Health and Social Care Bill

Priti Patel Excerpts

Tuesday 13th March 2012 Commons Chamber

[Priti Patel (Witham) (Con)]

As in the many other debates that we have had on this Bill, there is a strong sense of déjà vu here today. Opposition Members grind out the same old arguments over and over again to attack the Government. They spin the same misleading, scaremongering lines about privatisation. They proclaim the end of the NHS and talk down the medical professionals and patients who will be empowered by the Bill. They continue to support the bureaucracy that drains vital resources away from front-line care, certainly in my constituency. [Interruption.] As he did the last time we debated this, when I mentioned that my constituency had very little front-line local NHS care, the hon. Member for Copeland (Mr Reed) arrogantly sneers—

[Mr Jamie Reed (Copeland) (Lab)]

At you.

[Priti Patel]

No, at my constituents, actually. The Bill will bring much-needed front-line NHS resources to my constituency.

We have heard the shadow Secretary of State recycle the same speech from the Dispatch Box like a broken record stuck in the 1970s. The Opposition have nothing sincere to say and, as in every other debate on the Bill, my right hon. Friend the Secretary of State has rebutted all their opportunistic smears and given a robust account of the Bill and the benefits that it will bring. He has also ensured that the NHS budget is being increased.

Opposition Members would have done well to engage constructively on the Bill, instead of spending the past two years siding with the smear campaigns run by the left and its trade union paymasters that seek to misinform the public, play with their emotions and frighten them. In particular, we hear the Opposition complain about the involvement of the private sector in delivering health care, but it is this Government who are getting to grips with the spiralling private finance initiative costs that are crippling many NHS trusts in England, for which the Labour Government were entirely to blame.

I find it astonishing that the shadow Secretary of State can come to the Dispatch Box, week in and week out, and bleat on about the private sector without having the courtesy to accept that his Labour Government blew hundreds of millions of pounds of taxpayers’ cash on paying private providers for treatments that they failed to carry out. [Interruption.] Opposition Members should put away their synthetic anger for a moment and accept that, thanks to the Bill, expensive private sector pay-offs will be a thing of the past. When they were in government, they were enriching the private sector and creating an army of fat-cat NHS managers while failing to support patient care.

[Paul Uppal]

Opposition Members often try to portray us as callous and uncaring about the NHS, but is not reform absolutely essential if we want an NHS that is free at the point of delivery for our children and grandchildren?

[Priti Patel]

My hon. Friend is absolutely right. I mentioned front-line patient care in all our constituencies. This is about ensuring that resource goes to the front line, and that it is taken away from the back office, the bureaucracy and the managers.

Labour’s opposition to the Bill is shallow. Every time we have these debates—[Interruption.] We have had 13 years of Labour. Witham was once a Labour town, but my constituents have all woken up to the fact that, under Labour, there was no resource going to the front line of the NHS. Now, we are working across the parties to ensure that the Bill goes through Parliament, so that we can bring that much-needed front-line care to my constituents in Witham town. Labour’s opposition to the Bill is completely shallow, and every time we have this debate, its arguments are exposed as being ever more synthetic and opportunistic, with little connection to reality. The hon. Member for Bethnal Green and Bow (Rushanara Ali) talked about Labour’s commitment to the NHS. Just as history shows that Nye Bevan introduced the legislation to establish the NHS, it will show that this Secretary of State, through the Bill, has saved it for the patients who rely on it.

NHS Risk Register

Priti Patel Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Priti Patel (Witham) (Con)]

Having listened to the majority of this afternoon’s debate, I wish to start by paying tribute to my right hon. Friend the Secretary of State and his team for putting the interests of patients over the vested interests that we have heard continually try to vilify him this afternoon and over the past few weeks.

Many of my constituents have been concerned about the irresponsible spin being peddled day in, day out by Opposition Members and opponents of the Health and Social Care Bill. Frankly, they have become frightened by the rumours, rhetoric and misinformation emanating from Opposition Front Benchers. One constituent forwarded to me an e-mail, circulated by an NHS trust, that had been authored by the shadow Secretary of State. It referred to “our battle to save the NHS” and called on NHS workers to support Labour’s campaign to drop the Bill and stop the “Americanisation” of the NHS. By sending out such a provocative e-mail, he is attempting to demean my constituents and insult their intelligence. The Opposition’s motion refers to informing parliamentary debate—[Interruption.]

[Madam Deputy Speaker (Dawn Primarolo)]

Order. The hon. Member for Broxtowe (Anna Soubry) has been told about shouting across the Chamber by Mr Speaker. Will she please stop doing it?

[Priti Patel]

Those misleading comments from the shadow Secretary of State do nothing to add credibility to the wider debate or the Opposition position. Let us not forget that they went into the general election with a commitment to cut the NHS budget.

The need for this Bill is nowhere more evident than it is in Witham town in the heart of my constituency. Witham has a chronic lack of health care provision, which leaves my constituents with no choice but to travel to either Chelmsford or Colchester for the many treatments they need. That is why the local town council, including Labour and Conservative councillors, and local residents are campaigning for better local services. That is at the heart of the Health and Social Care Bill and will emanate from it—[Interruption.] Opposition Members laugh and sneer, but my constituents have been affected disproportionately by the way the previous Government maladministrated the NHS.

