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Dr. Taylor: Yes, of course it is odd. I shall shortly give my suggestions for enabling NICE to deal with affordability.
Mr. Evans: Does the hon. Gentleman not find it odd that constituents of mine have been denied certain drugs, although the same drugs are made available in Scotland? One of my constituents is having to pay thousands of pounds from his savings to get life-saving drugs.
Dr. Taylor: I agree with the hon. Gentleman. It is odd that NICE’s equivalent organisation in Scotland seems to get its answers out much more quickly. That situation needs to be addressed.
I return to the impact of affording the treatment for wet age-related macular degeneration. My PCT’s chief executive tells me that providing such treatment would cost Worcestershire alone £1.5 million a year, which, taken across the country as a whole, would mean a figure of about £150 million.
The answer is not to weaken NICE. I am sure that many hon. Members will have seen the dramatic headline in The Guardian a few days ago, “Open up NHS to our drug firms, White House demands”. We should not be swayed by that sort of pressure. There are ways in which NICE could have a lower cost-effectiveness ratio and thus be able to recommend much more in the way of treatment. This all comes down to the terrible phrase that we are not allowed to use, “health care rationing”. It is better to use the euphemism “resource management” in health care. We could free up money to be used for more in the way of drugs.
Many PCTs negotiate commissioning policies with clinicians and patient representatives. In a way, they are rationing, or allocating priority to, their limited resources already in subjects such as aesthetic surgery, and, in the case of my PCT, in respect of radiofrequency ablation for liver cancer, vacuum-assisted wound closure therapy and so on. Such resource management initiatives should be nationwide, and subject to public debate. Should we be paying under the NHS for tattoo removal, for treatment for male pattern frontal baldness, or for anti-smoking pills?
The Government have made a start by producing an invaluable document, “NHS Better Care, Better Value Indicators”, which goes through a range of procedures comparing the efficiency levels of primary care trusts and acute trusts. It measures things such as reducing length of stay, eliminating operations of doubtful value, increasing day case rates, variations in emergency admissions, and so on. If all trusts could be lifted to the standards of the best performers a lot of money could be saved.
Most dramatic and easiest to understand is section 3.1 of the document, which every MP should read. It is about the use of statins. I guess that many hon. Members are already on statins, and most of us will be at some point in our life, because their effect is dramatic. The Department of Health has studied the rate of low-cost statin prescribing. The first two statins are now off patent and cost a fraction of the others. The introduction to the section states:
“The volume of statin prescribing has increased several fold during recent years and there are large cost differentials between the different statin drugs. By ensuring that clinicians initiate patients on one of the lower cost drugs, PCTs can keep statin prescribing costs down.”
In 2005-06, statins cost about £500 million. The survey is of all PCTs and measures the percentage of low-cost statins they prescribe. The rate in the best PCTs is 84 per cent. At this point I have to praise my local PCT, which is second best, with a rate of 82.7 per cent. The worst is Rochdale PCT, where the rate is 19.2 per cent. The difference between the best and the worst is huge.
I looked up the statistics for the constituencies of Health Ministers. If the Doncaster PCTs increased their rate of low-cost statin prescribing to 69 per cent., which is the figure achieved by the top 25 per cent. of PCTs, Doncaster could save £967,000. If the Leicester PCTs did the same, £917,000 could be saved. Bury PCT ranks 298th out of 303 PCTs in the survey; it could save £1.2 million. Ashton, Leigh and Wigan PCT is 291st on the list; it could save more than £2 million simply by raising itself into the top quartile. Whole parts of the country, such as Lancashire and the surrounding area, are not doing especially well.
Daniel Kawczynski: Given that the hon. Gentleman has done so much analysis, does he agree with many Conservative Members that in terms of investment, the Government appear to be doing more for the Labour heartlands than for Conservative and Liberal Democrat constituencies?
Dr. Taylor: That is a red herring at this point in my speech. I shall address that very point later, in relation to hospital reconfiguration.
Mike Penning: On primary care trusts that seem to spend extravagantly when they could cut costs, does the hon. Gentleman think that that has anything to do with the situation in places such as Leicester, where, as the Secretary of State has admitted, £1,300 a year is spent per person? In my constituency we get only £960 per head, even though we do very well on prescribing.
Dr. Taylor: No, I do not think that that is the case. I praise the Department of Health for producing the document. It has only just come out, so we will see whether it has any effect. I would like hon. Members to look at section 3.1 of the paper and see how their PCT is doing, not because we can influence what doctors prescribe, but so that we can ask PCTs why they are not saving £2 million or £500,000 or whatever, when they can do so by simply increasing the proportion of low-cost statins to 69 per cent., as the top 25 per cent. of PCTs have done. That will not interfere with medical freedom, because it will give doctors the scope to prescribe some of the proprietary brands, if they feel that they have to. That is one way in which more money could be made available for the drugs that we really need. I hope that the Government will widen the initiative. I would love them to consider Viagra, for example. It costs about £5 per tablet to the NHS, and there are strict guidelines on when it can be used under the NHS, but it would be awfully useful to look at the figures across PCTs and see whether the same sort of discrepancy occurs with that drug.
