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Hon. Members asked about Sir Jim Roses review of the primary curriculum, which he began last week. That will have a strong focus on scientific understanding, as well as literacy, numeracy and the effective use of information and communication technology. We have to ensure that the enthusiasm of primary children, who are doing so well, survives the transition to the next stage of their journey through education to secondary
school. That is why the secondary national strategy is working with schools to promote high-quality interactive teaching, including imaginative use of practical work. At the moment, almost three quarters of pupils achieve level 5 at the end of key stage 3, and 41 per cent. achieve level 6. Those figures are much better than 10 years ago, but they are still not good enoughI am confident that the hon. Member for Basingstoke will agree.
Mrs. Miller: I should like to pick up on the point that the Minister made about the importance of imaginative practical work. The National Endowment for Science, Technology and the Arts has estimated that 87 per cent. of science teachers have been prevented from letting their students undertake practical work because they believe that health and safety regulations prohibit them from doing so. What work are the Government doing to help science teachers in this area, which is critical to the issue that the hon. Member for Bolton, South-East has raised?
Jim Knight: I was going to address that. To help smooth transition and keep the excitement in these subjects, from this September schools will start teaching the new key stage 3 curriculum to their year 7 pupils, which some of the hon. Ladys colleagues have been less than enthusiastic about. That will let the teachers engage the pupils by focusing more on the applications and implications of science and its relevance to and importance in everyday life. The new key stage 3 curriculum clearly says that there should be opportunities for pupils to experience science outside the school environment.
We agree that school trips are important. That is why we have developed the Learning Outside the Classroom manifesto to promote the value of trips and help overcome some of the associated obstacles, such as insurance and risk management. Equally, outside the timetable, 250 science and engineering after-school clubs are harnessing the interest and potential of thousands of 11 to 14-year-olds, bringing the real-world application of science into schools for them: how their iPod works or what chemistry is going on inside their brains when they fall in love. Perhaps they can do more of the science poetry that my hon. Friend the Member for Norwich, North mentioned. From September we will be doubling the number of these after-school clubs that we fund.
Results are improving at the next stage in the journey through school, at GCSE level. In 1997, 44 per cent. of pupils gained at least one higher-level GCSE in science; last year, the proportion had risen to 51 per cent. The statistics are similar for pupils taking two sciences, showing that when they do one well the chances are that they will do the other well. However, we want to go further.
We are offering a revitalised GCSE curriculum with more choices for students and more recognition for schools that offer quality science teaching. We have already slimmed down the secondary curriculum at key stage 4, giving teachers more flexibility to structure the lessons the way they choose. We have reduced prescription while maintaining breadth, depth and challenge, giving teachers the chance to concentrate on the big ideas and the excitement, importance and relevance of the subjectthe approach that captured those childrens interest when they started learning science in primary school.
My hon. Friend the Member for Bolton, South-East has seen in his constituency how enthusiastically the new curriculum is being received by pupils and teachers alike, and I hope that other hon. Members can see it in their own constituencies.
Beyond the changes in September 2007, we will go a step further in September this year, when all pupils who have achieved at least level 6 at key stage 3 will be entitled to study triple science GCSEs. I mention that in response to the question asked by the hon. Member for Basingstoke. That builds on what happened in September 2007, since which time all students have had a statutory entitlement to study science courses leading to at least two GCSEs.
From 2011, there will be a further option, from key stage 4, when the new science diplomas will offer another way to engage students in science and link them with employers and colleges. From this year, schools are getting specific recognition for good science provision, because we have added a new science indicator, for the first time, to this years attainment tables published last week. Parents can now see, for each school, the percentage of pupils with two or more higher-level science GCSEs.
As the study of science improves in numbers and quality up the school, I would expect more students to decide to carry on with science at A-level. Our Next step strategy, published in 2006, set out the targets, and in 2007 we saw a small rise to 23,932 in the number of A-level physics entries: the first increase since 1998. That is underpinned, equally, by expansions in the numbers doing physics at AS-level, and in the past few years there have been increases in the numbers of students doing chemistry. We are turning the corner in that regard.
One of the drivers of more students studying science at A-level and beyond will be the opportunities that are opened up in careers in science. We are working with schools, scientists and young people to let students see that science in the real world is well paid and works in various occupations. One day one of those occupations might be to follow the hon. Member for Bolton, South-East and be another passionate advocate for science in Parliament. We are increasing the number of ambassadors.
Mr. Crispin Blunt (Reigate) (Con): The principal institution in the Surrey and Sussex Healthcare NHS Trust is the East Surrey hospital in my constituency, hence the short title of this debate. It is a major NHS hospital, now serving some 450,000 people in Surrey and Sussex, which is more than three times the number it was designed to serve when it was built 20 years ago. Its location, which is adjacent to some of the busiest stretches of the motorway network, and particularly its proximity to Gatwick airport, with a daily transient population of 50,000, as well as a major incident risk, means that it serves far more than just the local population. It does so in one of the most pressured parts of the south-east, where providing public services on national frameworks has proved the most difficult. That is one of a combination of factors that has meant that the trust has accumulated a large deficit, and I understand that it is now the largest deficit in the country. The principal cause has been political, and I now seek a political solution.
