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we are considering the following measures for 2008/09: further refinement of the relative weights of the specialised top-up payments; basing prices for certain HRGs on the costs submitted from a sample of providers who deliver the highest volumes of activity in those HRGs.
Mr. Neil Turner: The hon. Member for Westbury said that the five hospitals receive this top-up tariff. I should point out that only four dothe Wrightington hospital does not. I do not know whether the Minister will come on to that, so will he tell us whether the Wrightington will get the top-up tariff in the interim period before HRG4 is introduced?
I was just about to discuss the particular issues that my hon. Friend raises. He tempts me to blur my roles and adopt a constituency hat. There is no doubt about the Wrightingtons place in medical history, given the work that he has described,
or the fact that its situation is different from those of the other hospitals that we are discussing. My right hon. Friend the Member for Oxford, East warned about the consequences of merger with a district general hospital, which, as my hon. Friend said, happened in the Wrightingtons case. It might be said that there are pros and cons to going down that route.
I understand my hon. Friends points entirely, but I must speak wearing my ministerial hat on this occasion. He talked about a moral obligation, and his comments will have been heard. He rightly said that the services of the Wrightington are not confined to his constituency or to mine, because it provides specialist work to commissioners in the whole of the north-west and beyond. It is fair to say that particular attention needs to be paid to the individual circumstances of the trust[Interruption.] I hear the hon. Member for Westbury laughing, but I am not making a constituency case. I am merely describing a self-evident truth: the hospital has not benefited from some of the extra help that has been available to the other specialist hospitals. As has been said, the losses incurred have been absorbed by the general income and expenditure of the district general hospital site.
My right hon. Friend the Member for Oxford, East talked about the dangers of mergers with district general hospitals. There is a danger in this debate of ascribing all the difficulties and uncertainties faced by the specialist orthopaedic hospitals to tariff; there is an easy dumping ground, because people can say that everything is an issue of tariff.
Let us be clear that questions of productivity also need to be faced by the specialist orthopaedic hospitals; they should not be insulated from such questions, because the rest of the national health service is not. Difficult questions about productivity, optimum use of facilities and the efficiency of working practices need to be addressed. The big point that I should make to my right hon. Friend is that, although I accept the obligation to help on some of the issues that he raised, a two-way street is in operation, because there is also an obligation on the hospitals to address questions of productivity, efficiency and changing working practices, where that needs to happen.
Mr. Andrew Smith: I take the point that the Minister makes: we are dealing with a wider constellation of issues and challenges. I am not lumping everything on to the tariff, but is there not a particular perversity? Such is the discrepancy between the cost of undertaking the specialist work and the prices that the hospitals are paid for it that the more productive they are, the worse off they will be under this system.
Andy Burnham: The point is well made, and we must have particular regard to it. I was struck by the point made by my hon. Friend the Member for Wigan that, if the merger he mentioned had not happened, more support would be given. I am sure that careful note will be taken of that by those who need to do so. The answer is to work towards a durable solution and take away as many of the imperfections as we can along the route. We need to whittle away the imperfections, while in no way undermining the organisations that are involved.
The question of independent sector treatment centresISTCswas raised by most of those present. The hon. Member for Southport began by describing the effect on peoples lives of the orthopaedic conditions that we are discussing. It is important to recognise that ISTCs have reduced the long waits that blighted the lives of those who were told that they had no choice, that there was not enough capacity and that they would have either to go private or wait for a very long time.
One thing that has bedevilled the orthopaedic sector is the lack of capacity around the country. It is sometimes suggested that there is an ideological commitment to saying, This must be the way that things are done. Nothing of the sort exists; we simply want to put in place the additional capacity to allow people who need access to treatment to improve their quality of life, to remove the blight on life that often exists, and to provide early and ready access to treatment.
In the past, the private sector traded on the back of the failings of the NHS. Waiting times are now coming down quite quickly. In this financial year, I believe that we will see a significant reduction in the waits for orthopaedic procedures as we move towards having an 18-week maximum wait. That is an important part of the role being played by the ISTCs. It is also indisputable that the presence of an ISTC has sharpened consideration of questions of productivity in certain hospitals. That is not a bad thing. It is good for patients, who get treated more quickly, and for the NHS, which is able to question and challenge what it does and improve how it operates. I shall cite an example of that.
Yeovil district hospital, in the south-west, is making huge strides towards delivering the 18-week target, which it confidently says will be hit at some point this year. All its patients will therefore be treated within 18 weeks of a general practitioner referral. It openly says that a large amount of the progress that it has made was kick-started by the arrival of the ISTC at Shepton Mallet, which was seen as an opportunity rather than a threat. Such things need to be borne in mind.
The hon. Member for Westbury raised the question of a level playing field. We are working towards that, but the NHS always spot-purchased from the independent sector and, in doing, so often paid inflated prices for the use of that capacity. I am sure that he knows more than I do about how that may have happened in the past and about how it was not necessarily the best use
Dr. Murrison: I need to correct the implication behind the Ministers remark. A few years ago, my colleagues were laying into him for the contracts with the private sectorwhat he termed spot-purchasingthat were wasting vast sums of money on his watch, not on mine.
