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18 Oct 2006 : Column 302WH—continued
I start by thanking the staff at Milton Keynes primary care trust and the hospital for their sterling work in difficult circumstances. If there is one question that I want the Minister to answer, it is this: why at a time when the Government are forcing Milton Keynes to expand are they forcing our health service to shrink? That is simply unacceptable. My hon. Friend the Member for Aylesbury (Mr. Lidington) touched on the normalisation procedure—the time delay between the increase in population and the funding that follows, which can be up to 18 months. Currently, 13 people a day are moving to Milton Keynes. That is 7,000 people in an 18-month period, which means a potential lag in funding of 7,000 people. That is why a local general practitioners’ practice in Milton Keynes village has had to close its books; it is full. Due to financial
constraints, the PCT is delaying issuing a new contract. Those are the sorts of problems that we have.
Our funding allocation in Milton Keynes is not quite as bad as it is for other hon. Members elsewhere in Buckinghamshire. We receive 95 per cent. of the national average, but that is still 5 per cent. below the national average. Earlier this year, I outlined the impact that the £5.5 million levy that the strategic health authority forced the PCT to cut from its funding has had on our services. In a moment, I shall touch on the effect that it has had on adult mental health services in Milton Keynes.
Last week was a bad week for health care in Milton Keynes, because, following another 6.2 per cent. cut, Milton Keynes hospital had to withdraw its application for foundation status. That is a major blow for the people of Milton Keynes.
The Government cuts are having an impact on adult mental health services in Milton Keynes. There have been many reports, both nationally and in Milton Keynes, offering visions of how the needs of people who experience mental health difficulties should be met. Two recent Government reports are particularly relevant. The first, “Our health, our care, our say: Making it happen”, has visions of creating health and social care services that generally focus on prevention and promoting health. Another report, “Improving Services, Improving Lives”—these are great titles—proposes to give local people a more direct influence over the services that they receive.
At a local level, a July 2005 report by the Sainsbury Centre for Mental Health proposed a restructuring of the mental health service to give a single point of contact for new referrals; a 24/7 service, including an out-of-hours phone number; a greater focus on recovery in its broadest sense; and a move away from the domination of a medical model of mental illness to a more holistic service. Those are great aims, and were broadly supported by service users in Milton Keynes, but, at a time when it has been agreed that our mental health services need additional funding, the cuts mean that the proposals that were recently consulted on will not be fully delivered. The cuts will affect community-based day services, a memory screening clinic and a community drug and alcohol service. That is a major blow for people in Milton Keynes.
Back in July, I presented a petition with the names of local service users to which the Government response was, unfortunately, “No comment.” They simply do not seem to care about what is happening in Milton Keynes and Buckinghamshire, or about the impact of the cuts. Exactly the same thing happened with the closure of the Fraser day hospital in Newport Pagnell. My hon. Friend the Member for Aylesbury outlined a report that shows how many more places we need, yet we are closing day hospitals. I simply do not understand.
I am conscious of the time, so I shall finish where I started—with staff. What does the Minister suggest that I should say to my constituent, Paula Gawronska, who came to my surgery on Friday to explain that, having just finished her nursing degree in Liverpool, she is pulling pints in Milton Keynes to pay off her
£12,000 student loan debt because there are simply no jobs for nurses in Milton Keynes or, it would appear, anywhere else in the national health service?
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Mr. Dominic Grieve (Beaconsfield) (Con): I do not want to repeat the comments of my hon. Friends. My constituency is the southernmost constituency in Buckinghamshire, so there is an issue about people using services outside the county, which is an essential part of living in a border area.
I could not fail to notice that, when my hon. Friend the Member for Aylesbury (Mr. Lidington) suggested that there was once better predictability in the NHS, a wry smile seemed to pass across the Minister’s face. Given the amount of money that the Government have sunk into the NHS in the past nine years—I am the first to acknowledge that—which constitutes a substantial increase in real terms, the problem that I face as an MP in Buckinghamshire is in understanding how that money has been spent locally and why we face a constant cutting of services, which is currently on an accelerating pattern from an already low base. I hope that the Minister will enlighten us on that. The point has been well made about our overall underfunding in national terms, but if the Government strategy were working, I would expect that somewhere along the line, some little crumbs from the cornucopia of money being spent would be falling off the table towards us. However, that is far removed from the reality of local health services. That is the key issue that the Minister must address in his reply.