What is more, because of the efforts of local primary care trusts, bureaucracy and red tape has taken money from the front-line care that my constituents could have benefited from—[Interruption.] It has a lot to do with this, actually. Instead of investing in front-line health care, which is exactly what the Bill is about, the money is going to recruit bureaucrats and managers. They might be part of the wider back-room team, but I am concerned about front-line care for my constituents. My constituents might not be important to Opposition Members, but they really are important to me. This is exactly why the Bill needs to be passed. This layer of bureaucracy needs to be scrapped. There is no doubt about it.

I find it astonishing that this afternoon we have heard Labour Members preach about publishing the risk register. Let us not forget that when they ran the NHS they embarked on widespread, top-down reform on a nearly annual basis, yet they never furnished this House, Parliament or the public with confidential risk registers, analysis or data produced by Ministers and officials, so how genuine and sincere are they? If Labour Members were sincere about the NHS, they would stop their scaremongering and misinformation and recognise that the Bill is about patients’ interests and putting patients first, not their own personal vested interests.

NHS Reform

Priti Patel Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I will tell the hon. Gentleman one thing: I and my colleagues on the Government Benches talk to people in the constituencies who are getting on with this. That is what is so impressive. People across the NHS are seeing the opportunity to bring more clinical leadership and more democratic local accountability to fashioning an improving health service. That is what I am determined to achieve.

[Priti Patel (Witham) (Con)]

Excessive bureaucracy and a record level of managers have dominated health care provision in mid-Essex. Will my right hon. Friend assure my constituents that, under his reforms, the funding for that excess will go to front-line patient care in the constituency of Witham?

NHS (Essex)

Priti Patel Excerpts

Tuesday 15th March 2011 Westminster Hall

[Priti Patel (Witham) (Con)]

I am grateful to Mr Speaker for granting me the opportunity in Westminster Hall to draw directly to the Minister’s attention a number of important issues regarding the performance of NHS services in my constituency and in the county of Essex. I suspect that the matters that I shall raise and the constituents’ cases that I shall mention are by no means unique to my constituency or the county. However, the Government are developing the most important and, in my opinion, long-overdue changes to the NHS, and I want to ensure that the problems and challenges faced by my constituents are thoroughly and fully considered.

Throughout the endless reforms and reorganisations undertaken by the previous Government, the health needs of patients were never afforded the same priority as the expanding tick-box bureaucracy suffered by my constituents. One consequence of the waste that was created is that the money put into the health service never achieved the true outcomes that my constituents deserved and needed. That has led in part to my constituents suffering poor patient choice and health care services. However, we cannot change everything about the past.

The Minister, the Government and, most importantly, my constituents want an effective NHS for the British people; it should deliver value for the taxpayer, ensuring that the mistakes of the past are not repeated and that all receive the care and front-line services that are their due. It is therefore essential that as the NHS is reformed, the needs of local communities in my constituency of Witham are not overlooked or ignored. That is why this debate is so timely.

By way of background, I shall give the Minister some details about my constituency and some of the health care challenges faced by my local community and me that are specific to the area, and the nature of current NHS services there. I shall then highlight the excessive and overblown bureaucracy that affects the NHS globally, which demonstrates the scale of taxpayers’ money that is increasingly and wrongly being taken from front-line services. I shall also draw attention to some of the most serious and heart-breaking cases that I have come across in the 10 months since I was elected, which show that the NHS too often fails the most vulnerable. I shall conclude my remarks by putting the case for new NHS services being delivered locally under the Government’s planned reforms.

Witham is a new constituency, so I forgive Members for not knowing much about it. It is not far from the London commuter belt, and lies within the heart of Essex. We have tremendous public transport and road links to London. The ports of Felixstowe, Harwich and Tilbury are not far away, and we have some major industrial towns and centres. It is not surprising, therefore, that Witham has experienced significant population growth in recent years. It is an attractive area to live in.

The three local authority areas in my constituency are Braintree, Colchester and Maldon. Under the previous Government, they were required to build more than 27,000 new homes in the 20 years to 2021, and 60,000 new homes between 2011 and 2031. Throughout Essex, the current population of 1.4 million could easily grow by 14% over the next 20 years. Members will be aware from their own areas that population growth inevitably puts more burdens not only on infrastructure but on the local NHS.

The local plans, particularly those that affect my constituency, unfortunately give no serious consideration to ensuring that the quality and quantity of local health services can keep pace with projected population increases and changing demographics. Although top-down targets are being scrapped by the present Government, the attractiveness and desirability of my constituency inevitably means that more people will move to the area, so we can expect to see a significant increase in the local population. That will put demands on local health services that are already struggling to cope.

It is not simply the sheer quantity of people that NHS services will need to support; they will also need to adapt to the changing demographics of the area. Because our local communities attract young families, we need stronger maternity services and paediatric provision. However, the most significant demographic change will be an acceleration of the number and proportion of residents over the age of 65. In that respect, my constituency and the county of Essex are not unique, as health services across the country are responding to an ageing population. By 2021, the NHS in Essex, along with its partners in local government, will need to accommodate the health needs of 45% more people in the county living beyond the age of 65, and 75% more people living beyond the age of 85.