Andy Burnham: I was explaining to the hon. Gentleman that one of the reasons for the ISTC programme was that it brought down the cost. The NHS has always used the private sector in that way, through various waiting list initiatives that occurred under his Government, as well as this one. The programme has enabled those reference costs to be brought right down, as Laing and Buisson recently recognised in their review of the private health care sector market.
We have had a rich debate on legitimate questions for these excellent national assets: the five specialist orthopaedic hospitals. I give my right hon. Friend the Member for Oxford, East an assurance that I am committed to reaching a sustainable solution at the earliest opportunity. I understand the points that he has raised. I simply ask him to acknowledge that there is another argument in respect of productivity and the need to ensure that the services are as efficient as possible. If the trusts and the Specialist Orthopaedic Alliance work with us on these questions, I am confident that, in a short timeperhaps a matter of months or a couple of yearswe shall arrive at the right solution for those important hospitals.
Ms Karen Buck (Regent's Park and Kensington, North) (Lab): The Governments initiative to end the use of bed-and-breakfast accommodation for homeless families is one of the achievements of which I am most proud, having served as a councillor in a borough where that was common practice, and where the living conditions that people endured were unacceptable in a modern society. Bed-and-breakfast accommodation has been replaced by reliance on temporary accommodation, which is superficially an improvement because, for the most part, self-contained accommodation is clearly better for families than living in one room in a hostel or hotel.
We have set a target for reducing the use of temporary accommodation by 50 per cent. There are wider policy issues, which I would dearly love to address, but will mention only briefly in this debate. As pressure comes to bear on local authorities to reduce reliance on temporary accommodation, I am finding a number of worrying problems, some of which flow directly from the drive to achieve the target, but others are deeper and arise from management failure to deal with the quality of accommodation.
I want to raise four issues. The first is the condition of the temporary accommodation in which some of my constituents live. There is much disrepair and extreme overcrowding, despite the assurance of the Government and local authoritiesin this case, Westminster city councilthat contracts with providers for temporary accommodation should at least ensure that people avoid the poor conditions that were a feature of so much bed-and-breakfast accommodation in the past.
Secondly, there is instability in the system as we move towards the target, perhaps as a consequence of some of the factors in the London housing market, particularly the recent strength of buy-to-let. As leases come to an end on temporary accommodation, families are made to move frequently and the casework that comes to me implies that they often have to move out of borough.
Thirdly, I want to spend a couple of minutes on rents and work incentives, and the fact that areas such as mine still face a real problem with work incentives for households in temporary accommodation, which the Government are not willing to address.
In essence, we all haveI certainly doa powerful desire to reduce reliance on temporary accommodation and, in a bigger context, to reduce homelessness. It is a terrible experience for households to go through, and it is an expensive option. We must manage the transition to a reduced proportion of households in temporary accommodation in such a way as to ensure that it is a decent experience for them on their route to a permanent home, and that it does not worsen the situation for other households in housing need. Neither of those objectives is being achieved at present.
The main concern is the poor conditions for people in temporary accommodation, with overcrowding and disrepair. The context is cost. In Westminster at the
moment, 3,064 households are in temporary accommodation, and I believe that two thirds are housed in borough. The rent payable by households through the housing benefit system last year was a flat rate of just over £440 a week, so the cost to the taxpayer is £70 million every year to keep families in temporary accommodation in one borough alone. According to my calculations, that adds up to £1.2 billion a year in London, 90 per cent. of which is funded by housing benefit. Despite that investment, conditions are routinely so appalling that it beggars belief that it constitutes value for money. I shall run through a few of the problems.
The first is overcrowding. Two weeks ago, I took members of the Select Committee on Communities and Local Government to visit family A in Westminster temporary accommodation. The family consists of two adults and three children: boys aged 18 and 17, and a girl of two. They live in a one-bedroom, ex-council flat in a tower block for which housing benefit pays £440 a week. Last autumn, the environmental services department assessed them, at my request, as constituting a category A, band 1 hazard under the housing, health and safety rating system. That family has been in one-bedroom, temporary accommodation for months. Why? Why can they not be moved at least into alternative temporary accommodation so that their needs can be met while they are waiting for permanent accommodation?
Another person in acute need and in temporary accommodation is Karen Moore. She lives in one-bedroom, temporary accommodation on the estate where she grew up and close to her mother, whom she helps to care for. Karen has three children aged six, five and three, one of whom has Aspergers syndrome, in that one-bedroom, temporary accommodation. I have been asking the council to find alternative temporary accommodation for a year. The officers with whom I work at Westminster city council are outstanding, helpful and give every indication of doing all they can, yet they tell me that, because of the cost barriers and the fact that they are withdrawing from leases for temporary accommodation, they are unable to find an alternative. To be fair, she was offered one alternative, but it was on the other side of the borough, and she has children in local schools and is the carer for her mother. That was the only offer.
