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The statistics I gave are not in dispute, but in various parts of the country accident and emergency attendances put huge pressures on the staffing resources of hospitals. At West Suffolk Hospital NHS Trust, A and E attendances
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have soared by 34 per cent. since 2001-02, at the very time when there have been staffing cuts at the hospitals and a reduction in the number of beds.

There has already been an allusion to the recruitment of doctors. It is a growing problem in Suffolk, so I welcome the Government’s announcement today that they are attempting to preserve health service jobs for British graduates. However, budgetary constraints are another reason why junior doctors struggle to find employment; GP practices are unable to fund extra posts. I have had many conversations about that point with GPs in my constituency.

I am constantly told by constituents and people who work in our hospitals that rather than cuts we desperately need more doctors and nurses in the local NHS, reversing the pattern of the past few years, yet instead the number of NHS managers is increasing three times as fast as the number of nurses. Between 2005 and 2006, twice as many nursing jobs were lost as managerial jobs. In the east of England, there has been a 4.9 per cent. increase since 1997 in the number of manager and senior manager positions—from 2,027 to 3,126—yet there has been only a 2.8 per cent. increase in the number of nurses, from 29,424 to 37,377.

Ann Keen: It is important to get the facts right. Our training levels for doctors have never been higher. The recruitment and retention rates for junior doctors, and for GPs in particular, have never been higher. It was right that we looked at their contracts some time ago, which has helped considerably in recruitment and retention, but I do not recognise the claim that there is a shortage. There are areas with inequalities and it may be more difficult to recruit GPs to them, but training in our medical schools, in particular for GPs, has never been at a higher level.

Mr. Spring: I agree that the level of training for doctors is of high quality, but over the last few years, because of the appalling mismatch between the training and production of junior doctors and the lack of opportunities, many of them have been unable to find jobs, so they have emigrated. I am pleased about the Government’s announcement, but I hope the Minister will not resile from the fact that over the last few years the morale of junior doctors has been severely tested by considerable confusion on the part of the Government, the results of which are clear to see.

Mr. Bone: My hon. Friend is making a powerful speech. Does he agree that one of the problems is not the number of doctors trained but the number of vacancies? In some cases, up to 20 qualified doctors apply for one post; on average three times as many people apply as there are posts.

Mr. Spring: My hon. Friend is entirely correct. In close memory, we saw junior doctors walking through the streets of London in protest against what had happened—an unprecedented situation in the history of the NHS.

Management costs in the Suffolk primary care trust increased by 22 per cent. in the last financial year. Amazingly, there are now more people managing and organising the NHS than there are beds. I hope that some justification can be given for the astonishing
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payments to officials in our strategic health authorities, where massive salaries are paid. My dealings with the East of England SHA have not inspired me with confidence that the organisation is on top of the role it is meant to play.

Mr. Baron: We all accept that there is a role for good management in any organisation, including the NHS. Does my hon. Friend feel that sometimes when we talk about bureaucracy the Government misrepresent the argument to make it seem as though we are attacking management, whereas in effect we are saying that there is room for good management but we must look at the costs of bureaucracy in the NHS for the benefit of all patients and staff?

Mr. Spring: I entirely agree. Of course, good management is important but I do not think my hon. Friend will disagree that the extent and volume of management, especially in our SHAs, has not been particularly productive and is extremely expensive. Considering the ever-greater pressures on the NHS, because of demographic and other factors, there is a mismatch, which is exactly the point he was making.

At West Suffolk hospital, there has been an increase of 184 per cent. over the past six years in the amount spent on salaries and wages for managers and senior managers. There has also been an 82 per cent. increase in the amount spent on salaries and wages for administrative and clerical staff. The figure has nearly doubled, yet there has been only a 73 per cent. increase in the amount spent on salaries and wages for nursing, midwifery and health visiting staff—from £16.6 million to £28.7 million.

The Prime Minister’s own independent reviewer of NHS finances, Sir Derek Wanless, said that little benefit has been gained from the huge pay deals that were a consequence of “Agenda for Change”. The Select Committee on Health criticised the Government’s poor financial planning:

Last year, while nearly £1.5 million was paid in bonuses to 231 “senior” civil servants in the Department of Health, a county such as Suffolk struggled to cope with an unfair funding allocation and considerable debts.

Like many other parts of the country, Suffolk has an ageing population. The number of people aged 65 or over has increased by 11 per cent. since 1997; 19 per cent. of the population of Suffolk are now aged 65 or over. Furthermore, much of my constituency is rural, which adds to the problems. That lies at the heart of the NHS funding problem.

