Westminster Hall
Thursday 14 December 2006
[Mr. Eric Illsley in the Chair]
Medical and Clinical Practice
Motion made, and Question proposed, That the sitting be now adjourned.—[Huw Irranca-Davies.]
2.30 pm
The Minister of State, Department of Health (Andy Burnham): Given the number of Opposition Members present, I feel a little outnumbered. However, I have plenty to keep us busy.
This is an important debate in which politicians must show a little more leadership. Many changes that we now see in medicine and in the health service are about human progress and health progress, and the focus of every single Member of Parliament should be on saving lives not buildings. That should be our guiding principle in consideration of health service change, and it is the right way to approach the subject. The issue is difficult, and we know that change in the health service is not easy. However, it is a question of demonstrating political leadership at times in localities, so that the public understand the changes that are proposed.
I shall put the matter in context. I am pleased that so many members of the Conservative party are present, because it is important that we remind ourselves of the health service situation in 1997, when the infrastructure in which we could deliver safe and high-quality care simply did not exist. There were too many old and inappropriate buildings, and the infrastructure was largely Victorian. According to the King’s Fund, in 1997, the average age of national health service buildings was older than the national health service itself. Capital spending in the latter years of the previous Administration was slashed, and between 1992 and 1997, there was little new development in the fabric of the NHS.
The problems were not only with buildings, but with people. There were staff shortages: 37 per cent. fewer doctors than there are today; 27 per cent. fewer nurses; 36 per cent. fewer allied health professionals; 17 per cent. fewer GPs; and health care scientists could not even be counted separately. The legacy of NHS underfunding created a cumulative underspend of£220 billion between 1972 and 1998 when compared with the European Union average.
Mr. Andrew Tyrie (Chichester) (Con): I hope that the Minister understands that our constituents will be perplexed by his launching into a description of what the health service may or may not have been like a decade ago. They want to know what the Government are going to do about the catastrophic crisis in health care at the moment.
Andy Burnham:
I am coming to precisely that topic, but I hope that the hon. Gentleman understands that it is important to set the context. There has been considerable change in the NHS since 1997. If he were
to deny that, he would not be speaking plainly to his constituents. There has been considerable change because of investment, and there must be further change. However, I shall come to his question if he will allow me.
Mr. Nick Gibb (Bognor Regis and Littlehampton) (Con): Ten years ago there was no threat to the accident and emergency unit at Worthing and Southlands hospital, nor was there a threat to the accident and emergency unit at St. Richard’s hospital. Both units are now under threat, and that is affecting my constituents. Is not it true that the West Sussex primary care trust’s £33 million deficit is due to a formula that was introduced in the past 10 years? There were changes to the formula in 1998 and in 2001. The Minister would be better off addressing that issue rather than engaging in historical analysis, and he would be better off addressing the funding formula rather than trying to downgrade the accident and emergency units at two well loved, highly efficient and clinically excellent hospitals.
Andy Burnham: Quite honestly, the hon. Gentleman has a nerve to say that the issue is about the funding formula. Over the past couple of years, every primary care trust in the country has received a considerable increase in funding. I do not have the exact figure, but the minimum increase was about 9 per cent.—in his constituency, too. Members shake their heads. Why then did the Opposition vote against the national insurance increase? [Interruption.] Let me just put my point.
Tim Loughton (East Worthing and Shoreham) (Con): Will the Minister give way?
Andy Burnham: No, I shall not.
If that vote had been carried, and the national insurance increase had been turned down, does the hon. Member for Bognor Regis and Littlehampton (Mr. Gibb) think that the primary care trust in his constituency would have more or less money today? Will he answer that question—simply? If he had had his wish in the House when he voted against that extra money for the NHS, would the PCT in his constituency be better or worse off?
Tim Loughton: I am grateful to the Minister for deciding to give way, because he has now been speaking for six minutes and I am still none the wiser as to what the debate is about. The title is “Medical and Clinical Practice”, but his office was unable to tell hon. Members what he intended to speak about this afternoon. Will he also explain the difference between “medical” and “clinical”? They seem to be the same thing. Can we return to the debate—the reason why we are all present—and to what he wants to tell us?
Andy Burnham: Does the hon. Gentleman want answers to questions that his colleagues have raised? He may not like the answers, but it is courteous of me to answer them.
