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9 May 2006 : Column 223

Mr. Burrowes: Although I agree that we can have a carefully reasoned debate about acute care strategy, there is a threat in my constituency of losing our accident and emergency department at Chase Farm hospital and of its being transferred to Barnet hospital, in the context of dealing with a £31 million deficit, and the financial concerns are paramount to residents when they see that they may lose their A and E department just to save money.

Dr. Stoate: Obviously, each area has its own problems. I cannot comment on the hon. Gentleman’s area because I do not know it. I am suggesting a debate on a much wider scale than individual hospital budgets. I am suggesting that we have a debate on the meaning of the acute hospital in the 21st century and whether we need to provide care in the way that we are currently providing it.

I shall give the House another example. I have recently met several consultants—one came to my practice only the other day, to ask why there are so many fewer admissions and referrals to his hospital than before. His first thought was that perhaps the hospital had become unpopular and that we were sending patients elsewhere. In fact, we are not sending them anywhere. What GPs are doing is keeping far more people than ever before in their practices. They are all running diabetic clinics, chronic obstructive pulmonary disease clinics, asthma clinics and minor surgery clinics. Treatments that were impossible 10 years ago are now routine and commonplace in general practice. Patients like being treated in their own practice. We are therefore not making the referrals to hospital.

I would go further. I spoke to a consultant cardiologist the other day, and he was not joking when he said that heart attacks—coronary thromboses—were becoming a scarcity in his hospital. He said that the cardiac unit was having to look around for other things to do because there was no longer a steady flow of cardiac problems. Why was that? “Because,” he said, “you GPs are preventing them. Because you are treating people with high cholesterol and blood pressure, managing diabetes, coping with the effect of their obesity and their smoking, we are not seeing the heart attacks that we saw before”. In other words, we are already seeing a fall-off of need.

My acute hospital in Dartford, the Dartford and Gravesham NHS Trust at Darent valley, was built as a private finance initiative hospital a few years ago, one of the first since the Government came to power. When it was being planned, I was vilified, the NHS was vilified, everyone was vilified in the press because, it was claimed, the hospital would be far too small. It was replacing three hospitals with one hospital, and the result would be chaos, meltdown, disaster—all the usual hyperbole.

Only last month I went to see the chief executive and asked how he was getting on. He replied, “Far from being too small, we are planning alternative strategies as to how to use our capacity in the coming years, because the pattern of admissions has changed. We are not seeing the queues of ambulances outside that were predicted. We are looking at our hospital in a slightly different way and seeing what alternative services we could provide with the space that we have.” Not only
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has he got enough space, but he may have more than he needs for the future. He is facing up to that and considering other ways in which his hospital might be used in the future. That is extremely good.

Far from the hospital service being static, it needs to be dynamic. I share the view of the right hon. Member for Charnwood that we need to consider the future of some of the facilities that we are building, including large-scale hospitals. Patterns of care are changing so rapidly, and so many more people are treated as day patients than ever before, that we need rational debates about whether we need so many beds or so many units and what we should do with the facilities that we are building.

I appreciate that many Members want to speak, and I do not want to go on too long. We must have these blue-sky debates in the House. Instead of hurling abuse at each other across the Chamber, I would much rather have a constructive debate with Opposition Members and the third party. What do we do with the health service? What should the health service stand for? It may be true that we are all in favour of the health service, but we have slightly different visions of it.

My vision is of a health service geared to patient need, where the episodes of care are delivered where it is best for the individual patient—not where it is best for the service, the Royal College of Nursing, the British Medical Association or Unison, but where it is best for that individual patient. My gut instinct is that patients being treated in their own home by their own practice nurse, their own doctor and their own team of associate support staff is the way to go. Big acute general hospitals are probably not the way to go. The interesting debate will be about how we get from here to there, and I look forward to many more of these debates in the future.

6.35 pm

Mr. Nicholas Soames (Mid-Sussex) (Con): I begin by saying how fascinated I was by the speech of my right hon. Friend the Member for Charnwood (Mr. Dorrell), and how right I think he is in his remarks about the nurses. I deeply regret the way the nurses treated the Secretary of State. It was a mistake on their part. It was clearly organised, and it was a foolish demonstration. I agree with the hon. Member for Dartford (Dr. Stoate) that nurses are far better paid than they were, and so they should be. That manifestation was not about pay at all. It was about the constant rate of change in the health service, which is proving so destabilising and bringing such great uncertainty not only to those who work in the health service, but in the long term to patients.

