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Westminster Hall

Tuesday 15 December 2009

[Mr. Peter Atkinson in the Chair]

Health Care (Buckinghamshire)

Motion made, and Question proposed, That the sitting be now adjourned.-(Mr. Watts.)

9.30 am

Mrs. Cheryl Gillan (Chesham and Amersham) (Con): May I say what a pleasure it is to serve under your chairmanship, Mr. Atkinson? I am grateful to have the opportunity to raise concerns about health services in Buckinghamshire, particularly in Chesham and Amersham.

When I applied for the debate, I did so not only in the interests of my constituents, but on behalf of my colleagues who are sitting here with me. I was the lead name for the debate, but I applied for it on behalf of my hon. Friends the Members for Aylesbury (Mr. Lidington) and for Wycombe (Mr. Goodman), and of my hon. and learned Friend the Member for Beaconsfield (Mr. Grieve). Unusually, I will also make some remarks on behalf of the right hon. Member for Buckingham (John Bercow) who, as you know, Mr. Atkinson, presides over the House and is unable to participate in such debates. Nevertheless, he feels just as passionately as we do about health services in Buckinghamshire and, with your permission, Mr. Atkinson, I have some speaking notes that I intend to deploy on his behalf.

I welcome the Minister and my hon. Friend the Member for Guildford (Anne Milton), who speaks on health matters for the Conservatives, to the Chamber. I am delighted to see the Minister, because we did some sterling work together during the course of this Parliament on the Autism Act 2009. When that provision was just a raw Bill, the Government, in the shape of the Minister and his colleagues, chose to oppose it. However, with persuasion and after winning the vote on Second Reading, the Minister and his colleagues saw the light.

We were able to exhibit-and I say this in a spirit of generosity to all the other parties-the House at its best and put an Act in place. I give notice to the Minister that in the interests of my constituents in Buckinghamshire I shall be holding his feet to the fire. I am looking forward to a wide and thorough consultation on the Autism Act, which will be part of our health care service. I hope that the Minister will bring the enlightenment that he eventually brought to the debate on the services provided to people with autism to this debate, which covers the wider health care services in Buckinghamshire.

After more than a decade with Labour in power, it is fair to say that the NHS in Buckinghamshire is facing a crisis. We have called this debate to find out just what the Minister and the Government are going to do about that. There is no time for warm words; the stark reality is that the health service in Buckinghamshire is fast approaching breaking point.

Buckinghamshire has one of the lowest-funded NHS systems in the country: it receives some 17 per cent. less per head than the UK average. Last year, we had the only primary care trust with a deficit of some £7.5 million.
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Although we have relatively good health, we have only average care-those are not my words; they are the words of health care management professionals. Are we 17 per cent less in need or 17 per cent. healthier than other areas? I think not. Sadly, we have poor dental access and poor ambulance times, because of the size of the county. We also have a higher number of delayed hospital transfers and an ageing population. All our constituents are living longer, so the disparity between the formula that is adopted and the outcomes is starting to widen and become greater. I believe that my colleagues may allude to that matter in more detail.

The financial situation is becoming dire. I believe that the Buckinghamshire Hospitals NHS Trust must find an efficiency saving of 3 per cent. annually, which is some £11.5 million. In addition, the PCT is now paying the hospitals trust at 25 per cent. of the tariff for the rest of the year for over-performance against most in-patient and follow-up out-patient work, which adds another £5.2 million of income loss and takes the total savings that have to be found to about £17 million by the end of March.

In fact, in Buckinghamshire, we are unable to fund the care records service, which amounts to some £2.4 million, or Maternity Matters, which is about £700,000. Our health service leaders have had to pull together a summit plan-in other words, an emergency plan. Given the hospitals trust's financial position and the PCT's structural deficit, more than £20 million has to be taken out of the health service in Buckinghamshire between now and the end of the financial year.

Remedial action has been taken to try to plug that gap. Attempts are being made to curb our urgent care demand, and our health service is aiming to make 100 fewer admissions a week and reduce the number of accident and emergency attendees by 30 per cent. I must tell the Minister that, after my last meeting with the hospitals trust, there is no indication that there have been any major shifts in that pattern at all, which means that the projected cost savings will not be made. We are also trying to reduce our GP referrals to hospital by 50 a day.

