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I recently conducted a survey of all local authority chief executives in the UK about the impact of NHS budgets on their local authorities, 25 per cent. of whom said that NHS budgets were hurting them. For instance, Buckinghamshire county council estimated a cost shunt of £670,000 from the health service on to the local authority. Camden is seeing an increase in the number of hours of home care as a result of faster hospital discharges. What discussions has the Minister had with the Department for
Communities and Local Government about the impact of NHS finances on local authorities and what action is she taking
Ms Hewitt: The hon. Gentleman reflects well the need for social services authorities and the local NHS to work closely together to provide even better care for the people whom they look after from both the local government budget and the NHS budget. We have increased both those budgets and my Department works closely with the Department for Communities and Local Government on that score. I hope that the hon. Gentleman will encourage Liberal councillors to ensure that they do not cut social services for vulnerable elderly people.
Ann Winterton: Notwithstanding the Secretary of States earlier replies, I still cannot see how the undoubted deficits in this years budget can be made up other than by cutting services. Mine is a predominantly rural constituency, and is she aware that my constituents will not take kindly to any cuts in services at hospitals in Macclesfield, Leighton or north Staffordshire, or at the Congleton War Memorial hospital? In addition, they will not accept cuts in the mental health services, which remain the Cinderella of NHS provision in this country.
Ms Hewitt: In that case, I hope that the hon. Lady will welcome the recent opening of a new day-case unit and a new medical admissions unit at Macclesfield district general hospital where, in addition, a new MRI scanner has been brought into commission. Moreover, we have invested more in mental health services in every part of the country than any previous Government.
Mr. Geoffrey Robinson (Coventry, North-West) (Lab): Is my right hon. Friend aware that we in Coventry have received enormous benefits from the great investment made by this Government? We have a brand new hospital, and there has also been tremendous investment in mental health services. That continuing success derives in part from the citys MPs ongoing close consultative relationship with the Department, which I hope will continue with her blessing.
Kitty Ussher (Burnley) (Lab): During the Christmas recess, did my right hon. Friend have the opportunity to read the Institute for Public Policy Researchs recent report entitled The Future Hospital? One element of the analysis stated that, on average, patients stay in hospital a day longer if they are admitted on a Thursday than if they are admitted on a Sunday. What is her estimate of the savings that NHS trusts could make if they corrected that inefficiency, without jeopardising patient care?
I did have the opportunity to see that report. It confirms that the NHS would save nearly
£1 billion every year if all hospitals ensured that patients went home as soon as they were clinically ready. That is what the best hospitals do already, and the report provides further confirmation that there can be no trade-off between better care for patients and better value for money. The two things go together, and that is what our reforms are designed to achieve.
Mr. Eric Illsley (Barnsley, Central) (Lab): What incentives are there for primary care trusts to try and balance their books? My Barnsley PCT has been funded under target for years, but it would have achieved financial balance by the end of this financial year had it not been required to pay £7 million to fund the deficits in Sheffield, Doncaster and Rotherham. How long is that money likely to be held by the strategic health authority?
Ms Hewitt: My hon. Friend makes an extremely important point, which reflects the fact that only a small minority of hospitals and PCTs are overspending. Indeed, 50 per cent. of the NHS deficit is concentrated in just 6 per cent. of its organisations, and it is unfair for that minority to overspend at the expense of the majority. That is why we are so determined to ensure that the NHS as a whole returns to financial balance, and that the minority of overspenders put their houses in order by making themselves more effective. They must deliver better care for patients and better value for money, and they must also repay the money that they have borrowed, as in the example that my hon. Friend gave.
Dr. Richard Taylor (Wyre Forest) (Ind): What steps is the Secretary of State taking to promote more widely the valuable information contained in the NHS quarterly Better Care, Better Value indicators? In particular, is she promoting that information to hon. Members, so that they can point out to their PCTs the benefits of prescribing generic statins? Is she aware that, in the league table of prescribing generic statins, the PCTs of two of her colleagues on the Front Bench are ranked 291 and 298 out of a total of 303? If they improve
Ms Hewitt: The hon. Gentleman is right; the quality and value indicators that we published last year repay close study. That is why we have made them available on a website so that each PCT and hospital can see where they need to make their services more effective, and how they can improve patient care and free up money for new drugs and new treatments. I certainly commend the quality and value indicators to every Member, because they show, once again, how better care for patients can go hand in hand with better value for the record sums of money that the Government have invested in our NHS.
