NHS Reorganisation
Grahame Morris Excerpts(13 years, 5 months ago)
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Mr Dorrell
I cannot summarise the Government’s proposals in the White Paper in three minutes, but one of their key drivers is to deliver far greater clinical engagement in the commissioning process than was achieved in the lifetime of the previous Government, in my time as Secretary of State or at any time in the 20-year history of health service commissioning. We want to achieve a step change in the engagement of the clinical community in the commissioning process. As long as commissioning is something that is done to clinicians by managers, it will fail. It has to engage the clinical community on both sides of the argument. That, as I understand the Secretary of State’s White Paper, is one of his core objectives, and if it is, it has my full-hearted support.
Grahame M. Morris (Easington) (Lab)
In advancing that idea, does the right hon. Gentleman accept that the power to commission is being given to clinicians only in primary care, and that clinicians who work in a hospital setting are not being empowered or involved in the commissioning process at all?
Mr Dorrell
The hon. Gentleman is a fellow member of the Select Committee and I know from our discussions that the principle of clinical engagement in commissioning is broadly supported in the Committee. It is fair to say that none of us would support the view—I suspect the Secretary of State would not either—that clinical engagement means only GP engagement. We should see the GP as the catalyst for broader clinical engagement in the commissioning process if we are to deliver our objectives.
To deliver the Nicholson challenge, we must have strong commissioning, with clinical engagement, and we have to remove unnecessary processes that do not add value. We cannot afford to waste money on them. We must have greater local accountability for the commissioning process in order to embrace public support for change on this unprecedented scale.
Health (CSR)
Grahame Morris Excerpts(13 years, 6 months ago)
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Grahame M. Morris (Easington) (Lab)
It is a pleasure to serve under your chairmanship for the first time, Mr Gale.
I thank the Backbench Business Committee for allocating this slot. I sought the debate to allow right hon. and hon. Members the opportunity to examine the real impact of the Chancellor’s comprehensive spending review on the Department of Health, the national health service and, indeed, public health.
The coalition Government have set out a 0.4% real-terms budget increase over the spending review period. Although the numbers suggest that the Government are providing the NHS with a modest increase in its budget, the decisions they are making will mean cuts to services, staffing, capital spend, medicines and care. In truth, it is the worst settlement for the NHS in its 62-year history.
During the course of the debate, I want to challenge the Government’s claim that they have met their coalition agreement pledge to guarantee that health spending increases in real terms in each year of the Parliament. Right hon. and hon. Members should note that £1 billion a year is being taken from the existing NHS budget to meet some of the growing costs of social care.
Not only is the coalition failing to rise to the task of dealing with the growing crisis in social care but, by transferring responsibility for social care to local government, it is trying to rob Peter to pay Paul, and then pretending that Peter still has money. Both the Nuffield Trust and the House of Commons Library have confirmed that due to the transfer of money from the health budget to social care, there will actually be a cut in the health budget. The latest House of Commons Library research report confirms:
“Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.”
For social care, there are storm clouds on the horizon. Even with the additional money taken from the health budget, there will be a shortfall of at least £2 billion—as set out by the Local Government Association—to maintain current standards by the end of the spending review period. It seems like another broken promise to say that the coalition will provide sufficient resources to maintain current levels of social care.
On top of that, the Government are removing the ring fence from the personal social services grant and merging the social care budget into the local government formula grant. The NHS Confederation has noted that with councils facing a 26% cut in their funding from central Government, money for social care might not get to those who need it. In short, this means that there is no guarantee that the money will be used as intended, thus creating a postcode lottery in care and a Government who are washing their hands of their responsibility to provide dignity to the most vulnerable in our society.
The Minister of State, Department of Health (Mr Simon Burns)
Just to put the hon. Gentleman out of his misery, as he has prayed in aid the King’s Fund, would he care to comment on—and does he agree with—its briefing for the debate? It says:
“In the context of significant cuts to other Whitehall budgets, the settlements for health and social care are generous. The government has met its pledge to protect the NHS budget and has prioritised additional funding for social care.”
Grahame M. Morris
We have crossed swords before over an interpretation of figures. Later in my speech—
Grahame M. Morris
I intend to come to the King’s Fund in a moment. I suspect that the Minister is quoting rather selectively from its brief.
Mr Burns
To help the hon. Gentleman, and because I would like an answer to the question, may I say that I am not quoting selectively? I suspect that he, too, has the briefing. The quotation is at the top of page 4. It is the first and only paragraph of the conclusions, so it cannot be out of context.
Grahame M. Morris
I will answer in a moment, if the hon. Gentleman gives me the opportunity.
I am also quoting figures from a recent House of Commons Library note—perhaps the Minister has a copy as well. It seems quite clear to me that, in terms of departmental expenditure limits and certainly in terms of capital, we are looking at a 17.9% reduction over the lifetime of the Parliament. Indeed, the Minister and I, and other colleagues from the north-east, have raised issues about NHS capital funding in the past—I want to mention those later in my speech. I am conscious that other hon. Members want to make contributions, so I shall press on for the moment and hopefully I can respond to the Minister in a little more detail in a moment or two.