I began by saying that the debate was about change in the NHS. It is about medical change: medicine is changing, and therefore the NHS may need to change,
so that we provide the very best service to our constituents. I gather that many of the hon. Gentleman’s colleagues are present because they want to discuss those changes in the health service. However, I hope that he will permit me to set out the context for those changes. I shall make some progress on those points.
Back in 1997, the adoption of medical technologies was late and slow, with those people needing medical care being the least likely to receive it. There is a history of widespread hospital closure in the 1980s. The closures, which were opposed by NHS staff, the unions and the public, included one in my constituency where an accident and emergency department was shut down. Since then, there have been far-reaching improvements. After years of low growth, UK funding matches European levels and we have increased capacity. There are now more than 300,000 extra staff, and there are more staff in every main category.
Mr. Peter Bone (Wellingborough) (Con): I have been alerted to an issue by someone who works in the health service in south Northamptonshire. Apparently, six midwives are supposed to cover that area, their number being down on previous staff levels. There are actually only four midwives because of the cuts, however, and they believe that the service is at breaking point. How does that relate to all the extra staff the Minister is talking about?
Andy Burnham: I shall examine the hon. Gentleman’s point. It is up to each local health economy to ensure that it has the right number of staff to provide safe and effective services, but if that is not happening in his constituency, I am happy to consider that particular issue.
We have also invested more in training places to secure future staffing levels. Some 10,600 more medical students have entered training since 1997; there has been a major expansion of dental training; and more than 10,000 extra nurses and midwives are being trained than in 1996-97. Facilities have been modernised: there are 54 major new hospitals, 2,850 refurbished or replaced GP surgeries, 520 new one-stop centres and 61 walk-in centres.
Peter Bottomley (Worthing, West) (Con): I am grateful to the Minister for listing those buildings—having told us at the beginning of his speech that the buildings did not matter. Will he take for granted that we have read Lord Warner’s speech, and move on to the subject of this debate, rather than repeat what was said in the House of Lords on 7 December at column 1289 of the Official Report?
Andy Burnham:
I know that Conservative Members feel uncomfortable about the story of progress in the national health service, but I shall lay out the facts. The fact is that the infrastructure in which care is delivered has been substantially modernised and improved. That sets the context for this debate. In many places, we have the most modern facilities possible, and I am proud of that. I visited University College hospital earlier this week. It is a superb facility providing possibly the
highest-standard health care that the NHS can offer today. It is extremely important that we do not gloss over such facts as though they were irrelevant or meaningless spin. They are not. They are the facts. Our facilities on the ground enable the highest standards of health care to be delivered.
Mike Penning (Hemel Hempstead) (Con): I freely acknowledge that Hemel Hempstead hospital has had substantial investment in the past 10 years in new cardiac unit, stroke and birthing units and extensive modernisation of the accident and emergency department, all of which will now be closed because of the funding crisis in the NHS.
Andy Burnham: As the hon. Gentleman knows, consultation will begin soon in Hertfordshire and will be developed in the new year. He might accept this point: there are four acute hospitals serving the county that he represents, a county of roughly 800,000 people. The problems that he is describing are long standing, and he should accept—
Mr. Andrew Lansley (South Cambridgeshire) (Con) rose—
Andy Burnham: I will give way to the shadow Secretary of State in a moment, but first I shall develop my point. My local authority has a population of about 320,000 and one acute hospital. The hon. Member for Hemel Hempstead (Mike Penning) should acknowledge the long-standing debate in his county about ensuring appropriate secondary provision without siphoning off funds and preventing money from being available for other areas. I have answered his question, and I give way.
Mr. Lansley: I am grateful. I hope that my hon. Friend the Member for Hemel Hempstead will forgive me if I pre-empt the point that he was going to make. I visited Hertfordshire the Monday before last. The people there have been debating for four years how they should respond to changes in clinical practice. The message that the strategic health authority is sending them even now is, “We need greater specialisation and greater concentration of services in major units in order to deliver.” That is what Members of Parliament in Hertfordshire signed up to in the investing in health strategy—they signed up to a new hospital at Hatfield. Just weeks ago, the East and North Hertfordshire NHS Trust said that, for reasons of affordability, it could not go ahead. What the Minister will tell the House should be happening is precisely the opposite of what is happening. The concentration of services in a new central unit will not happen in Hertfordshire. How does he explain that?