Let me begin with the good news. The trusts management have reduced the underlying operational deficit from about £27 million in 2004-5 and 2005-6 to £12 million in 2006-7, and expect to break even this year. That is a remarkable achievement. The accumulated deficit is no longer increasing, but the events of the past have left the trust with a £56 million debt to the Department of Health. At a cost of £2.7 million a year in interest, that loan is a serious burden on the trust, but capital repayments of the same order are also required. That will hold back the trusts service provision, quite apart from removing any prospect of foundation status.
All that is set against a bleak assessment of patient care. The Healthcare Commissions most recent appraisal of the trust was that it was weak in quality of services and in use of resources. Given where it was coming from in terms of finance, that seems little short of ungrateful, but I hope that it will change significantly this year.
Mr. Peter Ainsworth (East Surrey) (Con): My hon. Friend has taken a close interest in the matter for many years. Will he join me in paying tribute to the doctors, nurses, medical staff and all who work at the hospital, who have done so in very difficult circumstances in recent years?
Mr. Blunt: I am extremely happy to do so. The medical staff have had to work in trying conditions, because the hospital has been in turnaround state for three years with the additional strains arising from that. I do not believe that that is the responsibility of the management, and far less of the doctors, nurses and important support staff who work there. I join my hon. Friend in paying tribute to them, and I should be grateful for his support, as I am to my hon. Friend the Member for Mole Valley (Sir Paul Beresford), whose constituents are also served by the East Surrey hospital.
During the three years of turnaround, the trust has had four chief executives, but now seems finally to be returning to annual financial balance. Happily, none of
the Ministers in the Department of Health was party to the critical decisions on the reorganisation of the trust. The unnaturally high turnover of senior management also means that those who are looking to remedy East Surrey hospital's financial situation cannot be blamed for the circumstances in which they now find themselves, although I am inclined to acquit previous managers due to the impossible situation in which they found themselves.
The background is that in 1998 the Surrey and Sussex Healthcare NHS Trust was formed principally at the behest of the royal colleges drive for medical training requirements for a catchment area of 250,000 from the merger of Crawley and Horsham NHS Trust with East Surrey Healthcare NHS Trust.
Sir Paul Beresford (Mole Valley) (Con): My hon. Friend mentioned a number of constituencies, so this is probably the moment to emphasise to the Minister that a considerable number of constituencies, including my own, look to that trust. A number of hospitals serve my constituency, and two are under financial threat.
Mr. Blunt: I am grateful to my hon. Friend, whose intervention refers to my previous comment that the provision of public services in Surrey has proved to be an enormous challenge under the financial settlement that all the institutions in the county have received.
On reflection, the merger between Crawley and Horsham NHS Trust and the East Surrey Healthcare NHS Trust was not a marriage made in heaven. As in many such mergers, reorganisation was required to provide the best services throughout the new trust's two district hospital sites and its other sites, but the principal sites were at Crawley and in east Surrey south of Redhill. The trusts proposals for reorganisation were broadly supported by all local MPs.
The plan presented to Ministers in 1999 was that acute services, including major accident and emergency services and in-patient maternity services, should be co-located at the newer and less constrained East Surrey hospital. The plans were presented to the Department in 1999, but it took a year for approval to be given in June 2000 by the then Minister, the hon. Member for Birmingham, Edgbaston (Ms Stuart). Ministers dictated that a review was to be established to produce recommendations on the long-term provision of secondary health care, including the prospect of a new hospital on another site at Pease Pottage, just outside Crawley, after 2020. That review was to be chaired by Peter Bagnall, and whatever its health merits, its overt political purpose was to address concerns in Crawley about the loss of the local accident and emergency department.
Those conclusions would have meant the transfer of acute services from Crawley to East Surrey hospital. The closing of Crawley hospital's accident and emergency department would inevitably have been unpopular, but the professional consensus was that those changes were necessary, and I recall that the hon. Member for Crawley (Laura Moffatt) was part of the consensus. However, the local papers in Crawley were not convinced and ran a strong campaign against Crawley hospital losing its acute services. In response, Ministers altered the terms of reference of Peter Bagnalls review of future hospital services to consider changes to be made by 2010, holding out the prospect of a new hospital 10 years earlier than previously planned. That was still not enough to placate the residents of Crawley.
The hon. Member for Crawley lobbied the then Secretary of State, the right hon. Member for Darlington (Mr. Milburn), to postpone the transfer of services away from Crawley before the 2001 election. Meetings were held and a delegation taken to meet the Secretary of State for Health from which I and other local MPs were excluded. With weeks to go before the likely election in May 2001, which was later postponed to June 2001, the Secretary of State declared a moratorium on the clinical reconfiguration in March. That was despite that clinical configuration having commenced and maternity services having been moved. Paediatrics, ENT and gynaecology, all of which are associated with maternity, were left with twin-site working.
