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Andy Burnham: The right hon. Gentleman is straying into territory that is slightly dangerous for his party. His colleague the hon. Member for Wellingborough (Mr. Bone) said that health funding was inadequate because his PCT was under target, but the formula balances a range of factors, including deprivation, age, rurality and market forces, in producing notional target allocations for all PCTs in the country. Recently, the Opposition have suggested that health resources should be distributed according to what they called the burden of disease. The result of such a policy would be that the constituencies of every Minister on the Front Bench today would get significant extra resources, at the expense of the areas represented by the people who are pointing their fingers at me right now. The Tory party needs to decide
Rosie Cooper (West Lancashire) (Lab): Perhaps the Minister can help me, because my constituents, who used to be in the former West Lancashire PCT, are a little confused. The money from last years budget top-slicing will be used to finance NHS facilities in Lancashire, but that excludes the Southport and Ormskirk hospital, which serves my constituents. Moreover, South Sefton PCT
Andy Burnham: My hon. Friend raises an important point. Overspending by any part of the NHS means that another part of the system has to underspend to make up for that poor use of resources. I represent a constituency very close to hers, and areas such as ours are having to help the NHS collectively and put money into the system to help other areas where there are financial pressures. She is right to say that the system should ensure that the money goes to the areas that need it most, and I shall look very carefully at the problem involving the Southport and Ormskirk hospital.
Mr. Stephen O'Brien (Eddisbury) (Con): Let us try again, after the travesty of an answer that the Minister gave to my right hon. Friend the Member for Charnwood (Mr. Dorrell), a former Secretary of State for Health. The Government calculate the need for health care according to the weighted capitation allocation derived from deprivation indices, but the Minister must know that that need is determined largely by morbidity, and hence age. Northamptonshire Heartlands PCT has a projected deficit of £4 million, and it is being condemned to the regime of cash freeze and cuts experienced by most PCTs that serve older populations. Non-existent public health provision has failed socially deprived areas. Will the Minister concede that his funding formula discriminates against elderly people?
No, I most certainly will not. Our health formula gets funding into the areas that need it most, but it is time the hon. Gentleman made his mind
up. I think that I heard him correctly: he has just said, at the Dispatch Box, that funding should be distributed according to age. However, less than two months ago the Opposition issued a policy document that stated that funds should be distributed according to the burden of disease. That is entirely different. The burden of diseasethat is, the incidence of diseases such as cancer or coronary heart disease per 100,000 of the populationis larger in my constituency of Leigh than it is in his constituency of Eddisbury. If the Opposition want funding to be distributed according to age, they need to change their policy.
The Minister of State, Department of Health (Ms Rosie Winterton): Although this is a matter for the local NHS, I am advised that NHS Londons timetable is currently dependent on the developers finalising their own plans for the site.
Richard Ottaway: The key point in that reply is that the matter is in the hands of the developers. The Government made a pledge about the hospital nine years ago, which was repeated at the Dispatch Box five years ago, yet we still do not have a firm date, because the project is in the hands of the developers, who are now in some difficulty. Does the Minister agree that this is a classic example of how not to run a public-private partnership for building a new hospital?
Ms Winterton: I can certainly understand the hon. Gentlemans frustration about the considerable time it has taken to get the project started, particularly as it will bring in £9 million-worth of new investment and bring together acute and community care services, as well as mental health services and a minor injuries unit. I understand his frustration. In February a contract was signed with the developer, and the detail was signed off earlier this month. I know that the hon. Gentleman met the new chief executive of the trust, Helen Walleyon Friday, I thinkand I hope that gave him some confidence that the project is now moving forward. I met Helen Walley yesterday, and she is very keen to take it forward. She assured me that she would keep in touch with the hon. Gentleman about his concerns to reassure him that the project is moving forward.
The Secretary of State for Health (Ms Patricia Hewitt):
In the minority of organisations that do have deficits, the targets we have setfor example, on waiting times and faster access to cancer treatment
are being met. The overall quality of services to patients continues to improve, but I do not underestimate the very difficult decisions needed in some organisations to restore financial balance.
Mr. Lancaster: Since the Secretary of States visit to Milton Keynes in the summer, we have seen the closure of the Fraser day hospital and the surgical assessment unit, cuts to mental health services, cuts to language therapy, cuts to oral health services, cuts to podiatry, cuts in ambulance call-out availability, cuts to counselling services and cuts in payments to the hospital of £2.8 million. Despite all those cuts, the primary care trust still needs to find cuts of another £18 million before March, which the chairman says he has
not a cat in hells chance of achieving.
