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5.23 pm
Charlotte Atkins (Staffordshire, Moorlands) (Lab): The Government have invested unprecedented levels of funding in the NHS since 1997. Funding will have trebled by the end of the coming financial year, but in times of such plenty, the money is sometimes not invested as wisely as it should be. Certainly, there have been significant improvements in patient care, there is improved access to health services, and waiting lists are no longer the issue that they were back in 1997, but it is vital that all NHS organisations look carefully at the way in which they provide services to patients to ensure that they are delivering the best possible value for money. For instance, it often does not make sense to send patients to accident and emergency, as better management of their condition at home would save money—going to A and E costs hundreds of pounds—and provide much better care and outcomes for them.
It has certainly been a difficult two years for the health economy of north Staffordshire, where my constituency is located. The Secretary of State frequently says that overspending is concentrated in the healthier and wealthier parts of the country, but that is not the case in north Staffordshire. We may be the exception that proves the rule, because north Staffordshire has been historically underfunded. That issue must be examined urgently, although I recognise that the historical underfunding is not the only problem that north Staffordshire faces. We saw great headlines about 1,000 redundancies at the University hospital of North Staffordshire, and stories about the way in which that would devastate the local economy. I checked the figures today, and the reality is somewhat different. The figures are, in fact, 150 redundancies, of which 45 are compulsory—that is a little bit different from the 1,000 redundancies that were headlined in the local paper.
Mr. Khan: Is my hon. Friend surprised to hear that last year a political party scared local communities about the number of redundancies, yet in the entire financial year, only four redundancies were made?
Charlotte Atkins: That would not surprise me at all, because as I said, only 45 of those 150 redundancies were compulsory. Eight nurses were made compulsorily redundant—other nurses took voluntary redundancy. However, I do not wish to underplay the seriousness of the situation. A number of nurses who, traditionally, could expect to be employed by the local hospital, could not secure jobs. Now the local hospital is taking more nurses from Keele university, but many nurses have decided, because they have had offers, to go to Australia. That might be a fantastic experience—I am not suggesting otherwise—but the situation has led to some soul searching in the area.
North Staffordshire is an area of low skills, and we cannot afford to lose that valuable skills base. However, what worries me most is that clear mismanagement at the hospital was not picked up. It is accountable to the strategic health authority, but to whom is the strategic health authority accountable? It is responsible for the
performance management of trusts in its area, and it seems that it was asleep on the job. All the signs were there. The chief executive announced that he was leaving his job 13 months before he was due to go, but in all that time the hospital did not manage to find an adequate and effective replacement.
The report by the Select Committee on Health found that there is no failure strategy in the NHS. There should have been a strategy that kicked in at that point, and people should have said, “Hold on, there are alarm bells sounding here—we must take this in hand.” When the scale of the problem was finally revealed, members of the hospital’s management board resigned en masse. A new chief executive, Antony Sumara, was brought in, who made a very good job of sorting out the mess. He made much better use of theatres and day surgery. It is a sprawling hospital on three separate sites, and he rationalised activities on different sites to ensure that it worked more efficiently. However, even he could not do everything, because the hospital buildings are up to 150 years old, so there was a big challenge. We hoped that he would stay put after his year’s contract expired, and there certainly were suggestions that he would do so. But that has not happened. He was obviously headhunted to go elsewhere.
We now have an acting chief executive, who I am sure is doing all she can, but I do not know whether the management of the hospital is getting the support that it needs. Its task is not just to manage a dilapidated hospital. We are to have significant and very welcome investment in a new maternity and oncology block that is due to open in two years. It represents an investment of £71 million from the Department of Health. At the same time, the plans for building a new PFI hospital are well advanced. There are several balls in the air, and the acting chief executive may not be getting the support that she deserves. Because of past performance, I have no great faith in the strategic health authority to supply that support.
A real worry for everybody, especially patients, is the fact that infection rates remain stubbornly high. I know that much work has been done to reduce infection rates and meet Government targets, but I wonder whether the failure to get those rates down is a symptom of a wider problem. I hope not. When I talk to my constituents about their experience in the NHS, particularly in that hospital, by and large I get very good reports. It is only people who have not had recent experience of the NHS who say it is a shambles. However, experience in the hospital can vary from ward to ward. When my own daughter was in that hospital, her experience varied from ward to ward. She saw quite a few different wards, sadly.