Some of the most significant increases in Essex are expected to be in the Maldon district, part of which falls within the Witham constituency. It is worth noting that about 10% of the Essex population provides assistance, caring for family, friends or neighbours, with higher than average rates in Maldon, where the number of working-age people available to care for older persons will have nearly halved by 2029. These demographic changes present serious challenges to the front line of the NHS in my constituency and in the county.

I am pleased to report that Essex county council is taking a strong lead in implementing the Government’s reforms to deal with the challenge. It has already established a health and well-being board, and the Department of Health recognises it as an early implementer. I would welcome the Minister’s reassurance that the Government, unlike the Labour party, which has made no commitment to NHS funding to support this work, will continue to increase resources when necessary to support the health needs of my constituency and Essex. I shall emphasise throughout the debate the need for the money to be spent on front-line care, not bureaucracy.

That brings me to NHS bureaucracy in Essex and my constituency, and specifically to our local primary care trusts. The Minister will be aware that the medical needs of my constituents are served by a number of NHS trusts and by the East of England strategic health authority. There is no general hospital in my constituency; local residents usually use the Broomfield hospital run by the Mid Essex Hospital Services NHS Trust, which is based in the neighbouring constituency—that of the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns)—or the foundation trust hospital in Colchester for acute care services. Mental health services are provided by the North Essex Partnership NHS Foundation Trust.

My constituents are served by two of the five primary care trusts in Essex. Those who live in the Braintree district council or Maldon district council parts of my constituency fall within the area covered by the Mid Essex NHS trust, whose budget for 2011-12 has increased to just under £520 million. Those who live in the wards covered by Colchester borough council find themselves being dealt with by NHS North East Essex, whose budget for 2011-12 has risen to just under £547 million.

Later, I will give examples of cases in which constituents have faced unacceptable problems with those health trusts. In the meantime, it is worth looking at the obscene levels of bureaucracy, administration and management that have taken hold of those organisations. The number of managers and senior managers employed by the East of England strategic health authority doubled under the previous Government from 1,300 in 1997 to more than 2,700 in 2009. At Mid Essex Hospital Services NHS Trust, more than £10 million is spent annually on 29 senior managers and 79 managers. In the North East Essex PCT and its three predecessor trusts, the proportion of administrative staff rose from 19% to 33% between 2001 and 2009. The number of managers and senior managers increased from 25 to 84.

Finally, Mid Essex PCT, which serves the majority of my constituents, and its four predecessor trusts, saw administration and staffing levels rise from 17% to 33%, and the number of managers go up from 10 to 102. When we consider that those two PCTs were formed from seven predecessor organisations, it is fair to say that the growth in management and administration over eight years is quite shocking. The PCT now spends almost £13 million on management costs alone. That money, which my constituents and I view as hard-pressed taxpayers’ money, has been taken away from essential local medical care to staff a bureaucracy. Mid Essex PCT is also experiencing slippage in progress on its quality, innovation and prevention plan and, as a result, could now miss its year-end target by £2.7 million. On 16 November, the minutes of its remuneration committee, which have not been disclosed fully, indicate that performance bonuses were to be paid to the chief executive and its executive directors.

What concerns me is not just the vast sums of money increasingly flowing into the pockets of bureaucrats and managers, but the way in which the PCT is behaving and functioning since it embarked on its reorganisation. It seems to have no real idea as to what it is reorganising into. That is a cause for alarm. I hope the Minister is aware that last autumn, North Essex PCT and Mid Essex PCT decided to form a cluster with West Essex PCT under a new chief executive. The first I heard of that change was when I received a press release last September. In a massive blaze of glory, it was announced that the chief executive of the strategic health authority would form closer working arrangements with the PCT.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The hon. Lady has spoken at some length and with real passion about money being poured into the appointment of bureaucrats and managers. In her mind’s eye, a hospital bureaucrat is a man in a bowler hat with a brief case, but is she aware that many people who are dubbed managers in the health service are actually former senior nurses, such as her colleague, the Minister, who bring much of their clinical background and expertise to bear on their role? Nurses in particular get a little pained when politicians talk about managers and discount the fact that many of them are people with a very solid clinical background.

[Priti Patel]

I recognise that NHS managers have a range of health care backgrounds and bring a number of skills to the table. Of concern to my constituents though is the fact that we are dominated by managers who tend to have administrative rather than clinical backgrounds, and they are making key decisions about patient treatment, and even about medical care and access to drugs. None the less, I thank the hon. Lady for her comments and her valid point.

This brings me to the overall efficiency and effectiveness of the reorganisation. I have been told that reorganisation will lead to a significant step forward in delivering greater efficiency for the people of north Essex. None the less, I constantly have to ask the PCT, “What does this mean? What will this look like? What are the costs of the reorganisation?” I was told last autumn that the PCT could not quantify the cost of reorganisation as the process of reconfiguration had only just started. I have been asking for updates, but as yet, have not received any. Each time I ask anything, I am told that my question cannot be answered “at this time”.

