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15 Dec 2009 : Column 183WHcontinued
Mr. Paul Goodman (Wycombe) (Con): I congratulate my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan) on securing this debate. Despite her heavy commitments elsewhere, she has proved again this morning that she is a relentless and doughty champion of the health care and other interests of her constituents, as all of us in Buckinghamshire try to be. It is worth putting on the record once again that our colleague the right hon. Member for Buckingham (John Bercow) cannot be with us, but my hon. Friend spoke for him.
I cannot rival my hon. Friend the Member for Aylesbury (Mr. Lidington) in my use of the local NHS, although I have been through Wycombe hospital accident and emergency and in a ward there for a brief period, so I have had some personal experience of the NHS in Bucks, as well as the constituency experience that my hon. Friends have had as Members of Parliament. However, I do not want to start a Monty Python-type
competition, where colleagues and others compare their experiences of woe, especially-on a more serious note-given the experiences of some of my constituents, which I have heard about in my surgery and outside it over the past eight years. Given that I am leaving the House at the election, I shall speak at least partly in a valedictory spirit.
In my eight years as a Member of Parliament, undoubtedly the most important constituency issue has been health care: no other single issue compares to it in terms of the interest, concern and anxiety it arouses. In those eight years, the cuts and closures at Wycombe hospital-the loss of our children's ward, maternity ward and full A and E service-have created a huge ruction in Buckinghamshire. I want to make three simple points about that whole experience.
First, when I arrived as a new candidate in 2000, I visited Wycombe hospital and spoke to a gentleman called Roy Darby, who had been the chief executive there-Wycombe and Stoke Mandeville had recently been merged into a trust-for at least 10 years and, I think, longer. The NHS has always been primarily a nationally orientated and directed service, but the structures were reasonably stable and people such as Roy Darby knew their way round the local NHS backwards and exhibited a particular sense of responsibility, ownership and knowledge of it.
Since my being elected our regional health authority has been merged, as my hon. Friend the Member for Chesham and Amersham said. The three primary care groups that existed at the time of my election became three primary care trusts, some of which had deficits-as my hon. Friend the Member for Aylesbury is fond of saying, no one has ever found the balancing surpluses-and then became a single Bucks-wide primary care trust. The mental health trust has been merged with Oxfordshire and the ambulance trust has been merged. Wycombe hospital had just gone in with Stoke. We have experienced a kind of permanent revolution, as in Mao's China. Local people undoubtedly feel that their ownership of the service, which was never particularly strong, has been compromised in the past eight years, and that when cuts and closures have been put on the table, besides some of the improvements that have taken place, they have not had any say in what has happened.
Secondly, on the cuts and closures, as I have said, good things have happened and are happening at Wycombe hospital. I have good relations with the management team there and with the PCT, as my colleagues do: we try to work together. However, in 2004, when this wave of cuts and closures was announced and rippled through large parts of the country-including in substantial areas of the south of England, where Government Members of Parliament appeared to be less well represented than Conservative and Liberal Democrat MPs-there was a feeling that managers had been sent in from outside to ram these changes through.
Thirdly, the main substance of my hon. Friends' speeches is the problem with the funding formula. In a rational dispensation, spending would be related to need, meaning that spending would largely be related to age. As my hon. Friends have said, we have an ageing population in Buckinghamshire, particularly in south Buckinghamshire. In a rational dispensation, deprivation funding would be allocated from a separate budget. Under such a system it is unlikely that Buckinghamshire
would receive 17 per cent. less per head than the national average, which is the case. I am sure that my hon. Friend the Member for Guildford (Anne Milton) will say more about this later.