In speaking to the motion, I commence with the words of the magnificent Jeff Randall, one of our foremost economic correspondents, who remarked in his column the other day that it takes a very special, not to say a unique, genius to triple state expenditure on the NHS in 10 years to £96 billion, while simultaneously creating a financial crisis of such severity that perfectly good hospitals are closing, wards are having to be shut down and services cut, thousands of highly trained nurses are losing their jobs and there are few jobs for newly qualified doctors.

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In the south-east of England a health care crisis is developing throughout the region, and dealing with it will be extremely difficult. The Chancellor made a colossal error by announcing massive increases in public expenditure on health without demanding substantial productivity gains and further reforms. A very great deal of taxpayers’ money has been wasted and is about to be so again, and there is a substantial managerial failure which lies at the door of the Department of Health. It is not a failure, by and large, at local level.

Let us start where credit is due. The NHS needed more money spent on it. There has been a broad improvement in a substantial range of services and the right hon. Lady is to some extent right to feel that the press, as always, concentrates too much on the reporting of people’s negative experiences. All of us Members of Parliament know that serious complaints are made, but on the whole my postbag is filled not with complaints, but with letters from people saying how well they were treated and how grateful they are to the doctors and nurses for their skill and care.

However, much too much money is being wasted in the health service. For example, after seven years of wasted planning time, St. Mary’s hospital, Paddington decided not to replace its Victorian buildings with a new hospital, by which time the trust had spent £14 million on consultants’ fees. That is not acceptable, and there are many such examples.

There is a mixed picture, and in respect of my own constituency I shall say something about the Princess Royal hospital and the Brighton and Sussex University Hospitals NHS Trust. I have raised these matters on the Floor of the House on a number of occasions and at a series of meetings with Ministers, and I do not want to go over old ground. As I have said before, the trust is £21.3 million in debt, with no possibility, in my judgement, of paying it off in the time scale required. A similar point was made earlier.

I warned the Government at the time the trust was created what would inevitably happen when the two hospitals were merged. The position now is that a turnaround team has reviewed the situation with the trust managers and it is my firm conviction that, unless the debt is dealt with in a sensible manner—we must leave headroom and time to support a full recovery process—the trust inevitably will have to make substantial cuts in services, close wards and reduce vital services for local people. That cannot be what the Government want and it is certainly not what my constituents want. It would be a disaster locally and would, I am afraid, further damage my constituents’ confidence; already bruised following the “best care, best place” consultation.

I appeal to the Minister to accept that the trust is struggling with long-term financial burdens; they are not its fault and are, frankly, beyond resolution. The Government should not reward poor financial stewardship, but where such a situation exists—as it does with this trust and many others in the country— alongside a genuine commitment from the management and capacity to reform and increase transparency, the Secretary of State should act in a sympathetic and understanding manner.

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I want to speak briefly about the future of the NHS. The national health service employs 1.3 million people. In Surrey and Sussex alone—my part of the world—the budget is £2.8 billion and the NHS employs more than 50,000 people. On any one day, 4,500 people will be occupying a hospital bed and 1,100 will be admitted to hospital, of whom 720 will return home that day. About 2,350 people will attend an accident and emergency department on any one day in Surrey and Sussex, of whom about 560 will be admitted.

The local Surrey and Sussex health economy is now in great difficulty, from which it will be difficult to extricate itself. It is not possible any longer to run an organisation of this size as it is, and I believe that change is required, particularly around the issue of accountability at all levels. I applaud the work that the Government are carrying out to try to get that done, but I firmly believe that we need significant devolution of responsibility, autonomy and accountability at the local level and that it will be possible and equitable only if managers and clinicians are able together to set local strategies, targets and service delivery. They should be agreed by the strategic health authority, monitored according to that agreement and set within the SHA’s financial framework, aligned to the strategy of the Government of the day.