To highlight some of the anecdotal evidence, at a recent meeting of the Community Practitioners and Health Visitors Association, which is part of the union Unite, front-line workers gave their feedback on the impact of cuts already in the pipeline. They expressed concern that a reduction in the number of practitioners was eroding the service to the public, that specialist staff were already being made redundant, that vacancies were being frozen, that case loads were getting bigger and that patients had to wait longer. They further pointed to a reduction in vital health promotion work, which has been highlighted before, and the fact that health visitors were now working significantly over their paid hours in chaotic circumstances.
Alex Cunningham (Stockton North) (Lab)
I congratulate my hon. Friend on securing this important debate. Is he aware that, contrary to the Government’s claims that they will protect the NHS, many jobs have already been axed in our health service, including nearly 200 on Teesside alone in recent weeks? Is he also aware that, just this week, school nurses in that area are being targeted and asked to volunteer for redundancy due to the very real cuts being imposed?
Grahame M. Morris
I have a whole series of examples of hospitals and services that are threatened with closure or reductions in services from right across the length and breadth of the country, which was highlighted in a recent report in The Sunday Telegraph. I have the whole list, so I agree with the valid point that my hon. Friend makes forcefully.
After only six months in power, the coalition is putting the proud record of the previous Labour Government on the NHS in jeopardy. On top of this, feedback from the front line shows that the Government are removing the safeguards and patient guarantees that drove down waiting times and assured the same quality of care irrespective of where a patient lived. This is not a Government protecting the NHS. It seems as if this is round 2 of what the Tories never managed to accomplish in the 1980s: to break up and privatise the service.
Ian Lavery (Wansbeck) (Lab)
On 20 July, in evidence to the Health Committee, the Secretary of State said that he wanted to
“entrench the sense of greater ownership on the part of patients”—
that is ownership of the NHS. Is it not the case that the reforms will give ownership of the NHS to the private sector, and that only the NHS logo will be left behind?
Grahame M. Morris
My hon. Friend makes a valid point. The White Paper “Equity and Excellence: Liberating the NHS” certainly seems to be setting out in that direction.
Certain projects, and particularly one in my area, have suffered as a result of the departmental expenditure limits that I mentioned earlier, which will result in a decrease of 17.9% over the four-year life of the Parliament. A new hospital in the north-east of England at Wynyard was to have served the southern part of my constituency of Easington, as well as the constituents of Stockton North and Stockton South, and those in parts of Sedgefield and Hartlepool, but it was an early casualty of the cuts.
In the longer term, the coalition partners seem to want not a capital budget, but to pursue a roll-out of private finance initiative hospitals. They want to place every privately built hospital into competition in the private sector so that they can be commissioned by GPs controlling the entire health budget in the private sector. The direction of travel for the health policies of the present Government is clear, but it is my belief that the duty of the Government should be to protect essential public services such as the NHS from the distorting effects of the market.
We need to learn lessons from recent history. It is ironic that my party’s efforts in government to incorporate market conditions in health showed that that could drive costs up rather than bring about efficiencies. Such an example was recently cited in the media. The Coventry University hospital was built under a PFI scheme. As we all know, PFI allows private companies to build public sector infrastructure, but although it gives the benefit of delayed costs to the public purse, those companies are entitled to levy huge interest rates, fees and services charges in the longer term. Treasury figures show that when the contract for Coventry University hospital is paid off in 2041, the estimated cost to the taxpayer will be £3.3 billion. If the state had built the hospital, the cost would have been a fraction of that sum. Indeed, the hospital at Wynyard was costed at £464 million—that is an incredible difference. Market discipline and privatisation do not automatically produce value for the public purse.
Mr Simon Burns
Will the hon. Gentleman confirm that that PFI scheme took place under a Labour Government and was approved by a Labour Treasury?
Grahame M. Morris
The Minister is right, but I was making the point that important lessons from history need to be learned. We are reacting to evidence that PFI does not necessarily provide value for money. Each case has to be considered on its merits.
Given the real-terms cut to health spending, an agenda of wholesale management reorganisation and the effective privatisation of the NHS budget, the impact of the comprehensive spending review and the Department of Health White Paper will not only alter the principles on which the NHS was founded, but squeeze health provision, increase costs, allow hospitals to go bust if they are failed by the markets, and create a postcode lottery of health services. There is widespread opposition to elements in the White Paper among health care professionals, including from the British Medical Association, which is not noted as radical left-wing organisation. The BMA states that it has
“opposed the increased commercialisation and competition imposed on the NHS in recent years and there is little evidence of any benefits to patients. It brings with it additional costs as well as disincentives for collaboration and co-operation.”
Staff costs account for more than half of NHS expenditure. Future decisions on pay will have a great impact on the health budget. The Royal College of Nursing has already highlighted short-sighted cuts by NHS trusts to their work force and services. The RCN is aware that about 10,000 nursing posts have been earmarked for removal in anticipation of cuts to front-line services. What consideration has the Minister given to the pressure to increase staff pay in coming years? By 2013-14, GPs will have had their pay frozen for four years; consultants for three years; and NHS staff earning more than £21,000 for two years.
Ian Lavery
Is my hon. Friend aware that despite the two-year pay freeze on public sector pay for those earning above £21,000 a year, which was announced by the coalition in the emergency Budget, the King’s Fund notes that the NHS payroll bill is likely to increase by up to £900 million a year due to the increments that are built into most NHS contracts? Does he agree that that reinforces the inadequacy of the NHS settlement for patient care?
