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23 May 2007 : Column 1383

There are new rapid-care teams, care staff working in the community with mental health patients and new nurse consultants working with those most likely to return to hospital most frequently. We are intervening earlier and working on ways of providing preventive care closer to home. When the impact of the work of those staff on just the first few patients was analysed, it showed that the length of their stays in hospital away from their families had been reduced by an average of one week. The most recent figures show that the strategy has slashed the average length of stay in hospital by almost a quarter.

There are new case managers, who ensure that patients who can be treated at home are not unnecessarily admitted to hospital and that those who are admitted return home more quickly. Such managers cut emergency admissions. Again, it is worth referring to the figures: the work of one manager alone meant that 88 people could be treated at home, away from hospital, in one eight-month period.

We are linking up health and social services in ways that could never have been dreamt of before. We are cutting out inefficiencies, speeding up treatment and reducing waiting times. Under the superb leadership of Rachel Harris at Dudley primary care trust, we have pioneered a new community heart failure team, which provides new services in health centres and clinics. As a result, emergency admissions caused by heart failure were reduced by 16 per cent. in the first year; a nearby PCT that did not then have a similar service saw its heart failure admissions increase by 10 per cent.

As I said earlier, services at our district general hospital, Russells Hall, have also been transformed. We have a brand-new £200 million hospital, developed under the private finance initiative, with more doctors and nurses treating more patients more quickly than at any time in history.

That is not to say that things are perfect—they never can be. We have problems with car parking, and infection rates always cause concern. Other issues of chiropody and audiology have been raised by constituents.

The truth is that none of the improvements I spoke about earlier would have been possible without the extra investment that the Government have put into the NHS, which the Opposition voted against, despite what the right hon. Member for Charnwood (Mr. Dorrell) said earlier. Whatever they say about their new-found commitment to the NHS, we must not let anyone forget that they constantly opposed that extra investment and would cut spending on the health service if they had the chance to do so.

Under the Labour Government, investment in the NHS has doubled and it will have trebled by 2008 to more than £90 billion. The NHS is receiving an extra £8 billion this year—the biggest cash increase ever. All that investment means that there are about 280,000 more staff, as we heard earlier. There are more staff than at any period, with 35,000 more doctors, 80,000 more nurses—

Lynda Waltho (Stourbridge) (Lab): And they are better paid.

Mr. Austin: As my hon. Friend says, we have the best paid nurses in Europe.

Furthermore, 116 hospitals have already been opened, or will be opened in the largest hospital
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building programme in our history, and 2,800 GP premises have been improved or refurbished.

Whatever the words of the Conservative motion, the Leader of the Opposition said that the extra investment needed to deliver those changes was “fiscal irresponsibility” and he committed his party to a new fiscal rule that, whatever they claim, means that they would spend less on the NHS than we will.

Tim Loughton (East Worthing and Shoreham) (Con): That is not true.

Mr. Austin: The hon. Gentleman may say it is not true, but his leader and the shadow Chancellor have promised to cut taxes every year under a Conservative Government through a so-called proceeds of growth rule. Their new third fiscal rule applied over the economic cycle would require spending cuts—if enforced this year—of £21 billion. [ Interruption. ] Opposition Members are chuntering away, saying that they disagree, but they do not need to take my word for it; the Leader of the Opposition admitted that implementing the rule would lead to dramatic cuts in public investment compared with Labour’s plans. These are the right hon. Gentleman’s words—not mine. He said that

In the Budget, the Chancellor announced that spending on public services will be £61 billion higher by 2007-08 compared to 2004-05 and that total additional expenditure on the NHS in the coming year will be £10 billion higher than this year—a 10 per cent. increase. The Opposition refuse to match our spending plans.

Mr. Lansley: As we supported the spending plans of the current Labour Government at the last general election, and those plans take us through to the end of this financial year, what spending plans is the hon. Gentleman talking about?

Mr. Austin: I am just a comprehensive schoolboy from Dudley, so the hon. Gentleman must forgive me if I cannot work things out, but as far as I can recall the Opposition voted against the national insurance increase that delivered extra expenditure for the health service. They voted against the increased expenditure for the health service that has been delivered and at the last election they did not promise to match us on the health service; they promised to take funds out of the health service to subsidise private care. They are not promising to match us— [ Interruption. ] If the hon. Gentleman wants to intervene again to tell me that the shadow Chancellor has committed the Conservative party to matching us on health spending, I shall be delighted to hear it, because he has not done that.

Mr. Lansley: I am grateful to the hon. Gentleman for giving way. The Labour Government’s spending plans run only to the end of this financial year—that is, March 2008. We are indeed committed to matching those spending plans. If the hon. Gentleman has privy knowledge of the Chancellor of the Exchequer’s plans beyond April 2009, we shall be happy to consider them.

