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The charge is sometimes levelled that such deficits are down to inefficient management, so let us consider the figures provided by the strategic health authority. The official NHS analysis shows that in the most recent year for which figures were available, 2003-04, Thames Valley had the fourth most efficient services in England, that admissions were well under the English average, that prescription costs were likewise below the average, and that the number of available bed-days in hospital were considerably less than the average. It is not inefficiency that is at the heart of the problem. The truth, in Mr. Relphs words, is that
in order to balance the books commissioning PCTs should be purchasing 21 per cent. less acute community, mental health and other services than the English average PCT. It follows that in Thames Valley we should have one fifth lower hospital, mental health and community provision than the English average.
What does that mean for my constituents? Children who are diagnosed as needing speech and language therapy are being refused treatment and funding. At one school in my constituency, physiotherapy for physically disabled children at a special unit has been halved in frequency. I was told last week that child protection work is done by a community nurse who is so overstretched that she is unable ever to meet other members of her child protection team. The entire overnight community nursing service is now under threat and may be axed.
The Ian Rennie hospice at home has written to Members of Parliament and others to say that it is struggling to meet the demands placed on it and points out that only 14 per cent. of its costsless than half the national average for PCT funding of hospicesare being met by the Buckinghamshire primary care trust. I ask the Minister seriously to considernot in his speech, because he will have prepared a brief, but perhaps after the debatewhether the current distribution formula is not putting at risk some basic core health services in constituencies such as mine.
Steve Webb (Northavon) (LD): The hon. Gentleman makes a powerful case on behalf of his constituents, but I want to apply the logic of his argument as it applies to other constituencies. Is he saying that NHS money should be taken away from parts of the country where people die younger than in his constituency?
Mr. Lidington: I am looking not only at the straightforward matter of distribution but at the structure of the allocation system, and separating those parts of the NHS budget for which the costs are more or less the same throughout the country from those matters that are variable. I hope that my hon. Friend the Member for Westbury (Dr. Murrison) will be able to take up that issue if he catches your eye later, Mr. Cummings.
The growth of Aylesbury is of huge importance not only to me, but to my hon. Friends the Members for Buckingham (John Bercow) and for North-East Milton Keynes (Mr. Lancaster). As the Minister knows, the Government have decided to impose significant new housing growth on Buckinghamshire, and particularly on the Aylesbury vale area and Milton Keynes. Our area is one of the four zones in the south-east that have been designated by the Ministers colleagues in the
Government for major growth over the next 15 years. That clearly has serious implications for health provision.
I was referring to the impact on health services of the Governments plans for significant residential growth in the Aylesbury vale and Milton Keynes areas. I want to make two pointsabout the capacity of health provision that will be needed and the pace at which funding responds to population growth.
First, last year the chief executives of trusts in the Milton Keynes and south midlands growth area commissioned an independent report from the Hedra consortium about the impact on local health facilities of the Governments plans for growth. The conclusion of that report was that the Milton Keynes and Aylesbury vale areas alone will, if the Governments plans come to fruition, need 178 additional hospital beds by 2021 and 430 by 2031. Those are just acute hospital beds. The report added that within the same time frame an extra 958 community beds and 639 community day places will be needed.
Throughout that independent report ran a consistent theme: it would be a strain on the NHS to accommodate the demands of a significant rise in population and that it could be accomplished only on the assumption that the NHS would be able to reduce the average length of stay in acute hospitals and the provision of community and domiciliary services could be improved. Yet, in Aylesbury and elsewhere in Buckinghamshire today we are seeing measures to cut back on community and domiciliary care services. On the assessment of the primary care trust, there is the consequent impact of additional admissions to acute hospitals and longer stays, with additional numbers of delayed discharges.
Secondly, I was talking on Friday to local GPs about the pace at which funding responds to population growth. They said that, although it is true that, in time, additional per capita funding follows a growth in population, what the Department quaintly terms the normalisation procedure means a gap of as much as 18 months between new people arriving and health funding being delivered to local trusts and GP practices. That gap is too great, particularly if there is
an increase in population of some thousands each year for a decade and more. There needs to be a much smaller gap between the establishment of the need, the increasing demand for health treatment and the delivery of resources to meet that demand.
I also want to deal with the effect of the crisis in the Buckinghamshire national health service on NHS staff. I endorse everything that my hon. Friend the Member for Wycombe said in praise of those staff. They have been subjected to constant reorganisations, myriad targets and other changes. I shall give the Minister a couple of illustrations drawn from a meeting that I had last week with doctors from the Mandeville and Elmhurst surgery in my constituency. That practice serves an area that is as far removed from the caricature of leafy Buckinghamshire as can be imagined; it serves two of the poorest council estates in my constituency.
