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Another change that I welcome is the decision to press ahead with the new maternity and oncology building, with the £65 million being funded from the
Department of Health, rather than the private finance initiative. That will be completed in 2009. The cancer centre will be a purpose-built facility bringing together all day case in-patient and radiotherapy activity within one building. The new development will also bring together surgical and non-surgical management of cancer on one site for the first time.
At present, the oncology ward and radiotherapy services are located half a mile from where patients undergo surgical procedures for cancer treatment. All those buildings date back to the 19th century. The Secretary of State had the opportunity to see some of them. She asked when she visited the hospital, Are these the worst buildings? We had to tell her, No, these are some of the best. The maternity unit will offer a modern purpose-built facility based on the separation of a low-risk midwife-led model and a higher-risk medically led model. It will deliver the modern standards of privacy and dignity that every mother has a right to expect. The present facility just does not deliver that.
Parts of north Staffordshire are among the worst 10 per cent. of areas in England for deprivation. Almost 70 per cent. of the local population are among the 20 per cent. of the English population who have the lowest life expectancy, yet in the past north Staffordshire has been badly let down by Governments on health care. We are now at last getting the services that we deserve.
For decades, Governments have let down north Staffordshire. The area has always badly needed the best possible health care. Now at long last, with the new maternity and oncology building in two years time, a brand new state-of-the-art hospital a few years later, a huge expansion in primary care facilities, and a primary care trust that wants to ensure that it is designing services for local people in rural as well as urban settings, I am confident that we will have the services that we need, which are closer to patients homes and are geared up to the 21st century, not to the 20th or the 19th.
Mr. Michael Mates (East Hampshire) (Con): I am glad of the opportunity to contribute to the debate, not least because I, like many others here, have received a positive snowstorm of letters about the health service in past months. There is a sense of bewilderment about the changes. It is a pleasure to follow the hon. Member for Staffordshire, Moorlands (Charlotte Atkins), who started her speech by saying that there had been far too much change in the NHS, something on which all Conservative Members would agree.
People in Hampshire cannot understand why the huge increase in resources provided by the Government has not led to an improvement in services. Even worse, despite those increased resources, some services are being cut in some areas: dentistry and hearing aids are
two examples in Hampshire. The series of events has contributed to the feeling that the NHS is once again in crisis. I want to examine some of the reasons why, and to relate them to the problems that my constituents are experiencing in Hampshire.
First, there is a conflict between payment by results and the desire to retain and promote community hospitals. It is clear that payment by results should not have been introduced until a formula had been devised for protecting community services. Payment by results inevitably leads to larger hospitals, where there are economies of scale, having the opportunity to increase their patient throughput and therefore their income from primary care trusts, while the smaller community hospitals find that they cannot compete on the same basis. The Government said in their White Paper, Our health, our care, our say: a new direction for community services, that they wish to deliver more health services in the community. If that is the case, the Government needed to find a mechanism to ensure that payment by results did not undermine community services, but they failed to do so. It is no wonder that about 100 community hospitals are now under threat.
My constituents have experienced the vulnerability of community hospitals twice in the past few years. In Alton, the community hospital faced partial closure in the summer of 2005; 24 of the 48 in-patient beds were closed because of staff shortages and a financial crisis. Eventually, those beds were partially restored, largely as a result of pressure from local GPs and the community, which caused managers to look again at their priorities. The Grange maternity unit at Petersfield was also closed in 2005, at three weeks notice, because of alleged staff shortages. It took another vigorous campaignof longer than a yearto get it reopened.
The new chief executive of the NHS, Mr. David Nicholson, seems to suggest that midwife-led maternity units, such as the one that we have in Petersfield, should be closed and that only consultant-led maternity units should operate in future. That is a reversal of the move away from the highly managed, rigid and clinical approach to childbirth that was common in the 1970s. Some Labour Members seem to have forgotten that it was women themselves who rebelled against the birth factory concept and their campaigning helped to bring about the sort of local maternity services that we now have.
