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“the need to develop and improve acute hospital services”
and calls for more commissioning, yet the Conservatives voted against the extra investment that is paying for the 109 new hospitals that the Government are delivering. Indeed, the Leader of the Opposition said at the time that the investment needed to pay for those hospitals represented “fiscal irresponsibility”. He has committed his party to a new fiscal rule: the proceeds of growth rule.
Whatever the Conservatives say in the motion today, that rule represents a pledge to cut public spending year in, year out. If that rule were introduced this year, spending would be lower than it is under the Government’s plans. This year, the difference between the Opposition’s plans and the Government’s plans would be £17 billion, and the gap would be bigger next year and in every subsequent year. Given that health service spending accounts for almost 20 per cent. of total managed expenditure, a £17 billion cut in public spending applied across the board would mean cuts to the NHS of at least £3 billion this year. That would mean fewer new hospitals than the 109 new hospitals that have been opened or are currently being built. It would mean a £150 million cut in the £750 million investment in the new community hospitals and services being built over the next five years.
Hon. Members need not take my word for this. Whatever the Conservatives say today, let us remember what the Leader of the Opposition said about the proceeds of growth rule this year. He said:
“As that money comes in, let’s share that between additional public spending and reductions in taxes. That is a dramatic difference. It would be dramatically different after five years of a Conservative Government.”
He also said that he wanted to replace public services for the poor with
“a profound increase in voluntary and community support”.
So all this talk about a new modern Tory party is simply empty rhetoric. It is making the old Conservative commitment to a small state and cuts in spending, with charities stepping in to help the most vulnerable. That is why the Tories cannot promise that they will not cut funding for the NHS.
We should not be surprised about that; it is not a secret. Every Tory speech reveals the truth. They will not give us the details of which taxes they want to cut, which services they would cut to pay for that, or which bits of what they constantly call the big state they would cut. All the rebranding in the world cannot hide the fact that they are the same old Tories committed to the same old spending cuts. They would run down the NHS using the same old prescription of cuts, charges and privatisation.
The truth is that investment in the NHS has doubled nationally since 1997, and that it will treble by 2008. There are now 32,000 more doctors and 85,000 more nurses. We now have the best-paid nurses in Europe, and by 2010 there will be more than 100 new hospitals. Nobody should wait for more than 26 weeks for an operation—a transformation from the situation under the Tories.
Laura Moffatt: I thank my hon. Friend for allowing me to intervene during his excellent speech. When he was explaining the Conservatives’ fiscal proposals, did he notice that many Conservative Members were nodding in agreement? They obviously thought that they were good proposals.
Mr. Austin: I did not notice that, but I did notice that not one of them has got up to deny that the effect of their policies would be to cut public spending, which is what they believe in. They cannot deny that. It is an absolute fact that the effect of the proceeds of growth rule would be to cut public— [ Interruption.] Well, if the hon. Member for Hemel Hempstead (Mike Penning) would like to intervene on me to deny that the effect of the proceeds of growth rule would be to cut public spending, I would be more than happy to give way. Does he want to— [ Interruption. ]
Mr. Deputy Speaker: Order. May I suggest that the hon. Member for Dudley, North (Mr. Austin) should not tout for business in that way? I must also ask the hon. Member for Hemel Hempstead (Mike Penning) not to make any more sedentary interventions.
Mr. Austin: I apologise, Mr. Deputy Speaker.
The truth about today’s NHS is that 99 per cent. of cancer patients are seen by a specialist within two weeks, and 19 in 20 patients are seen, treated and discharged from accident and emergency departments within four hours. New facilities, technologies, treatments and drugs, and the investment needed to pay for them, mean that people now survive conditions that would have killed them just a few years ago.
Doctors and other professionals say that some services need to be concentrated in centres of excellence, so that clinicians with the right expertise, experience and equipment can treat the sickest patients safely and conveniently. I have seen that at first hand in the case of patients receiving angioplasty for heart problems at the new facilities in Wolverhampton. Expanding such facilities nationwide would mean about 500 fewer deaths a year and about 1,000 fewer heart attacks. New technologies in the health service mean that patients who would have had to go into hospital for lengthy treatment can now have treatment in local health centres and GP surgeries.
Again, hon. Members should not just take my word for it. Let me tell them about the experience of my constituent, Mr. Albert Williams, a 79-year-old war veteran who now suffers from two terminal illnesses. He wrote to me:
“The care that I have received in my home is a great example of the way the health service can treat people in the community, be visited by nurses, enabling them to live at home and free up hospital beds for other patients.”
He is now able to be treated in the home that he loves, surrounded by his family and friends, and in as much comfort as possible. That would never have been possible without the changes introduced by this Government.
5.1 pm
Alistair Burt (North-East Bedfordshire) (Con): This debate takes place in the context of health, but the backdrop is trust. The Minister should not be surprised at the treatment of the Secretary of State’s speech by Conservative Members, as it reflects the sense of complete distrust for anything that she says about what is happening in the NHS.