Fiona Mactaggart (Slough) (Lab):
In tackling the difficulties that some areas of the NHS have experienced with their finances, innovative programmes such as the one in our accident and emergency department to help older peopleare often the first to
go, rather than traditional programmes. What can my right hon. Friend do from the centre to encourage innovative programmes, which tackle health inequalities and provide improved access to services, and to ensure that they are not the first out under the last-in, first-out programmes that sometimes seem to happen when dealing with health budgets?
Ms Hewitt: My hon. Friend makes an important point. Sometimes, under the pressure of financial difficulties, local organisations understandably make short-term decisions that may undermine innovative programmes that give patients better care and prevent falls, injuries and disease in the future. They thus help to deliver better care with better value for money. We do not try to micro-manage every hospital and PCT from the centre, but we give guidance [ Interruption. ] We do indeed give guidance to ensure that such innovation is supported.
Mr. Peter Lilley (Hitchin and Harpenden) (Con): Can the Secretary of State tell us what proportion of the additional money going into the NHS is being absorbed by large pay increases, not for categories of staff in short supplyfor whom, as she knows, I have long advocated increasesbut for groups of highly paid staff, including consultants and general practitioners who have received increases of between £14,000 and £25,000 a year? Before the increases the General Medical Council was sending out notices headed Important information for medical graduates, which pointed out:
There are an average of 210 applicants for each advertisement for junior hospital posts. Many posts attract over 1,000 applicants.
Ms Hewitt: I am sure that the British Medical Association and its membership will note with great interest the right hon. Gentlemans desire to cut the pay of both hospital doctors and GPs. I am proud of the fact that about half the additional record investment that we have made in the NHS has gone on additional staff and better-paid staff. In the case of GPs in particular, the reason they are earning so much more with a Labour Government than they were under the right hon. Gentlemans Government is that they are doing so much more work, preventing so much more illness and caring for patients so much better.
Mrs. Sharon Hodgson (Gateshead, East and Washington, West) (Lab): I am sure that my right hon. Friend is aware that Gateshead Health NHS trust is one of five in the country that has innovated and now offers physiotherapy services over the telephone. I am sure that she will agree that that helps to reduce admissions by caring for people in the community, and that through such programmes money can be saved and lives transformed.
Ms Hewitt: My hon. Friend is absolutely right and I very much congratulate the NHS in Gateshead on that innovation. There is no doubt that as more orthopaedic patients receive physiotherapy directly in the community, those who need surgery can also be treated much more quickly in hospital.
Norman Lamb (North Norfolk) (LD): May I ask the Secretary of State about trusts that have massive historical deficits, often of more than 10 per cent. of their turnover? Nigel Edwards of the NHS Confederation said that for those trusts
financial recovery would imply such damage to patients that no sensible person would go for it. They would not compromise the survival of the people they serve.
Is the Secretary of State intent none the less on requiring those trusts to clear their deficits within a specified period, irrespective of their current financial performance and irrespective of the impact on patient care?
I have made it clear all along that we expect the NHS as a whole to return to financial balance by the end of the financial year. For the very small minority of organisations with very serious and long-standing deficits, it would be quite impossible for them to return to balance within one financial year, so they are being given longer. However, the longer they take to return to financial balance, the longer other organisationswe have heard from one of the primary care trusts todaywill have to hold back on some of their growth money to compensate for the continuing overspending elsewhere.
Mr. Lindsay Hoyle (Chorley) (Lab): Will my right hon. Friend ensure that the future viability of Chorley and Preston hospitals will not be put at risk through the transfer of work from those hospitals to the private sector? The issue is about capacity within those two hospitals and we do not want to see ward closures. Will she ensure that that work is not transferred?
Ms Hewitt: The new independent sector care assessment and treatment service that is proposed for the north-west will deliver to my hon. Friends constituents and many other patients a better and faster service and it will do so by providing capacity additional to the capacity already available within the NHS and by enabling NHS capacity to be used much more effectively.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Does the Secretary of State agree that the financial stability or otherwise of NHS organisations is a fundamental measure of overall financial performance? Halfway through the last financial year, 134 NHS organisations forecast a deficit at the end of the year. Will she tell the House how many NHS organisations this year are forecasting a deficit?
