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Like my right hon. and learned Friend the Member for Rushcliffe, I think that it is fundamental that we understand why that situation has arisen despite the huge increase in resources committed to the national health service. I was struck by the fact that the Secretary of State was lecturing the House from the Dispatch Box on the importance of Ministers and managers in the national health service facing hard truths about the requirement to use resources efficiently if the health service is to deliver its objective of equitable access to high quality health care. As my right hon. and learned Friend said, he has made that speech, as have Ievery Secretary of State for Health has made it. The problem is that this generation of Ministers had a once-in-a-lifetime opportunity to use resources to address some of those fundamental problems of efficiency in health care delivery in the health service and they fluffed it. They had an opportunity that was not available to my right hon. and learned Friend when he was Secretary of State for Health and that he made certain, when he was Chancellor, was not available to me when I was Secretary of State for Healthan opportunity to use that huge increase in resources to oil the wheels of change. The present Government had the opportunity to use those resources to provide a step change in the efficiency and quality of service that is being delivered by the health service. The present generation of Ministers has missed that opportunity and the result is that we are back with short-term responses and crisis management.
Let me give the House three specific examples of what that means in practice for people who deliver care to patients on a day-by-day basis, rather than make speeches about the health service. First, we have what are often called in health service-speak the priority services. There is an unintended irony in that phrase. I am talking about community services, therapies and the low-tech services that are delivered at community level that often bring a quite disproportionate benefit to the quality of life of patients. However, they are the easy targets every time a health service manager faces the need to make short-term cuts so that the books can be balanced. That is why we have unemployed physiotherapists throughout the countrythe health service cannot afford to employ themwhy occupational therapists are looking for jobs and why social services are complaining about their inability to get local partnership arrangements out of the health service.
The effect of such short-term cuts in community-based services throughout the health service is twofold. First, they undermine morale because those who are delivering the service know that it is not as good as it could be. Secondly, and absurdly, they mean that we are building up long-term costs in the health service because people are being trapped in hospital, rather than released to properly funded and resourced community services.
Mr. David Burrowes (Enfield, Southgate) (Con):
Will my right hon. Friend add to his concerns the example from my constituency of the effective cuts that have led to unfilled health visitor posts and caused the closure of baby clinics and the suspension of routine developmental checks? That, together with the danger that our children and maternity services will be
transferred, has led to profound concern that services are being hit where it hurts most. We have the agenda for Every Child Matters, but that certainly does not matter in Enfield, Southgate.
Mr. Dorrell: My hon. Friend is entirely right. He cites a perfect example of the trend about which I am talking, which exists throughout the health service. Resources are being taken out of the community services because they are an easy hit.
The second example of short-term crisis management is the difference between the rate of inflation of health care costs in the system and the change that the Government have made to the tariff charged by secondary care to PCTs and commissioners. We all know that health care costs are rising very quicklymy right hon. and learned Friend the Member for Rushcliffe referred to thatand the latest estimate from the Office for National Statistics, which was published in August, is that they are rising by 6 per cent. a year. Given that the costs are rising at such a rate and the tariff that the Government published on 26 January increased by 1.5 per cent. a year, one does not need to be a statistician to work out that that represents a 4.5 per cent. cut in the real resources available for the delivery of individual procedures by NHS providers.
The situation shows that Ministers are not facing up to the consequences of their actions. If costs are rising by 6 per cent., yet Ministers fund them to the tune of 1.5 per cent., Ministers are effectively hoping that all the people in the national health service will somehow cover up the 4.5 per cent. gap so that they can avoid political embarrassment. It is not surprising that those people find their morale undermined if Ministers apparently believe that they are employed to do such a job. Those people think that they are employed to deliver high-quality health care to patients, as they should be. However, their experience is one of being asked to cover up the consequences of ministerial unwillingness to face precisely the kind of tough decisions about which the Secretary of State talked.
The development of training policy in the NHS, which is my third example of the short-term responses, has already been referred to during the debate. I have previously welcomed in the House the fact that we now spend more on training doctors and nurses in medical and nursing schools than we did when I was Secretary of State. I have reminded Ministers on previous occasions that that has happened partly because of carrying through plans that started to be generated when I was Secretary of State, but the big increase is welcome. However, it is not welcome that people who leave medical schools, and especially nursing schools, find that they cannot be employed in the national health service because Ministers have not faced up to the need to improve the efficiency with which health care is delivered. Furthermore, not only do we have unemployed nurses and doctors coming out of the growing medical and nursing schools, but the operators of the schools anticipate a 10 per cent. cut in the budgets available for training future doctors and nurses for the national health service. The Government have created a growing training sector, but they are not employing the people whom it produces, and they are also preparing a substantial cut to the increased training budget for which they are claiming credit.