Ms Hewitt: I and my hon. Friends will promise to continue voting for record investment in the NHSin Milton Keynes and every other part of the country. The PCT in Milton Keynes is getting more money than ever before and there will be more fast growth in its funding next year. Yes, people have to make some difficult decisions to ensure that they give patients the best care within available resources. As spending for those of the hon. Gentlemans constituents who have cancer is below average, while spending on urgent care is above average, I hope that he will support his local PCT in ensuring that it rebalances that spending, puts more services into the community, and increases investment, for instance, for patients with cancer.
Clive Efford (Eltham) (Lab): Even at this time of record investment in the NHS, everyone involved in providing its services, including in my right hon. Friends Department, has to understand that resources are finite, so local services require careful planning. Does my right hon. Friend agree that introducing independent treatment centres in local health economies needs careful planning, as their effect could be to undermine health care trusts that are trying to recover their budgets and go into balance? Does she agree that where independent treatment centres may have such an impact, they need to be reviewed?
Ms Hewitt: I entirely agree. We have written a big cheque for the NHS, but it is not a blank cheque; it never has been and it never will be. Of course, we need to look at the introduction of independent sector treatment centres and we are doing so with the strategic health authorities and others, in each region, to ensure that the centres are properly integrated in the local NHS and continue to give NHS patients better care, but also faster care.
Mr. Paul Burstow (Sutton and Cheam) (LD):
On Saturday, more than 2,500 people marched in the rain to protest against closures and cuts at St. Helier hospital. What assurance can the Secretary of State give me and my constituents that the decision to close 200 beds and
cut 500 staff at the Epsom and St. Helier trust will not result in more mixed wards, more premature discharge of patients who are not well enough to go home and a rise in levels of infection at the hospital?
Ms Hewitt: The decisions at that hospital are taken first and foremost, as I hope the hon. Gentleman would expect, on the basis of patient safety and quality of care. Difficult decisions have to made in his part of London in order to ensure that the local NHS gives patients the best possible care within the available resources and does not ask other parts and services of the NHS to bail out its overspending. As demonstrated by the quality and value indicators recently published by the NHS Institute, there is ample opportunity, for example, for hospitals to do more day case surgery, providing better care for patients, with better value for money as well. Those decisions are difficult for the staff, as we all recognise, but it is all about getting better care for patients within budgets that are bigger than ever before.
Mr. Bob Blizzard (Waveney) (Lab): I fully accept the need for our PCT to deal with its own deficit and get into balance by the end of the year, but it is hard when the strategic health authority comes along in mid-year, takes the money away and tells it to get into balanceand even harder when, with four months to go, the SHA comes back and takes more. Will my right hon. Friend ask the SHA to give us a bit of leeway and assure me that we will get our money back quite quickly in future?
Ms Hewitt: I know that my hon. Friend recognises the difficult decisions that have to be made in order to be fair to trusts that have not overspent, and to ensure that those who have overspent get enough time to take good decisions to get themselves back on track. The NHS is committed to repaying money that has contributed to regional reserves as quickly as possible, usually within the three-year allocation period, and those with the worst health problems will get their money back first. That, I believe, is fair, but the speed with which it can be done depends on the speed with which difficult decisions by overspending organisations can be made so that they get back on track and do not keep asking other people to bail them out.
Mrs. Maria Miller (Basingstoke) (Con): Does the Secretary of State share my concern that the present financial crisis in the NHS may be leading hospitals into inequitable ways to balance the books? In Basingstoke, hospital car park charges were raised by 25 per cent. this year and the money was usedand neededto fund medical services in the hospital. Does the right hon. Lady feel that that is right?
I would have to refer the hon. Lady to what the right hon. Member for Witney (Mr. Cameron) has recently said. He is not prepared to wipe out overspending any more than I am. If the hon. Lady believes, as does her right hon. Friend, that decisions should be in the hands of NHS professionals, I wish that she and other Conservative Members would support local NHS professionals when they make proposals and decisions to give better care to patients, with better value for money. As her party voted against
increased investment in the NHS, I am not prepared to take lectures from the hon. Lady on how that money should be spent.