Anne Main (St. Albans) (Con): I agree with my right hon. Friend. I have four children, and antenatal care is important to women such as me. The fact that Hertfordshire has lost all antenatal care for new mums is particularly worrying and might well lead to more interventions at birth. People are very concerned about that. Does my right hon. Friend agree that that is not a satisfactory state of affairs?
Mr. Mates: Indeed it is not, and I am glad to have heard about a more personal experience of maternity services than I have, although I did have to take a leading part in fighting the campaign on behalf of all the mothers in Petersfield. My worry is that, our services in Alton and Petersfield having just returned, they will be undermined once again, this time because of payment by results and yet more NHS reorganisations.
The endless reorganisations of the NHS over the past decade are another major problem. I will not bore Members by listing them all, but I simply say that I do not know how anyone can expect high-quality services to be consistently delivered in an organisation whose managers seem to change responsibilities on an almost monthly basis. Those reorganisations have caused bewilderment to the public and confusion to managers and staff, and they have inevitably affected both services and morale. It is confusing enough for Members and their staff to deal with those constant changes of structure and personnel, and it is near impossible for the general public.
Bob Spink (Castle Point) (Con): Does my right hon. Friend share my concern that the independent sector treatment centres, which are one of the latest reorganisations forced on the health service, will take the more routine cases that cost much less than the more complex cases, and that those more complex and costly cases will be left with the general hospitals, so they will have to foot the bill for them? Does he think that the budgets of the respective organisations should be adjusted to reflect the actual costs of the cases with which they deal?
NHS administrators are not a popular group, but they do an essential job. I know that their morale locally is low. It is unfair to expect people constantly to reapply for their own jobsto give just one example of why morale is low. It is also wrong to blame managers for the consequences of ill-thought-out reorganisations pushed through by Ministers without proper consultation. A recent survey of civil servants in the Department of Health found that just 4 per cent. of senior officials think that the Department manages change well; 81 per cent. do not. Who on earth, one might ask, are the 4 per cent.? They must be so high in the stratosphere of Richmond house that they simply do not know what is going on. The Department has been disastrous at managing change, and all its senior managers ought to know that.
A further factor in the current difficulties is that these reorganisations and the confusion that they have created have led to a return to some of the slipshod practices that we thought we had left in the past. I was recently contacted by a constituent who had a post-operative appointment to see her surgeon after a hip operation in December. The lady, who is in her 80s, travelled from Petersfield to the hospital in Gosport last month, only to discover on arrival that her surgeon was off sick and his theatre list had been cancelled. No one had thought to warn the out-patient department that his clinic had also been cancelled. Despite being in pain, my constituent was then offered a new appointment in April. At that point she complained to me, and when I telephoned her she was in tears because she had just had another letter saying that her appointment had been put off until June. We have managed to sort things out, and she was seen last week. Such slip-ups might seem very minor to Ministers sitting in London and to officials in Richmond house, but they are crucial to the patients themselves. To judge by the number of letters that I receive about small but
significant incidents of that kind, there is a deterioration in the NHSs ability to deal with these matters.
Two other issues that are contributing to the current problems strike me as being of great concern. The first is the consequences of the introduction of the National Institute for Health and Clinical Excellence and its assessment of treatments. NICEs creation has led primary care trusts and NHS trusts to argue that a particular treatment should not be provided, on the ground that it has not been approved by NICE. The Minister will quite fairly say that that is not Government policy. Trusts can prescribe medicines and treatments that have not been approved, on the basis of their own assessment, but in practicethis is what really mattershospitals and PCTs do not generally prescribe drugs unless NICE has cleared them for general use across the NHS. There are examples of hospitals and PCTs approving individual items, but that simply demonstrates a return to the postcode lottery that I thought NICE was created to stop. The effect has been the stymieing of the introduction of new treatments that might have realin some cases, life-savingbenefits for patients.
