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18 Oct 2006 : Column 309WH—continued
The market forces factor also weighs on Buckinghamshire. It is meant to equalise costs in metropolitan and non-metropolitan areas with particular reference to incomes, but the national health service has national pay scales, so market forces do not apply to the NHS to the extent that they do elsewhere. However, they are still a factor. Many of us believe that
that should operate in reverse in many of our rural constituencies, such as Buckinghamshire, because we all know that more senior and elderly people tend to work in non-metropolitan areas. We have seen that in primary schools, where there is a particular problem in village schools, which face staff costs far in excess of those in more urban centres. It certainly applies in the NHS.
We see no reflection of rurality—
John Cummings (in the Chair): Order. We need time for the Minister to respond.
Dr. Murrison: By my reckoning, Mr. Cummings, I have seven minutes and I have spoken for five, unless you wish to correct me.
John Cummings (in the Chair): Order. Perhaps the hon. Gentleman will draw his comments to a close.
Dr. Murrison: Thank you, Mr. Cummings.
There has been no reflection of rurality in the funding formula, except in the ambulance service, and we need that. The solution is to have some flexibility on brokerage, which the Secretary of State has removed. That lies at the heart of what Buckinghamshire is experiencing. The brokerage that levelled up the unequal funding formula that I have described has been removed. In the long term, deficits should not recur, and we must consider service items in the national health service using a formula that is based more on the age demographic of the population, and less on social factors.
In response to the hon. Member for Northavon, it is equally important that we fund public health properly. We must separate it from service funding in the national health service, because health inequalities have got worse under this Government. We will not address those problems unless we isolate public health funding and deal directly and transparently with such difficulties as obesity, hypertension and hypercholesterolemia, which are arguably more prevalent in some of the communities to which the hon. Gentleman referred.
4.20 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): It has been a good debate, and I pay tribute to the hon. Member for Wycombe (Mr. Goodman) for securing it. I also pass on my good wishes to the hon. Member for Chesham and Amersham (Mrs. Gillan). I inherited her office when I took over at the Department for Education and Skills, and the curtains were very interesting, indeed. I pay tribute also to the hon. Members for Aylesbury (Mr. Lidington), for Buckingham (John Bercow), for North-East Milton Keynes (Mr. Lancaster) and for Beaconsfield (Mr. Grieve) for their contributions.
I begin by praising all national health service staff who make a difference in those hon. Members’ constituencies and throughout the country. We are united in the belief that staff on the front line make a tremendous difference to the quality of people’s lives. On many occasions, national health service staff go further than that by saving people’s lives.
I shall try to address sensibly and reasonably the comments of most hon. Members. First, however, I shall deal with the contribution from the hon. Member for Westbury (Dr. Murrison). It goes beyond the pale when a Front-Bench spokesman on behalf of Her Majesty’s loyal Opposition seemingly suffers memory loss. When the hon. Gentleman’s party left office in 1997, the national health service was by any standards and measure a complete shambles and in a complete mess. Subsequently, the Conservatives have repeatedly voted in the House of Commons against our proposals, particularly against our most significant proposal to increase national insurance to enable us to put far more money into the NHS.
At the last general election, the Leader of the Opposition wrote a manifesto that suggested the best way of reorganising the NHS was to incentivise people to leave the health service and spend money in the private health care sector. When the hon. Member for Westbury starts lecturing me on public health, I say to him that the Conservatives were the party that banned the use of “poverty” when it came to the development of any element of public policy. Let us please have a balanced debate about what is happening in hon. Members’ constituencies. He should not be impudent when he describes the health service and the improvements that have been made.
Hon. Members cannot argue for independence and the devolution of power to the front line in the health service, and then attend debates such as this day after day, demanding ministerial intervention in individual cases, reconfiguration and the prioritisation of resources in their local health economies. The two positions are intellectually incoherent.
On the question of the fair distribution of resources, we agree that public resources are always finite. The Government will always be required to make decisions about the distribution of resources, and we make no apologies for saying that those areas with higher levels of social exclusion, deprivation and health inequalities needed a larger share of the cake than they had received historically. That is why we reordered the formula. Some constituencies that have benefited are represented by Opposition Members, and I wonder how they would feel if we started to redirect resources. The issue is about fairness, and I do not apologise for focusing resources where health inequality is at its most acute.
I say also to the hon. Member for Westbury that we are right to say to the health service, “You have a budget, and finally, you have a duty and a responsibility to balance that budget just like any other organisation in the public or private sectors.” We cannot move forward organisationally until we control our finances. It is a basic fact for any organisation responding to perpetual change. If its finances are not under control, it is difficult to make the necessary changes.
I shall respond to the specific points that hon. Members have made about their constituencies, but if I do not reach their questions, I shall write to them in detail wherever I can. Buckinghamshire primary care trusts received £524.8 million for the financial year 2006-07, and they will receive £573.5 million in
2007-08. That represents a 19 per cent increase over two years, and by any standards, a significant year-on-year increase.