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Mr. Austin: What I have knowledge of is the proceeds of growth rule, which commits the hon. Gentleman’s party to spending less on public services than we would. He has not denied that the proceeds of growth rule would result in a Conservative Government spending less on public services than a Labour Government. As I said earlier, if that rule was introduced this year, it would mean that spending would be £21 billion lower than under the Government’s plans. It would be lower still in every year after that. Let me put it another way: spending on the NHS accounts for almost a fifth of the Government’s total managed expenditure, so cutting £21 billion from public spending would mean slashing £3.6 billion from the NHS. To achieve that, one would have to sack 100,000 nurses, 35,000 doctors and cut by a fifth the number of new hospitals, clinics and health centres.

All the talk about a new compassionate Conservative party that is committed to the NHS is exposed as the old empty rhetoric masking the same old Tory party. The Conservatives might not give us the details about where the cuts would fall, but every speech makes it absolutely clear. What do they mean when they talk about cutting back the big state or cutting the fat from public expenditure? They might not give us the details about which services they would slash to pay for the tax cuts or which bits of the big state they want to trim back, but the fancy photo calls, the so-called rebranding, the hospital visits, the fact that the Leader of the Opposition spent time in a school in Hull, and lived with what the Opposition patronisingly referred to as an ordinary family in Birmingham for a week, cannot mask the truth that this is the same old Tory party, running down the NHS because it is committed to the same old spending cuts.

The British people face a choice at the next election: record investment and reformed ways of working, transformed treatment, improved care and the aim of keeping patients at home and alive for longer under this party, or the same old Tory party with the same old package of cuts, charges, and privatisation.

6.36 pm

Tim Loughton (East Worthing and Shoreham) (Con): That was another good debate—at least until the last contribution—and another health debate in Conservative time. There was an unprecedented show of strength by Cabinet colleagues in feigned support for the Secretary of State’s valedictory performance, but we have to acknowledge the unprecedented scenes for which she is responsible. Thousands of doctors have taken to the streets to march against the Secretary of State and her policies. Thousands of Worthing residents, who are not known for taking to the streets, marched against the Government and the Secretary of State’s policy on health. Not so long ago, the Public Gallery erupted in applause at the suggestion that the Secretary of State might like to apply for her own job under the circumstances that she was forcing on doctors under the medical training application service—or at least she was until MTAS went pear-shaped.

The Secretary of State wants us to mention patients and staff. Those marching patients and staff are testimony to what she has achieved. They speak
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volumes. She talks about a 90 per cent. satisfaction rate among NHS patients. Back in 1994, there was a similar survey, with similar criteria, and what was the satisfaction rate? Surprise, surprise—it was 90 per cent. She wants to talk about the attitude of staff. Let me just remind her of some of the comments made this morning by midwives at the Royal College of Midwives conference at which she spoke. Rosemary Exton from Nottingham has been a midwife for 24 years and in the last year has seen “some real deterioration”, including

Midwife Liz Stephens from London said this morning to the Secretary of State:

There is a rather long charge sheet behind the motion. I will give the Secretary of State the abridged version. When she was first appointed back in May 2005, she said:

So, what did she do? From July 2005 to June 2006 she did not visit a single hospital outside London. She did not visit any of the Sussex hospitals—all of which are now threatened with closure or downgrading. In July 2005, she proposed merging primary care trusts and strategic health authorities, and the divestment of PCT provider functions. By November, that had been abandoned and she was forced to apologise. There have been three attempts at reconfiguration: the regionalisation of SHAs, the merger of primary care trusts and the regionalisation of NHS ambulance trusts.

The latest onslaught on the NHS locally is the reconfiguration that involves cuts masquerading as modernisation, as the Secretary of State knows. There are also the heat maps, and the 43 maternity units and the accident and emergency departments across all of Sussex and the rest of the country that are under threat on her watch. There is perpetual reorganisation, confusion and turmoil.

In the right hon. Lady’s first speech to the House as Secretary of State, she spoke of her aim

Since then, according to the Health Service Journal, health inequalities—the difference between the life expectancies of the richest and poorest—have become greater than at any time since the Victorian era. Let us consider the deficits under this Secretary of State’s watch. In 2005, she promised to reduce the overall deficit, yet the turnout was £1.31 billion of gross deficit, which was the worst in NHS history at that time. Hospital trusts have had their financial planning plunged into chaos due to the withdrawal of the tariff. A Healthcare Commission report showed that nearly a third of hospitals had failed to balance their books. Seven out of 10 chief executives said that the care of their patients would suffer as a result of short-term financial decisions, while, according to the Health Service Journal, two thirds of them were closing wards.

Virtually no area of the NHS has been immune from the Secretary of State’s incompetent meddling. The new dental contract has been described as a “shambles” by the head of the British Dental Association’s general dental practice committee. Just last month, 85 per cent.
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of dentists said that they believed that the new contract had not improved access to NHS dentistry.

Andrew Miller: Will the hon. Gentleman give way?

Tim Loughton: I will not.

We saw the shambles of the collapse of the home oxygen service in February 2006 under this Secretary of State’s watch. There has been the mess of the GP out-of-hours service—at least the hon. Member for Carlisle (Mr. Martlew) acknowledged that it had been a mess—which has cost £242 million more than the Government intended and led to a reduction in productivity. The targets to halve the number of MRSA infections have failed dismally, and now C. difficile, which kills twice as many people as MRSA, is endemic throughout the health service and growing at a faster rate than ever.

