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In 1998-99 there were 201,000 cataract operations; in 2004 there were 306,000a 52 per cent. increase. There was a 78 per cent. increase in heart operations over the same period, and an increase of 22 per cent. in the number of hip operations and 11 per cent. in the number of kidney transplants. The list goes on [ Interruption. ] The hon. Member for Beverley and Holderness can sit there interrupting all day, but I
am setting out facts that show what has been happening in our national health service over the past few years.
Let us look at heart disease. Waits for heart surgery are down to less than three months. In March 2000, 2,800 people had been waiting more than six months, and it was not uncommon for patients to wait up to two years. The average waiting time for heart procedures is down by a third since 1998-99.
Anne Milton: The right hon. Gentleman is getting angry, because he wants to read out his figures. Why does he think that staff morale in the NHS is so low? Why does he think that doctors and nurses are so angry? The Government are giving us a picture that is not recognised by the staff or patients.
Mr. Barron: I will refer to the hon. Lady as my hon. Friend because she serves on the Health Committee, but I fundamentally disagree with her. She was out with the Committee going round the health service, both the independent sector and the NHS, just a few weeks ago, and I did not hear anger when I sat in rooms with nurses, some of them from the private sectorthe independent sector, as it is calledand some of them from the NHS. I did not hear anger when we sat together, taking evidence for an inquiry that we are undertaking at the moment. I do not see that anger, but we get it from the top sometimes. We got it from the Royal College of Nursing, which, as I said in the media, was involved in a disgraceful attackan attack on freedom of speech more than anything else. I remember standing on picket lines with health service workers, when there were 85,000 fewer nurses in our health service, because they were getting hammered at that time . [ Interruption. ] The hon. Member for Eddisbury (Mr. O'Brien) is at it againif he wants to intervene, I am quite happy for him to do so. [ Interruption. ] No, he will have his say later.
Tom Levitt: Does my right hon. Friend agree that, whatever the frustrations of health service staff, those who used the opportunity of the RCN conference to exaggerate grossly and even fabricate the evidence that they were using to try to embarrass the Government were totally out of order, and did their cause no good?
I shall move on quickly. I was looking at heart disease. About 70,000 cardiac procedures were performed in 2004-05, which is a 59 per cent. increase in activity since 1998-99. In 2004 there were 15,300 fewer deaths from coronary heart disease than in 1997a reduction of 35,000 since the baseline assessment of 1995-97. Cancer deaths are down by nearly 14 per cent. in the past seven years, saving about 43,000 lives. Some 600,000 additional women are being screened for breast cancer. Cancer consultants have increased by 43.7 per cent. since 1997. There are more than 1,300 more cancer consultants in this country. No one can say that cancer services have not improved massively in this country; they certainly have done.
There are over 17 per cent. more diagnostic radiographers and over 24 per cent. more therapy radiographers than there were in 1997. Since April 2000, we have had 146 new MRI scanners, 135 linear accelerators, 224 CT scanners and more than 730 items of breast-scanning equipment. I only wish that all of them were being used as much as they could be in our NHS, so that we could get waiting lists down a lot more. That is the truth of what has happened in our NHS under this Government.
Kali Mountford: My right hon. Friend is giving a fascinating insight and a comparison between what we inherited in 1997 and the improvements now, but he is comparing like with like. Is it not the case that the range of treatments available in the NHS has extended, and that the cost of some of the new treatments, certainly in the early stages, is exorbitant but necessary? Has he done any analysis in the Health Committee about the effect of that on NHS spending?
Mr. Barron: We have done so on an ad hoc basis at this stage. Let me tell the House that early-stage use of Herceptin could add £1 million to my PCTs budget for the current financial year, and it is likely that many new drugs will put pressure on budgets in years to come. By and largenot in all cases, as these are clinical decisionsbudgets have been healthy enough to take up most of the cost.
Mr. David Burrowes (Enfield, Southgate) (Con): I am not sure whether the right hon. Gentleman was going to deal with diabetic retinal screening services. The reality in my constituency is that last week, the manager of that service in Chase Farm hospital had to cancel interviews, on the direction of those aboveno doubt because of the £31 million deficit. No doubt that will affect front-line services and those dealing with screening services. Where is the reassurance in the Health Bill about the protection of general ophthalmic services?
Mr. Barron: That is more a matter for the Minister than for me. There are many things involved. One Memberit might have been the hon. Member for North Shropshire (Mr. Paterson)talked about Herceptin and whether people in his constituency could get hold of it, because people in a neighbouring constituency could. I do not see many examples of patient care being affected at this stage.