The hon. Member for Beaconsfield asked what the funding has bought. I shall tell him. It has been instrumental in the fact that no patient in Buckinghamshire waits longer than 26 weeks for in-patient treatment and no patient waits longer than 13 weeks for out-patient treatment. No cancer patient waits more than two weeks from referral to being seen by a specialist, and more than 96 per cent. of people on being diagnosed with cancer wait fewer than two months after referral to be seen by a specialist. Without targets, many objectives would not be achieved. We should debate the right and smart targets, and the unintended consequences of targets, but it is nonsense to suggest, as the Opposition do, that we ought not to have targets for public service outcomes and delivery.
The increased funding has paid for 5,612 more nurses, 794 more consultants, 481 more GPs and 635 more dentists in the NHS south central area since 1997. It has allowed the provision of single specialist medical units for cardiology, respiratory and haematology, and a new stroke unit at Wycombe hospital. First-year data analysis from the strategic health authority shows reductions in length of stay, and improvements in outcomes such as mortality rates.
Hon. Members may be interested to know that the percentage of patients seen as soon as they felt it necessary by a GP in hon. Members’ constituencies rose from 56 per cent. last year to 81 per cent. this year. That is an important representation of how patients in hon. Members’ constituencies feel about improvements in primary care.
In 2003-04, the most under-target primary care trust was 22 per cent. under its fair share of available resources. By the end of 2007-08, Buckinghamshire primary care trusts will be only 0.3 per cent. under target. That represents significant momentum and improvement.
“Shaping Health Services” is the name for the reconfiguration of services. Surely hon. Members accept that it is impossible for a Minister in an office in Westminster or Whitehall to make a judgment about the most appropriate configuration in hon. Members’ localities. They must engage with managers, clinicians and the local community to achieve a sensible way forward. It is not right for Ministers to intervene in decisions about service reconfiguration.
Difficulties in accident and emergency departments and the shortage of anaesthetists have been recognised, and that is why health management has intervened and problems are being put right. The problems should not have occurred, but importantly, management are doing something about that.
It is not for me to write to Transport Ministers about issues in individual Members’ constituencies. However, if they can demonstrate a direct correlation, and they want me to pass on to Transport Ministers communications that relate directly to an impact on health, I am willing to consider it.
The hon. Member for Wycombe referred to the difficulties at Stoke Mandeville hospital. The Secretary of State commissioned an inquiry into Stoke Mandeville hospital, and we all agree that it spotted dreadful and unacceptable failures that led to tragedy.
The hon. Member for Buckingham spoke about speech and language therapy. He cares passionately about it and he is objective about it. He was right to raise concerns about the practical impact on young children such as Peter Metcalfe. I have said that it is inconsistent to ask for ministerial interference while demanding independence, but because the hon. Gentleman is genuine about that issue, I am willing to ask for information from the local health authority about the speech and language therapy situation, and specifically, about the action that it proposes to improve it.
If I have been unable to cover any other issues, I shall write to hon. Members.
Open Prisons
4.30 pm
Steve Webb (Northavon) (LD): It is my pleasure to raise again a matter that I raised a few years ago. In the spirit of agreeing that prevention is better than cure, rather than request an Adjournment debate in outrage when someone unsuitable is placed in open conditions and walks out, I felt it better to raise my concerns about those who are being sent to open prisons before things go wrong.
As the Minister knows, Leyhill open prison is in my constituency. I have visited it on a number of occasions, including recently. I do not want the views that I express to be taken as representing those of anybody else, although they have been informed by the people at Leyhill to whom I have spoken. Many of the comments that I make will be equally applicable to other open prisons.
I begin with a sincere word of praise for what goes on at Leyhill. It is clear that some people within the prison system, typically serving long sentences for serious offences, approach the end of their sentence without being ready to be sent out into the community. If we were to take them straight from closed conditions into the community, they might not cope or they might reoffend—who knows what might happen? I therefore support the principle of open prisons. Leyhill prison employs many people in my constituency, and people in my local community accept the principle of the work done there. I often meet people who are at Leyhill and are working in the community, getting back the ideas of discipline, personal responsibility and routine to equip themselves for life on the outside. That work is to be praised.
I also wish to praise the dramatic turnaround in the problem of absconding from open conditions. The shadow Home Secretary, the right hon. Member for Haltemprice and Howden (David Davis), received a written answer on 25 July showing the number of absconders from various open prisons. The number of people absconding from Leyhill, the prison in which I am particularly interested, went from 19 in 2001-02 to 33 to a peak of 114 in 2003-04—more than two a week. It then fell to 102 the following year and 66 in the financial year that has just ended. In fact I am told—the Minister will probably have more up-to-date figures—that in the first eight months of this calendar year, only eight prisoners absconded. That is obviously eight too many, and we all accept that we do not want anybody to abscond. Clearly, some of the people who do so have committed serious offences. However, there has been a dramatic improvement on the situation that existed in the not too distant past. I salute the intelligence-led work at Leyhill that has got that situation under control.
