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The consultation should include an option for two hospitals with accident and emergency and maternity services. There are good arguments for Princess Royal hospital in Haywards Heath, but to make people decide between St. Richard’s hospital at Chichester and the Worthing and Southlands hospitals in my constituency is wrong. The fourth option—knocked out at the last moment—should have been included, which, like the first option, includes a benefit to the NHS of more
than £20 million, but because it would be at Portsmouth in Hampshire it is not counted in the financial calculations. The Minister would have to look in a small box on page 7 of the fifth document attached to the seventh item of the PCT agenda to find it.
The PCT should also be required to reinstate one of the Government’s accessibility hurdles, which was dropped in March without anybody noticing. I should be surprised if any non-executive directors of the PCT understood what was happening at the time. What is proposed is wrong. Worthing has one of the best hospitals in the country. People want to be patients there. Staff want to work there and people want to be trained there. I declare a slight interest, as my doctor daughter was trained at the hospital.
My daughter is not the reason why I raise the next issue, which is the total mess of the Government’s nationalised scheme for choosing doctors for hospital training posts. In November and December 2006, there were warnings, in which I took part, that the modernising medical careers system and the computerised medical training application system—MTAS—would not work. In March, sensible directors of medical education advised deaneries that they should hold the system for a year and process applications manually. If that had happened, we would have known about almost every hospital position by May. Those positions are for the benefit not just of doctors in training but for patients. They also enable senior doctors to do their work properly rather than downgrading themselves to jobs that require less experience and skill.
The Government did not heed those warnings. We have reached the stage of resignations—not only of the chairman of the BMA and of some of the people who helped design the system, but of the Secretary of State for Health, the right hon. Member for Leicester, West (Ms Hewitt), who left her job for personal reasons, which we can well understand. The junior Minister responsible for some of those things has moved on to another post. The Select Committee on Health is to hold an inquiry and the Tooke inquiry is under way, but I should prefer Ministers to say, “We realise the whole thing is a total mess. We went on regardless and we were wrong.” The Minister will discover the strength of what is wrong if she asks Great Ormond street hospital whether it is true that it has up to 12 vacancies for posts that need to be filled on 1 August.
We are used to flood warnings, but we are getting to the stage where we should put out a warning saying, “Do not be ill in August.” That is not just because people are changing their jobs everywhere in the country and many vacancies will not be filled, but because many of those that are filled will be filled by people who did not want to have that specialty in that place. Imagine what it is like to be one of the people who is actually given a job that they did want in a place that they wanted, only to be told two weeks after receiving that news, “I am sorry; we made a mistake. We have offered six places for four posts, and two of you have to be picked to go elsewhere to do something totally different.” That is not the way to treat a committed professional, on whom this country has spent perhaps £250,000.
The same applies to people referred to as IMGs—international medical graduates: people who came to
this country to do A-levels, their first degree and their medical training. As a result of a change of policy by the Home Office in March 2006, brought about apparently by the Department of Health either conniving or being ignorant about the consequences, those people found out that by late last year a decision had been taken, without full information to everyone who would be affected, that it was now not enough to have a letter from the Home Office in order to switch to the highly skilled migrant programme, and that a stamp in one’s passport was also required. Given the delays at the Home Office, one would not only have to have applied, having obtained the qualifications to get the FT3 grade that gets one above the salary level that makes it possible to apply for the highly skilled migrant programme, but would have to have got in the queue where they open the letter and put the stamp in. A letter from the Home Office was judged not to be adequate.
What kind of a Government say that one Department can send a letter saying that a person is qualified whereas another can say, “Unless you actually turn that letter into a stamp in your passport by 5 February, you cannot take up a job on 1 August”? I would be ashamed of that and I expect that, privately, both Ministers and the officials involved are ashamed. It is wrong.
Some specialties, such as pediatrics and psychiatry, normally rely on international medical graduates. I suggest that the new Secretary of State goes down to the airport and tries to stop some of those people leaving the country. They may have been in this country for seven or eight years but they are needed here. I challenge the Government to publish during the next week, even though Parliament may have gone off on holiday, the figures for every deanery, hospital, specialty and grade, and to say where the gaps are and how many doctors are trying to enter the transfer system, where they can swap with someone else. For example, someone with a job in Scotland may want to be down in Kent. How can they swap? It is a shambles of a system and I am ashamed to be part of it. We as MPs have failed.