Our GPs and other NHS staff are working like Trojans to see more patients, as well as offering community services and trying to reduce the elective and out-patient demand. They are trying to balance the books, but they are doing so against almost impossible odds. We are trying to move from one model of care to another far too rapidly, which is causing big problems. One could consider the scarcity of funds to be a positive challenge-indeed, many people who work in health service do, because they regard the glass as half full, not half empty. In the long term, we all want better care closer to home, and we want people to receive the right treatment at the right time. I believe that the administrators who head up our services are doing the very best that they can to deliver them. However, what we are experiencing on the ground is the alarming effect of a pace of change that is almost impossible to achieve. Buckinghamshire will be the first area virtually to tip over, not least because of the historical financial deficit.

Clinics at Amersham hospital have been dramatically reduced, with many moving to Wycombe or Stoke Mandeville. That causes great difficulties for people who travel to get treatment. I can honestly say that
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some of the letters I have received are absolutely heart-breaking. Many of my elderly constituents find the journeys and the confusion of the changes almost impossible to deal with. Overall, more than 60 per cent. of the clinics can be maintained, but that means that there is a 40 per cent. reduction, which is an enormous drop by anyone's standards.

The PCT has given notice to providers of primary counselling services that their services will end early next year, which, when combined with other cuts to Mind centres and the managed services, means most of the counselling services in Buckinghamshire will be removed in the very near future. Our ambulance services, which do a fantastic job, do not operate on a level playing field. The per capita allocation of NHS funds reduces payments to the so-called affluent areas, such as ours. However, the cost per capita of providing ambulance services is much higher than in urban areas, which puts even more pressure on the service in Buckinghamshire.

With our services operating under such pressure, I am concerned about what will happen if we are hit by a flu epidemic and a harsh winter. Our senior managers have a mandatory duty to break even and deliver on budget, but they are not going to do so if it means jeopardising patient safety. There is a real possibility of a major problem if we are hit by a flu epidemic. I have been told by our senior personnel that the board of Buckinghamshire Hospitals NHS Trust takes seriously its responsibility for the stewardship of our finances, which ultimately are funded by the taxpayer, but that its commitment to patient safety and the quality of services is its top priority. That means, in my language, that our health care professionals-they cannot say this, but I can-will put people before their budgets and their careers, and that is true dedication. However, the years of unfair funding for Buckinghamshire are now coming home to roost. If there is a crisis this winter, what will the Minster do to help to deliver health services in Buckinghamshire, which are stretched to breaking point, to our constituents?

I understand that we in Buckinghamshire are not alone in feeling the effects of the unfair funding and that similar effects are being felt in Hertfordshire, Berkshire, Hampshire and, indeed, Oxfordshire. Perhaps the Minister would confirm that many of those areas are approaching a financial crisis. I believe that the financial crisis is felt right across our area, and I am certainly not convinced that the advent of the South Central strategic health authority, which was formed on 1 July 2006, has helped. The fact that that authority has had not one, but three chief executives in that time has hindered, rather than helped the situation-it brings a whole new meaning to the word "continuity". However, I understand that that strategic health authority has reserve funds squirreled away, so perhaps the Minister would tell us the extent of those funds, which I understand could run to £30 million-plus, and how we can access them to alleviate the problems faced by my constituents and others across the county.

As I said at the beginning of my speech, I would like to make a few points on behalf of the right hon. Member for Buckingham, who has some specific concerns about his constituency. He has been contacted by several constituents concerned about the threat to mental health services and by people who are worried that the range
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of services might be reduced as a result of the planned review. He believes that the PCT might be planning to invest solely in cognitive behaviour therapy and wants reassurance that other forms of therapy will be recognised and receive investment.

The right hon. Member for Buckingham is also concerned about Buckingham community hospital, where doctors and patients are worried about the new contract and are concerned that the reduction in the number of hours of care would be detrimental to the hospital. That has already caused the transfer to Milton Keynes of patients who would have been treated in Buckingham community hospital. I understand that there is much anger about the downgrading of the community hospital among his constituents, and fears among the staff, who feel that the new arrangements are worse. Under previous arrangements, GPs could continue to visit their patients, but that is no longer the case. It is essential that the need for budget cuts does not result in a second-class service for the residents of Buckingham and the surrounding area.