John Bercow: Of course, that is true not only of doctors and nurses. Is it not particularly absurd that whereas there is a substantial increase in the number of trained and qualified speech and language therapists, there is also a substantial increase in the unmet need among children who require the service, but for whom the employed personnel to provide it do not exist?
Mr. Dorrell: My hon. Friend is right. Why does that undermine morale? It is partly because it results in unemployed people with training that they want to use and partly because the people in the service know better than the politicians the impact of the failures on the service delivered to patients from day to day. They can compare that service with what they want to deliver and what they know could be delivered if only the health service was led in a way that faced up to the real choices about which the Secretary of State likes to talk.
I agree with the Secretary of State when she talks about the importance of facing hard choices to deliver real improvements in health care. However, I look for a Minister who not only talks the talk, but walks the walk. I want to link the situation to the seven or eight rounds of bureaucratic change that we have had in the health service since 1997. The Government have brought us back round to virtually the same point at which they started nine years ago. Not only has that process led to a huge waste of resourcesI have seen estimates suggesting that the whole rigmarole has cost roughly £1 billionbut more fundamentally and importantly, it has meant that the kaleidoscope of changing management structures simply has not addressed the real choices about which the Secretary of State has talked. That is the link between the bureaucratic changes for which the Government are responsible and their fundamental failure to deliver improvements in health care, which is what hon. Members on both sides of the House want.
Mr. Gordon Prentice (Pendle) (Lab): The Member for Rushcliffe (Mr. Clarke) gently mocked Labour Members for hyperventilating when it comes to the Conservative record of all those years ago. I agree with him that policy convergence is taking place. In fact, the Prime Minister is on record as saying that a lot of policy cross-dressing is going on, yet we have these debates that are full of sound and fury about what the Conservatives did in their 18 years, and I think that it is just a big yawn.
The Prime Minister can be very tribal. At Mondays meeting of the parliamentary Labour party, he told usjacket off; gleaming white shirtThe Conservatives have a marketisation agenda, you know. Get in there on Wednesday. Goodness me, I thought. I will come on to the business of new Labour and the market in a minute.
I also wanted to pick up on the point made about structural change, which has been hugely debilitating. In the time that I have been a Member of Parliament, strategic health authorities have changed massively. We have a huge strategic health authority in the north-west. In east Lancashire, which is where my constituency is, East Lancashire health authority morphed into Burnley, Pendle and Rossendale primary care trust, which has morphed into an even bigger PCT.
We had two hospital trustsBurnley hospital trust and Blackburn hospital trustbut they have been merged. The Lancashire ambulance service has been abolished and we now have a regional ambulance service. Community health councils have been abolished and we now have public and patient involvement forums, which are about to be abolished and replaced by patient links.
Tony Baldry: Is it not especially tragic that while we started off with community health councils that people understood, no one now understands how patients or the general public have a voice in NHS change?
Mr. Prentice: I agree entirely. Last year, there was a lunatic proposal from Lord Warner to transfer 250,000 people directly employed by primary care trusts from the NHS into the private, voluntary and not-for-profit sectors. That was stopped only because of the huge outcry from Labour Members. The announcement was made on 28 July, and it was finally overturned by my friend the Secretary of State last November.
Debilitating change has taken place. The Prime Minister tells us that we are the change makers, but every time that we change the organisation, it is set back a year, or perhaps 18 months. It takes time to recover, and as soon as it has recovered, we slap it in the face again and reorganise. The way in which we endlessly reorganise the health service is Maoist, which is why people in the health service are so antagonistic towards us, why the platform lost an important conference motion moved by Unison in Manchester, and why a statement by the national executive committee, saying that more work had to be done to engage people working in the health service, was rejected by the conference. We regard people working in the health service as pawns that can be moved about, but they are finally saying, No, we are not having it.
The private sector is moving into the health service in a big way, but that is being done surreptitiously. Ministers do not say that it is taking place, although they should do so. All the arguments are wrapped up in issues such as contestability; instead, we should just play it with a straight bat and say, There are too many people sleeping at their desks in the national health service; we will put 20,000 volts through the NHS and bring in the private sector.
That is what is happening in my constituency, where Netcare, a South African firm, has become involved. I have a letter from my primary care trust that reminds me that Netcare runs a local mobile ophthalmology unit at Rossendale hospital, but I am told that Netcare is coming to Lancashire in a big way. The contract will be signed by the end of the year. I am told that Netcare services
will be established in the following specialities
I thought that it would just deal with the odd cataract, so that we process ophthalmology patients quickly, but it will be involved in work on ear, nose and throat, general surgery, trauma, orthopaedics and rheumatology. Urology and gynaecology, too, may be included, which does not leave much. Let us not kid people outside. The Prime Minister and the Government have a pro-market agenda, and they are pursuing it.