Grahame M. Morris
I do indeed. My hon. Friend makes an important point. Another is the impact on the NHS budget of the VAT increase that is to be implemented on 1 January 2011.
Kieran Walshe, professor of health policy and management at Manchester business school, has criticised the coalition Government’s approach of making change without evidence. The implementation of the massive reorganisation that is set out in the White Paper will need at least another £3 billion in addition to the sums already identified, such as for wage costs, inflation, and the increase in VAT. That is at least another £3 billion from the NHS coffers, and the plans were still being altered after the coalition agreement was published. The decision to abolish primary care trusts seems more like a last-minute whim of the Secretary of State than a well-thought, evidence-based approach to health service reorganisation.
Professor Walshe said:
“the transitional costs of large scale NHS reorganisations are huge…projected savings from abolishing or downsizing organisations are rarely realised.”
Those of us who have been involved with local government will appreciate how true that is. He continued:
“Closing down or merging organisations produces a round of expensive redundancies, early retirements, and redeployment, while new organisations find new premises and appoint lots of new staff.”
I echo the concerns of Mencap—I am grateful for its briefing—which states
“As the government have still been unclear about the transitional and ongoing costs for moving to the new commissioning arrangements, this settlement may not be sufficient to deliver against needs.”
In contrast, the Secretary of State still believes that he can save money by carrying out the biggest reorganisation in the history of the NHS. Indeed, on 2 November, he said:
“We are cutting management costs in the NHS by 45%. We will cut total administrative costs as well, and in total that will save £1.9 billion a year by 2015.”—[Official Report, 2 November 2010; Vol. 517, c. 759.]
Will the Minister tell us what account has been taken of the unknown costs of the reorganisation?
Professor Chris Ham is the chief executive of the King’s Fund—the Minister’s favourite organisation. He questions why the Government would
“embark upon such a fundamental reorganisation as the NHS faces up to the biggest financial challenge in its history.”
Is it not the case that Ministers should be honest with the public? The impact of the spending review will mean deep cuts to vital services in the NHS. When the Health Secretary delivered his White Paper to the House, he said:
“The dismantling of this bureaucracy will help the NHS realise up to £20 billion of efficiency savings by 2014, all of which will be reinvested in patient care.-—[Official Report, 12 July 2010; Vol. 513, c. 663.]
Coalition Minsters are trying to give the impression that health provision has somehow been protected by a real-terms increase in the health budget, but that myth is starting to unravel. The coalition Government have admitted that current levels of health care will not be maintained. They are undertaking a massive reorganisation and all the evidence suggests that the projected savings will not be realised.
Edward Macalister-Smith, the chief executive of NHS Buckinghamshire, said:
“the amount of money that is available from administrative savings, management savings and the financial back office, is a very small proportion. Most of the money is spent on clinical care. If you want to reduce your spending, make your spending more efficient, that is, I am afraid, where you have to concentrate.”
It is simply not possible to achieve the sort of savings that the Government have outlined. The settlement for the NHS will come no way near maintaining current health care levels. Some £1 billion is being taken to plug the hole in social care. Many more billions are being wasted on a wholesale reorganisation, and the coalition seems to have agreed to take a gamble with the £80 billion NHS commissioning budget.
According to research carried out by the King’s Fund, the VAT rise to 20% from January next year will cost the NHS an additional £250 million a year. Furthermore, additional pressures will be placed on the NHS, thanks to the massive cuts that are being levied on local government budgets. There are also serious concerns that cuts to local government will lead to a shortage of hospital beds as the elderly and vulnerable are left without local care, thus placing even greater pressures on the NHS. The 26% cut in central Government funding for local authorities will pile on the pressure for the NHS. Nigel Edwards, the head of the NHS Confederation, has warned that the pressure on beds could mean that hospitals will be unable to admit patients “who badly need care”.
It is wrong for Ministers to pretend that their reorganisation will improve service delivery or that it is possible to save £20 billion through efficiencies alone. They should be honest about what they are doing to our national health service. The Government are not keeping the promises that they made to patients and staff to protect NHS health care funding.
Mr Simon Burns
I would hate the hon. Gentleman to escape from his earlier promise. He said that he would comment on the quote I cited, which, I repeat, has not been taken out of context. Let me remind him what it:
“In the context of significant cuts to other Whitehall budgets, the settlements for health and social care are generous. The government has met its pledge to protect the NHS budget and has prioritised funding for social care.”
Does not the hon. Gentleman agree with that element of the King’s Fund briefing; he seems to agree with anything that suits his argument?
Grahame M. Morris
Yet again, the Minister is quoting one specific element of the evidence. The King’s Fund evidence is quite extensive. It is logged on the Health Committee’s website and is open for the public to see. Many commentators and respected organisations take a view that runs counter to that expressed by the Minister.
I shall conclude because I know that other hon. Members wish to speak. Political and NHS leaders need to be realistic about the implications of the financial situation for patients, the public and staff. There are no pain-free options for the NHS. It is time that Ministers were honest about the future of the NHS. There is no doubt that over the spending review period, the NHS will have its spending power reduced. It is time for the Government to be honest with the public about the decisions they have made.
