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I have been looking at the Dr. Foster data that is sent to my practice every month. What I have here is a month of data from my practice alone. It is
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extraordinarily difficult to make any sense of it. I asked my practice manager, an extremely experienced man, to try to do so. He told me that it had taken one member of staff three days merely to establish whether the patients on the list were registered with the practice, and that it was impossible to conduct any meaningful analysis of the data on a monthly basis. Ministers should bear in mind the fact that if we are to have access to data to help us make decisions, there must be a possibility of our understanding it.

An elderly patient was taken to A and E with a nosebleed, which cost the practice £1,500. The practice was recently charged more than £200 for a hospital appointment that had been cancelled by the acute trust. Then there are patients whom we choose to refer to hospital for specific reasons, and who are then treated for completely different reasons. A patient whom we sent to hospital for a routine back operation surfaced 141 days later at a cost of £38,000 to the practice. I am not saying that that was not justified; what I am saying is that there was no way in which the practice could have had any input into the management of the patient, or any say in alternative pathways of care.

I would go as far as to say that rather than there being a Berlin wall between primary and secondary care, there is a black hole. Not only do hospitals suck in enormous amounts of resources, but very little light emerges. We must look carefully at the interface between primary and secondary care to ensure that enormous amounts of information do not overwhelm our ability to ensure that patients are given the best possible treatment. I believe that the only solution is to provide more vertical integration between the primary and acute sectors. That, I think, is the only way in which to establish a meaningful dialogue between GPs and hospital-based consultants, and prevent hospitals from simply using the system for their own ends.

I think that we have a lot to learn in that respect from the Kaiser Permanente scheme, which was cited in the White Paper as a successful example of integrated prevention-oriented health care. The Kaiser model owes much of its success in reducing acute sector activity to its decision to invest in a network of community-based specialty clinics in which primary care professionals work alongside specialists. The clinics have the facilities to cater for more or less every step of the patient’s journey, from initial assessment, through diagnosis and treatment, and eventually to follow-up. The most important part is that, unlike in the NHS, there are no structural distinctions between the primary and secondary care sectors. Not only is the model vertically integrated, but the ethos is based on prevention, integrated working and the belief that the most effective and cost-effective care is that which is given as close to the patient’s home as possible.

It is highly questionable whether we can get the same benefits in this country without looking at a similar model of health care. We should give serious consideration to integrating primary and secondary care under the aegis of a single, discrete care trust. That must involve a radical change and is far more than just a rebranding exercise. We certainly cannot reduce hospital activity without looking at the incentives and how hospitals are managed at the moment to ensure that they are not driven simply by financial needs, rather than patient outcomes.

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We would need integrated care teams and properly set up community teams to ensure that most care is given close to the patient’s home; the vast majority of cases can be treated in that way. We would need professional executive committees that were powerful enough to make those decisions without being swayed by individual pleading. We would have to ensure that we avoided acute admissions as far as possible and that we did everything possible at primary care level to avoid the need for people to go into hospital with acute needs in the first place.

I believe that all those things are perfectly doable, but only with a radical rethink. On top of that, I am also calling for the setting up of polyclinic-style clinics in each community. If we integrate the primary care sector with secondary care specialists, nurses, physiotherapists, occupational therapists and so on, most care can be provided at that level without necessarily having any acute in-patient beds in such clinics, which could do a lot of procedural investigations and minor surgery, again avoiding the need for acute hospital admissions. That would free up the hospital sector to provide the care that only it can provide. I believe that that would be a far more coherent structure for the health service.

What is more—this is the most important part—if such polyclinics were set up properly, it would be obvious to the patients that they were situated in their communities and that people were getting much better care much closer to home. Such an arrangement would also reduce the need for patients to travel to hospitals. It would not only be much more cost-effective for the health service, but would gain the consent of patients. Indeed, at the end of the day, if we are going to reform the health service, it can be done only with the informed consent of the public. After all, it is they who pay for, use and benefit from the service, and we must ensure that they see the benefit for themselves.

That is why I propose a radical rethink of the health service involving much more vertical integration and providing far more services far closer to home, based around the primary care unit. I think that such an approach would meet all our Government objectives, achieve good financial management and good husbandry, and use resources to the maximum benefit.

4.38 pm

Mr. David Wilshire (Spelthorne) (Con): At the beginning of this debate, I listened to the Secretary of State in utter disbelief. Either she lives on a different planet or she has never set foot in Surrey. [Hon. Members: “Both.”] Indeed, although perhaps there is another factor: she spends so much of her time trying to buy votes by building things in Labour marginals. Whatever the reason, however, I simply did not recognise the world that she inhabits, and my constituents do not recognise it either.