Although unable to speak on the matter, the right hon. Member for Buckingham is no less concerned than my colleagues, who will speak in this debate, and me about the resources available for providing proper health care through the NHS to our constituents. I am sure that his comments would mirror some of my earlier remarks. I am particularly worried about the effect on NHS staff in Buckinghamshire. I have had talks, as have my colleagues, with the chief executive of the hospital trust and I know that it will try to reduce any redundancies to the absolute minimum. However, it has had to establish employee assistance and a redeployment bureau. Consultations with affected staff, although under way, mean that many of our dedicated personnel in the health service now fear for their jobs as we approach the Christmas season.

I therefore ask the Minister not to put on the rose-tinted glasses of office when he responds, but to realise that with our existing structural budget deficit, the need for productivity improvement, the financial downturn and the fact that Buckinghamshire received 17 per cent. less funding than the national average, we have an ever-increasing problem that will not go away. To deliver in this financial year and just break even, the cost improvement programmes equate to stripping out about £35 million in total. That would be asking a lot of any health service in any part of the county, but it is especially true in our area, where the demand is so high.

What is particularly worrying is that the problem will be exacerbated in future. With a forecast increase of only 5.1 per cent. next year and little or no increase in the budgets thereafter, there will be reductions in funding in real terms, which will mean real cuts to our health service that cannot be concealed or dressed up by fancy words. They will come as a result of the actions that have been taken by the Government in power at the moment. Will the Minister tell me how he can help us in this financial year, how he will ensure that people in Buckinghamshire continue to receive a high-quality, safe and accessible health service and how it will be sustainable in future years? I am sure that he would not want his legacy in government to be the fact that people in Buckinghamshire do not get a decent national health service. I hope he can rise to the challenge and will not produce the usual official script.

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9.46 am

Mr. David Lidington (Aylesbury) (Con): I congratulate my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan) on securing the debate. I should also declare an interest in two respects. Since I might refer to mental health services, I declare that I am an honorary vice-president of Buckinghamshire Mind. I should make it clear, moreover, that my family and I have been using local health services in the county throughout my time as a Member: all my four children were born at Stoke Mandeville hospital and, because of family illness, I have had occasion to visit the accident and emergency department at Wycombe general hospital, and both the accident and emergency and in-patient wards at Stoke Mandeville hospital within the past 10 days.

My hon. Friend set out clearly in her speech the financial challenge the local NHS faces. Some of the problems we have faced over the years in persuading officials and Ministers to take those challenges seriously arise from the misleading impact of average statistics for the country, which show Buckinghamshire as being prosperous, healthy and therefore able to cope with significantly less than the average per capita funding for England. Of course, those averages sometimes conceal the fact that there are certainly pockets of poverty, both in Aylesbury and in High Wycombe, as I am sure my hon. Friend the Member for Wycombe (Mr. Goodman) will say later. Certainly, anyone who visits Southcourt or Quarrendon in my constituency would not regard those estates as prosperous. There is a disparity in the county between the south, where the population is ageing rapidly, and the Aylesbury area, which is one of the fastest-growing parts of England and has a young population.

It is wrong to assume that old people are passive these days. When I speak to GPs in my constituency, they say that elderly patients come in, describe their symptoms and then explain that they have looked their condition up on the internet and discovered that some new treatment is available. They then tell their doctor, in forthright terms, that they want that treatment and are unwilling to take no for an answer. They have high and increasing expectations that a previous generation of retired people did not have.

Mrs. Gillan: I had a case exactly like that in my surgery as recently as yesterday. A constituent had been told by his GP to look up what could be done for his condition, and he went back with what needed to be done. The GP would very much like to recommend the treatment but, of course, would be running against an ever-diminishing budget.

Mr. Lidington: My hon. Friend is right, and all of us are finding such cases arising in our constituency work load. I do not know whether she recalls this, but I believe that it was the first of the strategic health authority's trinity of chief executives who questioned in a valedictory memorandum whether the current level of funding for Buckinghamshire was sufficient to maintain a core service at the level which local people are entitled to expect.