On a different subject, during the break I am going to America to help win a clemency hearing for a man called Krishna Maharaj. The former Prime Minister mentioned him. Several members of the present Cabinet signed up to the amicus curiae brief signed by nearly 300 MPs and MEPs in the House of Lords. I hope that I can come back knowing that Florida will grant a clemency hearing to this man and have a full investigation. If he cannot be ordered a new trial, at least he can get the clemency hearing that he richly deserves.
2.43 pm
Kate Hoey (Vauxhall) (Lab):
The first issue that I shall raise has already been raised by the hon. Member for North Southwark and Bermondsey (Simon Hughes). That is no surprise, because it is the question of the closure of the emergency clinic at the Maudsley hospital. All the Members of Parliament in south London, the two local authorities of different political persuasions and health scrutiny committees of different political persuasion united to say that they did not want it closed and that they did not want it moved to an inferior position at King’s College hospital. The
former Secretary of State for Health did not listen to any words that we said. I hope that the Deputy Leader of the House will make a point of drawing this matter to the attention of the new Secretary of State for Health even though that has already been done.
The local paper, the South London Press, has led a very good campaign on this issue, and has really got people in south London to see mental health issues as central to the problems that many of my constituents and other Members in south London face. Each week now in the South London Press we read of people who have been treated very badly indeed, and we read of the bureaucracy that is involved in that change. And yet £6 million was going to be spent, although it has not been spent yet, to move a service that nobody wanted moved. I still do not understand the reasoning behind that.
I am delighted that my right hon. Friend the Prime Minister has made three changes in the last week or two, and all of them are on issues on which I voted against my own Government—on the questions of cannabis, casinos and 24-hour licensing. I am hopeful that, over the next few weeks and perhaps by the time that we come back in the autumn, there will be more changes on policies on which I was against the Government and on which they have now seen the error of their ways. I hope that the new Secretary of State will look again at the issue that I have raised, because it is not too late to change.
I also wish to draw to the House’s attention the way in which the ballots for arm’s length management organisations are carried out and I hope that the Deputy Leader of the House will refer it to whichever Minister is responsible for monitoring the conduct of those ballots. There has recently been a ballot in Lambeth for an ALMO and I was ashamed by the way that my borough handled it. The ballot form was biased and set out in a way that was clearly one-sided. Something like £400,000 was spent on glossy brochures, DVDs and all sorts of other things that were sent to tenants, and they amounted to propaganda as to why the tenants should have their housing put out to an ALMO. Despite all that, there were questions such as
“Are you aware that the ALMO could attract over £200 million of additional investment to make homes decent in Lambeth?
Yes No Don’t know
Are you aware that with the ALMO for Lambeth you will remain tenants and leaseholders of the Council?
Yes No Don’t know”.
The whole ballot form was not in any way a fair way to ask tenants’ opinions, especially after the expenditure of £300,000.
Ironically, of the 30,986 council housing tenants and residents who had the right to vote, the total number of valid votes cast was 8,278. Of that, the number voting yes was 3,518, the number voting no was 3,362 and the number voting “don’t know” was 1,398. The council leadership portrayed that as a great victory for the ALMO and claimed that it had received the support of 52 per cent. of the tenants voting. However, when we add the figures up, we see that a minority of the people voting voted for an ALMO. I ask the Deputy of Leader of the House to make sure that the Minister responsible is made aware of that.
Although we need extra resources to improve the homes in my borough, setting up a bureaucratic way of proceeding is not what residents and tenants want. I hope that Ministers will study that carefully and realise that Lambeth council would have done much better to spend its money and resources on improving the repair system and the whole system for the management of housing rather than on paying overtime to extra staff to knock on doors so many times that the residents told them to go away and locked their doors. Lambeth might then have had the chance to become a two-star housing authority, which it is not.
Instead of Lambeth council wasting money, it could have campaigned for the fourth option of direct investment in local authority housing. That is needed and I hope that my right hon. Friend the Prime Minister is moving towards greater support for council housing. I am fed up with the terms “affordable housing” and “social housing”. Let us get back to using the term “council housing”, because that is what people mean when they talk about improving some of the housing. It does not mean that other types of housing cannot be built, but people know what council housing means and that is what we want.