The Government are hoist by their own petard. We have not forgotten how the Labour party treated the health service in the run-up to the 1997 election. We have not forgotten the treatment by then Labour Members and parliamentary candidates of attempts to modernise the health service to assist patients, or reductions in beds. We have not forgotten the screeching in the House about the prospect of privatisation. Ten years on, people have seen what is happening to the health service under Labour, and how the Government have turned on their head to put into practice the same things that they complained about in opposition.
It is no wonder that there is a sense of complete distrust about what the Government do. That is the reason for the general distrust about the fiddling of waiting list figures. No one believes the waiting list figures in this country any more, because every doctor in the country, at both primary and secondary level, knows how the figures are manipulated so that the Government can then spout them.
Sadly, that is the context in which debates on the health service take place, and it is a shame. I want to say good things about what has been happening in Bedford, and to relate that to the debate on the acute services review. I start from a position of having a father and a brother who work in the health service, and of having no private health insurance. The NHS really matters to me, and I am concerned about its future and how it is dealt with.
In Bedford, the debate about reconfiguration takes place against a historical deficit of £11.9 million—an arbitrary calculation, to which I shall return later. There are difficulties in the eastern area, where, strangely, we seem to have a preponderance of poor managers, given the preponderance of health service deficits that do not appear in urban areas. According to the Secretary of State, that is all due to management, when we know that that cannot be the case.
Bedford hospital has done well despite what the Government have done, rather than because of what they have done. The chairman of the Bedford Hospital NHS Trust, Helen Nellis, is standing down. She has given excellent service to the area. She is a loyal, committed woman who has worked her socks off to do what the Government wanted to bring the hospital up to the highest possible standards. Despite her efforts, she has seen the hospital’s finances messed around with constantly. Cancer care outputs are extremely good at Bedford, partly due to the Primrose cancer unit, which was built by the community, not by the Government. Cardiac care at Bedford hospital is excellent. Both my mother and father have recently sampled that care and been tremendously well treated.
Throughout the health service, we will find examples of good practice and improvement. That has happened year on year since the 1940s. It is bound to happen. Trying to make out that one Government stop all improvement, and that another Government create it, is nonsensical. However, recognising good care, good practice and hard work by Bedford hospital, nurses, doctors and all other staff, and that there are improvements, does not stop us from asking key questions about whether all the investment that the Government have put into the health service has produced the results that it should have produced, whether money is properly spent throughout the system and whether it is distributed fairly around the country.
The acute services review puts into sharp focus the problems that hospitals such as Bedford hospital have in fighting with one hand tied behind their back because of the constant changes in the health service and its structure and finance, to which my right hon. Friend the Member for East Hampshire (Mr. Mates) referred. That makes it so difficult for any stability or continuity to occur. It makes it difficult to drive forward change with any sense that what happens today will be recognised in three or four years and be given a chance to work.
My constituents are determined to ensure that the current acute services review in the eastern area is dealt with from the bottom up, not the top down, and that medical and clinical need take priority rather than the rather strange economics that affect the region. Let me give three particular reasons why the review is a matter of some concern. First, there is general scepticism. In Hertfordshire, three years were spent on the massive document “Investing In Your Health”, involving the whole community and producing the idea of a new hospital. That was overturned overnight. More than that, the new hospital was said to be outdated before it even got going. What system could produce such a nonsensical review and take such an amount of time? Therefore, no one has any confidence that the current review will necessarily produce anything different.
Anne Main: As my hon. Friend rightly says, most people accepted “Investing In Your Health” and the promise of a new super-hospital. In fact, it was widely touted—Ministers were saying all around the constituency that it was going to happen. Now we have seen the demise of the super-hospital, we cannot seem to get any explanation of the mess that my hon. Friend has just described. The Government have not explained why it was all going wildly and wonderfully in 2005, yet the minute that the then Minister for Public Health, the former Member for Welwyn Hatfield, and the MP who represented St. Albans both disappeared off the map, the hospital went with them. There is a degree of cynicism among my constituents.
Alistair Burt: My hon. Friend puts it well. Who knows what the current acute services review will produce and, once it has produced an answer, whether it will last and anyone will take any notice of it?
Secondly, there is concern about the distribution of funding in rural and semi-rural areas. The Government have been presented with evidence of how that works. The concern is not that there are not problems in urban areas, but that problems in rural and semi-rural areas are treated much more lightly and not given the consideration that they should be given. That is why expenditure per head is lower. That is why, even though there is a lower number of hospitals per head of the population in the eastern area, there will be no attempt to rebalance that by producing new hospitals in our area, and the same degree of relative deprivation will continue.
Andy Burnham: The hon. Gentleman is well placed to comment on these matters because he previously represented a Greater Manchester constituency. Does he therefore accept that, for example, there are more GPs per head of the population in his current constituency than in his former constituency, and that the difference is considerable?
Alistair Burt: There is a difficulty in pulling just one statistic out of the hat. Statistically, I am sure that the Minister speaks the truth, but the point is that it is noticeable that, over time, the illnesses and problems that my constituents have are treated less seriously and given less funding and support than those in urban areas. I do not regard the illnesses or difficulties of my constituents as any less serious than anything that happens in urban areas. Why are the majority of trusts in balance found in urban areas and the majority in deficit in semi-rural and rural areas? Are all the bad managers concentrated in the rural areas of Britain? No; it is the way the funding formula works.