Mr Barron
That is absolutely true. There are fewer resources, because more is being taken out of administration than was planned before the spending review came along.
I am intrigued by the idea of giving clinicians power or giving GPs power. The British Medical Association is not saying no to the idea of GP commissioning. That is good—I have some quotations from it in front of me—but it would want to look at having a real local clinical partnership that included clinicians who worked in the local provider—the local hospitals. It believes that if we are going to do this, that ought to be looked at. I am interested to see whether the Minister agrees. One reason I say that is because, when we took evidence from his favourite organisation, the King’s Fund, the Royal College of Physicians and others thought that PCTs should be retained, but that hospital clinicians and GPs should work more closely together. Professor Ham, who is obviously one of the Minister’s favourite authors in these matters, said:
“There should be progressive migration towards clinically integrated systems, building on the most promising aspects of current reforms and drawing on evidence that shows the benefits of integration and the challenges of making a commissioner/provider split system function effectively.”
He was arguing for real integrated care, but my understanding is that that is not what the White Paper is proposing. It is proposing that only GPs will have the power to spend 70 or 80% of the NHS budget, not other local clinicians as well. I would like the Minister to reply on that specific point.
Grahame M. Morris
I thank my right hon. Friend for giving way on the point about GP commissioning. That is an issue that the Minister might address. If streamlining in commissioning bodies saves money—I think the previous Labour Government demonstrated that by reducing the number of PCTs from 350 to 150, which was acknowledged by Sir David Nicholson—how can it save money to be creating a plethora of GP consortiums that will be responsible for commissioning? Creating such a plethora of bodies must add to administrative costs.
Mr Barron
I am grateful to my hon. Friend for his intervention. I have to say to the Minister that at no time when members of the Health Committee in the previous Parliament were looking at commissioning did we ever think that the Government would hand it over to GPs in the way being proposed in the White Paper. It has huge implications, not just for the NHS, but for GPs themselves. The only evidence we saw was that GP fund-holding has struggled for nearly 20 years to be a good, proper and efficient way to commission services. Frankly, nobody submitted any evidence to my knowledge for the leap into the dark of handing commissioning to GPs in such a quick period of time. Nobody gave that evidence whatever. There were some arguments about keeping the PCT and adding GPs to it, so that they could get the experience. Frankly, there should be more medical leadership in our national health service; I have no doubts about that. This leap in the dark with GP commissioning is something that, I fear, is unlikely to work. The professionals who work in the health service appear to have that same fear.
The Minister of State, Department of Health (Mr Simon Burns)
I begin by thanking the Backbench Business Committee for and congratulating the hon. Member for Easington (Grahame M. Morris) on this interesting debate. In passing, let me say what a difference six months makes. Six and a half months ago, all the Labour Members who are sitting on the opposite side of the Chamber were in government. Some of the examples of reconfigurations and decisions taken on the health service happened under the last Labour Government, although some hon. Members seemed oblivious to that as they criticised what is happening.
Mr Burns
One moment; let me make a start. We have taken difficult decisions and, as I will explain, we have honoured our election pledge on a real-terms increase, albeit a modest one, as a number of hon. Members, including the hon. Member for West Lancashire (Rosie Cooper), pointed out. However, no hon. Member tried to explain why that increase had to be so modest, which amazed me. The reason was, quite simply, our inheritance of the most horrendous debt and deficit problems, left to us by the previous Government. That would have tied the hands of any party, including those of the Labour party had it won the election. Rest assured, if the previous Government had been re-elected, they would have been making serious cuts.
Having listened to a number of speeches, it is slightly ironic that some hon. Members present seem to be oblivious to the fact that one of the Labour leadership candidates during the recent campaign, the former Secretary of State for Health, the right hon. Member for Leigh (Andy Burnham), criticised us for honouring our pledge of a real-terms increase in NHS funding. He said that it was a disgrace that we were keeping to that pledge and that, in the overall spending programme, we should not be honouring our pledge of a real-terms increase in health spending. I find that a bizarre proposition from a former Labour Secretary of State for Health, but that was his view and his decision. Judging by the faces of some Labour Members, they seem oblivious to the fact that the right hon. Gentleman criticised us about that. That somewhat undercuts the arguments that I have heard today from those who say that we have broken our promise and not kept to a real-terms increase. They will have to make their mind up one way or another.
Grahame M. Morris
The Minister has just destroyed my reputation. My point is about the cost of the reorganisation at what is a difficult time for the economy. Why embark on an expensive major restructuring of the health service? It does not make any sense. Previous reorganisations were expensive and time consuming. Surely, if we learn anything from evidence, it is that now is not the time to do this. Another top-down reorganisation is the last thing we need.
Mr Burns
I am grateful to the hon. Gentleman for that intervention, and I am sure that his reputation will survive my praise of him. I shall, in my own way, come to the point that he raises.
Before I begin to explain why we have not broken our election pledge, let me congratulate the hon. Member for Halton (Derek Twigg). He is a dedicated and decent man who was always an exemplary Minister when he was in government. I am delighted to see him back on his party’s Front Bench, albeit in a shadow ministerial post, and I wish him well in his endeavours. I trust that he will be doing the job for many years to come and that the same fate will not befall him as sadly befell him when he left the previous Government: ironically—I grieve as much as he does about this—his place was taken by someone who was ostensibly a Tory, who was, for some bizarre reason, embraced with both arms by previous Prime Minister. It is great to see the hon. Gentleman back, and I look forward to many debates over the coming years as our careers continue.