There is far too much uncertainty. I welcome reorganisation, efficiency drives and reductions in management and bureaucracy costs, but there are major implications for front-line services. The language of the PCT is constantly about reorganisation producing greater efficiencies, which I would not dispute, but the PCT still has no detailed plans to show what the greater efficiencies will look like and what the formation of the new cluster will mean for local services.

The merging of back-office functions to save money is to be welcomed and I have no issue with that. In this case, however, I have discovered that there is no forward plan in the form of a route map and details of how things will operate. I have been asking questions for six months, but I have not received any substantial details about the new cluster, the staffing arrangements and what it will all mean for patient choice locally. I have sent written questions to the Secretary of State about the reorganisation but, again, I have not had a response.

Will the Minister examine this reorganisation and ensure that more information is made available to the public so that they have some sense of what kind of decision making is taking place locally within the new cluster and the PCT, and what it will mean to them in terms of access to health care and local services? It appears that many of the decisions have been taken behind closed doors, with very little accountability and transparency. It is in the public interest to know what has transpired within the reorganisation, and what the new arrangements will look like as well as the costs and the benefits.

As the PCT should rightly be beginning its winding-down process prior to its abolition, I would like to hear from the Minister about the redundancy arrangements for senior PCT managers. I am sure that that is a matter that is naturally in their minds right now. In view of the colossal levels of waste caused by PCTs, my constituents will be very disappointed to see PCT chief executives and other senior directors receive golden goodbyes to boost pension pots or huge redundancy pay-outs. In the interests of accountability and transparency, all constituents across the country will be looking, during the NHS reforms, for some encouragement from the Government on that issue.

Before I move on to some individual cases, let me just say that I make no apologies for being critical of NHS bureaucracy. In my limited time as an MP, I have seen endless examples of red tape standing in the way of my constituents getting the best health care that should be available to them. I am overwhelmed by the whole culture of tick-box management that has pervaded my local NHS. It is something with which I have been battling, day in, day out, on behalf of my constituents. It is an alarming state of affairs.

Let me now draw to the Minister’s attention a couple of cases. I have been in touch with the Minister and the Department about the issue of Sativex. There have been two cases in my constituency in which the PCTs have refused to treat patients on the NHS with the drug Sativex despite their doctors’ recommending its use to help with multiple sclerosis. In both cases, the PCTs have been able to afford to pay more to their managers and to spend more on red tape and bureaucracy, but have refused to provide vital medical treatment to my constituents.

First, Mr Shipton from Tollesbury was recommended Sativex by four doctors, to help his condition. Those doctors are medical experts who have been treating him and who are aware of his condition and medical needs. However, last September Mid Essex PCT, acting through officials sitting on its area prescribing committee, thought that it knew best and decided that it would not accept a request for Sativex to be prescribed to Mr Shipton on the NHS. That left him in considerable pain and distress. It then took more than a month for the chief executive of the PCT to respond to my request for copies of minutes of the meeting at which that decision was made. The minutes stated that the PCT declined to prescribe Sativex to Mr Shipton

“due to a lack of evidence of significant long-term benefit. Clinical trials are of very short duration and do not compare with current treatment.”

Despite that, however, Sativex is already licensed—in fact, it was licensed last June—for use to improve symptoms in multiple sclerosis patients with moderate to severe symptoms, clearing the way for the PCT to prescribe it. Indeed, the PCT itself had made 31 previous prescriptions of Sativex in 2009-10.

My constituent, Mr Shipton, ended up sourcing Sativex privately, at the cost of £125 plus VAT per bottle, which is a course of treatment that lasts for only two weeks. Contrary to the conclusions of the area prescribing committee, the drug is having a hugely beneficial effect on Mr Shipton. If the bureaucracy of the PCT had not stood in the way, he could have received that treatment at a much earlier date and he would not have had to endure extreme suffering and pain, as well as what I would describe as an unnecessary bureaucratic process.

I have another constituent, Mr Cross from Tiptree, who has also experienced horrendous problems. In fact, his wife, Mrs Cross, is on the phone to my office on a weekly basis, updating us about the terrible position that her husband is in and the suffering that he is experiencing. He has had horrendous problems receiving a prescription of Sativex, although in this instance the obstacle has been dealing with North Essex PCT. Mr Cross is wheelchair-bound and in terrible pain, experiencing constant spasms. In fact, he has recently been in hospital. Given his condition, any treatment would be a welcome relief for him. There is double suffering for his wife, as it were, because she is now effectively his full-time carer. Once again, getting access to this drug has been terrible. He has had his consultant neurologist battling for him and making his case, and I too have battled for him and made his case. But North Essex PCT, despite issuing 16 prescriptions for Sativex in 2009-10, still refused to prescribe this treatment for Mr Cross and gave him a highly dismissive response.