The primary care trust in my area is doing much better. We merged two primary care trusts, and I am grateful to Ministers for overruling the strategic health authority and supporting local people in our fight for a local PCT. The record of that PCT has justified Ministers’ confidence in it. It is brilliantly led by the chief executive, Tony Bruce. As a result, the PCT is expected to be in balance this year, while achieving all the Government’s expectations and ambitions. It would have been in surplus if it had not been top-sliced. As Tony Bruce told me the other day, the next two years
are crucial, not just because NHS finances will be tighter, but because we have to make the right investment decisions now to ensure that we improve the lives and reduce the dependency of patients.
The Minister of State, Department of Health (Andy Burnham): I have been listening closely to my hon. Friend’s remarks. I recognise that the trust has been dealing with problems that have built up over many years, but does she agree that the announcement in the summer of last year—in the present financial year—that the PFI scheme for the trust would go ahead will give the trust confidence about the future? One of the problems has been that services have been provided over too many sites, often in poor and outdated accommodation.
Charlotte Atkins: Absolutely. The decision to ensure that the PFI hospital went ahead in a slightly smaller form was sensible, because we could have ended up with a white elephant—a huge hospital that would not have been fit for purpose in the 21st century because so many good things are going on in the local PCT area. We are sending far fewer people to hospital. Central out-patients has had a reduction of 20 per cent. in GP referrals because of the work that GPs and PCTs are doing locally to prevent the admission of patients to hospital.
The work that is being done locally to make sure that patients are less dependent and do not end up in the acute sector is to be praised, but there must be consistency. My local PCT, the North Staffordshire primary care trust, is doing a fantastic job in that respect, but I am not convinced that that is happening countrywide. We must resolve those issues. If we do not, the increasingly elderly population will mean that we find ourselves in another crisis.
The Department of Health cannot micro-manage the NHS; it has to be down to local organisations to do that. I am pleased that PCTs and trusts now have to achieve financial balance. The need to balance the books has driven much of the good change that we have seen. It has been necessary to drive down costs and deliver value for money, but in my area that has not been at the cost of patient care—in fact, it has improved patient care. We have introduced community matrons; I think that there was a financial incentive to do that, in the context of reducing acute admissions. We also have deep-vein thrombosis testing locally in Leek, the prevention of falls programme—again expertly led at the local Leek hospital—and PhysioDirect, which allows physiotherapists to treat people without a doctor’s appointment. All those services have ensured that care is delivered locally, where people want it, and not in the acute sector.
I very much welcome the transparency that has come with the tightening of the NHS financial regime. In the past, we had constant rumours about how Staffordshire had lent vast sums of money to, say, Shropshire, but it was never clear on what basis that was done and whether interest rates were paid; I do not think that they were. We were never really informed of what was going on. Now the financial position of each organisation is known. Many PCTs resent the top-slicing of their allocations, but I hope that that is only a short-term measure, and that PCTs will be able to
manage their local budgets appropriately and not have to shore up the strategic health authority balances.
The Select Committee suggested that some deficits were down to the growth in staff costs. To some extent, that was a result of pay rises and GP and consultant contracts, but it was also a result of the vast increase in the number of staff. I have no particular difficulty with GPs being paid more, as long as they deliver more for patients. It cannot be right for doctors to claim payments for access to their services, in terms of appointments, when some are clearly not doing that. It is important for PCTs to police the contracts properly, so that where doctors are getting more money, they deliver the services well. Payments must bring results, and that has to be the case at every level, including the GP level.
I am concerned about the decision to stage the nurses’ pay award. The independent nurses pay review body has done a fantastic job for nurses ever since it was set up many years ago. By considering the evidence from the unions, employers and Department of Health, it bases an award on the careful consideration of the facts. The review body came up with a 2.5 per cent. settlement. It was not generous, but it was fair. No matter how we dress it up, however, staging the award means that the pay award has been reduced by 0.6 per cent.—a cut that many nurses cannot afford if they are trying to get on the property ladder or raise a family. In the Department’s response to the Select Committee’s report, it says that staff costs are not a main reason for deficits. I cannot understand, therefore, why we are paring down the nurses award.