Essentially, given the pace and scale of change that my hon. Friends are describing, in Buckinghamshire we are like the Red Queen in "Alice's Adventures in Wonderland", who had to run to stand still. Given the funding disadvantage, our NHS staff and managers have to climb a steep incline to get on top of their deficits and manage the restructuring at a time of great change, because there is an enormous knock-on effect from our having 17 per cent. less funding per head. For example, there is a clear effect on my poorer constituents in areas such as Castlefield and Micklefield. My hon. Friend the Member for Aylesbury mentioned the poorer areas in his constituency, such as Quarrendon. In effect, our poorer constituents, because they are not surrounded by others who are as poor as they are, are disadvantaged compared with poorer constituents elsewhere living alongside those who are as poor as they are. That has had a substantial effect on communities in my constituency containing people who may not speak English as a first language, some of whom have recently arrived and many of whom may not always have grasped how rapid the pace of change has been and what effect these changes were having on their local services.
Mrs. Gillan: May I say how much my hon. Friend will be missed as his constituents' representative when he leaves the House? He has taken the headlines on many occasions, particularly in respect of health and health services, defending his constituents' rights to a decent service. Does he agree that this double hit on those people in our constituencies who are less wealthy and have less disposable income is exacerbated by poor public transport systems? Therefore, the changes that accompany this downturn in financial circumstances often mean moving out-patient clinics, even though people have established a pattern of travel and find it almost impossible to reorganise their travel arrangements to get to farther-flung clinics. They are disproportionately affected at a time when they are trying to be treated by the health service, and their poverty means that, in many instances, they are unable to travel to some of the changed services.
Mr. Goodman: I agree. I will return to that point in a moment. As my hon. Friend the Member for Aylesbury rightly said, one effect of change being implemented is that transport has to take the strain, and that applies whether the ambulance service is involved, or whether poorer people are travelling who may not have access to their own private transport.
I have touched on the implications of the change for my poorer constituents. Obviously, in respect of the better-off ones, if they are elderly they are still entitled to such care. That group of people is more likely to need the NHS than others, as my hon. Friends have said.
The funding shortage is having a paralysing effect on change in the local NHS. Wycombe hospital and Stoke, in the trust, want to achieve foundation status. We support foundation status, as the Government do, but the deficit, and the shuffling of deficits back and forth between the hospital trusts and the PCT, is a millstone round the neck of the foundation status application.
Our health service is prevented from moving forward by the deficit. As my hon. Friend the Member for Aylesbury said, not only can it not move forward; we are now faced with the hospital review to which he referred. I am sure that my constituents and our local paper, the Bucks Free Press, will look on that with a searching light.
I will not labour the point that my hon. Friend the Member for Chesham and Amersham made about transport, but if, at the same time as going through the changes, doctors are being told to look for ways of not referring patients, the stress on patients who are referred will fall on the transport system. The Chamber will have noted what my hon. Friend said about the ambulance trust.
All together, some good things have happened in the Buckinghamshire NHS Hospitals Trust, but the system is under great strain. With the approach of an election, in which I shall not be participating, many of my constituents will cast their minds back to 1997 and the claim of the then Leader of the Opposition, Tony Blair, that voters had 24 hours to save the NHS. They will look at their local NHS and acknowledge the many good things that have happened, but they will remember that in 1997 Wycombe had full A and E, a maternity unit and a children's unit. Although they will understand that change must happen, it cannot be forced through against a background of having, unfairly, 17 per cent. less funding than the national average.
Mr. Dominic Grieve (Beaconsfield) (Con): It is a pleasure to be able to participate in this debate. I hope to do so briefly, because much of what I want to say has been said by my hon. Friends. In particular, I thank my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan) for securing this debate and opening it.
It might be helpful for the Minister if I try to step back a little from the immediacy of the funding issues that we have described, and go back to some basic principles. It will be widely acknowledged on both sides of the Chamber that NHS resources are not infinite. If my party has the opportunity of forming a Government, we will face exactly the same funding constraints, particularly in the current financial climate, that the Government must face. However, those constraints should not allow us to engage in propaganda exercises to pretend that something is when it is not. My hon. Friend the Member for Wycombe (Mr. Goodman) rightly highlighted the extent to which the Government have met the promises that they made pre-1997, but it is impossible to reach that conclusion for Buckinghamshire as a whole and south Buckinghamshire in particular because of the extent to which services have been curbed or cut.