It is easy for us to cite examples. In a sense, that is all we can do as MPs, because we have to marry up what the Government tell us in theory with what the evidence and anecdote tell us in practice. First, criticisms are sometimes made of those who run our hospital health trusts and PCTs. In nine years, I have, on the whole, been impressed with the people who run our NHS trusts and PCTs. We have had differences, but I do not think that the place has been run by incompetents. Therefore, the overall impression I derive is that people are labouring under impossible conditions. The report by Professor Sir Ian Kennedy on clostridium difficile at Stoke Mandeville hospital amply illustrates that point: targets are incapable of being met without disrupting clinical practice.
Another example comes from Wexham Park hospital, just across the border, on which a great many of my constituents depend—this is the border issue that I raise with the Minister. Evidence has been presented to me by nurses about management interference in clinical judgments on who should be seen in the accident and emergency department. Decisions might depend on the amount of time that people have spent there. At Wexham Park, as the four-hour point approaches, managers come down from their offices to redirect the nursing and medical staff towards their own priorities and not those of the nursing and medical staff. I am sure that that is occurring.
Secondly, anecdotally, I am told that the Haleacre unit for mental health at Amersham is unfit for purpose. That is clear, and anyone who goes to have a look at it can see that for themselves. When my
hon. Friend the Member for Chesham and Amersham (Mrs. Gillan) and I visited it, we were appalled at the demoralisation of the staff and the general conditions. To learn that it needs replacement and then to find, to our amazement, that somebody has decided that it can manage on refurbishment is another illustration of the extent of the crisis that we are facing.
The points have been made about specialist services, speech therapy, which is raised with me frequently, and the understaffing of the child and adolescent psychiatric unit at Amersham, which means that children are waiting far too long to be seen. There is a constant sense of disruption. We are also facing a 50 per cent. cut in district nurses. No sooner has something become a centre of excellence, for example, a physiotherapy service offered by a particular practice, than it is chopped, because a decision is taken that it is absorbing too much money in one location and the money must be redistributed more generally. All those things are pictures of a service in crisis.
I shall give the Minister one final example. It concerns a constituent, who, following a failed operation for a hernia at Wexham Park hospital, developed a fistula. She was sent to St. Mark’s hospital in west London, at Northwick Park. At that stage, it was thought that she would die very quickly, but the Northwick Park and St. Mark’s hospitals thought that they could do something for her. She received excellent specialist care, but it became clear that they had done as much for her as was possible, and that her condition could be managed but not cured. Her returning to Buckinghamshire totally fazed the ability of the PCT and the health trust to manage it, until we finally got to strategic health authority level. It was managed; she died eventually, but she got the services and support she needed.
That did not illustrate to me that these people were uncaring. It illustrated that the moment we put something slightly unusual into the system, it had no flexibility to respond to it. The district nurses pointed out that her case was so difficult to manage that management at home was being proposed, partly for financial reasons although I am sure, it was impossible. The local hospital did not have the resources to do it, and the thing had to be put together as a special package. That does not surprise me, but it troubles me that it needed so much external interference from Members of Parliament and others to sort out a straightforward management problem of a seriously ill patient that ought to be capable of being resolved routinely. That is the extent to which our services are overstretched and cannot cope.
A new raft of cuts are coming up, which we have heard about. I should be interested to hear the Minister’s comments about how he thinks the savings in the PCTs will be achieved without closing community hospitals. I think it almost inevitable that such closures will happen, yet we are told that community hospitals are now rather an important priority for Government. How does the Minister reconcile those two concepts?
The truth is that Buckinghamshire remains seriously underfunded. The hon. Member for Northavon (Steve Webb) raised a point: where there is underfunding, is
there a proposal that we should take money from elsewhere, where the need appears to be greater? I am not in a position to answer that question. I am able to say that the redistribution of wealth from wealthy to poorer areas is the precondition of the running of a unitary state, so I accept it. However, I worry not that what is being done is an equalisation to provide a uniformity of service, but that the end result is that those who are disadvantaged in my constituency—despite its being wealthy, there are many disadvantaged people; one ward is listed in the indices of disadvantage—are getting some of the poorest services in the land. They would be far better off moving to north Liverpool. Although there might be other drawbacks of doing so, their health care per head of population and the expenditure would be much greater.
