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The result of the new contract is that GPs are providing better services for patients according to the
quality and outcomes framework, and doing much more work on prevention and long-term care. They are also receiving big increases in payments. I think it right for us to ask patients for their views on their local practices, and to adjust payments to general practices accordingly.
Mr. Lansley: It is always rather depressing when it clear that the Secretary of State does not understand. If GPs are not commissioned to open their surgeries on Saturday mornings, there is no basis on which they can do so, and it is therefore difficult to assess them on that ground.
The satisfaction survey ought surely to extend to out-of-hours services, but the Government do not seem to intend that to happen. Will the Secretary of State undertake to extend the survey to those services? Then, perhaps, she will be able to explain why patients have an out-of-hours GP service that is much less satisfactory to them than it used to be, and why the Government are spending not the £105 million that they thought it would cost last year, but £346 milliona quarter of a billion more than they expected.
Ms Hewitt: It is the hon. Gentleman who simply does not understand the new GP contract. The new contract, which has led to primary care services being rated as better in our country than in almost any other advanced countryas is shown in a recent survey by the Commonwealth Fundallowed GPs to choose whether to provide out-of-hours services, in which case they would receive higher payments, or to hand the responsibility back to the primary care trusts. PCTs commission out-of-hours services where local GPs have decided not to provide them themselves. If all PCTs commissioned those services as efficiently as the best, they would save money on the allocation that we made, rather than overspend.
Andrew Gwynne (Denton and Reddish) (Lab): Choice has also been a major factor in patient satisfaction. Patients in parts of my constituency now have access to their medical records online, which is proving hugely beneficial. Has my right hon. Friend any plans to roll that out so that all my constituents can benefit from it?
Ms Hewitt: My hon. Friend is absolutely right. By extending choice and the control that patients have over their own services, we are in increasing the responsiveness of the NHS to what patients want and contributing to that increased satisfaction. Through the NHS IT programme, we are trying to ensure that patients everywhere will have access to the online services about which some of my hon. Friends constituents are already so pleased.
The Minister of State, Department of Health (Andy Burnham): The Mid Essex Hospital Services NHS Trust has announced that 24 members of staff have been made redundant. The trust is making every effort to protect front-line services.
Mr. Burns: I am staggered by the Ministers response because a written answer from his Department of only two weeks ago informed me that the figure was 42, rather than the number that he has given. Also, as the Minister should know but might not, on the same day a further 203 jobs were cut in the hospital trust. I am therefore staggered by the Ministers response. I want him to explain something to me and my constituents. Since those 245 job cuts were announced, the Government have changed the regime for redundancy pay. Given that those job cuts are being made to reduce the deficit in the trust, how do the Government reconcile changing the redundancy arrangements for trusts seeking to cut their deficits?
Andy Burnham: I will check whether there is that discrepancy between the figures that the hon. Gentleman has brought to my attention, and if there is I will correct it. However, yet again he and other Conservative Members are seeking to spread anxiety by quoting figures that do not reflect the reality. [Interruption.] They seek to create an impression that P45s are being handed out to nurses up and down the country; in reality, that is not the case. [Interruption.] If he or his party continue to try to spread anxiety in that way, that will not reflect well on them.
The hon. Gentleman and his colleagues have been lobbying me about a new hospital for the trusthe goes quiet and listens now that I mention that. If that trust is to get that new hospital, it must of course be financially viable. Although the decisions that have been made are difficult for the staff concerned, I hope that the hon. Gentleman will support my party in helping the trust make the difficult decisions that will get it into a financially stable position, as that will enable it to have the new hospital that he keeps on asking us to provide.
Dr. Richard Taylor (Wyre Forest) (Ind): Does the Minister agree that compulsory redundancies are likely to be only part of the cause of staff reductions in that trust and throughout the rest of the NHS? As an example for the rest of the NHS, will he consider breaking down staff reduction figures into compulsory redundancies, voluntary redundancies, retirements and the vacancy factor effect in respect of the 10 per cent. of staff that are turned over every year?
Andy Burnham: I thank the hon. Gentleman for that constructive question, because he is absolutely right. We want to put correct information into the public domain. There are some who seek to use figures to scare, and spread anxiety in, the national health service, so we fully recognise the need to put accurate figures into the public domain so that people can make their own judgments about the state of work force planning within the system.