I have had this debate twice in one week with the general secretary of the Royal College of Nursing and I have asked her to send me examples. I am sure that the Health Committee, which I chair, would want to look at examples if patient care is being affectedas opposed to jobs being affected in certain circumstances. There are several things involved. The general secretary of the Royal College of Nursing said on BBC radio that the safety net was being removed from under national health service patients in this country. I challenged her to give evidence of that. To date I have not found any evidence whatsoever. If it is out there, I would like to see it.
The hon. Member for South Cambridgeshire (Mr. Lansley) did not entirely answer the intervention made by my hon. Friend the Member for Dartford (Dr. Stoate) about seeing suspected cancer cases within two weeks, and the situation that existed before. More
than 99 per cent. of suspected cancer cases are now seen within two weeks. That is up from 63 per cent. in 1997. Again, there has been a substantial increase. Those are the figures that the hon. Gentleman should have given.
My final point relates to my earlier intervention on the Gentleman. In my view, we should measure what is happening inside our national health service in terms of its impact on patients, not jobs. The national health service is there primarily for patients, and not as an employer. There were many times when large parts of the public sector were there to provide social employment; that is not the case any more. God knows, in my own constituency, I saw thousands of jobs go from public sector industries that were there for social employment reasons. That is how we should look at the situation now.
A MORI poll on public attitudes to our national health service draws attention to users good personal experience of the NHS. It says that 81 per cent. of hospital users were satisfied with their last visit. In a Populus poll, 70 per cent. said that, based on their own experience, a good service was provided in the NHS. That is not anecdotal evidence. We are not talking about vested interests being shouted out in television studios or conference halls. The polls reflect the views of the people whom the NHS is there for. There is no doubt at all in my mind that in 1997 a turnaround team was put into the Department of Health, and it is working wonders for an area of the public sector that was badly neglected for many years.
Mr. Stephen Dorrell (Charnwood) (Con): I will begin by following on pretty directly from what the right hon. Member for Rother Valley (Mr. Barron) was saying. On the basis of his speech, I could couple him with the Secretary of State and ask him to reflect on why the reaction that the Secretary of State received to her statement that the NHS had just enjoyed its best year ever was as strong as it was. On the basis of his speech, he is clearly bemused by the reaction that the Secretary of State received and he prefers to believe that it was all got up by a group of Tory politicians and journalists. The right hon. Gentleman and the Secretary of State would serve their cause better if they reflected a little longer on the fact that the Secretary of States comment received an intense reaction not just in the political world, but right through the national health service. They might serve themselves better if they set out to understand why people reacted as strongly as they did.
Mr. Barron: I made this point, in effect, in an earlier intervention. If the statement had been that patients had had a better year, nobody could have grumbled about that, because that is the case. The right hon. Gentleman was a Health Minister so he should know all about the issues inside the health service. We then come to the question of how there could be a so-called spontaneous demonstration at a conferencewith hundreds of people sitting there all wearing the same protest T-shirts. The simple answer is that that was not patients being mad at the national health service; it was people who might have to move and change their jobs in the next few years. If that improves patient care, they should get on with it.
Mr. Dorrell: The right hon. Gentleman was kind enough to refer to the fact that I was once Secretary of State for Health. I have read briefs very similar to the speech that he just made to the Houseon occasion, I have even read them to the House. They are no substitute for an honest reflection on why people react to circumstances in the way that they do. He is quite right to sayand the Secretary of State may reasonably reflectthat the national health service has been the beneficiary of record levels of expenditure. He is quite right to say that record numbers of people, in the history of the national health service, were treated last year, record numbers of clinicians were employed and records levels of resources were deployed. Given those facts, why did people dispute the proposition that it was the best year ever? I want to focus on that question, because some important policy conclusions can be drawn from the reasons people reacted in the way that they did.
Dr. Stoate: Perhaps I can help the right hon. Gentleman to explain why there was such a strong reaction. As someone who worked in the health service and spent a lot of time speaking to people who use the health service and people who work there, I know that the facts are that people have much higher expectations than they had beforeand so they should. People expect to have better treatment. They expect to be treated more fairly and more humanely. That is the way things should be, and long may that continue. Things are available now that were not even conceived 10 years ago. As my right hon. Friend the Member for Rother Valley (Mr. Barron) said, most people receive a far better service than they did beforealbeit that the health service staff might not entirely always agree with that point.