When I took up Mr Cross’s case from September 2010 onwards, I began a process of constant correspondence with the PCT. All I received were evasive non-responses and the odd reference to Mr Cross’s “medical needs”, which were then just dismissed. I found that totally unacceptable. Mr Cross’s condition has since deteriorated and he has been in hospital again. There needs to be a recognition of the endless stress and strain that this process puts on his own domestic set-up, especially his dear wife who is now his constant carer.

There is a compelling case for action in both of those cases, to press the PCTs to provide this drug. Also, both of my constituents have made the point that they have spent their lives working hard, doing the right thing and contributing to society. They felt that in their hour of need the NHS would be there for them, but now they feel that it has not been there for them. That is unacceptable. Although I appreciate that the Minister cannot intervene in individual cases, I ask her at least to examine these cases if she possibly can.

There are two other cases that I want to touch on briefly. The first is that of my constituent Mrs Emily Wetherilt, and again I would welcome the Minister looking into it. It is another example of a local PCT failing to perform adequately to meet the medical needs of my constituents. Mrs Wetherilt is 96 years old and requires 24-hour care. However, despite her case meeting the published criteria for NHS continuing health care funding, Mid Essex PCT has refused to provide any care whatsoever. So there has been no support for her from the PCT. Mrs Wetherilt’s daughter has taken up this matter directly with the PCT’s panel twice and she has been declined on both occasions. The PCT categorically refuses to look into this matter again, because an appeal had not been lodged within the two-week window that was available to Mrs Wetherilt’s daughter.

Many of us recognise that in cases such as this one, when a constituent’s family is caring for them, the family’s priority is looking after their family member and it is not to follow an appeals process within a two-week window. People become very emotional and providing care takes precedence. That care is the priority. Consequently, the tone and the attitude adopted by the PCT are utterly bureaucratic and deeply unhelpful.

Mrs Wetherilt’s daughter has also offered to work with the PCT to find out whether it is possible for the PCT to part-fund her mother’s care, but that suggestion was dismissed by the PCT without even being addressed. That is another example of the inflexible bureaucracy that fails to put patients’ care and needs first. It is more about the process—ticking boxes and filling in forms—and that is wrong.

I have a final shocking case to highlight. It is one that I have raised previously in the House and it is that of my constituent, 14-year-old Bethanie Thorn. Last October, Bethanie was struck down with a terrible illness and left bed-ridden. She literally went from being a healthy teenager one day to being completely bed-bound two days later. The cause of her symptoms was unknown and she became unable to eat as her condition deteriorated. Nevertheless, she faced lengthy delays to get an MRI scan and the other vital checks that were needed to diagnose her condition.

It was only last November, when I raised this matter on the Floor of the House, that the Secretary of State looked into Bethanie’s case and appointments were made for her to have an MRI scan. People in urgent need of an appointment should not have to rely on the Secretary of State, local newspapers or their constituency MP to raise their case and sort appointments out. It shows how serious this case was that, shortly after her scan and check-up, Bethanie was admitted to hospital and she was only able to return home two months later, at the end of January. Her mother has effectively become her full-time carer and her family have had to battle at every single stage for care, appointments and treatment, which is appalling. I must say that, if Bethanie had received the appointment that she needed straight away, she would probably be in a better state of health today. The Minister will appreciate that this has been terribly distressing for Bethanie and her family.

When the NHS was pressed about this case, the only explanation given for the delays was something described as a “broken pathway”. I have no idea what a “broken pathway” is in NHS management talk, but the case has highlighted just how damaging poor performance and failures in NHS services can be to individuals. This girl’s life has changed beyond all recognition now. This case also demonstrates what can go wrong when there are endless layers of bureaucracy in the NHS; it was unclear throughout whether it was Bethanie’s GP, the PCT or the hospital services who were actually responsible for ensuring that Bethanie received the care that she needed. There was to-ing and fro-ing constantly—there really was.

Like all Conservatives, at the last general election I was absolutely proud to stand on a manifesto commitment to cut the waste and bureaucracy in the NHS, so that we could invest in the front-line services and give more powers to doctors and patients. I want to reiterate that in my short tenure—10 months—as a Member of Parliament, all I have seen are examples of how bureaucracy has got in the way. If nothing else, I will continue to battle to get the services for my constituents, in the face of adversity—that is, in the face of bureaucracy.

I welcome the measures that have been announced by the Government about the reforms and plans for the NHS. The purpose of mentioning these cases now is to highlight the fact that in Essex we have seen more of the non-medical side of the NHS in action locally than we have of the medical side, which shows the need for reform of patients’ treatment.

Finally, I want to draw attention to the fact that there is some hope for my constituents. That is the hope that they have placed in Government legislation to reform the NHS. As the Minister will recall from Health questions last week, Witham town is the most urban part of my constituency and Witham town council and others have put forward a very strong case for there to be more health care specialist services in our town. Although Colchester, Braintree and Chelmsford all have significant health facilities, including general hospitals and community hospitals, there is nothing for the people of Witham in our town, and there is nothing for the people from the surrounding villages. That gives the impression locally that there is a two-tier health system.