The House should not adjourn until it has debated another issue. For 150 years, we had a wonderful universal postal service that was carried out by the Royal Mail. It was the envy of the world, with low, uniform stamp prices and six-day deliveries. I believe that the rapid introduction of full liberalisation in January 2006—well ahead of all other European countries—has created an unlevel competitive playing field for the Royal Mail that is now threatening its commercial viability and the future of the universal service. Postcomm has not carried out its duty very well in allowing foreign competitors to enter the UK market while denying the same opportunity for Royal Mail to compete in Europe. As the Communication Workers Union predicted, competition has amounted to cherry picking and to allowing the private competitors to cream off the Royal Mail’s most profitable bulk mail business. Real competition has proved a myth, with no other competitor being prepared to develop a national collection and do all the things that we are so used to with Royal Mail.
Those who run Royal Mail, Mr. Leighton and—I’ve forgotten his name, but I do know him. [ Interruption. ] Mr. Crozier. They have got themselves into a situation where they are refusing to negotiate properly with the Communication Workers Union. I have a long association with the Communications Workers Union, dating back to when it was the old Union of Communication Workers, and I know that the people who work for the Post Office do not want to strike. However, the Royal Mail has handled the situation appallingly. It goes on about huge salary increases for its workers, who actually earn a small amount, while people such as Crozier award themselves huge amounts of extra money every year. Over the summer, the Government need to get involved, address the issue, and knock some heads together at Royal Mail.
There are two final issues that I would like to mention. I know that my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart) will probably have more to say about one of them. It is quite wrong that we are going off for the long recess without having
a proper debate on the need for a referendum on the European Union constitution. For me, it is still a constitution. It is disgraceful that, unless it has been produced today, we still have not seen an English edition of the so-called constitutional treaty. It is quite clear that the vast majority of the original 250 proposals in that constitution are there in black and white as they were before. A very strong commitment was given in the manifesto that I stood on that we would have a referendum on that constitution, and we need a referendum. The demands for that will grow over the summer. Before we come back in the autumn, I hope that my right hon. Friend the Prime Minister will change his mind on that, as we changed our minds on the original referendum—unfortunately, we were not able to have that referendum because other countries voted against the constitution.
Finally, a lot of my constituents will be travelling this summer. They will be flying off and using the airports. I want to put in a word for some kind of reality check on the question of terrorism and the various measures that have been introduced. I am absolutely certain that one of the things that the terrorists want to do is to change our way of life and to change the basic idea in this country that we do things within the law and we do not change our behaviour too much. I am afraid that, as a constant traveller—quite often I go back and forward to Northern Ireland, where there is no alternative but to fly—I have noticed the attitude and the way in which people handle the security process. Quite honestly, if anyone wanted to do something, they would simply do it around the long queues at check-in and security.
The Government have to allow a more common-sense approach to hand luggage. I had a tiny bottle of blackberry jam, which my mother made, taken off me because it was slightly bigger than the size of blackberry jam bottle that I would have been allowed to carry. There is no common sense in the attitude to the kind of measures that are being taken. Unless we take people with us on the measures, people will react. Although everyone wants to see normal security carried out, they do not want to see more and more people acting as if they just quite enjoy having a little bit of power over ordinary people. I hope that, over the summer, Transport Ministers do not react too much to suggestions that there should be even tighter security. We should take a common sense approach and recognise that the answer to terrorism does not lie in just making the lives of everybody in this country more difficult.
I am sure that many other Members want to speak. May I wish you, Mr. Deputy Speaker, and all the staff a good long recess? We London MPs do not disappear off; we are usually seen wandering around the House of Commons where lots of work is going on, because we do not go off unless we are actually on holiday.
2.55 pm
Mr. John Horam (Orpington) (Con): I congratulate the hon. Member for Vauxhall (Kate Hoey) on a common-sense speech. We all admire her independent spirit, and I hope that she gets her way on a referendum, as she has done on other matters, such as casinos, now that the new Prime Minister has taken over.