The hon. Gentleman is right that there is a need to put out more information, and we have put information into the public domain about voluntary
redundancies. On a trust-by-trust basis, trusts are making statements about reducing their use of agency staff. I will constructively take on board the point that the hon. Gentleman has made, and we will of course seek to put accurate information into the public domain as and when we can.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): It is for primary care trusts, in consultation with local people, to decide what small, localised services are needed in their areas.
Natascha Engel: I thank my hon. Friend for that answer. In particular, I want to raise the issue of toenail-cutting services for elderly people. It is an important service and it should be raised. Because of the redrawing of the boundaries of the primary care trusts, I am seriously worried that small local services that are vital for elderly peoplesuch as those who cannot reach their feetare not being safeguarded. I would very much like the Minister to give an answer that reassures me that such small, vital services are being safeguarded in PCT funding.
Mr. Lewis: My hon. Friend raises an important issue: toenail-cutting services are important for older people, particularly those with diabetes or vascular problems. In such circumstances there is a commitment to maintain those services. However, I must also say to my hon. Friend that one of the reasons why a review is taking place is that some people have been receiving those services for more than 10 years, and although that might be entirely appropriate for some older people, it might not be necessary for others. The objective is to make sure that those services are protected where there is clinical need, because they are an important lifeline for many older people, but we must also make sure that resources are used appropriately.
David Tredinnick (Bosworth) (Con): Is the Minister aware that among the worst affected small local services are the integrated health care services of chiropractic, homeopathy and herbal medicine? Is he also aware that his right hon. Friend the Secretary of State for Health, when she was presenting the Acorn award for integrated health care at the NHS Alliance conference last week, said that they are what patients want? Why, therefore, are there cuts across the board in primary care trusts, and why are the Tunbridge Wells and Royal London homeopathic hospitals under threat? Will he and the right hon. Lady
I know that the hon. Gentleman has a long-standing interest in, and commitment to, complementary medicine, as Members in all parts of
the House will acknowledge, but the fact is that more than 50 per cent. of GPs do use complementary medicine and make sure that it is available to their patients in some circumstances. The hon. Gentleman asks me to intervene in local PCT decision making, but I should point out that his own Front Benchers are suggesting that we have complete operational independence for the health service, where local decision making will be the norm.
Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): Has my hon. Friend heard from the Minister, my hon. Friend the Member for Don Valley (Caroline Flint), about the interest that she has taken in Trevi house, which is a unique drug rehabilitation centre in my constituency for young mothers and children? Indeed, I thank her for the help that she has recently offered to them. However, will he and his colleagues give serious consideration to issuing guidance to PCTs about the position of such small services? Two or three places are provided for the Plymouth PCT area, but a regional and a national service is also provided.
Mr. Lewis: My hon. Friend the Minister has made me aware of the excellent work that Trevi house does. I believe that my hon. Friend the Member for Plymouth, Sutton (Linda Gilroy) has visited the service, and she makes a really important point. An holistic approach is taken there, and the rehabilitation services that are available not only for women who have had drug-related problems, but for their children and other family members, are incredibly important. In issuing commissioning guidance to PCTs, one of the things that we are most concerned about is rehabilitation outcomes and the needs of those women and children and the families as a whole. Where such quality services are being provided in the voluntary sector or perhaps by social enterprises, we will try to ensure that commissioners understand that we expect them to commission such services against the outcomes that we specify.
Mr. David Heath (Somerton and Frome) (LD): One way to conserve and perhaps develop local services is to realise redundant assets. Will the Minister therefore look at the situation of the Queen Camel doctors surgery, which has lain empty for several years since the new surgery was built? It is situated right in the middle of a village, is vandalised regularly and is an eyesore, yet my repeated approaches to the South Somerset primary care trust, and now to the Somerset PCT, have failed to lead to its being sold. Will the Minister look into this issue, find out why probably £500,000 of NHS assets is being wasted, and write to me?
Mr. Lewis: I am more than willing to ask the PCT to have a look at this issue, which is exactly the sort with which the Member of Parliament concerned, the local authority, the PCT and, indeed, the local voluntary sector should engage, in order to come up with a solution that meets the needs of the local population. However, this is not necessarily a job for me, sitting in an office in Westminster or Whitehall, but I am willing to contact the PCT and to ask it to engage properly with the hon. Gentleman in an effort to resolve the issue.
6. Mr. David Anderson (Blaydon) (Lab): What assessment she has made of the potential impact of retirement through ill health of NHS staff on funding available for service provision; and if she will make a statement. 