When I was first elected, my constituency had its own district general hospital and accident and emergency department. In fact, a Conservative Government virtually rebuilt the whole of Ashford hospital. Since 1997, however, cut after cut has decimated that hospital. Let me take but one example of what my constituents have had to put up with—accident and emergency. First, a Labour
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Government decided that they would axe accident and emergency, which led one of the consultants in the hospital to say of my constituents that some patients would suffer and some would die because of what the Government were doing. They gave us an emergency department for a bit, thinking that that would shut us up, but then they axed it. Then they thought that they would try to keep us quiet by giving us a walk-in centre with a telephone that people could ring at night for a doctors’ deputising service. Recently they have decided to insult us further by saying, “Don’t take wounds or sick children to that walk-in centre, because it won’t treat them.” That is what my constituents have had to put up with.

Since 1997, more and more of my constituents, some seriously ill and many in pain, have been forced to travel across the Thames, and sometimes down a gridlocked M25, to St. Peter’s hospital in Chertsey. The Government have the nerve to try to justify making them do that by saying that they are bringing services closer to the people. That is a sick joke.

As a final insult to my constituents, the Government have spent the past three years trying to give away the remaining theatres and wards to a private company from Sweden. In 1997, when the Labour party came to power, Labour Members had the nerve to accuse us of wanting to privatise the NHS, yet this Government have spent three years trying to privatise my local hospital. That is hypocrisy and humbug.

The NHS crisis in Surrey gives the lie to the Government’s claim that cuts and closures are improving services. Last March, the then acting chief executive of Surrey primary care trust told me and my Surrey colleagues that it was £120 million in debt, that it had been ordered by the Government to eliminate that debt before the end of the financial year, and that the only way he could do that was by closing a hospital—not just an A and E department but an entire hospital, including its A and E department.

Not satisfied with that, last November the Government decided that they would launch a review of the funding formula because, they said, Surrey receives £135 million too much. In other words, they are demanding that we cut not only £120 million but £135 million. Curiously, I happen to agree with them that the funding formula has nonsensical elements. Morbidity plays a part, because the younger that people in a community die, the more money is necessary there. I understand that argument. However, the Government do not seem to understand that because people over the age of 65 need the NHS most and cost the NHS most, the more of them there are, the greater the demand on the service; and for some reason people in my constituency live longer than most.

Poverty also plays a part in how the Government decide that the money should be distributed. Under the funding formula, the figure for poverty is based on the national average wage. I am delighted that, on average, my constituents earn a great deal more than the national average wage—that is how things are in Surrey. However, it has not dawned on the Government that in an area where people earn more, they have to spend more because the cost of living is so high.

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I cannot help concluding that the Government want me to tell my constituents that if they want a decent health service they should die younger and earn less. Are the Government proud of that? They should be ashamed of themselves.

The Minister of State, Department of Health (Caroline Flint): Rubbish.

Mr. Wilshire: It is not rubbish. If one distributes money according to the age at which people die without taking account of the fact that my constituents live longer, and according to a poverty factor that takes no account of the cost of living in my constituency, what other message can I give them?

Caroline Flint: Nonsense.

Mr. Wilshire: It is not nonsense; it is the truth. If the hon. Lady would care to come to Surrey, we would explain it to her, but she keeps refusing to meet us.

After 10 years of Labour mismanagement, Surrey residents now face cuts of £120 million and £135 million. The result is that, last year, we were caught up in discussions about closing one of Surrey’s hospitals and an accident and emergency department. Now, 10 months later, we are caught up in discussions about closing more than one hospital and shutting all the A and E departments in Surrey except one. What else will we be faced with?

Andy Burnham: I am listening to the hon. Gentleman in amazement. Would he care to enlighten the House as to what the state of the health service in his area would be if his vote against the extra funding for the NHS through the national insurance increase had been carried? What vista would he see if he had got his way and the money had been denied the health service?

Mr. Wilshire: The Government have a script. [Interruption.] I remember the arguments at the time and the way that I voted. If a Government and a country can afford to spend more, I am prepared to support that, but my constituents— [Interruption.]

Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Gentleman but the debate must be conducted with one person speaking at a time.

Mr. Wilshire: If we can afford to spend the extra money, my constituents are pleased and relaxed about it, but they do not care for the fact that it is wasted. What is better in Surrey, given that more money has been spent? The Minister asks whether we support spending more money, but he should ask whether we support spending money sensibly.

Andy Burnham: Was the hon. Gentleman right or wrong to vote against the increase in funding for the NHS?

Mr. Wilshire: The Minister will keep going on about the point. Given the circumstances at the time and the arguments that the Government used, I do not regret what I did. Subsequent experience justifies my reservations. The Government said that they would spend more money and they have blown it. There is no improvement. Indeed, there is a worse service in my
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constituency. It is all very well for the Minister to shake his head. Of course there is a better service in Labour marginal seats—that is what it was all about.

Anne Milton (Guildford) (Con): Does my hon. Friend agree that the two Ministers present clearly need to visit Surrey to see for themselves? They have no conception of what is going on there. If all the money has gone into health, it is not getting through to our Surrey residents.

Mr. Wilshire: My hon. Friend is right. I repeat the invitation to Ministers: come and talk to us, see the position for yourselves and try to justify it. Given events in Surrey, it beggars belief that the Government have the nerve to claim that the sort of review that we face is about improving services. That is an insult to my constituents’ intelligence. Surrey PCT is running around, presumably at the Government’s behest, waving documents called “Clinical case for change”, and telling people, “Forget what we said last year; this is the justification for the cuts.” That is a pathetic smokescreen.