Turning to NHS reconfigurations, it is essential to differentiate between acute hospital reconfigurations and community hospital reconfigurations. We need the truth about which constituencies hospitals are in. I have a list of 39 acute hospitals for which a merger or reconfiguration is under discussion. There are 39 MPs involved, 18 of them Labour, 16 Conservative and five Liberal Democrat, so there is only a very slight bias. I have not analysed the figures for community hospitals, but if one thinks of the sort of constituencies that have community hospitals, there is bound to be a preponderance of Conservative and Liberal Democrat-held seats, rather than Government-held seats, represented, so the accusations of political bias are probably rather overplayed.
Dr. Andrew Murrison (Westbury) (Con): If the hon. Gentleman looks at the figures for maternity services, he will find that 80 per cent. of units under threat are in non-Labour constituencies. Would he like to comment on the bias that that implies?
Dr. Taylor: I think that the same applies, although I must admit that I have not looked at the figures in detail. Many of the midwife-led birth centres will be in community hospitals, and so are probably more likely to be in Conservative or Liberal Democrat constituencies, but I have not looked into the matter in detail.
To return to hospital reconfigurations, we have to accept that some changes must occur. Given the European working time directive, changes in medical practice and health service deficits, not all acute hospitals can keep all services, particularly when they are close to other acute hospitals. In the past fortnight, I have been lucky enough to have a meeting with the Health Secretary and the chief executive of the NHS, because I regard myself as one of the few people who know absolutely how not to undertake a hospital reconfiguration. I told them that the sort of thing that happened in my area—the loss of all acute in-patient services, and the total loss of accident and emergency services and any practical emergency facilities—would never be acceptable. I told them that people want fairness; they want the pain of reconfiguration to be borne equally. They understand the need to travel to treat rare and complex conditions, but they wish common emergencies to be treated closer to home.
Since we were drastically downgraded, there have been lesser downgradings, which I have mentioned. The changes at Hexham and Bishop Auckland are much more likely to be acceptable. At my meeting with the chief executive of the NHS I learned something amazing about a tiny hospital in Yorkshire. When he was chief executive of the Doncaster Royal Infirmary NHS trust he oversaw the merger of the tiny Montagu hospital at Mexborough with Doncaster royal infirmary, but he made sure that the Montagu retained medical admissions. In 2000, however, we were told that it was quite impossible for our hospital to do so. The tiny Montagu hospital has 115 beds, including 56 for medical admissions and 16 for rehabilitation, three physicians and five senior house officers—so it is possible to offer such services. The chief executive of
the NHS says that many hospitals must be altered, but he oversaw a merger that did not rob a tiny hospital of everything, and kept various services that we all want. Indeed, far more was kept than was kept at Kidderminster. The bulk of emergencies are medical emergencies, so if a hospital accepts such admissions it sees most people who would otherwise go to a full accident and emergency centre. Reconfigurations and mergers can be managed so that they work and are more acceptable than those that took place in my patch.
“My Government will carry through the modernisation of healthcare based on the founding principles of the National Health Service.”
The Government’s view of those founding principles is distinctly different from other people’s. They certainly think that the NHS will remain a national health service provided that patients receive free treatment. Many people in the NHS want to go much further, as they believe that unity of providers, rather than competition, is what Bevan wanted. A personal view was expressed in the British Medical Journal on 23 September by Ian Greener, who is not a doctor but a senior lecturer at the centre for public policy and management at Manchester business school. Nearly 60 years after Bevan, he said:
“we find ourselves with a government committed to changing Bevan’s NHS to a form its founder would surely struggle to recognise.”
“These reforms seem more radical than commentators in this journal dared imagine...If we add in the vagaries resulting from the PFI process, then we have a reform agenda that seems to sweep away Bevan’s NHS across the board, blurring the boundary between public and private not only in financing the service but also in the provision of care”.
I appeal to the Government to protect the National Institute for Health and Clinical Excellence, to look at criticisms that have been made, to expand resource management to make more money available, to carry out reconfigurations and mergers sympathetically, and to slow down reform. I shall check Hansard carefully, as I am sure that the Secretary of State responded to an intervention from a Labour Member by saying that the Government expected a period of calm in the NHS. I take that to mean that she thinks that the pace of reformation and change in the NHS should slow down. I certainly hope so.
3.35 pm
Mike Penning (Hemel Hempstead) (Con): I am pleased that the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) has returned to the Chamber because, unusually for me, I am about to praise her. I congratulate her on the mental health Bill that is to be introduced, on which my colleague on the Labour Back Benches, the hon. Member for Bristol, North-West (Dr. Naysmith), worked so hard on the Health Committee and the Regulatory Reform Committee on which he serves. He is truly an expert in the field. I hope that much of the work that has been done on previous Committees is incorporated into the Bill that will come before the House.