I should like to raise a subject that will be of interest to the hon. Lady and the hon. Member for North Southwark and Bermondsey (Simon Hughes), who spoke earlier, namely health care in south London. More particularly, I want to discuss the disturbing financial situation of the Bromley Hospitals NHS Trust. The trust has two hospitals: the Princess Royal University hospital in Farnborough, and a smaller hospital—a community hospital in effect—the Orpington hospital. The PRU, as it is known locally, is a brand-new private finance initiative hospital that opened four years ago. It was financed by land sales and a PFI scheme.
When the PRU was built, part of the original plan was that the Orpington hospital would be closed down, despite it being a community hospital, and its buildings would be used to house the trust’s accounts department. With the help of a magnificent, formidable group of ladies in my constituency, who run an organisation called the Community Care Protection Group, I petitioned against the change, under the slogan “beds before bookkeepers”, and managed to save Orpington hospital, which is one of my greatest triumphs as a Member of Parliament. I give the Government great credit for the fact that the Secretary of State for Business, Enterprise and something else—[Hon. Members: “Regulatory Reform.”]—yes, reducing regulation or something, opened a new treatment centre four years ago, on which the Government spent £8 million of taxpayers’ money. I therefore have a brand-new PFI hospital and a community hospital, both of which are four years old, so we have excellent new facilities in my constituency, and I give the Government credit for that.
All seemed to be going well, even over the past year, although, as we know, there is a £500 million deficit in the NHS countrywide, and 20,000 nurses and others have been laid off. There are difficulties across the country, but the fact is that in Bromley patients were very satisfied with the new facilities. The staff morale was good, and the nurses and clinicians do a terrific job. High recommendations came from the Government. The possibility of foundation status was mooted and worked towards. More and more stars were allocated, and all seemed to be going well. It was recognised that the financial situation was perhaps a little challenging, but it was understood that the operating deficit was under control, and would be eliminated this year.
Imagine our horror when the new management of the trust revealed, in the past two months, that there was in fact an £87 million deficit, and that the financial situation demanded a cut of £20 million in the current financial year. That has staggered everybody in the local community, as the Deputy Leader of the House can well imagine. I have been trying to find out the exact reason for that abrupt volte-face, and as far as I can see, it is first down to a very bad PFI deal. I have looked at the appendices attached to “A Picture of Health”—it always amazes me that the Government have jolly little titles to conceal very uncomfortable facts—and it says that the occupation costs of the PRU are very high; indeed, they are double what they would be under conventional public-sector financing. They
are so high that they are worse than those for most other PFI hospitals, and I understand that that is because it was an early PFI scheme, so the hospital got a worse deal than some others did.
In the circumstances, one would expect a refinancing of the debt. Indeed, that took place when the construction was completed, but it has finished, and the downside of the refinancing is that the debt arrangements will remain the same for the next 35 years. There can be no further change in the debt arrangements. The banks and so on that picked up the debt get their interest, uprated for the retail prices index every year, and there is no risk transfer whatever. Now that the hospital is in financial trouble, there is no possibility of them taking up some of the slack. They get their money anyway. It is astonishing that there has been no risk transfer in the whole of the PFI operation, as there has not been in many others.
Bonds were used in the refinancing and because the bond-holders are difficult to locate, there can be no leasing out of the facilities, which would otherwise be a possibility in such a situation. The financial position is bad and it gets worse. Recognising the difficulties brought about by the hospital financing situation, the Government gave Bromley Hospitals NHS Trust an annual sum of £6 million to cover the difficulties. That has been abruptly withdrawn, and we do not know why.
Will the Minister ask her colleagues in the Department of Health why that substantial sum—£6 million out of an operating deficit of possibly £20 million—has been abruptly withdrawn with no explanation? The hospital management, to whom I spoke last week, does not know why and is trying to find out. I do not know. I hope the Government know why that extraordinary action was taken.
The Government have put in place a new tariff system for the recovery of health costs throughout the country. That is based on average cost. The problem is that Bromley NHS trust has above average costs. It is therefore providing many items and carrying out many clinical jobs at a loss, thereby contributing to its operating deficit.
As a consequence of all this, the Government have looked at all these matters in south-east London as a whole on a cash basis and are no longer prepared to consider the sort of financial devices that carried hospital trusts in that situation from one year to another. They will no longer contemplate that, presumably because they are running out of money to finance the NHS, as a result of all the bungles that have occurred over doctors’ salaries, IT, the legacy of extra bureaucracy and so forth. There is an acute financial crisis.
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