A live issue is the extent to which an area should receive funding in relation to its need or indices of deprivation. The county, including my constituency, is prosperous by national standards, so one can understand that the Government might argue that the population's health care needs are likely to be proportionately less. That may be correct, and the indices of overall health in Buckinghamshire do not seem to be very bad, but the difficulty that arises with that approach is that as services are progressively phased out, those who may need them will be unable to access any service at all. That is the
hallmark of the problem that I face in my constituency. It consists of some people who are very rich, and some who are on middling incomes and who can manage, but it also has pockets of extreme poverty which is every bit as bad in one or two places as in inner-city areas in London.
One of my wards was, and still may be, ranked 13th in the indices of deprivation in the south-east, although that is not as bad as some of the wards in the constituencies of some of my hon. Friends here today. People there find that the services that they need and cannot access through the private sector are simply not available in the health service.
This is an old theme, and the second or third time that we have had a similar debate about the problem of funding of health services in Buckinghamshire. Returning to that theme, I well remember that as one of the Government's first actions when they came to office in 1997-I give this to the Minister by way of illustration of the problem-they removed the tax breaks for people of pensionable age taking out private health insurance. I remember that vividly, because the consequence was to create the first winter crisis after I was elected to Parliament. Those people could no longer access private health care, particularly in my constituency, or beds in private hospitals when they had pneumonia in winter, so they started to fill the hospital at Wycombe. I remember the administrators saying that they believed that that was the cause of that sudden surge, thereby making it even harder for those who were more deprived to obtain access.
How does the problem of chronic underfunding manifest itself? My hon. Friends have made some important points, and I do not want to repeat them, but I endorse what they said. I shall give the Minister some examples that may interest him in understanding what is going on. The first has been alluded to, but I am returning to it. It is the problem of the reverse turf war between social services and the health service. Generally in a turf war, people are told to get off someone else's patch, but throughout my time as a Member of Parliament since 1997 I have witnessed the struggle between social services and the health service in asking the other to come on to their patch and take over responsibility for the services that they should provide.
We have discussed acute services, and I want to move away from that a little. A matter that fills my surgeries weekly is arguments about elderly people with modest circumstances in hospitals-where they will go next to be cared for, what the element of nursing care should be and who should take responsibility for it. Leaving aside the fact that I am perfectly aware that individuals may have a financial interest because of the extent to which they must pay from their pockets, that happens even when people will never be in a position to make a contribution to their care if they move into a care home. It is a source of endless correspondence, and all because the PCT and social services want to pass responsibility round and round because neither has the resources to meet the need.
That is one example. The second is the PCT's approach to those who are, perhaps fortunately, a small minority but who, for one reason or another, need specialist provision that falls outside the competence of the
Buckinghamshire Hospitals NHS Trust and Thames valley hospitals. I am sure that the Minister will acknowledge that what should be a reasonably rapid bureaucratic process, by which referral to a specialist London hospital that will provide what is sometimes life-saving care takes weeks, almost inevitably requires my involvement in writing letters to him, or to the head of the PCT or the regional trust trying to kick someone into acknowledging that specialist provision that can be accessed only at, for example, St. Thomas's hospital, should be provided.
There is a constant, underlying theme of difficulty in moving the bureaucratic logjam. Although 99 times out of 100 we will probably end up getting what we asked for because it is the right thing to have-I say that to reassure the Minister-in the meantime, the patient and their family can legitimately claim that the wait and delay have had a significant impact on the health of the individual. I do not regard that as acceptable.
Given the human condition, I know that we will never have a perfect service, and I do not expect one. However, the amount of time, effort and energy that is devoted to bureaucracy is worrying and must also cost money. In my role as an MP, I keep thinking about the amount of money that could be used in front-line services that is being squandered in shoring up the bureaucratic paper round. That process dilutes the amount of money that I and wealthy members of my constituency pay in tax, before the money can be translated into the service and used to the advantage of the person who needs it. Such bureaucracy adds to that process.