The doctors first told me about independent treatment centres. I have no problem with the principle of independent treatment centres and involving the independent sector in providing NHS care on contract. However, the doctors told me that the practice has £65,000 deducted from its budget each year as a notional contribution to the cost of independent treatment centres, but that the nearest ITCs are not in Aylesbury. They are in Banbury, Reading and Milton Keynes, which are a minimum of an hour away by car and for which public transport is at best inconvenient and at worst non-existent. When the doctors patients ask, Why on earth do we have to go to those places? Cant we go to Stoke Mandeville hospital just around the corner? The doctors usually say, Yes, youre right, because in Southcourt ward, which is served by the practice, 35 per cent. of households have no car. Common sense tells us that those without a car are most likely to be pensioner households, and pensioners are the biggest consumers of health care and most likely to be in need of elective operations. Therefore, the location of those ITCs is doing little good for the patients of that Aylesbury practice. Money is being taken away in return for slots at ITCs that cannot be of service to the patients in the Southcourt, Walton court and Elmhurst estates. The Government need to look at that again. I support bringing independent advisers into the NHS, but they should be brought into the same framework of money following treatmentpayment by resultsas existing provider institutions.
The second anecdote is about the enhanced services budget, which in this case went to provide a minor injuries service at the Mandeville and Elmhurst practice. The tariff for treating a minor injury was £50. The practice could actually do it for £15, but the crisis of funding at the PCT meant that the service was cut. The result was fairly predictable: patients were instead referred to the local accident and emergency department where the treatment for a minor injury costs £100 a case. No money was saved for the local health economy; the bill has actually gone up and the PCT is now trying to work out how to reinvent the service that it had got rid of in order to try to save money. It is little wonder that staff are frustrated and in many cases very angry.
I am prepared to believe that Health Ministers from any political party discharge their responsibilities with the best of intentions towards the health service and those who work in it, but in the past year senior
executives and non-executive directors have telephoned me on their private mobiles from their homes and told me that they are doing so because they dare not tell the truth about the local NHS from their offices as the Department of Health can and will interrogate them on whom they have been telephoning and to whom they have been sending e-mails.
I have had in my constituency surgery health managers and health visitors who are at the sharp end of the service wanting to tell me about their disquiet about what is going on, but begging me not, under any circumstances, to reveal their names because they fear for their jobs. In the past month, I have had nurses saying to me that they are afraid to speak out about the changes proposed for reductions in primary care services in Buckinghamshire and that they have been reminded by management of their duty of confidentiality and that they should attend classes on how to prepare and present their CVs in preparation for when they will need to reapply for posts under the new structure. I am genuinely sorry to say that there is, in my experience, a culture of fear among a great number of national health service staff at the moment. Any Government of any political party ought to hang their head in shame over that.
John Bercow (Buckingham) (Con): Between them, my hon. Friends the Members for Wycombe (Mr. Goodman) and for Aylesbury (Mr. Lidington) have offered the House an erudite and clinical exposé of the NHS crisis in Buckinghamshire and of the Governments culpability for it. In the short time available to me, I should like to focus narrowly on two issues within the NHS of particular concern to me and to the substantial number of constituents who have approached me about them.
First, I should like to focus the attention of the Chamber and the Minister on speech and language therapy. In the vale of Aylesbury, five and a half whole-time equivalent speech and language therapists cater to the needs of the entire area. It is posited that in due course that number will rise with the amalgamation of the local primary care trusts, but there is no guarantee of that happening. We are talking about five and a half such qualified personnel for the whole of the vale of Aylesbury. There is a recruitment freeze now, which seems set to continue for an indefinite period, so an increase in staff is simply not on the agenda. As we speak, the human consequence of that freeze and of the manifestly inadequate resource available is clear for all to see. Two hundred children in the vale are waiting. They have serious problems and need help, but they have not been diagnosed or assessed and, in the vast majority of cases to which I am referring, they have not been seen at all.
From the panoply of cases that have come to my attention, I should like to focus simply on one, that of two-and-a-half-year-old Peter Metcalfe; he will be three on 13 December this year. His mother, Brenda, is understandably upset and furious about the situation in which she and her young son find themselves. They were seen by a health visitor in November 2005. It was clear that there was a problem, although at that stage the extent of it was uncertain. They were told that an appointment could be made for three to six months
time, at which progress could be reviewed. Specifically at that pointI underline the significance of thisBrenda Metcalfe was told that, in the event that she wanted at that stage to have an assessment, an immediate assessment could be provided at a drop-in centre.
June 2006 is reached, the health visitor comes and the extent of the problem is clearer. The extent to which the young boy is behind where he should be is apparent to the health visitor and to the mother, and she of course then wants an assessment. She goes to the PCT and asks for an assessment, but is told, No, you cant have an assessment. Theres no prospect of that at the moment. There is a recruitment freeze. We have a cash crisis. The service isnt available. Nothing can be done to assist your child. In the circumstances, it is absolutely understandable that Mrs. Metcalfe is disorientated and disgusted by the lack of help available from the PCT for her young child. There is nothing on offer.
Subsequently, to add insult to injury, two suggestions were made to Mrs. Metcalfe, and I think that my right hon. and hon. Friends will testify that this is symptomatic of a wider picture. First, Mrs. Metcalfe was offered a meeting. She had a meeting, but it was utterly pointless, as it transpired, for it turned out to involve simply an explanation of the financial difficulties besetting the NHS in the vale of Aylesbury and of the steps that the local PCT was taking to seek to address those problems. There was no offer made, no hope held out, and no assistance on the table.