This debate goes to the heart of two of the coalition Government’s main priorities: bringing the public finances back on to a sustainable footing and ensuring the future health of the nation. Our manifesto commitment, reiterated in the coalition agreement, was to increase spending on the NHS in real terms for every year of this Parliament. Notwithstanding the comments of some hon. Members, I am tremendously proud of the fact that we have kept the faith and honoured that pledge. Before anybody jumps up to try to intervene, let me remind them that I am proud of keeping that pledge.
The right hon. Member for Leigh, the former Secretary of State in the outgoing Labour Government, has criticised my party for keeping that pledge because he thought it was wrong. It would be difficult for any Labour Member to claim that we have broken the pledge, because, by definition, if we have broken the pledge, the right hon. Gentleman is factually incorrect in his criticism of us. It is a bit of a dilemma for Labour Members.
Grahame M. Morris
It is an important point, and an issue that the Select Committee has considered. Evidence presented to the Committee shows that, over the lifetime of this Parliament and beyond, the gap between funding and demand will grow. There will be an ongoing problem of underfunding in social care. I would not like the Minister to give the impression that this demographic time bomb can be resolved by this single measure.
Mr Burns
The hon. Gentleman is right. I do not claim that the demographic time bomb will be resolved by this measure. The trouble with personal social care is an historic one; Governments have always been playing catch-up. That is beyond dispute. I am saying that we recognised the growing pressures, and we believed that we had to act. That is why we have done so. It will reduce the problem, but the hon. Gentleman is right that it will not solve it, as more work has to be done. No doubt, it will be done, as we catch up with the past. I hope that I have reassured the hon. Gentleman. I now wish to make progress.
We believe that funding social care is important not only in its own right but for the sake of the hundreds of thousands of people who rely on it—and because the NHS cannot function without social care. Without it, people have to stay in hospital beds for longer, inappropriately blocking beds that other patients could use. It is important that we invest the money to ensure that there are no delayed discharges, and that we can provide an appropriate setting for those who are discharged.
Grahame M. Morris
With the leave of this Chamber, I thank you, Mr Gale, for your courtesy and stewardship of this debate. I thank my hon. Friend the Member for Halton (Derek Twigg) and the Minster for responding, and the Backbench Business Committee for giving us the opportunity to hold this debate and to scrutinise the impact of the comprehensive spending review on the Department of Health. Within the context of the CSR, Members present have highlighted concerns about the cost pressures on the NHS arising from the huge organisational change, hidden costs of VAT increases, drug inflation and cuts in local government and welfare budgets. Indeed, many questions have been raised that may be the subject of future debate in Westminster Hall or in the Chamber.
Members on the Labour Benches call on the coalition Government to honour their pre-election pledges to safeguard the NHS and enable it maintain a comprehensive service that is free at the point of need. I make this pledge. We on the Labour Benches will hold the Government and Ministers to account for their stewardship of the NHS.
Finally, I thank all of the Members who are here today. More than a dozen have participated, which is too many to mention by name.
Question put and agreed to.
Hospital Services (North-East)
Grahame Morris Excerpts(13 years, 9 months ago)
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Grahame M. Morris (Easington) (Lab)
I am pleased to serve under your chairmanship, Mr Sheridan, in this important debate. I congratulate my hon. Friend the Member for Hartlepool (Mr Wright) on securing this debate on hospital services in the north-east. In my remarks, I intend to focus on the future of hospital services for my constituents in the south of Easington who, until June of this year, were looking forward to the benefits of a new acute hospital at Wynyard, which would have served local people in five parliamentary constituencies: Stockton North, Stockton South, Hartlepool, Easington and Sedgefield. This state-of-the-art hospital costing £464 million was granted approval in March following many years of preparation and consultation, with health professionals and clinicians working on the ground. The original concept for the new hospital was set out by Professor Sir Ara Darzi, and proposals by an independent reconfiguration panel were clear in recommending a new hospital to replace the existing provision spread across two sites, 14 miles apart.
It is evident that the North Tees and Hartlepool NHS Foundation Trust will struggle to continue to provide high-quality health care as we move forward into the future with the existing, ageing configuration. I commend the work of health care professionals and ancillary support staff at the University hospital of North Tees and the University hospital of Hartlepool, without whose dedication and commitment our health service could not function.
North Tees and Hartlepool NHS Foundation Trust has worked hard to meet key targets—Labour’s targets—to ensure a high quality and universal standard of health care for all the people in its catchment area. More than 90% of outpatients and 85% of inpatients wait no more than 18 weeks from being referred by their GP to receiving their first treatment in hospital, which is no mean achievement. The trust has also consistently managed to see, treat, admit or discharge 98% of patients within four hours of arriving in accident and emergency. Like services across England and Wales, the North Tees and Hartlepool NHS Foundation Trust guarantees to see patients within two weeks if a GP thinks that they may have cancer. That final target, the cancer guarantee, has been kept by the Minister, although my right hon. Friend the Member for Leigh (Andy Burnham) had to work hard for that victory. If the proposed hospital at Wynyard does not go ahead and our services must continue to be delivered from inadequate and increasingly outdated hospital buildings, I have a real concern that patients will suffer. Within the context of the proposed new hospital, I want to touch briefly on NHS targets. The Government’s principal argument against targets has been eroded since they accepted the two-week cancer guarantee, so why can they not admit that targets are important to ensure a universal quality of health care?