One aspect of mental health provision is particularly important. It is right that we do not have the sort of Victorian institutions that I grew up around. The Runwell hospital in Essex, which was close to my home and where many of my friends used to work, was an appalling institution where people were sent for reasons that had nothing to do with mental health. It was right and proper that care in the community was introduced.
However, I have raised with the Minister previously my grave concern that at times people need help which cannot be delivered in their homes or in the community by their local GPs and other experts. Very often, people want to admit themselves to a ward, not only to get the help that they need, but so that their carers can get the help that they might need at times. Sadly, some of those wards are under threat as a result of the deficits in some mental health trusts—not least St. Julian’s ward in St. Albans in south-west Hertfordshire.
So many of the patients and carers to whom I have spoken need such wards as a safety net. The wards need not be full every day or every weekend, but they should exist as a facility so that when care in the community cannot quite cope with individual cases, patients can be admitted to a ward. In the vast majority of cases, those are self-admissions. There is a great deal of fear out there that we pushed too hard down the avenue of care in the community, believing that everything could be done outside a ward—often outside a secure ward.
There is also fear—ill-founded in many cases—that people who go into a ward are a danger to the public. Very often, they are admitted because they are a danger to themselves, and they know it. That is a difficult mental health issue, as I know the Minister recognises. Although I praise the work that has been done and look forward to the Bill, the contraction in secure wards must not go too far, or we will have even more problems in the community. I am pleased to see the Minister nodding, indicating that that will be looked at.
Before I go on to speak about the circumstances in my constituency, I shall deal with another aspect of health that worries me greatly: health in the armed forces. I have the honour of participating in the armed forces parliamentary scheme, and I also had the honour of serving in the Army when I was much, much younger. I recently visited the Army recruiting centre down on Salisbury plain. A matter of grave concern is the shortfall of about 7,500 servicemen, especially in the infantry and the Royal Artillery. Furthermore, almost 10,000 servicemen and women are sick and unable to be deployed on operational duties. That is a huge figure for a standing Army of fewer than 100,000. Together, those numbers mean that about 17,500 servicemen and women are unavailable for operational duties.
If the contraction of medical services in the armed forces continues, that will place an increasing burden on the health service. I asked the senior generals in charge: who was signing off the soldiers—who was responsible? Was it the medical officers in the armed forces?
Angela Watkinson:
My hon. Friend makes an important point. On Remembrance day this week, I spoke to servicemen who had been retired for a
considerable time, but who were clearly still suffering the long-term effects of active service and had not had any treatment.
Mike Penning: Any Government of any political persuasion should look after their armed forces, who have given so much to the country. It is extremely worrying that such reports are still coming through.
I asked the generals whether so many people were unavailable for operational duties mainly because of injuries resulting from conflict, and the answer was no. In most cases, sickness notes are signed by civilian doctors—GPs—who do not necessarily understand the ethos of the armed forces quite as well as they should. Many of the ladies and gentlemen who serve in the armed forces may not be operationally available to serve in Iraq, Afghanistan, Sierra Leone or elsewhere around the world, but they may be able to do a desk job or something while they are recovering from their injuries.
I was most grateful to General Viggers when he said that many servicemen who have had amputations as a result of injuries sustained in Afghanistan and Iraq would not automatically be discharged from the armed forces, as would have been the case when I served in the Army, when those with a serious injury would have been thrown out on to the dustcart. These days, common sense prevails and people’s skills are used.
Daniel Kawczynski: My understanding from what the Prime Minister has said in the House previously is that he will consider giving the armed forces only a dedicated wing of the hospital in Selly Oak, whereas on the continent many countries have a specific hospital in their capital city that is purely for their armed forces and their relatives, who, in the event of the deaths of their partners obviously need that special care as well. Does my hon. Friend agree that our country, which has the best armed forces in the world, should also have a dedicated hospital for our armed forces?
Mike Penning: As a former soldier, I could not agree more. I am due to visit Selly Oak hospital in the near future; it does some fantastic work. Selly Oak is working hard, but the ethos in the armed forces is completely different from that in a civilian establishment.
I ask the Minister to look carefully at health care for our armed forces, which in most cases these days because of the closure of military hospitals is provided by civilian GPs and surgeons. It is important to look after our servicemen and women when they are in desperate need. Will the Minister also look into why so many of our armed forces are sick or unavailable for operational duties? Ten per cent. of the standing Army seems a huge amount; a figure that we probably would not accept on the civilian side.
Mr. John Hayes (South Holland and The Deepings) (Con): As my hon. Friend has made such a compelling case, would he use this opportunity to invite the Government to make time in their agenda to debate more fully the issues that he has raised on medical services for the armed forces, because I do not think that the House has said or done enough about that?
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