On Monday, I met a young woman who had written to me to say that her temporary accommodation had become overcrowded following her mothers death when an aunt and her two daughters moved in to care for her. For four years, that family of fouran adult and three children aged 23, 20 and 16have shared a one-and-a-half-bedroom, converted flat. The daughter wrote:
My mother and I moved in 2002 and sadly my mother got ill...she was diagnosed with liver cancer and passed away in 2003. Whilst my mother was ill, my aunt moved in to look after me because I was still at school. While we were still grieving, they registered us intentionally homeless...we went to a solicitor to appeal...it took a long time but in 2005 they accepted us and told us we had to choose between bed and breakfast or temporary accommodation. The flat we live in is overcrowded and damp and it has a lot of bad memories.
Despite assurances to the contrary, and despite the expense, some of the worst housing conditions encountered by members of my staff are in the temporary
accommodation sector. Another lady whom I met on Monday was promised alternative temporary accommodation in May 2005 because she is disabled and cannot manage stairs. No offer has been forthcoming despite the promise.
daughter is sick from pneumonia...my flat is exceptionally cold because the windows are no good and the heaters don't work...I have been in a hotel for 3 years and a temporary flat for 3 years.
Perhaps the worst instance I have seen concerned Mrs B, whom I visited at home a few weeks ago. The condition of her property was unbelievable. There were holes in the walls big enough to put a fist through, and leaking water was running into the electricity in the downstairs flat, which was also temporary accommodation. There was black mould on the walls and inside cupboards, cabinets were broken or missing, and walls were stripped of plaster and paper. To my astonishment, I was told that Pathmeads was first advised about the level of disrepair in February 2006, but when I visited the property 12 months later, nothing had been done. According to Westminster city council,
a full assessment of the works required was completed and agreed with Pathmeads in Feb 2006...who will be working with the landlord of the property to have all works completed as soon as possible.
Another Pathmeads tenant told me that she was without hot water for a year and that her gas meter was capped without her being told. A tenant of Notting Hill housing trust temporary accommodation complained of excessive cold and was living in one downstairs room with her children. The trust told me repeatedly that the repairs had been carried out, until finally a senior officer at my request visited Mrs. T and accepted that that was not true.
In another instance, I had to take a member of the trusts board to visit another tenant, my neighbour, who had complained of water pouring into his flat from upstairs for well over a year without any response.
since your last letter, we have had many more problems...leaking from the flat above which no one took responsibility for...I reported this to Acton Housing Trust and they sent an officer and a surveyor who confirmed that this flat was not suitable for anyone to live in...and last night there was leaking from the flat above into my bedroom...this flat has to be properly repaired because it is not safe for anyone...the ceiling could fall in at any day.
As a practising health visitor with 16 years experience, I was absolutely shocked by the risks presented to the family by the present accommodation.
Mr. Andy Slaughter (Ealing, Acton and Shepherd's Bush) (Lab):
Many of the issues and case histories that my hon. Friend raises will be familiar to many London MPs, and particularly to me, because I represent a neighbouring constituency. Has she come across the practice, as I have with my local authorities, of taking blocks of flatsparticularly those awaiting development or demolitionfrom which there have been decants, and using them to house families in temporary
accommodation? It means that no work is undertaken for three or four years sometimes, and conditions that would be unacceptable in other accommodation are now endemic.
Ms Buck: I have indeed had experience of that practice. It is striking that some of the most vulnerable families, who have become homeless, are placed in the worst accommodationnot all, but too much is the worst accommodationat the most staggering expense.
When the Government adopted the bed-and-breakfast target, two factors helped to drive the decision: the hell of families being cramped up in a single room; and families being forced to move so frequently, with the consequential upheaval in education, health and, in some instances, child safety. Unfortunately, far too many families in temporary accommodation experience the same instability and, from my caseload, it appears that the situation may be worsening precisely because of the instability resultant from the closing of contracts and the ending of leases.
In the past few months, I have been approached by an increasing number of families who have been confronted with yet another move, or even worse, with a move out of borough, despite in some instances, the families having either been born in Westminster or having 10 to 20 years of local connections in private rented accommodation.
One family had to spend two months in a hostel in east London earlier this year, despite representations from social services who were concerned about the extreme vulnerability of a teenage child who had just been bereaved. They pleaded with the housing department to keep the family in Westminster with all their connections. The family have now returned, but they should not have had to go through that trauma.
Mrs. H has been in the local area for 10 years, but the lease ended on her temporary accommodation on 5 March. She came to me pleading not to be moved out of borough, because she had been told that that would be the likely outcome. I am unable to ascertain the location at which she and her three children are living.
Three families in the past six months have told me that they have been commuting from east London back to their childrens school every dayin one case back to workbecause their entire support systems are locally based. I am sure that my hon. Friend the Minister can imagine not only the expense of taking one, two or three children on the tube every day, but the sheer pressure on those families. However, they want to commute, because they do not have any idea how long they will spend out of borough. The one constant for families in such difficulty is the childrens school, and they will do anything to avoid moving. However, we do not consider that situation to be a sufficient factor.
One lady, who came to see me a couple of weeks ago, is recovering well from a history of substance abuse, and she is caring for her young child in an attempt to get her life together. She was born in Westminster, and her nine-year-old is already in her third primary school. The lease on her temporary accommodation expires this week on what is her 12th address. The council told me that she was
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