I do not want the Minister to give us a list of what is being done through spending money or capital projects. Some of those may be worthy, but if the revenue expenditure does not accompany it, they will never function properly. I am eager to hear him explain how a Government that are apparently spending so much taxpayers’ money and raising so much more for the national health service than in 1997 should have an area such as Buckinghamshire where the history of service provision is one of continuous cutback.
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Steve Webb (Northavon) (LD): I am sure that all hon. Members wish to give the Minister plenty of time to respond, so I shall curtail my planned remarks. I am sure that my Conservative counterpart will do the same. I congratulate the hon. Member for Wycombe (Mr. Goodman) on securing this debate. I believe that it is not the first debate that he has secured in the House on health services in Buckinghamshire. I share the good wishes he gave to the hon. Member for Chesham and Amersham (Mrs. Gillan), who I think took part in the last such debate.
The contributors to this debate have all spoken powerfully on behalf of their constituents in Buckinghamshire, and rightly so. One of the interesting features of participating in these debates as a Front-Bench spokesman is that I get to see certain trends occurring across the counties. Some of the examples from Buckinghamshire that we have heard are all too often mirrored in other areas, and I should like to give one example of that.
Clearly, there is always a legitimate argument to say that hospital services should not be set in stone, that they can be looked at and that reconfiguration can be considered. The two preconditions for any consideration of reconfiguration are that it should be clinically driven and locally accountable. The example given by the hon. Member for Wycombe, where the clinicians, local politicians of all parties and local people appear to be pretty much uniformly against the proposals, is a classic case of where the system is failing.
Nobody is arguing that there should not be change in the NHS as we learn new ways of doing things. Perhaps we can do things better. We know that population shifts and that transport networks change, so there is no argument that there should not be review
and reform. However, as the hon. Member for Aylesbury (Mr. Lidington) said, it should be driven not by short-term financial crisis management, but by long-term strategic planning. It should also be democratically accountable, with not merely the consent but the active support of the clinicians, to whom one would hope the Government were listening. I agree that when that does not happen it is simply unacceptable.
We lack democratic accountability in the NHS, because where local people are not happy with the reform, as has happened in Buckinghamshire, the best that they can ultimately do is appeal to the mercies of the Secretary of State, who may or may not refer it to an independent reconfiguration panel, in itself a quango. If the Secretary of State declines to refer it, that is it. Clearly, one can campaign in all sorts of other ways, but the only democratic back-stop to reform in Buckinghamshire, as elsewhere, is the Secretary of State, who may simply decide not to refer or reconsider, and then the deal goes through.
We have also heard from the hon. Member for Wycombe about the knock-on effects when money is tight in primary care trusts. Some eloquent contributions have been made about what gets cut. We have heard about cuts in mental health services. All too often, it is the apparently peripheral services—the unfashionable services, where perhaps the client groups are least able to shout the loudest—who suffer. The hon. Member for Buckingham (John Bercow) spoke effectively and made a powerful contribution about the impact of the cuts in speech and language therapy. No doubt the Minister will read out lists of millions and billions of pounds. Nothing can be done without millions and billions of pounds, but the financial straits in which the hon. Member’s constituents find themselves have a human impact. I hope that the Minister will respond to the hon. Gentleman’s plea and explain whether the Government have any views on how the problems with speech and language therapy in Buckinghamshire will be addressed. I hope that he will not simply say that that is a local problem for the hon. Gentleman, which is what I presume he will say.
The hon. Member for North-East Milton Keynes (Mr. Lancaster) highlighted a problem that is peculiar to Milton Keynes and applies more broadly in Buckinghamshire—population growth. My friend and colleague, Jane Carr—I am sure that the hon. Gentleman knows her—gave me a briefing about the situation in Milton Keynes which tallies with what he said. She said that the population growth in Milton Keynes is such that the area requires a class of children a week. Clearly, the figures must reflect that, but they must reflect it more quickly because capital costs are involved in adjusting to a rapidly rising population. Marginal increments are not sufficient. New facilities are required and there is clearly a time lag before they can be put in place. If the money does not come through for 18 months or more, that makes things difficult for people on the ground.
First, I accept that the calculation of the entitlement of a particular area should be based on accurate figures. In the case of Milton Keynes, it is widely accepted that it was not based on accurate figures. Secondly, it should adjust promptly to the situation on the ground. Thirdly, if there is a formula, leaving aside
what it is, and 100 per cent. of the funding under that formula is available, areas should receive 100 per cent., not 95 or 97 per cent. I agree with the contributions that we have heard on that point.