Secondly, such difficult cases are further complicated by existing NHS rules on the use of private treatment. There is a young father in my constituency who suffers from advanced colorectal cancer, for which a new drug is now available: Avastin. However, his local NHS trust will not prescribe it. He decided to pay privately for Avastin because he was told that it was the only way that he could prolong his quality of life and, indeed, his life itself. Now, he is obliged under NHS rules to pay for all the other NHS treatment that he needs as well. I can understand that the NHS does not want to become a provider of private sector services free of chargethat would make nonsense of the free at the point of delivery principle under which it has always operatedbut in my constituents case, the rigid enforcement of these rules means that he is forced to pay not only for the drug Avastin, but for all the other treatment that he would otherwise be entitled to receive free. His consultant considers that scandalous. My constituent thinks it intolerable, and I and doubtless many others think it quite unacceptable.
Mr. Hunt: I, too, have a constituent who needed Avastin, whom I saw at a constituency surgery on Saturday. Does my right hon. Friend agree that the cynicism that people feel about the NHS when they cannot get vital drugs and they see their local hospitals being closed boils down to the feeling that there has been boom and bust in the NHS since Labour came to power? That is the root cause of the problem that needs to be addressed.
There are two potential difficulties on the horizon. One of them, the move towards larger hospitals, could become a reality quite quickly. For more than 10 years, the Royal College of Surgeons has argued for a smaller number of larger hospitals. It is true that district general hospitals have emerged as a patchwork of
provision, rather than in the systematic way originally intended. However, the public are deeply concerned by the notion of having fewer but larger hospitals further away from where patients live. That issue is especially important to those of us who have large rural areas in our constituencies, as many of my colleagues have mentioned. There is inevitably a delay in getting an ambulance to an urgent case in a rural area and, once the patient has been stabilised, in getting them to hospital.
Fewer but larger units may make sense in large urban areas, but much of England is a mixture of large market towns and smaller rural communities. Many of those towns have had district general hospitals that now face closure of the whole or part, such as the accident and emergency service, as many hon. Members have mentioned, and the transfer of services to larger and more distant regional units. That does not improve services for those of us in rural areas.
I simply warn the Minister that when my party set out, on the strong advice of the Royal College and other experts, to undertake such a reconfiguration of services in London, which might have made some sense, the Labour party used that as a stick to beat us with in election after election. To pursue a policy that could see three quarters of accident and emergency units in England closed would not only be of dubious medical value, but would be incredibly unpopular. Ministers can try to close only hospitals in Conservative-held seats, and some of my colleagues would claim that such a programme is already under way, but they should not imagine that they will get away with it.
The whirlwind of change of the past few years shows no sign of slowing down. Local maternity services are under threat again, local accident and emergency units are being questioned and long-established hospitals serving large catchment areas arewe are toldno longer big enough for the new NHS. The financial position of community hospitals remains uncertain. All that is happening without the support of many of the Governments own Ministers, whoas we have seenhave taken to the streets to campaign against the effects of Government policies. That is a remarkable breakdown of collective responsibility.
Without a period of stability and continuity, the NHS threatens to go into a permanent decline, as it struggles to provide the care that patients need and for which they feel, as taxpayers, they have more than paid over the years. If Ministers think that they can carry on pushing change through the NHS regardless of public or political reaction, they are mistaken. No amount of careful planning with heat maps or other tricks will avoid the inevitable and disastrous consequences of the Governments approach.
Frank Cook (Stockton, North) (Lab):
It is a pleasure to follow the right hon. Member for East Hampshire (Mr. Mates). I hope to introduce a note of amiability into the debate by agreeing with his comments on Avastin. The issue requires serious investigation and perhaps correction, but one needs the full facts. However, the hon. Gentlemans comments on accident and emergency services are worthy of more corrective
comment. In my view, it is crazy to have accident and emergency facilities open 24 hours a day if we do not have accidents and emergencies happening 24 hours a day. Therefore, we should have some form of scheduling. We have already had the comment from my right hon. Friend the Secretary of State that victims or casualties do not necessarily have to rely on road- borne ambulances. In the same way, we no longer rely on handcarts, as they did in the middle ages.