Hospital services in the north-east have offered high-quality standardised care during the past decade. As I have mentioned, my concern is that, if North Tees and Hartlepool NHS Foundation Trust is forced to deliver care to patients from two existing and increasingly outdated hospital buildings, the removal of targets that would have guaranteed a certain level of patient care will put patient care at risk. It is possible to foresee a scenario whereby, in comparison with those areas where the Government have allowed the construction of new hospital buildings to go ahead, the services provided in North Tees and Hartlepool—in much more challenging circumstances—could fall behind the standard of care offered by the new hospitals elsewhere in the country.
I remember that the Minister had some difficulty over the figures that were quoted when he responded to my hon. Friend the Member for Stockton North (Alex Cunningham) on 5 July, as has already been mentioned; perhaps there was some confusion over the figures. I would appreciate it if the Minister could clarify this point, because the record was corrected and I am taking these comments from Hansard, concerning the evaluation of the relative costs of providing health care with and without the new hospital. The corrected version of Hansard reads as follows:
“Over the appraisal period of 35 years”—
that is, the life span of the hospital—
“the total net present cost—that is, the whole-life cost—of building, maintaining and operating the new facility was £5.033 billion, but the cost of repairing”—
Grahame M. Morris
I want to continue on this point, because the Minister is reinforcing my point in relation to the costs. He said on 5 July that the cost of “operating the new facility” was £5.035 billion over the 35-year period that is the hospital’s life span. He continued:
“but the cost of repairing defects, maintaining, operating and providing services from the two existing buildings was £5.24 billion.”—[Official Report, 5 July 2010; Vol. 513, c. 150.]
Therefore, although it was not immediately clear, is that incorrect?
Grahame M. Morris
Okay, thanks. The cost difference is very marginal, when we factor in things such as NHS inflation and so on. The Minister has already given some clarification, but my point is that by not continuing with the proposed new hospital the cost of delivering health care may in fact—
Ian Mearns (Gateshead) (Lab)
I have to say that the figures that the Minister has just given in his intervention on my hon. Friend seem to make the Government’s position even worse than I thought it was. What we are actually talking about is a margin of difference of £11,000—based on the figures that he has just given us here in Westminster Hall—across the 35-year operating programme. Now, I am not sure if that is actually correct. I wonder if it is a bit like the lists given out by the Secretary of State for Education; the figures and the numbers keep altering on us. But based on the figures that the Minister has just given us, we are talking about £11,000, and that is the cost of not having a brand spanking new state-of-the-art hospital to serve five constituencies: my own constituency; the constituencies of my hon. Friends the Members for Stockton North, for Hartlepool and for Sedgefield (Phil Wilson), and the constituency of the hon. Member for Stockton South (James Wharton).
Grahame M. Morris
There seems to be some confusion here with the figures. However, in my mind, perhaps in the minds of other Labour Members and certainly in the minds of the good people of Easington, it only shows what a bad decision it was. I do not believe that it is being made for the stated financial reasons, but instead seems to form part of some type of idelologicallybased course of action taken by the coalition Government.
It is clear now that the saving of £464 million—the figure that was widely quoted to the media at the time of the hospital’s cancellation—is completely misleading. At some point, I hope that we will also get to the bottom of the true costs to the taxpayer of cancelling and pulling the plug on this new hospital development, which, as my hon. Friend the Member for Hartlepool has indicated, has been in the planning since 2005.
On 2 May 2010, in an interview with Andrew Marr, the right hon. Member for Witney (Mr Cameron) talked passionately about how a responsible society should protect the vulnerable. This is what he said:
“The test of a good society is you look after the elderly, the frail, the vulnerable, the poorest in our society. And that test is even more important in difficult times, when difficult decisions have to be taken, than it is in better times.”
I am sure that many of my colleagues knew at the time, as I did, that that statement lacked substance.
Easington is one of the most deprived areas in the United Kingdom. Health inequalities still play a large role in Easington; there is shorter life expectancy and poorer quality of life. Life expectancy in Easington is a full two years lower than the national average. The proposed new hospital was part of a clinically led strategic reorganisation of health provision for one of the poorest areas in Britain, which would have gone some way to tackling some of the worst health outcomes in the country.
The latest figures that I have been able to access are the 2007 statistics on standardised mortality rates per 100,000 population. They show clearly that death from illness that is amenable to health care—that is, deaths that would have been preventable with health interventions—accounted for 256 deaths per 100,000 of the population in the Easington local authority area, compared to an average of only 195 across the rest of England and Wales. For all causes, the figure for Easington is 713, compared to 582 for England and Wales. For coronary heart disease, the figure is 112 per 100,000 in Easington compared to 90 per 100,000 across the rest of England and Wales. For cancer, the figure for Easington is 219 per 100,000 compared to 175 nationally.
Mr Kevan Jones (North Durham) (Lab)
Does my hon. Friend agree that one of the success stories in his constituency has been the local primary care trust’s anti-smoking policy—the area has seen some of the largest drops in smoking anywhere in the country? Does he also agree that the fact that that policy will be abolished too will add to the health inequalities in his constituency?