I mentioned at the start of my remarks that the Witham area includes some pockets of serious deprivation and has a growing population. Unfortunately, the PCT has not taken enough action to close the gap created by the changing demographics and local needs. Maltings Lane is a new housing development in Witham town. It has evolved over a number of years, and many more new homes and other facilities will be built there over the next 10 years, but it was begun with no plans whatsoever for additional health care services. That issue needs to be addressed in the long run, and I hope that the Minister can help my town council, along with our district and county councils, to work with the PCT and the forthcoming GP consortia to develop additional local services that seek to meet local needs. The issue is one of supply and demand, and there is a crying need but no provision.

As a starting point, the town council, to its credit, is working cross-party locally with all our councillors, and has put together a list of services that Witham needs, including an additional surgery, an out-of-hours walk-in clinic, minor injury, oncology and out-patient clinics and a diversity of medical-testing facilities. By adding some of those services to Witham and the surrounding communities, we will naturally see real benefits in the form of health care provision, choice and diversity, and we will enjoy the convenience of more local NHS services.

I am conscious that I have spoken for a considerable time and that many other Members wish to speak, so I shall conclude by saying that although I could raise many more health-related issues, I hope that I have given the Minister a real insight into the challenges that we face in Mid Essex, where we are surrounded by a lot of health activity but have had this bureaucracy that has stifled both the delivery of front-line care to patients, and the choice aspect of health care provision locally. I thank the Minister and colleagues for their patience in listening to my remarks, and I look forward to the Minister’s response.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The hon. Member for Witham (Priti Patel) is to be congratulated on obtaining the debate. Many of my constituents move to Essex as a kind of upward trajectory, so I listened with great interest to what she had to say about a part of the world with which I am not as familiar as I probably should be. The week after the Lib Dems have turned savagely against the Conservative-led coalition’s health care policies—the British Medical Association is debating them today and, as we know, doctors are very worried about what is proposed—hon. Members will expect me to touch on the health reforms generally and how they will affect the people of Essex.

I listened with some sympathy to the complaints of the hon. Member for Witham about bureaucracy. As I have been a Member of Parliament for 20 years, I have tangled with more bureaucrats than I care to remember. However, I always like to stop short of sounding as if I am dismissing people who work for the health service as a whole. My mother was a nurse. She was one of that generation of West Indian women who helped to build the health service after the war. We have to remember that however frustrating it is as Members of Parliament or even as members of the community to deal with bureaucrats in the health service or elsewhere, there are thousands and thousands of people without whom the health service could not work or function. They will tell us that they have survived more reorganisations than they care to remember. They are still there, getting their heads down and trying to provide a service for our constituents.

The hon. Member for Witham made an important point about the proportion of elderly people in our population. We do not have time to deal with that matter fully, but people are living longer and they are suffering from ailments such as Alzheimer’s and other things. Elderly people make up an increasing proportion of the population. A few weeks ago, I went to a nursing conference and a senior nurse said to me that, when she was on the wards, the mean age of elderly patients was about 80. The mean age of elderly patients is now 90 or 100. Elderly people now pose very different problems from those that the elderly posed a few years ago. It is important that we consider the question of how we secure high-quality care—I am reminded of that awful ombudsman report that was published a few weeks ago—how we pay for it and how health care interconnects with the issues of public health and social care. I hope that we will have a chance to return to those matters.

I remind the hon. Lady that, despite her letters to bureaucrats and her undoubted frustrations on behalf of her constituents, when my party left office, satisfaction with the health service was the highest it has ever been. Hon. Members can say that the population was deluded on that, but I do not think that that is correct. We are talking about massive MORI polls. People’s satisfaction was higher than ever. There had also been massive levels of investment, not least in Essex. She will be aware of the new unit at Colchester general hospital, which includes an updated children’s ward. It is fully open and operational, and that £20 million project marks the biggest investment in the hospital’s facilities since it opened in 1985.

Apart from general frustration with bureaucracy, there are specific issues in relation to health care in Essex that are worth mentioning in this short debate. The hon. Lady mentioned Broomfield hospital. She will be aware that, just a few weeks ago, it was highlighted that although the hospital takes more than £1 million a year in car parking charges, its car parks still lose money because it is spending £1.2 million on running costs, including on CCTV, attendants and capital investment—they must be extremely well paid attendants. We also know that the hospital’s move into its £148 million PFI wing was delayed twice before finally opening in late 2010. The opening day was pushed back because staff were trapped in faulty lifts. We also know that the same hospital spent £400,000 on art for its new wing, which was commissioned as part of the development and funded through PFI. PFI is expensive enough—we may debate that at another time. To spend the money on art, when we know how ridiculously expensive PFI can be, seems quite strange.

There have been all sorts of care warnings about hospitals in Essex, such as Queen’s hospital in Romford. We know that the Romford project will be the first of a number of pilot reviews of PFI contracts to see if the costs can be brought down, and anyone who cares about the health service must welcome that. We know that the Braintree community hospital has defended itself after paying out nearly £20 million in damages for clinical negligence. If we are focusing on bureaucracy, we have to focus on how those things happen. We know that the Southend University Hospital NHS Foundation Trust, with which hon. Members will be familiar, has had to respond to concerns about safety, which were raised by the Care Quality Commission. We know that the West Essex primary care trust risks not being able to give an 18-week referral-to-treatment time. We know that NHS South West Essex has a very large overspend—its deficit has been improved, but it still has an overspend—in relation not to bureaucrats, but to acute hospital activity.