I returned from Brussels this morningI was on NATO Parliamentary Assembly businessand I was not sure that I would get a chance to contribute to this debate. I thought that we might have a sensible exchange about patient needs and community care, but for the most partespecially at the beginning of the debatewe have been treated to the standard Supply day swill-bucket that we were used to years ago. Frankly, that does no credit to the health service or the patients who require it, and it does discredit to the Opposition that they cannot marshal their arguments in better form or put them in a more presentable way.
Let me give some examples of what I mean. The hon. Member for Ribble Valley (Mr. Evans), who is not present in the Chamber at the moment, accosted the Secretary of State with the comment, Were you right then, or are you right now? You cant be both. Well, of course she can. Times change. If someone says one thing three months ago and makes a comment on it today, times have changed in between, so they can be right on both occasions. But perhaps that logic is a bit deep for some of the characters on the Opposition Benches.
The hon. Member for South Cambridgeshire (Mr. Lansley) made a similar remark when he kindly referred to the hospital provision on Teesside. I am talking about the general hospital in Hartlepool and the University hospital of North Tees. He reminded the House of the comments of the then Secretary of State for Health and the then Prime Ministerhe is still Prime Minister now, I ought to remind the hon. Gentleman. He commented that he did not know whether the report was right or wrong. I can tell him that it is in fact wrong. The comment that was made then is right, but the inference that he drew from it is wrong.
The report from the independent reconfiguration panel states that a third hospital will be provided. I ask the hon. Gentleman to put on his planning hat. If a third hospital is ultimately providedat the moment the services that will be included in that hospital are still under considerationas the services there develop and become established, that third hospital will withdraw specialisations from the other two. I hope that that principle is clear. I can see nodding, which is good. As those specialisations are withdrawn, the other two hospitals, in Stockton and Hartlepool, will reduce in size and so take on the character of less acute attentive clinics, which will enable the footprints of both those hospitals to decrease and therefore enable some of the property to be
Mr. Iain Wright (Hartlepool) (Lab): I suggest that my hon. Friend is mistaken in that. The independent reconfiguration panel says that the two hospitals in North Tees and Hartlepool should be closed to build a single-site hospital north of the Tees and that the surplus land would be used to fund that local hospital.
Frank Cook: I am grateful for the intervention. My hon. Friend cited what the IRP said. I have had full discussions with the strategic health authority and its chairman, Peter Carr. He has confirmed to me that my version is correct and that the IRP and The Guardian report are inaccurate. I hope that my hon. Friend can accept my assurance on that fact. As far as being right or wrong is concerned, I hope that that clears it up.
Mr. Lansley: It does not clear it up at all. The hon. Gentleman implied that I somehow misrepresented the situation. It is very straightforward. The Prime Minister went to Hartlepool. He said that there was no question of the general hospital in Hartlepool closing or being run down. The truth of the matter is that the North Tees review had proposed that it should be run down and eventually closed and that a new hospital should be built. The Department of Health put in Sir Ara Darzi, who seems to be its spokesman of choice for this purpose, in order to try to keep the hospital going. He said that it could be kept going. The matter then went to the IRP and the IRP went back to the North Tees review. According to the IRP, the hospital will be run down and then closed.
Frank Cook: I accept the statement of opinion that is being given [ Laughter. ] I do not find this amusing at all, funnily enough. Is the House simply interested in ridiculing the efforts that are being made to provide medical aid to patients?
Let us look at the principle: as one hospital builds up its services, the others will run down their services. That has got to happen. There will be in place primary care, with the paramedics, nurse practitioners and the general practitioners in their health clinics. Secondary care will be provided in the Stockton hospital of North Tees and Hartlepool general hospital, which will take care of less acute need. Tertiary specialist care will provided in the new hospital[Hon. Members: No.] Well, that is what reconfiguration means in my head, and it makes sense to me.
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