The first offer, of a meeting, raised expectations and was taken up, only for those expectations to be dampened. The second proposition was, Go private. First, very large numbers of people cannot for one moment contemplate going private because they simply cannot afford to do so. Ministers need to understand that point and to lodge it firmly in their heads. Secondly, even for people who can contemplate the possibility of going private, why on earth should we in what is supposed to be a national health service freely available to people on the basis of clinical need and not on the strength of capacity to pay?
The reality is that Peter Metcalfe, approaching his third birthday with a very severe problem of speech and language difficulties that requires immediate attention, is not getting that attention. The point that I want to emphasise in this context is the manifest disparity between what Ministers say and what is medically understood to be important on the one hand, and what is happening at the coal face on the other. In the special educational needs codes of practice, as this Minister will be well aware, it is underlined almost in triplicate that it is important to identify special educational needs as early as possible. To that observation is added the significant observation that once those needs have been identified, early action is vital to address them. That is said there, but it is also said elsewhere, in the Department for Education and Skills 2005 advice to parents. In that context, it is on the record what Ministers think on the strength of the professional advice that they have received. The document states:
Language is the core to all social interaction. Without it, a child is isolated.
In Every Child Matters, the Government have once again pinpointed the significance of early intervention. It is not only that early intervention is valuable; there are significant downsides in its absence. If there is not early intervention to tackle speech and language problemsthe problem being suffered by so many children in the vale of Aylesburyreal problems result. There are likely to be emotional and psychological difficulties. Educational attainment will be lower. There will be a persistent communication handicap and there will be damaged employment prospects to boot. In very practical terms, grave and possibly irreparable damage can result.
I hope that the Minister will understand when I say to him that it is reasonable for hon. Members to expect consistency between the words that Ministers utter and the deeds that they dobetween the promise and the performanceand that is lacking at the moment. I am grievously concerned about large numbers of children in my constituency who are suffering and will continue to suffer unless they get the help that they need. They will not be able to access the national curriculum. They will have damaged prospects in school and their chances of acquiring the training, education and qualifications that they need will be significantly undermined.
A second problem, to which I want briefly to allude, is the threat to the district nursing service. A cut of 50 in the number of district nurses is on the table for Buckinghamshire; that is the proposal. I have met countless constituents who have said what an enormously valuable service it is. I think of Arthur Christian, who wrote to me recently. He is a cancer patient who has been a direct beneficiary of the district nursing service. We are talking about qualified specialist high-achieving nurses, capable of performing a wide and disparate range of specialist tasks for the benefit of patients. If the district nursing service is slashed, people such as Arthur Christian will lose out in consequence. Again, I point to the disparity between promises made and performance achieved to date. It is not merely that my hon. Friends and I are wont to invoke the merits of the district nursing service; the Government themselves have consistently been doing precisely that.
The Secretary of State for Work and Pensions, when he was Minister of State in the Department of Health, acknowledged and highlighted in a written answer on 8 September 2003 the importance of the work of the district nursing service. He said that he wanted that work to be extended and that a greater prominence should be given to the role of the district nurse. In pursuit of that worthy and noble ambition, he announced that he had issued a document entitled, Liberating the Talents: Helping Primary Care Trusts and nurses to deliver The NHS Plan, so he thought that it mattered. The Government reckon that it is important but now propose a scenario of substantial reductions in the numbers of district nurses, and their replacement by less well qualified and, inevitably, less
dextrous health care assistants. That is not to knock them, but they are not as well qualified.
My hon. Friends have touched on a plethora of serious concerns that affect our constituents. I underline in particular my anxiety about the prospects for an expanded Aylesbury vale if the Government do not get their act together and focus in an intellectually muscular fashion on the task before them. I am expected to absorb another 1,000 houses a year in Aylesbury vale, and my hon. Friend the Member for North-East Milton Keynes (Mr. Lancaster) has to contemplate the prospect of a substantial increase in the population of his community. We are already underfunded and there are major service problems. Significant parts of the national health service in our communities will become inoperable unless the Government recognise that an increased population will inevitably bring an increase in the number of children, in the demand on services and in the requirement for appropriate funding, which is not there.
I like the Minister very much and have a high regard for him. I have liaised with him about the Nuffield speech and language unit and he has been courtesy and responsiveness itself. I appeal to himwhose career, as long as this Government are in office, I wish wellto go better than the average. He should not content himself simply with reading out the prepared brief. He is a bright man and I look to him to respond to the serious points that my hon. Friends and I have sought to put on the table, not in the spirit of political partisanship, but in the interests of our long-suffering constituents. Too many of them have suffered too much for too long with too little being done about it, and that must change.
Mr. Mark Lancaster (North-East Milton Keynes) (Con): It is a pleasure to speak with you in the Chair, Mr. Cummings. I congratulate my hon. Friend the Member for Wycombe (Mr. Goodman) on securing this valuable and timely debate. I shall be brief so that other Members can contribute.
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