Grahame M. Morris
That is a very good point and the development of community health infrastructure has been integral to the proposal for the new hospital. It is key to improving health and tackling health inequalities.
I have some sympathy with the Minister, as it seems that the proposed hospital suffered at the hands of the Chief Secretary to the Treasury as he searched to save around £2 billion in June. However, regardless of the changing economic circumstances that saw Britain’s budget deficit improve by £10.4 billion from the original pre-election forecasts, I do not believe that it is too late for the Minister to give the proposed new hospital a second chance, following a reconsideration of the evidence.
Grahame M. Morris
If you do not mind, Mr Sheridan, I will not give way to the hon. Gentleman. I know that time is short, but I am almost finished and I think that the hon. Gentleman will have an opportunity later to speak. I have almost completed my contribution.
As it stands, the future of health provision in North Tees and Hartlepool is being put at serious risk. The cancellation of the hospital at Wynyard can only ever be viewed as a delay—the need for it still exists. Whether it is a delay of five years, 10 years or longer, the people of Stockton North, Stockton South, Hartlepool, Easington and Sedgefield need a new hospital. I invite the Minister to think in the long term and not to abandon a well thought-out project that would improve health care for people who have suffered a legacy of some of the worst health outcomes in Britain.
Mr Burns
Because, as I will again explain—this is similar to what I said on 5 July—there were a range of criteria determined and, as the hon. Gentleman is aware, we took the decision on the hospital on the grounds of affordability and the foundation trust status of the hospital. If he will bear with me, I will explain that again, so that even if he does not accept the decision, he will, I hope, come to understand the reasoning behind it.
On 17 June, the Chief Secretary to the Treasury, my right hon. Friend the Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), announced to the House the decisions made following the Government’s review of spending commitments. The review cancelled 12 projects, including the proposed new hospital at North Tees and Hartlepool.
The aim of granting foundation trust status is to give bodies, such as the trust in the area represented by the hon. Member for Hartlepool, greater financial independence. As well as being able to keep any internally generated resources, foundation trusts also have greater freedom to borrow from either the public or the private sector. As the proposals required an allocation of public dividend capital from the Department of Health of more than £400 million, they were not consistent with that financial independence. Treasury and Department of Health Ministers, including me, decided that, overall, those factors—affordability within the changed economic climate and the hospital’s foundation trust status—weighed against the £458-million scheme for North Tees and Hartlepool more than they did against the other three schemes at Liverpool, Epsom and St Helier, and the Royal National Orthopaedic hospital. For those reasons, the Government withdrew support for the scheme.
Following our previous debate, I was pleased to meet, on 8 July, Paul Garvin—the chair and non-executive director of North Tees and Hartlepool NHS Foundation Trust—together with the hon. Member for Hartlepool and many of his hon. Friends now present. At that meeting, we discussed the possibility of the trust putting forward a new proposal under the private finance initiative. As I have said repeatedly, I cannot in any way give any guarantees that such a scheme would, or would not, be approved. Like any proposal, it would have to be considered on its merits and in the light of the economic climate at the time it was put forward for consideration and possible approval.
However, the advice I would offer the foundation trust is the same advice I would offer any organisation putting forward such a proposal. Any scheme must reflect the changed realities of the national health service, as set out in the White Paper. It would clearly have to demonstrate that it passed the four tests for reconfigurations set out by my right hon. Friend the Secretary of State. That is, it has to have the support of GP commissioners; arrangements for public and patient engagement, including with local authorities, must be strengthened; there must be clear clinical evidence underpinning any proposal; and it must develop and support patient choice.
The economic and policy circumstances have changed since the original proposals were put forward. It would be advisable for the foundation trust to make sure that any revised proposals reflect those changes, and can demonstrate that they have the full support of GPs, the public and the local authority. Any new proposal must be realistic, affordable and provide value for money.
Grahame M. Morris
On the point about providing value for money, and the elephant in the room, which is the implied advice that the appropriate route for a foundation trust is a PFI initiative, does the Minister accept that the evidence suggests that over the 35-year write-off time, or life of a hospital, there would be an estimated additional cost to the pubic purse of £5 million a year as a result of going down the PFI route? That would cost the public purse an additional £175 million over the lifetime of the hospital—money that would otherwise go into patient care.
Mr Burns
I have to say, in the kindest, gentlest way possible, that I fear we are beginning to go around in circles. I have given the corrected figures; confusion was caused by what Hansard originally printed in the last debate on the subject, when I talked about the comparable costs of maintaining the two hospitals that exist and building a new one. There was a marginal £11 million difference.
Mr Burns
The hon. Gentleman must wait a minute, because I have only 10 minutes in which to answer the questions that the hon. Member for Hartlepool asked. The fact is that the decision was taken on affordability and on the fact that the trust was a foundation trust and so was free to seek other means by which to finance the project, rather than going to the Department for capital funding. Those decisions were taken because of the tough economic situation we inherited after 6 May and the massive deficit the country was left with. My right hon. Friend the Chancellor of the Exchequer rightly believes that the No. 1 priority for sorting out the economy is to get rid of the deficit as quickly as possible. Regrettably, tough decisions have to be taken in the light of the dire economic situation.