The NHS will never work efficiently and truly effectively until empowerment and ownership of services and service delivery are an absolutely integral part of the success of achievement. At present, many of the clinicians to whom I speak are, as my right hon. Friend the Member for Charnwood argued so effectively, feeling disillusioned and disconnected from the process and restrained. Managers who, given their heads, could do a much better job, feel disempowered and are unable to take initiatives that they know to be right. Only in genuine partnership will clinicians and managers be able to deliver the sort of dynamic service that is really responsive to the needs of patients. We need that to happen now and the Secretary of State needs to do more to encourage it and to make it happen.

It has always been my experience in public life that pay is not the only driver for those who work in the NHS or elsewhere in the public services. Job satisfaction, improving patient outcomes, applying new and valuable initiatives and good systems changes, alongside feeling valued and respected, are just as important. Ethos matters very much to most public servants. There are some outstanding managers in the NHS, but there are also too many inadequate ones who are recycled from job to job. The good ones need to be nurtured and developed. Initiative, and particularly risk taking, needs to be encouraged and managed.

I have a suggestion for the Minister, which he is at liberty to use. I believe that the Government should set up a staff college, based on the services model, to which all managers marked out for further and higher command above a certain level in the NHS have to attend. Such a course could be run at business schools throughout the country to ensure that only the very best managers go on to the most important jobs. As in any other business, the leadership or senior management is absolutely crucial to the success of the enterprise. The NHS should be no different, so my right hon. and hon. Friends are right to be critical of the Secretary of State in that respect.

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In the last five years, the NHS budget has increased by 40 per cent. in real terms, while output has increased by less than half that. In its doctors and nurses, the NHS has one of the most committed work forces in the country, yet management has significantly failed to motivate and engage those dedicated professionals towards a common goal of increased productivity.

David Taylor (North-West Leicestershire) (Lab/Co-op): The hon. Gentleman is perpetuating—unintentionally, I am sure—a bit of a myth here. Of the significant extra tranches of money invested in the NHS, it has been clearly demonstrated that 48 per cent. has gone into new posts, operations and new drugs; 30 per cent. into pay, which needed to be tackled; and a further 18 per cent. on capital investment, environment, equipment and so forth. Those are not unreasonable figures, so the suggestion that it is all somehow dribbling down the drain is not worthy of the rest of the hon. Gentleman’s speech, which has otherwise been excellent.

Mr. Soames: I am attempting to suggest no such thing. The hon. Gentleman is right about capital expenditure and all the rest of it, but I am suggesting only that for an investment of this size, one would expect to see a greater degree of productivity right across the board. It is a fact, as the hon. Gentleman well knows, that the inefficiencies in the health service are legion. The way the NHS does its business is still many years behind what goes on in the private sector. I am not suggesting that the private sector is necessarily a perfect role model, but the NHS has many lessons to learn from how the private sector runs its affairs.

Daniel Kawczynski rose—

Mr. Soames: I am going to press on with my speech.

While the “payment by results” initiative has brought the impetus to improve productivity in the NHS, the real challenge lies in empowering and engaging its front-line staff and getting them to take personal responsibility for the performance challenge. That is a technique that has been implemented time and again in the private sector to very great effect.

I want to conclude by saying that the national health service is, in my judgment, a truly remarkable organisation, which is greatly valued by the people of this country, but it could be and should be so much better than it is. There is nowhere better to be, frankly, if people are really ill, and I know that most of the people who work in the NHS find the teamwork and comradeship extremely rewarding. Most feel that it is a great privilege to work in the NHS, but they all have one thing in common, as eloquently argued by my right hon. Friend the Member for Charnwood: they absolutely yearn for a period of stability. They yearn for the ability to take the best decisions for their local communities, to provide the best care that they can, and to deal with the abuses and inefficiencies that are all too rife. Many of the NHS’s difficulties are systemic and the deficits can be wiped out only by fundamental change: the NHS and its people, wherever they work, need the time, the space and the resources to achieve it.

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6.49 pm

Tom Levitt (High Peak) (Lab): The Opposition motion, which

is not so much tongue in cheek as foot in mouth. The Conservative party has opposed every penny of extra money that this Government have put into the NHS. As an alternative to our strategy, its current leader has, so far as we can tell, designed the patient passport, fought a general election on that issue and then ditched the policy. It is the party of GP fundholding, unfair competition and constraints on NHS spending, which lead to growing waiting times and waiting lists.