My key theme is that I am concerned that the good work and progress on both rehabilitation and cutting the number of absconders is about to be undermined and jeopardised if open prisons are used as a kind of overflow car park or dumping ground for prisoners for whom we cannot find anywhere else. The public’s attention was drawn to the matter recently, after my recent visit to Leyhill, by a memo from the governor of Her Majesty’s Prison Ford, who
said that by the autumn of last year open prisons were operating close to 95 per cent. capacity. She said that
“the instructions coming down...state that local prisons must review prisoners serving short sentences for non-sexual or violent offences who are relatively low risk and likely to be suitable for transfer to open conditions...we are likely to get more very short termers, some who should really be in Cat C conditions... this will mean almost inevitably that the abscond rate will go up in Cat D prisons. Ministers have apparently been briefed to this effect and are taking this risk.”
There is no point in being hysterical; that is all pretty much a statement of fact.
The Parliamentary Under-Secretary of State for the Home Department (Mr. Gerry Sutcliffe): I appreciate the spirit in which the hon. Gentleman is putting his case. It is not the Government’s policy to comment on leaks, but I can say that the leak to which he refers was completely wrong.
Steve Webb: I look forward to hearing the Minister clarify the way in which it was wrong. Perhaps the Home Secretary was also wrong; he appears to have reinforced the impression given in the leak when he spoke in the House of
“providing maximum flexibility within the prison estate to allow transfers to the open estate under severe restrictions in addition to those transferred as a matter of course.”—[Official Report, 9 October 2006; Vol. 450, c. 33.]
In other words, we have a system of transfers to open prisons, for which people are risk-assessed. The Home Secretary used the words “in addition”; in addition to what? He means that in addition to the people who would ordinarily be assessed as suitable for open conditions, more people are being placed in them because of the pressure elsewhere in the system, albeit, as he said, “under severe restrictions”. It seems uncontentious to say that that is what is happening. I have also learned that there is something called an overcrowding draft. I do not know whether that is a colloquialism, but it is understood within the Prison Service. It means that when a closed prison simply cannot cope on a particular day or night, it contacts Leyhill or another open prison, often at short notice, to say, “Can you take five lads? We can’t fit them in our prison tonight.” I find that worrying.
I tabled a named day question on the matter, but the Minister was regrettably unable to answer it in time for this debate. I hope that he has brought the requested information with him. The question asked how much of this is going on. In other words, how often are overcrowding drafts issued? Where are prisoners sent from and to, and how long do they stay there? Who are they and how many of them are? There are several questions and I do not expect the Minister to answer them all, but I have no sense of the scale of the overcrowding drafts. I have not asked the governor of Leyhill these questions, but is that prison regularly getting people because of overcrowding elsewhere? Is it exceptional? When it does get them, how long do they stay? Are they there for the rest of their sentence, or are they sent back? We need that information.
Mr. Edward Garnier (Harborough) (Con):
Is the hon. Gentleman aware of the term “churning”? It means prisoners being moved from prison to prison
without ever getting on to a training or rehabilitation course. They are “churned” because there is insufficient room in the prison estate as a direct consequence of the Government’s failure to plan.
Steve Webb: I am indeed familiar with that term. The hon. and learned Gentleman touches on a point that I shall come to later: the impact on inmates of churning—the shunting of prisoners around the system.
I understand that prisoner numbers at Leyhill have risen by almost 100 in six weeks. That is a dramatic increase on an initial population of a little more than 300. The latest official figures on the Home Office website are for August, so I do not know whether the number that I have given is up to date or whether it has risen more rapidly. An extra 100 is a substantial number of people to accommodate, and there are three principal problems with that.
First, if prison officers and staff have to devote their time to taking in dozens of extra inmates, often at short notice and in high volumes, they cannot do the day job properly. They cannot spend the time and effort required on the rehabilitation work that they need to be doing. Prison officers’ time and managerial energy is being devoted to containing short-term inmates and overflow prisoners rather than to the long-term rehabilitation work that open prisons are uniquely well placed to perform. It is preventing them from doing what they are there for, which is very damaging.
Secondly, the problem is terribly bad for the morale of officers. They go into those situations, often working with difficult offenders who have committed serious offences, because they believe in the possibility of rehabilitation, yet they cannot do it to the quality that they would want because of the short-term pressures.
As the hon. and learned Member for Harborough (Mr. Garnier) pointed out, the practice is no good for the short-term prisoners who are being shunted from one part of the system to another. For example, how can an inmate with basic literacy problems be taught to read better if they are not in any one place long enough to do a course? How can offending behaviour be tackled if they are being shunted around all the time? If open prisons are simply being treated as a series of successive high or low-security bed-and-breakfast establishments, rehabilitation goes out of the window and reoffending rates soar.
That is one of the nubs of the argument. The concern is not simply about the welfare of the inmates, but about the welfare of members of the wider population, who we do not want to become the next victims of crime. If we fail to rehabilitate inmates in closed or open conditions, we will have more reoffending, more victims of crime and more calls for locking more people up, and we will end up in a downward spiral.
I mentioned my debate from a couple of years ago on a specific case, and it is striking that we have been in this situation before. I have with me the annual report of the chief inspector of prisons for 2002-03. Based on
a review of all the inspections of open prisons in that year, he—I think it was he at the time, but I might be wrong—said:
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