We also know, which I find alarming, that the Basildon and Thurrock University Hospitals NHS Foundation Trust is now trying to make savings by allowing waiting lists to extend. That implies a 14-week wait on first appointment, which is why an hon. Member on the Government side said that, when ordinary residents and voters are told that money on the health service is being ring-fenced, it rings rather hollow. Up and down the country, not just in Essex, they can see waiting times lengthening, and new hospitals and new health care facilities that have been promised being delayed. It is for the Government, who have made much of their protection of health care spending, to explain that. The real issue is this. The hon. Member for Witham spoke glowingly about the reforms, but sadly I have news for her. She seems to believe that those reforms will help with the issues that she has raised. As she would know, however, if she had followed the Health Committee, there is a real challenge involved in trying to introduce those reforms, whatever we think of them, while at the same trying to achieve unprecedented savings in health care. The Health Committee doubts whether that can be done.

No one argues with the notion that GPs could have a lot to offer in the commissioning of care, but as the president of the Royal College of General Practitioners has said, there are other ways to do that without subjecting the health service to a top-down reorganisation. I do not want to be unpleasant, but the Government promised, all through their time in opposition, that they would not subject the health service to any top-down reorganisations.

[Priti Patel]

Will the hon. Lady give way?

[Ms Abbott]

Time is against me, because I want to give the Minister plenty of time to respond. That is what we were promised—no more top-down reorganisations. As for waste of money, one problem with letting all those PCT bureaucrats go is that they have to be paid redundancy. The hon. Lady said that she hopes that they will not be paid big redundancy packages. I am afraid that they will be, and many will be re-employed. GPs will be less accountable to patients and the danger that many people, including GPs, see is that the big American health maintenance organisations will be able to get inside and act as commissioners for GPs, who, after all, joined the health service to heal and not to be managers.

I feel sorry for Government Back Benchers. They believe that the issues that they find so challenging about bureaucracy, cuts and patient accountability will be solved by the reorganisation. I can say with complete confidence that, if anything, the reorganisation, which is too fast and at the wrong time, will make those problems worse. It gives me no pleasure to say that, but anyone who has analysed the so-called reforms can see that they are a car crash in slow motion.

Oral Answers to Questions

Priti Patel Excerpts

Tuesday 8th March 2011 Commons Chamber

[Paul Burstow]

I think that more than one of us wanted to do just that, because the Anthony Nolan trust does a fantastic job. The hon. Gentleman is right to raise awareness of it, and all hon. Members should take the opportunity to visit its stand today.

[Priti Patel (Witham) (Con)]

T8. Witham town council and my constituents are deeply concerned about the lack of local medical facilities serving our town. Will the Secretary of State reassure my constituents that under the new commissioning arrangements medical provision in our town will be able to expand?

[Mr Lansley]

I can give my hon. Friend the reassurance that in future her local general practices—together in a commissioning consortium—and their other health care professionals, meeting with the health and wellbeing board in the local authority, will be able to bring democratic accountability in order to ensure that they have in her town and surrounding area the necessary services, based on a strategic assessment of need in their area.

Health and Social Care Bill

Priti Patel Excerpts

Monday 31st January 2011 Commons Chamber

[Priti Patel (Witham) (Con)]

I am grateful for the opportunity to speak in this important debate. I congratulate the Secretary of State and his ministerial colleagues on this landmark piece of legislation, which I welcome for fundamental reasons that are specific to my constituency. This legislation will put patients and medical practitioners at the centre of the NHS, putting an end to the era of bureaucracy and mismanagement seen under the previous Labour Government. As my hon. Friend and neighbour the Minister will be aware, patients in my constituency have suffered for a considerable period. They have had their care compromised by the excessive layers of NHS bureaucracy that, as far as I can tell, the Opposition seem determined to keep. I have endless examples of where such bureaucracy has had a devastating impact on the very patients whom the NHS is there to serve.

Late last year I raised with the Leader of the House a case involving a teenage girl in my constituency who had been experiencing unacceptable delays in receiving an MRI scan. She was unable to eat, and basically went from being a healthy teenager to being completely bedridden. Despite needing the scan to help to diagnose her condition, she had to wait for more than a month while her case was being handled—incompetently, I should say—by administrators and managers. The delays were exacerbated by what the local PCT described to me as a “broken pathway”. It was only after the matter had been raised directly with the Secretary of State in the Chamber that she received the scan and has since received medical treatment. However, the delays have compounded her illness. Three months later, that young lady is still in a critical condition. Cutting back on such bureaucracy, investing in the front line and giving patients and their doctors more power will prevent such incidents. Instead of managers hiding behind “broken pathways”, we can have doctors held to account by their patients.