Ms Hewitt: The information, as at the six-month point, was published in that financial report, but we will update that next month when we publish the quarter three financial report. As I say, I remain entirely confident that the NHS will achieve overall financial balance and that more organisations will move towards financial balance this year.
I am surprised that the Secretary of State did not tell us; the answer to the question is 175 NHS organisations this year. What is particularly worrying is that last year the situation deteriorated between month six and the end of the year. An
additional 45 organisations went into deficit. Can she explain why she believes that fewer NHS organisations will be in deficit this year and how many she expects to be in deficit? If they remain in deficit, precisely what the hon. Member for Barnsley, Central (Mr. Illsley) described will continue to happen: the money for organisations across the country will be top-sliced and their growth money will disappear in order to fund continuing deficits.
Ms Hewitt: I notice that the hon. Gentleman never has anything constructive to say about the need to get better value for the record investment in the NHS and nor does he ever support NHS organisations in making the difficult decisions that are needed to get better value. We are publishing quarterly financial reports on the NHSwe are the first Government to have done soprecisely so that we and the NHS can track the progress that is being made, see exactly what steps need to be taken and take account of additional factors, such as the further cuts in prescription drug prices that are coming through, to ensure that the NHS gets back on track financially and continues to improve services for patients.
6. David Taylor (North-West Leicestershire) (Lab/Co-op): What discussions she has had with ministerial colleagues on the funding required to establish a network of NHS psychological therapists. 
The Minister of State, Department of Health (Ms Rosie Winterton): Improving access to psychological therapies formed part of ministerial discussions for the White Paper Our health, our care, our say. The two demonstration sites that have been established will provide evidence for a business case on investing in local psychological therapy services across England and will form part of our discussions with the Treasury as part of the comprehensive spending review.
David Taylor: The Government have done a good deal to tackle the Cinderella status of mental health within the NHS, but there remain difficulties with access to psychological therapies such as cognitive behavioural therapy, where waiting times exceed 12 months in 90 per cent. of primary care trusts. Can the Minister please act to ensure that such talking therapies are made available to all who need them and not just to those whose employment prospects will be improved and, in particular, to widen access to marginalised groups such as children, adults in hospital or in prison and black and minority ethnic communities?
My hon. Friend is quite right to say that waiting times are too long at the moment, particularly for CBT. The point of putting the demonstration sites together is to learn from them exactly what is working so that we can make the case to persuade other areas to follow that example. As well as improving the number of clinical psychologists, it is important to look at the part that other health care professionals can play, particularly in the case of the new graduate workers that we are bringing in, and to look at extra training for health care visitors, for
example, so that they can reach out to some of the groups that he has outlined to make sure that they get access to these important therapies.
Simon Hughes (North Southwark and Bermondsey) (LD): Will the Minister look at the effect of the delays in psychological services generally and cognitive behaviour therapy specifically on young people, including students? All the evidence is that young people going into early adulthood, particularly at universities and colleges, are the most likely to commit suicide or to self-harm. There are often long waiting lists and no local services available, even with the best will of the universities. Will she see whether she can either buy in more services or allow people to use other services locally to prevent a crisis or worse?
Ms Winterton: The hon. Gentleman is quite right: it is important that we look specifically at younger people. There are many instances where different agencies could work more closely together. I am talking about some of the personal advisers through the Connexions services and some of the facilities available in schools. We need to look at how we can bring those more closely together to make sure that, when people need those kinds of services, we are able to provide them more readily than they are provided at the moment.
Angela Eagle (Wallasey) (Lab): Will my right hon. Friend look closely at the positive results coming from pathways to work pilots, where cognitive behaviour therapy offered by the NHS, but paid for by the Department for Work and Pensions, is having an enormously beneficial effect in improving peoples mental health and allowing people not only to re-enter the work force, but to be happier as human beings? Clearly, that needs to be available in the rest of the country. Will she also look at the evidence that this therapy can be offered not only by psychologists, but by other health care professionals such as nurses and health visitors?
Ms Winterton: My hon. Friend is absolutely right. Part of the important work that is being done in the pathways to work pilots is making that connection with employers. There is a lot that employers can do not only to break down some of the stigma and discrimination that there is against people who have mental health problems returning to work and remaining in work, but to support them when they have those difficulties. Again, the demonstration sites, linking with the pathways to work project, show a way in which we can build that into the services that we provide more widely. She is absolutely right that, as I have said, there are other health care professionals who, with a little extra training, can provide some of these services extremely effectively.
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