Andy Burnham:
I explain it very clearly. The Government do not say that services should be provided in any particular way. If the hon. Gentleman thinks that we do, I am afraid that he does not listen to our points. We say clearly that it is for each local health economy to decide the right shape of services for itself. We do not say—I ask him to show me where we say it—that one model of care should be imposed on every community, nor do we take decisions at ministerial level about whether a scheme should go ahead or be
scrapped. Those decisions are taken in the locality, and I believe that if the debate is conducted in the right way and Members listen to the arguments rather than simply pulling out their placards and going out in the street, they will do their constituents a service.
The issue is not just about buildings. Recently, there have been enormous improvements in mortality rates. Deaths from cancer in under-75s fell by nearly 16 per cent. between 1997 and 2004—that is 50,000 lives saved. We are on track to reduce deaths from heart disease by 40 per cent., saving 150,000 lives, by 2010. I am immensely proud of those achievements.
Mr. Lansley: Will the Minister give way?
Andy Burnham: I would like to make some progress, as the hon. Gentleman’s colleagues are accusing me of not making any, but I give way.
Mr. Lansley: I am grateful to the Minister. He and other Ministers often make the point that, under this Government, deaths from coronary heart disease have decreased by 150,000 since 1997. However, one of his colleagues answered a question on similar terms. Health Ministers were asked how many lives had been saved from coronary heart disease between 1979 to 1997, so will he confirm that the answer was that 535,000 lives had been saved from coronary heart disease and premature mortality in the preceding 18 years, compared with the 150,000 that he mentioned?
Andy Burnham: I will be honest with the hon. Gentleman. I do not have those figures to hand. Obviously, it is his job to make the case for his party’s Government, but I am making a proud case for mine with the health improvements that my constituents and those of my hon. Friend the Member for Ogmore (Huw Irranca-Davies) have seen in recent years. I give way one more time.
Miss Julie Kirkbride (Bromsgrove) (Con): The Minister is gracious in giving way. On the same point, will he also confirm that during the 18 years that the Conservative Government, whom he has been doing his best to denigrate, were last in charge of the national health service, the decline in mortality rates was comparable to that of the past 10 years under the present Labour Government, despite their proclaimed achievements?
Andy Burnham: As I said, it is not my job to make the case for the Conservative party. The national service framework introduced by this Government for coronary heart disease made an immediate and important change to the care of coronary heart disease patients when it was introduced in 2000. That change came with the change in Government. As a result, a large number of people in the hon. Lady’s constituency and mine were prescribed statins, and a much greater emphasis was placed on preventive health care. Hon. Members might be claiming that the national service framework had no impact on the health of coronary heart disease patients, but I am not sure what intellectual credibility that argument would have with specialists in the field. I notice that the hon. Member for South Cambridgeshire (Mr. Lansley) has gone quiet on that point.
I am proud of what has been achieved in the national health service with the investment that we have made. It has been achieved with change—sometimes painful and difficult change—but more is needed if we are to make the long-lasting improvements in health and social care that everybody wants to see.
Consultation for the White Paper “Our Health, Our Care, Our Say” told us that patients want services that are more convenient and closer to their homes. Many of the commitments in the White Paper were developed with that in mind. For example, we are supporting a procurement exercise to secure more primary care services where the number of GPs is insufficient and people have to travel some distance to visit a doctor. We will also be testing advanced assistive technologies, such as telecare, that would enable frail and elderly people with long-term conditions to be more independent and reduce the need for frequent visits to hospitals and doctors. We are carrying out a major project with a number of royal colleges and other professional bodies to consider care pathways and models to make care more accessible for patients in six speciality areas.
We have asked the National Primary Care Research and Development Centre at Manchester university to review care services and generate an evidence base for replicating existing good practice. It will be researching the cost, work force, safety and equipment implications of shifting care, as well as what patients think of the shifted services.
Mr. Tyrie: Did the Minister say that research would be undertaken to generate the evidence base for the changes that will be made? If so, does he not think that it would be a good idea to acquire that before embarking on the changes?
Andy Burnham: In the abstract, that is a good point. Acquiring the evidence base is often an important precursor to change, but we are talking about the years to come. Some of the changes about which the hon. Gentleman and his colleagues are getting excited have yet to happen.
We have a model of health care in this country that is still dominated by the acute hospital. That situation will change over the next 50 years, whatever Government are in power. There will be a trend towards more self-care and more care in the patient’s home. The advent of some of the more personalised pharmaceutical technologies will lead to far more different treatments. I am not sure that we can imagine today quite how medicine will change in the next 20 to 25 years. So yes, it is right to generate that evidence base as we go along.
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