Meg Hillier: Does my hon. Friend agree that although the vast majority of NHS services in this country are provided in NHS facilities by NHS-employed staff, there are examples of cases in which it is not the best provider? I can give a personal example of a family member who was waiting for a wheelchair. She received it free at the point of delivery, but it was made by a private company, and private companies undertook the fitting. She was glad to receive the wheelchair. Is my hon. Friend suggesting that the NHS should open a wheelchair factory and make all the component parts, and provide the wheelchairs as well as the free service at the point of delivery?
Mr. Prentice: That is the argument about NHS Logistics. We can deconstruct organisations such as the police service. One might say that police officers should be fighting crime, not patrolling motorways, so we should take that responsibility away from them. The same could apply to the national health service. There are many people who want to be in the national health service family, and I agree that they should be part of it.
Mr. Prentice: I very much doubt it, because there are no consultation procedures when services are moved from the NHS into the private sector. There was no consultationit just happened. I got my information from the PCT; I did not have an opportunity to say that I do not want Netcare to be responsibly for urology, gynaecology, and ear, nose and throat procedures. I do not want that South African company to be responsible, but I was not asked, and nor was anyone else.
Patrick Hall: I shall be brief. May I give my hon. Friend an opportunity to return to his characteristic loyalty to the Government by at least agreeing that the difference between the Conservative and Labour parties is that we do not pretend that we can grow the NHS while cutting tax?
I am glad that my friend the Member for Burnley (Kitty Ussher) is here, because the latest shock to the system is that we may be losing the blue-light accident and emergency department at Burnley general hospital, which serves my Pendle constituency, too. Those services may be moved to Blackburn on the other side of east Lancashire. I do not believe that a proposal to close the blue-light accident and emergency services in Blackburn and transfer them to my friends constituency would see the light of day. Tomorrow, the councils overview and scrutiny committee will make a decision on whether or not to refer the issue to the Secretary of State for Health. My friend and I are against it, the patient and public involvement forum is against it, general practitioners and others in the medical community are against it, and local people are
against it, yet there is a possibility that tomorrow the overview and scrutiny committee may not recognise the strength of public opinion. That is why my friend and I will go up to Blackburn to speak to that committee, regardless of what the Whip says here. [Interruption.] I am speaking for my friend, and I think that I am doing so very well.
The issue of ambulance times is critical. In my PCT area, it takes an average of 38.57 minutes to take someone to the nearest accident and emergency department. In West Craven, where I live, it takes 54.48 minutes, and that is before the possible closure of blue-light accident and emergency services in Burnley. The ambulance will shoot past Burnley general hospital to reach Blackburn, way over the horizon.
We hear from Ministers all the time about the need to listen to peoplewe heard about it today from the Prime Minister and from the Secretary of Stateand if decisions on the NHS are to be made locally, the overview and scrutiny committee ought to listen to their voice.
Mr. Austin: I am grateful that, finally, my hon. Friend has allowed me to intervene. I would like to ask him whether anything that the Government have done since 1997 has been welcomed by the people of Pendle and whether he can present a rather more balanced picture. Does he welcome the extra resources that have gone into the NHS in his constituency, and does he welcome the increased number of people who have been treated there? Does he welcome the financial position in his constituency, as I understand that both the hospital trust and the PCT have a surplus?
Mr. Prentice: My friend has abused the generosity that I demonstrated when I allowed him to intervene. There are plenty of opportunities for balanced discussion at the meetings of the parliamentary Labour party. I am trying to save my local accident and emergency department, as the decision will be made tomorrow.
The overview and scrutiny committee reports to my friend the Secretary of State, who has the power to refer the proposal to the independent reconfiguration panel, which consists of independent clinicians from across the United Kingdom who do not know east Lancashire. If they say that the department has to be closedI say this to my friend the Member for Wigan (Mr. Turner), who takes great delight in interrupting me all the timewe can live with that, because
independent clinicians will have made that recommendation, not the director of accident and emergency services, who will speak at the overview and scrutiny committee minutes before the councillors are invited to make a decision.
There have been 13 recommendations from overview and scrutiny committees to the Secretary of State but she has passed only two of them on to the independent reconfiguration panel; that is not good enough. I had a meeting yesterday with Dr. Peter Barrett, who chairs the independent reconfiguration panel, and I told him that I hoped that there would be a reference through the overview and scrutiny committee to the Secretary of State, and that she would not throw it in the wastepaper basket, but that she would pass it on to that panel, which we on the Labour Benches set up to make recommendations that would carry public confidencein this case in my constituency and the neighbouring constituency of my friend the Member for Burnley.
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