I raised an important point during an intervention. If I were a Member of Parliament for Buckinghamshire, I would have done precisely what the hon. Members who have spoken have done—plead for more money for their constituents. There is no reason why they should not do that because the financial pressures in Buckinghamshire are clearly leading to some practical problems. However, Conservative Front Benchers cannot say that they want more money in Buckinghamshire, Bedfordshire and Hertfordshire—I have taken part in all those debates—without simultaneously saying that they want less money in north Liverpool, Manchester and so on, which was implied. It is reasonable for a political party to say at an election that it will give more money to the south of England if people vote for it and less money to the north of England. If that is the prospectus for the next election, the electorate can make a fair choice.
Dr. Andrew Murrison (Westbury) (Con): Will the hon. Gentleman give way?
Steve Webb: I shall let the hon. Gentleman speak in a moment.
It is legitimate to raise a debate about the formula and whether the weightings are correct, but I hope that the debate will be consistent because I do not want hon. Members to say one thing in one part of the country and something else in another part.
On the substance of the debate, clearly, there are pressures in Buckinghamshire because of data being out of date, information not being updated, and not being paid at 100 per cent. as should be the case, whatever the formula. Those points have rightly been raised and I hope that the Minister will make a constructive response.
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Dr. Andrew Murrison (Westbury) (Con): The hon. Member for Northavon (Steve Webb) did not give way to me, as is his right, but had he done so I would have pointed out that he is defending a system that results in his constituents in south Gloucestershire receiving £227 per capita in 2006-07, less than the English average, and £245 in the coming financial year. The correspondent for the Western Daily Press was sitting in the Gallery earlier but has now departed and I am sure that he will be interested to hear the hon. Gentleman’s justification for defending a system that so clearly sees off his constituents, as it sees off mine and those of my hon. Friends who have spoken so eloquently today.
I congratulate my hon. Friend the Member for Wycombe (Mr. Goodman) on securing this debate and on introducing it in his usual robust way. I am pleased to hear that my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan), even from her sick bed, has contributed to this debate by proxy.
Where Buckinghamshire fits into the Secretary of State’s heat map is uncertain. Our freedom of information request on this subject comes to light in a
few days—we hope that the response will be free and frank, otherwise we shall apply to the Information Commissioner. My suspicion is that it will show Buckinghamshire as being pretty cold. The reason for that is deficits, which lie at the heart of the difficulties that my hon. Friends have expressed and that I have experienced in my constituency. It beggars belief that the Secretary of State can claim that it is all down to bad managers, which is her thesis. Bad managers choose their appointments for many reasons, but I fear that they do not choose them based on whether there is a Conservative Member of Parliament representing their area. Perhaps it would be a good thing if they did so, but they most certainly do not. We must nail that first and foremost.
We are talking about a matter to do with the funding formula. The hon. Member for Northavon raised it and I shall talk about it in some depth because it relates directly to what my hon. Friends said. Indeed, it lies at the heart of that.
I hope that the Minister has read the work produced by Professor Asthana and Dr. Alex Gibson. He should have done because it was recently submitted in evidence to the Select Committee on Health. They work from the university of Plymouth and have done extensive work on the funding formula. If the Minister has not read it, I seriously recommend that he does so without delay. It points out clearly that deficits are strongly associated with per capita allocation of funding and levels of deprivation. However, it is old age that drives cost in the national health service and the Minister should know that. Old age overwhelmingly causes costs to be generated within the national health service and as diseases of old age—chronic diseases and long-term conditions—become more and more prevalent, it will need more and more focus in a funding formula that since 2003 has given equal weight to measures of social deprivation as it does to old age.
The gradient in the prevalence of chronic disease is much steeper across age bands than across social class bands. I appreciate that the Secretary of State has a particular political axe to grind, and my hon. Friend the Member for Beaconsfield (Mr. Grieve) touched on redistribution. We all accept that redistribution is what Parliament does. It is part of the deal. However, I suggest that redistribution through the funding formula for the national health service is inappropriate and takes us away from what we should be doing: funding disease burden and health care need. What drives those above all else is age. We must all appreciate that because we are all getting older and will increasingly become prey to such conditions, which I fear will be insufficiently funded because of the funding formula that has operated since 2003, when parity was achieved between indices of social deprivation and old age in terms of how funding is apportioned.
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