Mental health provision has been mentioned. It is a subject of interest to me, and in the past I have been involved with Mind, when I was vice-chairman of a group in London. Mental health provision in the county is, frankly, poor. That is not the fault of the professionals who provide it, and if I were to be optimistic I would say that it is perhaps on a mildly improving graph. There was a period about two years ago when mental health provision had become so bad that I thought it had reached the abyss.
My hon. Friends have highlighted the issue of counselling services, and I would like to pick up that subject to illustrate my point. Counselling services are accessed directly on referral by a GP. One of the features of the briefing that was helpfully provided by Buckinghamshire primary care trust, is that it wants to cut costs by lowering the number of admissions to accident and emergency and referrals to hospitals. We all know that mental health problems exist, and with the economic downturn and the various other financial pressures on families, I get the distinct impression that that trend will be rising.
Counselling and referral systems operated in the county very cheaply. Buckinghamshire PCT gave a £300,000 funding subsidy, which it is now withdrawing. Of that, £90,000 is being withdrawn from Bucks Mind which, as the Minister will know, provides a largely voluntary service. On the face of it, that is not a large sum of money, although I accept that in the context of the PCT this is probably an essential cut to try to meet budgetary constraints and to save money. However, if that service cannot be provided because the money has been withdrawn, what will the consequences be on the need to access more specialist services through accident and emergency or elsewhere?
This is a classic illustration of where by trying to make savings and cuts of this kind-particularly the virtual closure of a voluntary service that simply needs help with its overheads-we are likely to put greater pressure on the health service elsewhere. When the cut was proposed, it was suggested that the referral service for counselling to Buckinghamshire Mind was not a good system. However, Buckinghamshire PCT was clearly aware of Mind's effectiveness, as it had been happy to fund it without any difficulty for years in the past, arguing that it was extraordinarily good value for money. The fact that the PCT now believes that such funding will no longer be possible, illustrates that a series of warped priorities have been imposed on it due to the current problems that it faces.
I will not go on at great length, but I will conclude with another illustration of my point. The ambulance service has been mentioned, and we learn that although the apparent needs of the area are not as great as elsewhere, the service has seen an inexorable rise in volume demand by more than 6 per cent. per annum in recent years. It is currently running at 8 per cent. up on last year, and has pointed out that that is not sustainable given that only 60 per cent. of patients go to hospital when an ambulance is called out, and only 10 per cent. need extended hospital treatment on admission. That strongly suggests that the ambulance service is being used as a bottom-line safety net for the provision of primary care services to the local community-indeed, I know that to be the case.
All of us on this side of the Chamber are supportive of the Thames Valley air ambulance service, which is entirely voluntarily funded. One of its complaints is that it is being used for routine hospital transfers to save the ambulance trust cash. It resents that because it is a specialist emergency service that intervenes when somebody has to be transported rapidly from one place-often removed from a road-to a hospital. I hope that the Minister will forgive me this digressory tour to illustrate what is happening on the ground in our area.
I do not expect the Minister to be a miracle worker. I know that his Government have wrecked the public finances and now have to pick up the pieces, and I fully appreciate that the area I represent will never receive the same amount of funding per head of population as a place such as Liverpool or another great city that has higher levels of deprivation. However, we cannot go on in this way. At some point, this will all go badly wrong for the Government. Illustrations of serious failures will be visited on the Minister, which will be entirely due to a failure to do any creative, sensible, medium-term planning for how to secure effective services in health care for our constituents locally. It requires doing something more than submitting the poor old primary care trust-which in my view does its best-to an endless cycle of crisis management.
Norman Lamb (North Norfolk) (LD): I congratulate the hon. Member for Chesham and Amersham (Mrs. Gillan) on securing this debate, and on getting a good turnout from her colleagues, who have all spoken passionately about the health needs of their county.
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