We have got every reason to be proud of what the NHS has achieved. If we think back to when my hon. Friends and I were elected in 1997, we realise how things have changed. We have already doubled spending since then, and it will have trebled by 2008. We were spending at well below the European average on health after years of Tory cuts, and waiting was the keynote that typified NHS services in those days, whether it was waiting on those ever-increasing lists for operations, waiting on trolleys in accident and emergency units or waiting for winter to end—the extra deaths caused by winter used to generate fear every year. In my first few years as a Member of Parliament, I used to receive far too many letters from constituents who did not know whether they would get their hip or knee operation done or whether they would die first. We used to get letters like that, but I am delighted to say that I have not received one for some years.

At that time, the health service in my constituency was typified by the Devonshire royal hospital, which rattled around inside a magnificent grade II* listed building. The building was in a poor state, and, although people were fond of it, few High Peak residents used it as an in-patient hospital, because it was a centre of regional excellence for head injuries and rheumatism treatment in the north-west—it happened not to be in the north-west region, which was one reason why its closure was proposed. Many people were against the closure, but when the hospital closed, no services were lost. Out-patient services were transferred to the two community hospitals or, as is increasingly the case, to GP surgeries. Now, nobody would attack the decision to close that hospital on the basis of the health care that is provided in the area.

David T.C. Davies (Monmouth) (Con): I am grateful to the hon. Gentleman for recognising that hospital closures and mergers can occasionally play an important part in improving services within the NHS. Does he therefore condemn the actions of previous Labour Oppositions, who used hospital closures and mergers as a political football to try and attack the Government of the day?

Tom Levitt: The shadow Chief Whip is not in his place. The hon. Gentleman has criticised the words of some Conservative Members, and I am sure that the shadow Chief Whip will notice.

Although there are no acute hospitals in the High Peak constituency, we have got a foundation three star hospital at Stockport Stepping hill, which is on the
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outskirts of my constituency, and a brand new hospital, which is awaiting the outcome of its foundation application, is about to be built to replace the present Tameside hospital. No one waits for four hours in A and E in either of those hospitals, and in-patients, who typically faced a 12-month wait in 2002, now wait for less than six months. Out-patient waits in the area were typically 21 weeks in 2002, but they are now less than 12 weeks.

There are two PCTs in my constituency—Tameside and Glossop and High Peak and Dales—and they are both hitting all of their key targets, which benefits their patients, providing more and more services within communities and working closely with an excellent team of GPs. Furthermore, an increasing number of non-GP health staff are working inside GP surgeries delivering basic community health services. As far as Tameside and Glossop PCT is concerned, Shire Hill hospital in Glossop has now achieved step-up, step-down status, which means that people who do not need to take an acute bed can use a GP bed in that hospital. Similarly, people who have been in an acute hospital can use that hospital as a staging post on the way home. A walk-in centre will be built in Glossop through the local improvement finance trust programme, and I am delighted to say that the town has a high level of registration by dentists. Tameside and Glossop is an historically low-funded area, so I am pleased to say that it is getting a 9.4 per cent. increase this year and a 9.3 per cent. increase next year.

High Peak and Dales PCT also has a record of excellence, although the locality is different. The Corbar maternity centre is a centre of excellence, and it was recently reopened and reinvigorated in Buxton. The Stonebench ward is one of the most deprived wards in my area, and for the first time it has both GP and dental services provided through PCT investment in the Sure Start programme. It also has the first four dentists employed by the NHS who do not have the option of going private. That historically high-funded area will still get an 8.1 per cent. increase this year and an 8.2 per cent. increase next year.

There is an issue about the High Peak and Dales PCT budget, because—sin of sins—the PCT has overspent by 1 per cent. on its 2005-06 budget, which has resulted in the closure of the minor injuries unit in Buxton for eight hours a day between midnight and 8 am and the failure to bring an elderly person’s ward at the Cavendish hospital back into use after refurbishment. I agree with the protestors who say that the minor injuries unit should be available 24 hours a day, and I hope that the PCT will make sure that it comes back into service in one form or another. Between midnight and 8 am, the unit used to serve an average of two people a night—on average, one of them would go to A and E, while NHS Direct would probably be able to deal with the other. Nevertheless, public pressure is such that the situation requires a response. Equally, I agree with the PCT that the elderly ward should be brought back into use first when the money becomes available. In dealing with that minor overspend, no redundancies have been necessary, and I hope that the situation will be corrected before too long.

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