As I said earlier, last March we were told that a hospital and an A and E department had to be shut to save money, but the document that is now waved about claiming that there is a clinical case for shutting A and E was not even commissioned till nine months after we were told the truth about the reason for the cuts. The documents are a smokescreen. They may contain some substance for the future, but if the debate is about improving services, why did it not start with the documents?

If the debate is about clinical services, and there is to be genuine consultation, I invite the Minister to confirm in his winding-up speech that it will, indeed, be genuine and that he disowns the chairman of Surrey PCT when he goes around telling people that we can have as many petitions and demonstrations as we like, but they will have no effect because he has to make cuts. Will the Minister state that the consultation will be genuine and tell the chairman of Surrey PCT not to make such remarks, if they are untrue?

I have always tried to conduct my politics here as calmly as possible. However, the Government have treated my constituents outrageously. I am angry on their behalf. I do not want them to suffer or die, but, rather than improving care, the Government increase suffering, according to consultants in my constituency. According to a consultant, rather than extending life for my constituents, the Government are putting their lives at risk.

Caroline Flint: Name him.

Mr. Wilshire: I have named him many times as Dr. Bellamy, who was an accident and emergency consultant. He is on public record as saying exactly that some people will suffer and some will die.

Mike Penning: They will sack him.

Mr. Wilshire: The Minister does not need to try and sack him; because of the way he was treated, he has already retired—but there we go.

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At the start of the debate, we heard a smug speech from a Secretary of State who lives in a fantasy world. I am appalled at what she had to say this afternoon. I am appalled at what the Government are doing to my constituents. The Secretary of State, Ministers on the Front Bench and the Government as a whole should be ashamed of themselves.

4.50 pm

Mr. Ian Austin (Dudley, North) (Lab): I start by thanking the Opposition for choosing this subject for today’s debate, although I have to tell them that the national health service that we have heard described this afternoon is not one that the people of Dudley would recognise, as extra investment and new ways of working have delivered real improvements for patients.

Over the past four years, Dudley PCT and the Dudley group of hospitals have radically reshaped the way that health services are delivered in Dudley. Our flagship £200 million hospital, incidentally, does not serve only my constituents in Dudley, North, as it provides a first-class service to residents of villages such as Kinver, Wombourne and Swindon—in South Staffordshire, which is represented by an Opposition Member—and, indeed, to residents of Bromsgrove. The idea that the services are improved only in Labour constituencies is completely false. The new £200 million hospital is at the centre of the modernisation of health services in Dudley and has been matched by a far-reaching reform of community services to ensure that more and more personalised care can be delivered outside hospital.

A range of new services has been introduced, which, along with existing services, is changing the way that care is provided. Many services have been expanded with new rapid care teams, and a pathways service for hip and knee patients has been expanded to take account of other services. Care closer to home is now proving effective, providing treatments traditionally found only in hospital in the comfort of patients’ own homes. We also have new outreach teams working more closely with mental health patients in the community.

New nurse consultants are a key part of our new model of care—working, for example, with the 100 people who return to hospital most frequently. They intervene earlier and provide preventive care closer to home. As a result, a sample of 14 patients analysed shortly after the service was introduced showed 98 bed-day savings. The latest figures show that the average length of stay has reduced by more than a fifth.

New case managers prevent admissions into hospital and speed up returns to the community. Those nursing teams are reducing emergency admissions to the acute services. As we heard earlier, one case manager alone prevented 88 admissions to hospital in just an eight-month period last year. Our new pathways service shows how partnership working between health and social services can provide high-quality care, starting and finishing in the community, for patients awaiting elective surgery. It has reduced inefficiencies in the system, ensuring that the patient is treated in the most appropriate place by the right person.

We also have a new community heart failure team. Under the leadership of Rachel Harris, the chair of
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Dudley Beacon and Castle PCT, new community-based services and a new community-based palliative care team for patients with heart failure have been introduced. The team provides new services in health centres and clinics and an additional team of five nurses visits patients in their own homes.

Those new services have resulted in emergency admissions avoidance for heart failure patients. Across Dudley we saw an 8 per cent. drop in heart failure emergency admissions in the last two quarters of last year compared with the last half of the previous year. The PCT has reduced heart failure admissions by 16 per cent. and a neighbouring PCT, which did not implement a similar team, saw a rise of 10 per cent. over the same period. When it introduced a heart failure team based on ours, it saw a 23 per cent. reduction in the first year.

That is not to say that everything in Dudley is perfect—of course not. Things can never be perfect in every case and there are issues, for example, with chiropody services in the community. However, the truth is that none of the improvements that we have seen could have been achieved without the extra investment delivered by the Government and the new ways of working that the Government have introduced.

Despite the Conservatives’ warm words on the Order Paper about the NHS, it is impossible to say that they believe in the NHS or that they would adequately fund it in the future. The motion, which stands in the name of the Leader of the Opposition, claims to recognise

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