David Taylor (North-West Leicestershire) (Lab/Co-op): My near parliamentary neighbour the Secretary of State is right to say that record investment has transformed performance at the three acute hospitals in the city of Leicester that serve our constituencies. The award of an excellent rating a few weeks ago, followed by an award for being the joint best teaching trust, was no great surprise. Was my right hon. Friend disappointed that, almost in the next post, the strategic health authority wrote requiring the University Hospitals of Leicester NHS trust, which covers the three hospitals, to make further in-year savings of £15 million, which led to operational delays, frozen posts and a range of other changes, including reduced training? Can she reassure the House, our constituents and the million people in Leicestershire, Leicester and Rutland that this bitter pill to swallow will
Ms Hewitt: My hon. Friend is right to congratulate those at University Hospitals of Leicester on the excellent quality of care that they give to their patients, as confirmed by the Healthcare Commission, but he may not have noticed that, for instance, on day-care surgery those hospitals are well below the national average. On length of stay, for instance for hip fractures, they are well above the national average. Certainly, when I recently met the chair and chief executive of the hospital trust, they confirmed that there is ample scope for them to become even more effective in their use of resources and to continue to give excellent care to patients as a result.
Tim Loughton (East Worthing and Shoreham) (Con): May I turn the Secretary of States attention to deficits in mental health trusts? She knows that in May, Rethink produced the report A Cut Too Far, which identified at least £30 million-worth of cuts to mental health services, in response to which the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), who has responsibility for mental health, said:
There is no evidence to suggest that mental health services were being disproportionately targeted compared to other health trusts.
some acute trusts should be ashamed that they have had to be helped out by services that have been historically underfunded
Both our tsar and the Minister of State are absolutely right. There is no evidence that mental health trusts are being asked to take any disproportionate burden while the financial problems are sorted out, but the problem that this underlines is that all too often in the past mental health trusts have
bailed out acute hospitals. There is a need to make acute hospitals more efficient, and that means more day-case surgery and reduced lengths of stay so that patients do not spend unnecessary days and weeks in hospitals when they would be better cared for at home. It is high time that the hon. Gentleman supported difficult decisions to make acute hospitals more efficient, to give better value for the money contributed by taxpayers and patients, and in that way, we will ensure that we can go on increasing the already unprecedented funding for mental health services as well.
Tim Farron: A constituent of the hon. Member for Morecambe and Lunesdale (Geraldine Smith) suffered a suspected heart attack earlier this month, but instead of being rushed to his nearest heart unit in Lancaster, he was redirected to the heart unit at Westmorland general hospital in Kendal in my constituency, because there were not enough beds at the Royal Lancaster infirmary. Does the Minister therefore share my horror that the trust is planning to close Westmorland general hospitals excellent heart unit? Will he intervene to save it?
Mr. Lewis: I understand the concern that the hon. Gentleman expresses, but the Liberal Democrats seem continually to advocate devolution, and decisions being taken as locally as possible. To then suggest that a Minister ought to intervene in local decision making is nonsense. Decisions on patient safety and quality of care must be made locally. Those must be the guiding principles that determine such decisions. I urge the hon. Gentleman to make representations on behalf of his constituents, but to accept that those decisions are responsibly made, and best made, locally.
John Mann (Bassetlaw) (Lab): At a cost of only £250,000 a year, my primary care trust is treating 400 drug addicts, thus reducing accident and emergency hospital admissions and the use of beds by drug addicts by more than 400 per cent. Should we not be looking throughout the NHS to see where else we can remove the unnecessary use of NHS beds by drug addicts and others?
I entirely agree with my hon. Friend. We want exactly that kind of best practice to become mainstream. The difficulty is that when there is local advocacy to shift resources, quite rightly, from acute services to community-based and preventive services, the Opposition parties irresponsibly proclaim that that
means cuts, when those changes will in fact lead to better services for patients and more rehabilitation, thus preventing such conditions from deteriorating. Surely that is the responsible way to develop a modern national health service.
Dr. Andrew Murrison (Westbury) (Con): Those of us with community hospitals and other health care assets that are being shut down on the back of sham, tick-box consultations will agree with the new NHS chief executive, who wrote to MPs last week in the following terms:
The NHS certainly needs to improve how we listen, engage and respond to the genuine concerns of the public, patients, clinicians and other stakeholders.
Developing that statement of the glaringly obvious, will the Minister say specifically what shortcomings Mr. Nicholson has identified during his short tenure, and what improvements in listening, engaging and responding our long-suffering constituents can look forward to?
Mr. Lewis: The Opposition really must think that the British people are stupid. This is the first Government to announce a £750 million programme over five years to develop a new generation of community hospitals, which will shift resources from acute health care to preventive and community-based solutions. It is not true to say that we are going backwards in terms of community hospitals. This is the first Government to say that we need to modernise and improve community hospitals. As for consultation, when we proposed the reconfiguration of primary care trusts, the consultation process took note of what local people said, and as a consequence, many of the proposed reconfigurations were changed. We will take no lectures on consultation from the Opposition.
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