The Minister of State, Department of Health (Andy Burnham): There has been a major decrease in the number of awards of ill health retirement in the NHSfrom 9,520 per year in 1993-94 to 2,673 per year in 2005-06. It was estimated in November 2001 that each ill health retirement involving a pension cost the pension fund up to an extra £60,000, and cost the trust the same again in indirect costs.
Mr. Anderson: I thank my hon. Friend for that answer. Will he reassure the House that staff are not being coerced or forced into applying for early retirement in order to mask the numbers facing compulsory redundancy?
Andy Burnham: I certainly can give my hon. Friend that assurance, and I also wish to pay tribute to him and other colleagues in the trade union movement who have played a part in bringing down the number of ill health retirements in the NHS. The NHS as an employer has been in the spotlight this year, and today in the House, but sometimes the good things that it doesincluding the way in which it looks after its staffdo not get the appropriate praise. We should give the NHS that praise. My hon. Friend will know that the NHS, in consultation with the unions, has looked at managing ill health retirement and, by making earlier use of occupational health services and redeploying staff from onerous duties, it has managed to bring down the figures. More work remains to be done, but I would never countenance the manipulation of the figures that my hon. Friend suggests.
Andrew Mackinlay (Thurrock) (Lab): Those figures, which are welcome, suggest abuse in the past, and that people have retired on health grounds without justification. At a time when we are reorganising the NHS, will my hon. Friend and his colleagues ensure that any applications for retirement on grounds of ill health or redundancy are rigorously examined, bearing in mind the fact that there is a duty on the trade union and the employer to explore all opportunities for redeployment, to avoid those bogus and costly charges on the public purse?
Andy Burnham: My hon. Friend makes an important point. Of course, the peak of 9,500 in the early 1990s was for a much smaller work force. The figure for the last financial year2,673is for a much larger work force, with some 300,000 extra staff. That shows a much better performance. My hon. Friend is right about redeployment, and we will continue to work with NHS employers to look at every possibility for keeping staff in the service and retaining their skills and knowledge, by helping them to work elsewhere if they are struggling in their existing job. I will reflect more on the important point that my hon. Friend makes.
7. Mr. Peter Bone (Wellingborough) (Con): What the weighted capitation allocation for Northamptonshire Heartlands primary care trust was for 2003-04 to 2005-06; and how much was available to be drawn down by the PCT over the same period in relation to the capitation allocation. 
The Minister of State, Department of Health (Andy Burnham): Northamptonshire Heartlands PCT received revenue allocations of £222 million in 2003-04, £244 million in 2004-05 and £267 million in 2005-06. Over the three years covered by this allocation, Northamptonshire Heartlands PCT received an increase of £63.6 million. By the end of 2005-06, the PCT was 4.4 per cent. below its target allocation.
We are however the worst funded SHA relative to the national capitation formula...Indeed North Northamptonshire is our most pressurised health community. Northamptonshire Heartlands PCT which covers this population...is £32 million (9.9 per cent.) below capitation.
Does the Minister agree with Sir Richard, and is it not true that we do not have a national health service any more, but a postcode lottery health service? The people of Northamptonshire have drawn very bad numbers.
Andy Burnham: I do not agree with that statement. The hon. Gentleman should cast his mind back to the NHS of the early 1990s before making such comments. Let us get the matter straight. The funding increase that his party voted against [ Interruption. ] Instead of rolling his eyes, the hon. Gentleman should listen to the facts. His PCT received an increase over the two years of this funding allocation of 29.4 per cent. The national average increase for PCTs was 19.5 per cent. and
Andy Burnham: The hon. Gentleman cannot keep saying that. The resources that this Government have put into his local PCT are on a scale never seen before, and they have been adjusted to account for the population increase in his area. Overall, they constitute an extremely generous package for the health service in his area. If he wants more resources for the health service, he should try voting for them next time.
Mr. Stephen Dorrell (Charnwood) (Con): Does the Minister agree that the principle of fair funding, which the Government say that they espouse, should mean that resources within the growing budget of the NHS, which we all welcome, should be targeted at health need? Does the Minister understand that there is a growing perception throughout the NHS, including in Northamptonshire, that resources in the health service are no longer allocated in a way that reflects the health needs of the population, but are increasingly distributed in a way that reflects the political needs of the Government? Is there not an urgent need
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