Our local NHS struggles to match the needs and demographics of the local population. The Minister talked about inequalities, so I shall address that point firmly. For 2007-08, the per capita spend on the NHS was £1,156 in my constituency, well below the national average of £1,388. However, in the Prime Minister’s constituency in Scotland, which does not experience the health crises that people have to put up with in a constituency such as mine, the per capita health spend was £2,019, almost double the amount in Suffolk, so the service cuts and huge debts in Suffolk have not happened in his constituency.


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Sir Nicholas Winterton: My hon. Friend is making a most interesting speech. I am most impressed by his statistics. Has he any statistics about the problems relating to mental health, where the shortage of professionally qualified staff is creating problems for GPs?

Mr. Spring: My hon. Friend has always made an enormous contribution in the House on health matters, in which he takes a close interest. His question is about what is commonly described as the poor relation of the health services. I do not have specific statistics about the problem, but I am sure that he agrees that one of the tragedies in how mental health has been handled, from a financial and back-up point of view, is that many individuals who are tragically caught up in the vortex of mental ill health land up in the criminal justice system, where they remain for good. Nothing is more tragic in personal terms; it is also very destructive for society as a whole.

I welcome the 5.5 per cent. increase that all PCTs are receiving in 2008-09, but it does not sufficiently address the problem that I have outlined. I have met officials at the Department of Health on several occasions to discuss the funding given to Suffolk, and have spent a great deal of time examining the funding formula that distributes funding to PCTs. The strategic health authority has accepted that we get a particularly raw deal. Rural areas such as Suffolk—many of my hon. Friends will be in exactly the same position—have been adversely impacted by a funding formula that discriminates against them.

I raised the issue at a meeting with a former Secretary of State for Health, and she agreed that if the NHS structures in Suffolk and elsewhere were in financial balance by last spring, she would re-examine the problem of rurality as part of the NHS funding formula. I hope that the reason why the advisory committee on resource allocation has requested more time to finalise its review of the resource allocation formula is that it is seriously examining the rurality factor. I eagerly await the report, which we hope will finally be published this summer. I hope that the revenue allocation in my area will be considerably greater. The impact of the cuts on staffing is just one manifestation of the negative effect that the skewed funding formula has had in Suffolk and other more rural parts of the country.

At the level at which most people have contact with the NHS, I fear that we are seeing a similar discriminatory effect. Haverhill, which is the largest town in my constituency, is being affected by the operation of the Carr-Hill formula, especially through its effect on the weighted list size of each practice. That has caused considerable distress to my constituents. I touched on the national funding formula and the fact that it has thrown up various anomalies over the years. Now we have an anomalous situation closer to home.

For most people, contact with the NHS is most frequently made through their local GP surgery. A general practitioner is invariably the first port of call for people seeking help and GPs are hugely trusted in the local community. Yet the application of the centrally determined Carr-Hill formula has resulted in the town in my constituency which is the largest and most rapidly expanding in the whole county experiencing cuts of £280,000 for the local GP
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practices. That has meant that those practices will have to cut back, possibly remove staff, and make additional savings.

People read the huge headline rates of supposed increases in spending in the NHS and they hear about the increased commitment by the Government, but they cannot marry that up with the fact that they see cuts in the local hospitals, beds being removed, staff given the sack, and the GPs in the biggest town in my constituency up in arms because they are faced with substantial cuts—about £280,000. The community has come together in an unprecedented way. Petitions signed by more than 10,000 people have been delivered to No. 10 Downing street and to the House.

People cherish the NHS and want it to work. They cannot understand why such situations continuously arise. Having to deal with the consequences is hugely undermining for those who so loyally work in the NHS. I read Lord Darzi’s proposals with great interest. In the report published last autumn, he proposed that each PCT should have a new GP-led health centre. I am delighted that an initiative is under way in Suffolk that may bring one of those new walk-in centres that is open from 8 am to 8 pm to Haverhill in my constituency.

However, that does not offset the fact that one of the consequences of the budget cut in Haverhill, with its impact on staffing, is that some of the satellite surgeries that the GPs were able to operate in the villages surrounding the town will be cut, notably in the village of Kedington. People have got used to having a satellite surgery and they value it because public transport is limited. Because of staff pressures resulting from the cuts, the surgery there will be cut again. That undermines people’s confidence in the NHS. They keep asking where all the money has gone. Such is the outrage in the village, where the GPs are held in high regard, that we are holding a public meeting. I will do everything in my power to encourage the survival of the GP surgeries, because they are held in great esteem.