Conservative Members’ warnings of 20,000 job losses were derided by the Secretary of State, yet according to her work force planning department there will now be 37,000 job losses, which is 2.7 per cent. of the work force. There have been failures in public health on obesity, mental health, binge drinking and sexually transmitted diseases.

Mr. Jim Devine (Livingston) (Lab): Will the hon. Gentleman give way?

Tim Loughton: I will not.

The independent advisory group on sexual health and HIV found that substantial parts of the £300 million that had been set aside to improve sexual health had been raided by PCTs to cover deficits and that the money reached the front line in only 30 out of 191 PCTs. The ticking time bombs that are being built up under this Secretary of State could create catastrophic conditions in the future. Most recently, we have seen figures showing that a fifth of hospitals have failed to eliminate mixed-sex wards. Disgracefully, in the mental health service, 55 per cent. of acute hospitals now have mixed-sex wards. We do not need to repeat the debacle over the medical training application service. We should not be surprised about all that because the Secretary of State has form—she showed it when she was Secretary of State for Trade and Industry.

The Secretary of State has received a vote of no confidence from her own staff. An external survey for Whitehall showed that fewer than two out of 10 senior civil servants at the Department of Health believed that it was well managed, while only 4 per cent. thought that the Department was able to manage change well. If the right hon. Lady cannot successfully lead the 3,500 people in her Department, she cannot be trusted to lead the 1.4 million people working in the NHS.

A recent survey in Hospital Doctor showed that under this Secretary of State, 69 per cent. of doctors would not recommend a career in medicine. Some 56 per cent. of doctors believe that there have been no improvements in the NHS since 2002. According to an official survey by health service regulators, fewer than half of NHS staff would be happy to be a patient at their own hospital. What an indictment of the Secretary of State’s policies over the past two years. A survey by Health Service Journal found that among
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NHS chief executives, the right hon. Lady was the least popular Secretary of State for Health in the past decade—and she had some competition.

The Secretary of State has no support in her Department, no support in the NHS and, apparently, no support from her Front-Bench colleagues. The chairman of the Labour party has protested against the closure of maternity services and the Secretary of State for Culture, Media and Sport has protested against the closure of 24-hour emergency clinics. The Minister of State, Ministry of Justice, the right hon. and learned Member for Camberwell and Peckham (Ms Harman), and the Chief Whip have protested against the closure of maternity services, as have the Minister for Local Government and the Health Secretary’s departmental colleague, the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis). The Solicitor-General, Home Office and Work and Pensions Ministers, and Parliamentary Private Secretaries to Ministers at the Departments of Trade and Industry and of Health have all protested against the right hon. Lady’s health policy, on her watch as Secretary of State for Health in this Government.

The right hon. Lady has lost the confidence of her Department. She has lost the confidence of junior doctors and the next generation trying to train for a career in the NHS. She has lost the confidence of the RCN and nurses. She has lost the confidence of midwives. And she has lost the confidence of the patients she is here to serve.

The right hon. Lady has taken the culture of “Not me, guv” to new heights. It is never her fault. In November 2006, she told the Health Committee that it was the fault of the NHS for employing too many staff. In March 2006, she blamed “clinical resistance” to change in the NHS for all the problems. Just last week, for MTAS she blamed the BMA, the royal colleges and the postgraduate deaneries—never herself—and today we have seen her blame African Governments for her Government issuing 50,000 work permits for African nurses working in the NHS. It is never the fault of the Secretary of State for Health, never the fault of her Ministers and apparently never the fault of her Department.

There has been a catalogue of departures by people around the Secretary of State. In March 2006, Sir Nigel Crisp departed, as did a Health Minister in the Commons and another in the Lords. Since June 2006, no fewer than six of the 14 board members at her Department have departed. Most recently, James Johnson, chairman of the BMA, fell on his sword after MTAS. Why? It is never the Secretary of State who takes responsibility.

The NHS budget is larger than the GDP of 155 member nations of the UN and it needs skill and expertise to run it, yet under the right hon. Lady’s leadership the central management of the NHS has rapidly come to resemble one of the less distinguished banana republics. The Home Secretary has just announced a £3.5 million bonus scheme for his Department, which he described as “not fit for purpose”—a perverse system that rewards failure. The Secretary of State should take the leaf out of her own policy of seeking to implement payment by results and to link elements of GP pay to patients’ satisfaction—but I fear that if she took that route, she would end up
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a net contributor to the Exchequer, rather than taking the modest £1,000 reduction that our motion proposes.

This Secretary of State has taken complacency, incompetence, fantasy and the art of the patronising to new heights. She has exploited the good will and hard work of staff in the NHS, whose dedication has been in spite of her, not because of her. Their loyalty and patience have been and are being severely tested. Reducing her salary by £1,000 is poor compensation for two years of mismanagement. She is past her sell-by date. It is time that she gave the NHS a break. It is time for her to go.

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