, which is of massive concern to the constituents of all hon. Members who represent Buckinghamshire constituencies.
I shall touch briefly on three subjects—finance, the implications of housing growth on the health service, and staff morale—but I start by making an
acknowledgment on two fronts to the Minister. First, there always has been and always will be change in the national health service. We have to accept that and work with it, but I and my constituents are worried because change in Buckinghamshire seems to be driven by short-term financial crises rather than by a considered assessment of the developing needs of patients and the possibilities of medical science.
Secondly, I happily acknowledge that not everything that has happened under the stewardship of this Government has been wrong. I am sure that the Minister will have in his brief a list of projects that the NHS has completed in Buckinghamshire over the past nine years that he will be able reel off. I remember similar lists being available under the previous Conservative Government.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Not on the health service.
Mr. Lidington: Yes, very much on the health service. Although the Government have increased considerably the amount of money spent in Bucks and elsewhere, we are entitled to ask why our primary care trust is struggling with a deficit of £18 million—a deficit that it will find difficult to reduce by a mere £3 million during the current financial year. That comes at a time when the county faces a further reconfiguration of hospital services next year and when our constituents are experiencing cuts in the quality and scope of the health care available to them locally day by day.
I turn to the funding formula. I accept that the NHS budget is finite, and that the principle of having some form of distribution formula based on need is correct. However, like my hon. Friend the Member for Wycombe, I rely not on a Conservative party handout for my comments on the impact of the distribution formula but on a more independent source. I shall make considerable reference to board paper 33/06, published by the Thames Valley strategic health authority in May under the signature of Nicholas Relph, the then chief executive.
The paper found that by 2007-08, the average primary care trust in England would get £1,388 per head to spend on health care, while the average PCT in Thames Valley, covering the counties of Buckinghamshire, Berkshire and Oxfordshire, would receive £1,125 per head. As my hon. Friend pointed out, that is the lowest per capita rate anywhere in England. If Thames Valley were funded at the national average, it would receive an extra £575 million per year extra; if it were funded at the level of the highest paid—I do not argue for that today—it would have an extra £1.1 billion for local health spending. Mr. Relph’s conclusion was that the distribution impact of the formula is so significant that it must be asked whether it is too great, and that it leaves some parts of the country with such a low level of funding that the range of care provided will have to be constrained. The board paper went on to say:
“What might be considered core services elsewhere will have to be critically examined to see if they are affordable.”
That is the considered view of a senior professional health service executive who was responsible for NHS resources in our area.
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