During the past 10 years the whole of the NHS has suffered badly, but in Suffolk it has been hit particularly hard. As the Minister said, the NHS marks its 60th anniversary this July. It was based on the founding principle of providing health care for all citizens and it is very much cherished, yet if the Minister has listened to what I said—I have tried to cite the statistics as accurately as possible—she will accept that people question whether that principle is still upheld. They do not understand what is happening.

Our hospitals are at bursting point. There is no question but that staff morale in the NHS is very low, we do not have enough beds, patients are being discharged too early—not for clinical reasons, but because of the target-driven culture—and the obsessive bureaucracy is impacting on the lives of our doctors and nurses. When patients go into hospital, there is the danger, as a consequence of superbugs, that they will leave in worse health than when they were admitted. There is the prospect that some of my constituents will be without a local GP surgery. As the elderly population grows, the situation will become worse.

In conclusion, yes, there has been an increase in staffing overall, although recently that has not been the pattern locally. Yes, more money has gone into the NHS and technology has improved. But my
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constituents share the concerns of doctors, nurses, community nurses and ancillary workers about what is going on in the NHS. Despite all the good intentions that may exist, morale is probably at its lowest point in the history of the NHS. That is a terrible indictment of what the Government have done.

1.57 pm

Anne Milton (Guildford) (Con): I associate myself with the comments of my hon. Friend the Member for West Suffolk (Mr. Spring) about staff in the NHS and I, too, pay tribute to them. Seventy per cent. of NHS funding is spent on staffing, and the effectiveness of the NHS depends on that work force. The recruitment, training, professional development and morale of the work force are crucial to the effectiveness of our NHS.

There has been an absence of planning for and with staff to ensure that they can deliver the care and services that people need. My hon. Friend the Member for West Suffolk spoke about morale. The Health Committee report in 2007 stated that there has been a disastrous failure of work force planning. Although I always enjoy a history lesson on the inception of the NHS, I was disappointed that the Minister did not address work force planning, which is central to today’s debate.

What are our NHS staff doing? A survey of nurses last year found that 66 per cent.—two thirds—spent more than a third of their time on paperwork. Eighty-one per cent. said that less than half the forms were important for patient care. The nurse of the year last year said that some days she did not see a patient, and that was not good. She said that she was a nurse and she wanted to nurse—that was her profession. She cited “constant pressures with bureaucracy” as her primary reason for leaving.

What about the money? In 2006, the NHS paid out £192 million in severance and redundancy payments. We have heard about the scandal of the pay-offs that the chief executive of Maidstone and Tunbridge Wells NHS Trust might receive. The Health Committee mentioned the huge growth in funds, and nobody would doubt that the Government have made considerable investment in the NHS. The question is about what they have done with the money.

The Health Committee also talked about the demanding targets that are now set and the staff increases that far exceeded the NHS plan. The NHS was spending too much, and boom quickly turned to bust. The nurse of the year said:

Mr. David Evennett (Bexleyheath and Crayford) (Con): My hon. Friend is making an excellent speech; we are listening with great interest. Is she aware that in my area, the accident and emergency units and maternity
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units are threatened with closure? That is disillusioning staff—hard-working nurses and midwives. They fear that the closures are due to financial pressures, not clinical need.

Anne Milton: My hon. Friend makes an excellent point —[Interruption.] The Minister is smiling, but she would be wise not to. The problem is that the Government have put huge resources into the NHS—more than three times as much in 10 years. However, what is happening to that money? The Health Committee stated:

It went on to say that there is

In other words, the Government have not made NHS staff—70 per cent. of what the money is spent on—a priority.

Ann Keen: Where is the evidence that the NHS does not make work force planning a priority? I chair a group under the Lord Darzi review—the first ever that involves all aspects of health care workers and those from the voluntary sector. Does the hon. Lady accept that that is good practice?

Anne Milton: I accept that the report from which I was quoting was produced by a Committee with a dominance of Labour Back Benchers, and was chaired by a Labour Member. I am simply quoting a report that has come from the Minister’s own party’s Back Benches.

The Audit Commission is reviewing the SHAs’ work force planning but that is to be kept a secret. There is fury in the press about that. Reference has been made to NHS managers. It is not that we do not need managers; one of my hon. Friends made the very good point that the NHS is enormous and needs management. However, there has been a 73 per cent. increase in the number of managers since 1996 and only a 31 per cent. increase in clinical staff.

Ann Keen rose—

Anne Milton: I shall not give way because I am short of time and the clock is not stopping.


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