Mr. Dorrell: The hon. Gentleman is quite right to say that things are being done in the health service now that were not done in 1997. It is equally true that things were being done in the health service in 1997 that were not done in 1987. That is the first point to make when thinking about why the Secretary of State was so misguided as to present her case in the way she did. In fact, in every year of its history, the national health service has used more resources, treated more patients and employed more clinicians. The proposition that everything is better this year than it was last yearor better this year than in 1997is one that every single Secretary of State for Health from Aneurin Bevan onwards has been able to make, and justify.
As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said, the thing that causes offence in the national health service is the suggestion that that progress, which is the result of the efforts of individual clinicians and employees right through the service, is due to the interventions of politiciansin other words, politicians claiming credit for the endeavours of employees. My hon. Friend was entirely right to say that, in the health service today, there is a broad sense that people are making progress, as the health service has always made progress, but doing so despite the intervention of politicians, rather than because of it. That is the first point.
Let me move on to the second point. The argument that has not yet surfaced in the debate is that one of the reasons for low morale and demotivation in the health service, as well as one of the reasons for the major waste of resources in the health service in recent years, is the programme of constant reorganisationthe bureaucratic moving round of the deckchairs. Let me briefly recite the Governments record on the reorganisation of the service.
When the right hon. Member for Holborn and St. Pancras (Frank Dobson) was appointed, he said that he would abolish the internal market, but then the right hon. Member for Darlington (Mr. Milburn) was appointed and said that that was wrong and that the Government would reintroduce foundation hospitals. The present Secretary of State says that the Government were wrong to abolish not only the independent management of hospitals but fundholding, so back comes practice-based commissioning with a deadline of involving every general practitioner in GP fundholding, or practice-based commissioningthey are exactly the sameby December this year.
I intervened to ask the Secretary of State about the role of PCTs in the delivery of service, because it is one of the issues on which the Government have caused deep confusion throughout the service in the past 12 months. She said, as though it was somehow clear and everyone knew it, that PCTs would go on being involved in the delivery of community-based health service care. However, that is absolutely not what Ministers have been saying over the past 12 months.
PCTs will become patient-led and commissioning-led organisations with their role in provision reduced to a minimum.
There was confusion about that and Ministers announced an extension to the deadline, which was originally the end of 2008. When the then Health Minister, who is now Secretary of State for Work and Pensions, gave evidence to the Health Committee on 1 November 2005, he was asked by the hon. Member for Pendle (Mr. Prentice):
Are you telling us that the Government is as committed as it ever was to see frontline medical staff move away from employment in Primary Care Trusts? Is that what you are telling us?
I think we have set ourselves a long-term objective, yes, but I think what was clarified was the removal of the 2008 timetable for that.
There was thus a statement in July 2005 to say that PCTs would divest themselves of the services. By November, they were still going to do that, but do so without a deadline. However, today, the Secretary of State says that PCTs will not divest themselves of the services. It is small wonder that there is confusion in the service about where the bureaucratic deckchairs will come to rest when Ministers can give three fundamentally different answers in 12 months to a very simple question.
Tom Levitt: I hope that I can demonstrate that I do. The right hon. Gentleman has been considering the question of what is good for the NHS in terms of structures and processes, rather than patients. However, on his specific point, let me refer again to a question that I asked the Secretary of State during Health questions on 25 October. Her reply was:
I assure my hon. Friend that district nurses, health visitors and other staff who deliver services in the community will continue to be employed by the PCT unless and until it decides otherwise.[ Official Report, 25 October 2005; Vol. 438, c. 152.]
Mr. Dorrell: If the Secretary of State said that on 25 October, presumably, since the rest of the world knew that the matter was an issue of the moment, her ministerial colleague was aware of her answer when he gave evidence to the Health Committee on 1 November. Presumably the then Health Minister was expecting to be asked about the matter, yet he said:
I think we have set ourselves a long-term objective, yes, but I think what was clarified was the removal of the ... timetable.
Mr. Lansley: Further to add to the confusion about the policy, the interim chief executive of the NHS more recently told primary care trusts that insofar as they may continue to have a provider role, they must ensure that their governance arrangements wholly separate their commissioning and provider roles. We will thus end up with not just merged PCTs, but bifurcated PCTs.
Mr. Dorrell: I hope that those who heard the words of the senior manager in the health service will now regard the position as clear, although I gather from my hon. Friends tone that it is not clear to him. It is certainly not clear to me whether PCTs in the long run will, as the Secretary of State said in July and her ministerial colleague said before the Health Committee in November, ultimately be divesting themselves of provision, or whether they will remain bifurcated in the way management describes. I do not want to dwell any longer on the matter. However, I wanted to emphasise it because it is an aspect of the process of constant management change that is one of the reasons why the Secretary of State received such a reaction when she tried to suggest that the NHS had had one of its best years ever.
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