Andy Burnham: That is not the case.
Alistair Burt: It is. The Minister says no, but the answer is that it is.
Mike Penning: The Minister says from a sedentary position that that is not true, but the Health Committee, which is dominated by Labour Members, said in a recent report that it is true.
Alistair Burt: Yes, it is true. I cannot spend any more time now on that point, but the Minister will have a chance to deal with it in his winding-up speech.
What I have said is true, and that creates a concern: if the same pattern of funding underpins the acute services review in our region, how can we be sure that decisions about where hospitals will be placed will not be made on the basis of the economics of the area rather than on the clinical needs of my constituents?
We also want to be sure that after the review is concluded hospitals and trusts will be able to get on with doing their job without the Government breathing down their necks and constantly making decisions about their funding and how they should spend money. The Minister knows about the current situation at Bedford hospital. There is a deficit of £11.9 million. That forces the trust to do some remarkable things that waste still more money.
Last summer, the trust decided that it could not replace an orthopaedic surgeon, but the flow of orthopaedic work did not diminish as expected. At Christmas time, staff were made redundant and wards were closed—that happened under Labour, I remind the Minister. Now, in the new year, it suddenly appears that there is so much orthopaedic work to be done that patients’ waiting times will hit the cliff edge of the new 18-week target that has been agreed, so more money has been found in order to make sure that that does not happen.
In fact, the treatments proposed will be more expensive than would have been the case if the trust had been able to replace the consultant and follow a normal pattern of work from summer until the end of the year. More money will go into the private sector, and money will be spent on evening operations if the staff can be found to do them, because Bedford Hospital NHS Trust is now readvertising for staff whom they sacked just a few weeks ago in the round of cuts at Christmas time. If the Minister can sit before us and think that he is presiding over an efficient and effective national health service as far as economics and financing are concerned, I am extremely surprised at him. He has a mess in those regards, which he must deal with. How can we have any confidence in the review if that is the economic basis underpinning it, under which hospitals will run?
If the movement of services into the community is to work, the GPs in an area must be able to take on the extra capacity and do the job required of them. I presume that the Minister agrees that that is the case. However, I recently spoke with Dr. Peter Graves, the chief executive of Bedfordshire and Hertfordshire Local Medical Committee Ltd, and he has passed on to me a series of concerns about GPs and the primary care service not being ready to meet the extra demands placed on them by the Government.
First, GPs need to be trained to become GPs with special interests. Unfortunately, the resources for that are not available, so GPs cannot get the training that they need in order to take on those specialties. Secondly, there is an issue to do with training multi-skilled professionals—the further training of other clinical professionals to cover the GP while he or she is carrying out semi-specialist services. Dr. Graves says:
“It remains very difficult to find appropriate training for nurses and other staff, and indeed difficult to find the nurses willing to undertake such training in the first place. In order to deliver Secondary Care services in Primary Care a multi-skilled workforce is essential.”
Thirdly, he talks about premises:
“The third aspect of this issue is around practice premises. Whilst there are some large purpose built premises in Central Bedford, which might have the equipment and space to undertake further services (should the staff capacity be available) many practices around the outskirts of Bedford and in North Bedfordshire remain totally inappropriate. We are reliably told that there is money available for the development of premises and yet we are having enormous difficulty accessing this and finding the necessary support to develop premises.”
My constituents’ perception of the acute services review is, first, that it is underpinned by dodgy economics, as reflected in rural and semi-rural areas, and secondly, that there is an issue to do with the way in which the finance is handled, as hospital administrators are forced to work with one hand tied behind their back, never knowing what their financial regime will be almost month to month. During the course of this financial year, some of them had to make £4 million-worth of savings and they were handed an extra £500,000-worth of savings in October because of a decision that involved deficits throughout the rest of the region.
There is also the question of whether such decisions will be made from the top down, or whether clinicians and doctors will be involved. As my hon. Friend the Member for Hemel Hempstead (Mike Penning) said, a lot of clinicians feel that they are out of the loop. Doctors and clinicians are not going to take these decisions; they will be taken from above, by administrators and people directed from Whitehall.
There is another problem. Once services have been reconfigured—once the decision has been taken to take them from the hospital and place them in primary care— who is going to do this work if the GPs have not been trained to do it and they do not have the necessary premises and staff capacity? We are heading toward a repeat of what we have seen in the past 10 years: well-intentioned efforts by the Government and huge sums of money being spent, but a real mess on the ground. As a result, their efforts simply are not effective.
Unless the Government stop living in a fantasy land in which there is no criticism and the Secretary of State believes that everything is working as she wants it to work, there will be no real delivery for patients, doctors and our constituents. All that we Conservatives are trying to do is to point out those problems, and that the health service and the people who work in it deserve rather better leadership all round than their hard work, efforts and determination are receiving.
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