The political nature of the decision was made explicit in a letter dated 28 February from Sir William Wells, who was then chairman of the south-east regional office of the NHS, to the Secretary of State. He said:
Although in practice there is little direct connection between the outcome of the Review and the need to move emergency services, in the short term this is not understood by the general public and in particular by Laura Moffatt's constituents and as a consequence she has asked whether there could be some moratorium on service moves until such time as the outcome of the review is known.
Laura Moffatt has agreed with the Secretary of State that, except on patient safety grounds, no further service reductions will take place at Crawley until the South East Surrey and North West Sussex Review is published in December 2001.
It is indeed a novel departure for a Back-Bench MP and a Secretary of State to thrash out health policy, which will affect hundreds of thousands of people, in the interest of one constituency. I was not consulted, nor was I offered a meeting with Sir William Wells, despite the site of one of the two hospitals concerned being in my constituency; nor were my hon. Friends the Members for East Surrey (Mr. Ainsworth) and for Mole Valley and those with constituencies in the wider area, including my right hon. Friend the Member for Horsham (Mr. Maude), invited to agree the postponement with the Secretary of State. Let us not fool ourselves. We all know what was going on in the run-up to the 2001 general election. However, even if we accept that Ministers were entitled to make that decision to address local public concerns, it was a ministerial intervention.
The Bagnall review was finally published in 2002 and turned out to be an expensive diversion. Its initial political purpose was to hold open the prospect of a new hospital, but it was then used as a pretext to delay the closure of Crawleys acute services. The continuation of twin-site working from 2001 came at an appalling cost both financially and in patient care. It cost the trust an estimated £10 million a year. That was not rectified until the end of 2004 or, arguably, September 2006 when Crawley hospital was finally taken off the books of the local hospital trust. The Secretary of States intervention cost some £40 millionor 1,600 heart transplants, 1,000 liver transplants or 50,000 cataract operationswhich was a substantial majority of the deficit accumulated by the trust. Documents obtained through the Freedom of Information Act 2000 show that the trust believed that clinical safety would be imperilled by that suspension. I am very cautious about making specific links between cases and the moratorium, but coincidentally mortality rates in the borough of Reigate and Banstead rose during the suspension while they fell in Surrey as a whole.
Peter Bagnalls team considered six options and, after an exhaustive process, recommended a new hospital at Pease Pottage. Bagnalls recommendation came with capital cost of £278 million and an annual additional revenue requirement of £42.9 million. His second choice, which was effectively the proposals put to ministers in 1999, envisaged a rise in the running costs of £24.5 million and a capital cost of £105 million. The strategic health authorities were then established by the Government and they immediately instructed health economists to review the Bagnall recommendations. In 2003, the recommendations were confirmed as unaffordable. The trust continued with the burden of a district general hospital that it did not want or need. In 2006, Crawley hospital was transferred to the local primary care trust.
Finally, the board was in a position to do what it had wanted to do all along, which was to operate with one district general hospital. Robin Eve, an excellent non-executive director at the time, has made that clear in public. However, the board was prevented from managing the trust as it wished by the politics of Crawley and ministerial decisions.
Today, we have arrived at Peter Bagnalls option 2, namely single site operation at East Surrey. That was the cheapest option in revenue terms, but it still required, on Bagnalls analysis, an enhancement of £21.5 million in revenue and a capital enhancement of £117 million by 2010. As far as I am aware, that capital expenditure has not been made despite it being the product of Bagnalls detailed review.
Let me return to the management of the hospital after the imposition of the moratorium in 2001. The financial position deteriorated over the next four years until 2005 when the trust was in the worst financial position in the country. The management had undoubtedly been demoralised by the intervention in 2001, but it had the benefit of a talented and experienced chief executive, Ken Cunningham, who had been hand-picked to replace Isabel Gowan, who had herself been removed in 2000 when her accounting to meet Government performance targets had been rather too creative. The Minister will recall that in this period of the management of the health service, deficits were an increasing problem as managers tried to balance the imperative of meeting their performance targets with sustaining a balanced budget. The costs of providing public services in the south-east are well documented and those pressures, overlaid with this ministerial decision, made the trust impossible to manage, and led to the deficit running out of control.
In February 2005, Ken Cunningham and his board agreed to leave, and Robin Eve had to be dismissed. They were replaced by an interim administration from the private sector under Anthony McKeever. His successor, Gary Walker from the private sector, was still dealing with a £20-million-a-year deficit in January 2006, and it had become clear that it was not reasonable to expect the hospital to resolve this deficit alone. That position was shared by his successor, Gail Wannell, who took over in August of that year. By October, the principle cause of the deficit had been removed, as Crawley hospital was placed in the hands of Crawley PCT.
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