I am particularly disappointed with the nurses’ pay award, because nurses have been through a lot. Even though there have not been a large number of nurse redundancies in my patch, there has been a great deal of anxiety among nurses about getting local jobs.
Sandra Gidley: All hon. Members will have been bombarded by e-mails from nurses who naturally feel aggrieved by the pay award. Will the hon. Lady accept that the vast majority of nurses provide unpaid work, because they are not clock-watchers who go home immediately at the end of their shifts, and they work more hours than they are paid for? Does she regret the moves in some areas of the country to persuade nurses to work for an hour a week for no pay?
Charlotte Atkins: As a Unison member and someone who used to write evidence for the pay review body, I would not encourage nurses to work an hour unpaid. Nurses need to ensure that they are not too tired to do the job, and they already face enough pressure not only in the workplace, but, because many of them are women, family pressure and other extra responsibilities. Given that we have an expert pay review body, it should deliver the pay award and the Government should accept it in full.
I appreciate that “Agenda for Change” has delivered fantastic opportunities for nurses in terms not only of pay, but of promotion prospects and of the chance to work in different areas. The whole role of nurses has vastly expanded, which has been encouraged by “Agenda for Change”. The addition of 85,000 nurses to the NHS since 1997 has had a huge impact on patient care. From talking to my constituents, I know how
much they value the work of nurses not only in the hospital but in the community. I certainly want to see the pay award honoured in full, and I hope that this will be the last time that it is staged.
Lastly, I want to discuss training, on which, as the hon. Member for Romsey (Sandra Gidley) has said, I have questioned the Secretary of State. I feel very strongly about taking money out of the training budget, which is the seed corn of the NHS. That is not acceptable. It may be an easy option to raid the training budget, but it will have an adverse effect on staff morale, and in particular, on development. Given that a major reason for the deficits is a lack of management expertise at all sorts of levels within the NHS, it is vital that we spend more on training, not less. I asked the Secretary of State whether she would ring-fence the training budget. She did not want to do so, but I suggested that it should be controlled by a body such as the Higher Education Funding Council, which would prevent the strategic health authorities from raiding it. I would certainly welcome a more robust regime, and we must not allow the easy option of raiding training budgets to be used again.
We now have a far more transparent system of NHS finances, but I still think that we lack sufficient management expertise in some areas. There appears to be a huge variation in quality, and we must find some way to ensure that the best-quality managers bring on the rest. From the evidence that we took in the Health Committee, it is clear that some managers are definitely getting it right and that others are definitely getting it wrong; unfortunately, north Staffordshire was one of the areas where management got it wrong. The situation needs to be urgently addressed, and if we do not address it, I fear that we will return to where we were a couple of years ago.
5.44 pm
Mr. Simon Burns (West Chelmsford) (Con): Let me start on a positive note by thanking the Minister for the tremendous work that he did over a considerable time at the back end of last year and early this year to help to ensure that Broomfield hospital private finance initiative scheme moved successfully to a positive conclusion. I am extremely grateful, as are my constituents, to him and to his right hon. Friend the Prime Minister for all the work that they did to help to achieve that.
I say that because it is relevant to what I want to say about Mid Essex Hospital Services NHS Trust and Mid Essex—formerly Chelmsford—primary care trust, which are both in deficit with a turnaround team trying to sort them out. I should like to pick up some of the points in the Health Committee’s report warning against short-term remedies to try to solve longer-term problems. Mid Essex PCT has a deficit of what was thought to be about £11 million but is in fact somewhat more than that, and Mid Essex Hospital Services NHS Trust has a deficit of £13 million. They are both trying to meet the Government’s requirements over the last financial year and for the forthcoming financial year and are having to take some tough decisions to break even and fit Department of Health requirements.
The problem is that short-term decisions are being taken to reduce deficits. In the case of the PCT, for
example, there is the closure of the only intermediate care wards at St. John’s hospital, which were brought in by the Government five years ago with a special grant to help to overcome the problem of delayed discharges at Broomfield hospital. I suspect that in the coming months the closure of those two wards will have the knock-on effect of increasing the pressures and problems of delayed discharges, so it is a false economy.