My hon. Friend put it well: there is little argument today about how health services are evolving and ought to evolve in this country. I am certainly not going to stand here and say that there cannot ever be change,
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and I believe that most of my constituents want health services to be delivered to them at home or as close as possible to their home. Trends in medical science and the trend toward concentrating specialisms-the treatment of particular cancers or particular types of heart attack-in a limited number of hospitals where all the experts and the best equipment can be brought together are certain to continue and will provide better patient outcomes.

The model for the future of a wide range of local, usually community-based services and in-patient stays in hospital reserved for serious conditions, for as short a time as possible, is one that I would endorse. However, my real fear about what is happening in Buckinghamshire is that although we are seeing that reconfiguration happen, it is driven not by clinical developments and priorities but by the urgency of making the books balance in a short period of time.

The Buckinghamshire Hospitals NHS Trust and the Buckinghamshire primary care trust have agreed a financial plan that involves cutting the number of hospital admissions by 100 a week, and securing a 30 per cent. reduction in admissions to A and E. That all has to be achieved by the end of the current financial year, and we are already seeing the results. I had a letter from a constituent the other day in which she complained that she had received a letter offering her an appointment at Stoke Mandeville hospital for treatment for which she had been referred by her GP, but then she had a telephone call to say that the offer was being withdrawn because her case no longer fitted the new criteria that the PCT had imposed for financial reasons.

I fear that community services, primary care and preventive services not only will not be developed in time to meet the demands of the new model of health care but are actually under acute strain at the moment. Let us look at what is happening with the PCT. I have been told by local GPs that the health visitor service has been cut, and moved from GP surgeries into a central office location. When I visited a GP surgery on one of my most deprived estates the other week, I was told by the nurses and other staff that it is sometimes difficult to get hold of a health visitor because health visitors often do not know from one day to the next where they will be based or which people they will be able to see. Comprehensive coverage by health visitors of the poorest areas of Aylesbury may still be an aspiration, but it is not happening in practice.

The same is true for district nurses and the school nurse service, which is desperately stretched. The truth about primary care in our county is that anything that is not the subject of a specific Government target is liable to be squeezed and cut.

There is little scope for GP innovation that would push up the standard of service. GPs tell me that they feel frustrated when they come up with a new idea but are then told by the PCT that unless it can afford to fund the innovation throughout the county, no practice is allowed to provide it. That undermines professional responsibility and stifles the possibility of some real improvement in the quality of health care locally.

I have already referred to the pressure on Wycombe and Stoke Mandeville hospitals to cut admissions and attendances at A and E, but we have learned recently that there is to be a further regional review of hospital capacity, which will involve Berkshire and Buckinghamshire and possibly Oxfordshire as well-my understanding is
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that the John Radcliffe hospital is also under acute financial pressure. Local people will greet the prospect of a further hospital review with horror, and there will be fear that another round of hospital cuts is on its way.

If we are to move to the new model of health care, it is clear that an effective ambulance service will be important. Paramedics need to be able to reach patients quickly and to stabilise their condition, and we need an effective ambulance service if more patients are to be transported significant distances to the specialist hospitals and units of the future. However, the South Central Ambulance Service NHS Trust is already struggling to meet its targets. Yesterday, I had a letter from the chairman of the trust, who said that services in rural areas of the south-central region in particular were under huge strain.

The other element that is missing from the discussion about the new model of NHS care is the place of county council social services. As the Minister will know, Buckinghamshire county council is already a floor authority, and news has just come through that it will again receive the smallest grant increase of any shire county in England for the next financial year. The eligibility criteria for access to social care are being tightened year on year. My fear is that, inevitably, that will mean that more elderly and disabled people, and more people with a chronic illness who are unable to qualify for care that they might previously have received, will fall over or have accidents. They will be admitted to A and E, and possibly for an in-patient stay in hospital. Paradoxically, that would increase rather than reduce the financial pressures that some of the reductions and reconfigurations in service have been designed to achieve.

In conclusion, I want to leave the Minister in no doubt that those are not just my views as a politician. The view of nearly every doctor and nurse in my constituency to whom I have spoken is that the local health service in our county is struggling, and that, yes, there needs to be a coherent look at the configuration and pattern of health care in Buckinghamshire, but that that needs to be linked to an examination of the funding system to ensure that people get the quality of service they are entitled to through payment of their taxes.

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