I must tell the hon. Members for Hartlepool and for Kingston upon Hull North (Diana R. Johnson) in the nicest terms possible, that it was their party’s mismanagement of the economy and deficit that put us in the current situation. We will have to take tough decisions if we are to have a buoyant, vibrant economy again. [Interruption.] If I might continue—[Interruption.]
North Tees and Hartlepool NHS Foundation Trust
Grahame Morris Excerpts(13 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Alex Cunningham
These issues were extensively explored with the public. There was detailed and extensive formal and informal consultation involving public meetings, leaflet drops to households and a radio campaign. The Government had promised additional funding to tackle some of the transport issues and communities across the place were in favour of the hospital.
I must outline why the new hospital should remain a priority for the new Government.
Grahame M. Morris (Easington) (Lab)
I congratulate my hon. Friend the Member for Stockton South— [Interruption.] I am sorry—we will get that one next time. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate. People in my constituency and the five others that were to have been served by this new hospital need to know why this project was cancelled when three other schemes elsewhere in the country were approved. The Minister is being coy in his written answers to questions, but we really need answers. The need remains. Issues of health inequality need to be addressed. I want to place it on record that south Easington, which would be served by this new hospital, is one of the most deprived communities in the United Kingdom, as identified by the indices of multiple deprivation. Health inequalities still play a significant role in determining life expectancy and quality of life. Health inequalities remain a big issue: they are inequalities not just in terms of outcomes but in access to health care resources—
Mr Speaker
Order. May I say very gently to new Members, whose passion for this subject I respect, that although the hon. Member for Stockton North (Alex Cunningham) is showing great forbearance there is a difference between a speech and a short intervention?
Mr Burns
If the hon. Gentleman waits, as I develop my argument I shall continue to explain the reasons for cancelling the scheme within the public spending review.
Treasury and Department of Health Ministers, myself included, decided that, overall, these factors—affordability within the changed economic climate and the foundation trust status—weighed more against the scheme for North Tees and Hartlepool than against the other three schemes for the Royal Liverpool and Broadgreen University Hospitals NHS Trust, Epsom and St Helier University Hospitals NHS Trust and the Royal National Orthopaedic hospital. For those reasons, the Government withdrew their support for the scheme.
If I may, I shall just answer one question that was mentioned in an intervention on the hon. Member for Stockton North. The question was, “Why North Tees and Hartlepool and not the three other schemes?” After looking into the situation, we found that, for example, the Royal Liverpool university hospital building is not compliant with fire safety regulations, and that its mechanical and engineering services are more than 30 years old and at increasing risk of failure. Some 94% of St Helier hospital’s buildings are more than 50 years old, and the 2007-08 data show that the total maintenance backlog for the Royal National Orthopaedic hospital is £53.8 million; for Epsom and St Helier it is £23.8 million; for the Royal Liverpool it is £16.3 million; and for North Tees and Hartlepool it is £3.5 million.
Grahame M. Morris
On the point about affordability and the Minister’s suggestion that the foundation trust look towards PFI, how would such a proposal be more affordable when the evidence suggests that PFIs are 14 to 20% more expensive to deliver? The need certainly exists, and we need to deliver quality health care, but affordability suggests that the public purse is the best way to do it.
Mr Burns
I am very grateful to the hon. Gentleman. Earlier today, his right hon. Friend the Member for Leigh (Andy Burnham) made the point that it would be cheaper to have a new hospital than to maintain the existing two ageing hospitals. I do not believe that that is accurate. The business case actually showed that the whole-life costs of continuing to operate and provide services from the two hospitals were very similar, but slightly lower than the whole-life of costs of operating and providing services from the proposed new facility. Over the appraisal period of 35 years, the total net present cost—that is, the whole-life cost—of building, maintaining and operating the new facility was £5.033 billion, but the cost of repairing defects, maintaining, operating and providing services from the two existing buildings was £5.024 billion.
However, the North East strategic health authority, Hartlepool primary care trust and Stockton-on-Tees primary care trust have pledged to continue working closely with North Tees and Hartlepool NHS Foundation Trust to plan and develop the best possible health services for the local population of Hartlepool and North Tees. I understand that the chief executive of North Tees and Hartlepool NHS Foundation Trust is currently reappraising the available options. As I have said, NHS foundation trusts have greater financial independence, which includes consideration of the private finance initiative. I am advised that the chief executive of the trust has already said that the PFI is one of the options that he is looking at, but any new proposals must be realistic, affordable and provide value for money. I cannot in any way give any guarantees that such a scheme would or would not be approved. Like all schemes, any proposals that might come forward would have to be considered on its merits and in the light of the economic climate at that time.
The local health economy is also ensuring that the wider momentum project, which involves bringing health care services closer to communities, will continue. I am delighted that on 10 May this year, the new integrated care centre known as One Life Hartlepool, located in Hartlepool town centre, opened its doors to patients. Hartlepool primary care trust has transferred a range of community services into this new £20 million facility. The PCT is working with North Tees and Hartlepool NHS Foundation Trust to agree a programme for moving a range of out-patient services into the building. In addition, work is continuing on the outline business cases for integrated care centres in Billingham and Stockton.
In conclusion, any new proposals to develop—