In both organisations, there have been redundancies, most of which have been voluntary or achieved through not replacing unfilled posts. Again, that has a knock-on effect in causing problems for existing staff who have to do extra work under extra pressure. On top of that, 50 nurses are being made compulsorily redundant. During questions before Christmas, the Minister gave the figure of 20 or 22 compulsory redundancies, but by the end of this financial year it will have increased to 50. Those are not long-term realistic views but short-term decisions to meet an immediate problem, and the adverse knock-on effect will not be helpful for the hospitals concerned.
I should like to make a special plea on behalf of Broomfield hospital, which I visited last Friday. I went to see an ophthalmic surgeon who is extremely concerned about the Government’s proposal to create three independent sector treatment centres in Essex—in Southend, Basildon and Braintree, about eight miles from Broomfield hospital. If that decision had been taken five or six years ago, when there was a particular problem with waiting times and waiting numbers in Mid Essex Hospital Services NHS Trust—the figures show that in the first four years of this Government, the trust faced an inexorable increase in the number of people waiting for treatment, although there may have been falling numbers elsewhere—it could have played a very positive role in helping to deal with the problems at the hospital by providing extra capacity. As its record shows, Broomfield hospital is meeting the key targets that the Government set. My fear, and that of many at Mid Essex Hospital Services NHS Trust, is that if, on top of the trust’s deficit, about which it is taking tough decisions, an independent treatment centre goes ahead at Braintree, it will siphon off patients because it will undertake some of the work that Broomfield does. Although the price will be the same, there is a fear that patients will be siphoned off to the Braintree ITC. That has significant and serious implications for the funding streams and finances of Broomfield hospital.
I therefore ask the Minister to consider what could be a serious problem and possibly think again, even at this late stage. He may not yet be aware that I faxed a letter to his private office at approximately 7 o’clock this morning. I hope that he will agree to meet me and the senior management of Mid Essex Hospital Services NHS Trust in the near future—because of the time scale—to discuss the matter.
I should like briefly to consider another matter. Several people who gave evidence about recovery plans to the Select Committee, including Mr. Everett, the director of recovery at Kensington and Chelsea primary care trust, made the point that it was important to deal not only with capacity but improving clinical and administrative efficiency in running
hospitals. Any sane person wants to remove excess bureaucracy. I am the first to admit that, given the size and scale of the work that the NHS does, one has to have a first-rate management team to ensure effectiveness and efficiency, but one has to guard against going beyond that to a bloated administrative system. Management teams should seek, in administering hospital procedures, to get an effective, cost-efficient system.
In that context, I draw the Minister’s attention to something that I discovered personally in the past week that appears to run contrary to the Select Committee’s report on effectiveness and efficiency and the evidence that it was given. Most people would agree wholeheartedly with the concept of offering patients choice. My party has advocated it for some time, and we always welcome converts to the cause, so we are delighted that the Government have embraced the concept.
However, before choose and book was introduced, there would be a consultation when patients visited their GPs, who determined the best way forward. If they could not treat the patients, they would recommend that the patients went to their local hospital to see the local consultant who was a specialist in the relevant condition. In my experience and that of my children in the past, one would usually get a letter in a week or so from the local hospital trust to say that one had been referred to Mr. Bloggs the consultant and to set a specific time on a certain date to see the consultant, who would then determine the required treatment and book one into the hospital for an operation or other treatment. That was an efficient, swift and sensible way to proceed.
Under choose and book, the process is no longer sensible, efficient and cost effective. I do not know whether the system is unique to Mid Essex—if so, someone should explain to the trust that it is the wrong way to proceed when trying to be cost effective, efficient and to save money to plough more into patient treatment. Patients now go to their GPs, who identify a problem and say that they will refer them to a consultant. It is the first time that I have come across choose and book because I fortunately do not visit my doctor often. I was given a choice of five hospitals. I chose my hospital and off I went.
Six days later, a letter arrived. It was not from the hospital that I had chosen but the GP’s practice. It stated that, following my recent appointment, an assessment of the GP’s decision to refer the patient to a consultant had to be conducted. If I passed the assessment and it was decided that I should see the consultant, I would have to wait seven days from receipt of the letter and ring a telephone number at the hospital trust to make an appointment to go to the hospital of my choice and see the consultant. It is odd that a committee—presumably—assesses and second-guesses whether the GP has made the right decision.
The letter was four pages long and included some gobbledegook. By the by, it told me that the location that I had chosen was not the location that I chose. If we are trying to be more effective and efficient, why cannot we retain the tried and tested old system?
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