I also support the Bill because it will help my constituents to receive the treatment and the drugs they need. As the Secretary of State will be aware, in recent months two constituents of mine who suffer from multiple sclerosis have contacted me because two PCTs—Mid Essex PCT in one case and North East Essex in the other—have refused to allow them the prescribed drug Sativex on the NHS, yet both have prescribed the drug to other residents. My constituents’ doctors have recommended the treatment, yet management and bureaucracy are again standing in their way, and in the way of common sense and the essential health care that my constituents need. Instead of receiving that treatment, they are now having to wade through a convoluted appeals process, which naturally makes them feel extremely despondent and disappointed, as the NHS, which they have supported through their taxes, is letting them down. They believed that they would get the care that they needed when they needed it, and never expected that the requests of their doctors could be ignored in that way.

I want the Government’s reforms to be introduced without delay. Indeed, it will not surprise the Minister or the Secretary of State to learn that, as far as I am concerned, the abolition of the PCTs in 2013 is still a bit too long to wait. I would like it to happen sooner rather than later. I would therefore like the Minister and Secretary of State to accelerate the process and remove that fundamental layer of bureaucracy, which is a barrier to delivering positive health outcomes to my constituents. I would also like the Minister to ensure that PCTs play their part in facilitating an orderly transition to GP consortia, as he will be aware that Mid, North East and West Essex PCTs have come together to form a cluster, with one chief executive. It is now a large organisation that is responsible for a lot of public money.

I have since discovered that between now and 2013, those three PCTs have a target to reduce management costs—that is completely welcome and long overdue—by £13.9 million; they currently stand at some £37 million. However, I should add that that figure is still significantly lower than the £20 million of combined savings that were previously agreed for each PCT by the strategic health authorities. I mention that because that money would naturally make a fundamental difference—a tremendous difference—to those patients being refused treatment on the grounds of cost. When we hear the Opposition questioning whether GPs will be able to handle NHS budgets, they need look no further than the resource-intensive PCTs, which not only need to go, but frankly need to go sooner rather than later.

Because of the shortness of time, I want to highlight one more thing. It is irresponsible of the Opposition to justify the ever-increasing layers of bureaucracy that have been associated with the NHS. I welcome the Bill, which is long overdue. I want to see the patient’s voice put first, greater accountability for public money and proper commissioning of local services. For a new constituency like Witham, that is vital when we face a crisis of out-of-hours health care provision. Fundamentally, the Bill is important because it will put patients first, which, as I said, is long overdue.

Epilepsy Services

Priti Patel Excerpts

Tuesday 12th October 2010 Westminster Hall

[Priti Patel (Witham) (Con)]

I pay tribute to my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for securing this debate, and for his tremendous personal account of the condition of epilepsy, and how it has impacted on his life and his journey to Westminster and becoming a Member. I thank my hon. Friend the Member for South Thanet (Laura Sandys) for being frank and for providing powerful insights into the work and role of general practitioners in her constituency. Clearly, they are making a difference.

My contribution to this debate is about the structure of the NHS, especially in the light of the fact that significant and welcome Government reforms are coming soon. In Witham, the number of administrators and bureaucrats in the local primary care trust—Mid Essex PCT—has increased fourfold in the past 10 years. In this debate, we are talking about general practitioners, commissioning, the postcode lottery in terms of services, nurses, access to care, real care provision on site and the ability to deal with epilepsy. I am sure that the Minister agrees that epilepsy services could be served so much better by getting rid of a lot of the waste and bureaucracy. This is an opportunity to redirect the resources to ensure that epilepsy is given the right kind of local care provision and to ensure that GPs who are commissioning services are dedicated the right kind of resources and professional expertise that are so desperately needed out there.

One of my constituents is here listening to the debate. It is self-evident, from looking at my local PCT, that provision is hit and miss. It comes back to data, which we have heard a great deal about this morning. There is not enough data out there. I struggle with that notion when I hear locally about the bureaucracy in my PCT, which has been so vast that one wonders what it has been doing to secure data in the past decade. I plead with the Minister to ensure that all the resources out there are redirected to the right purposes to serve local epilepsy sufferers in the right way.

My hon. Friend the Member for South Thanet mentioned stigma, but I should like to talk about quality of life and referrals to specialists. I have heard from my constituent who is here this morning about how epilepsy can prevent people from getting back into work. In respect of anybody who is up and able and wants to be an active citizen and contribute to their local economy, or even make a difference in some service, it seems self-evident that we desperately need local services and agencies working together to break down the barriers of stigma; to work constructively to enhance the quality of life of epilepsy sufferers; and to be more accommodating and understanding of the needs of people going into the workplace, without being patronising, enabling them and supporting them perhaps even to develop careers in the field or profession in which they choose to work.

The Government have an opportunity to consider generic substitution in the round, without coming to any rash conclusions. We are talking about savings, in this era of the comprehensive spending review, but this is about understanding that epilepsy is a subjective condition that affects individuals differently, not about a one-size-fits-all approach in respect of the drugs and prescribing regimes. This is a plea to the Minister to ensure that the right decision is made on behalf of sufferers.

--- Later in debate ---

[Paul Burstow]

I am grateful to the hon. Lady for raising that point. In the proposed quality and outcomes framework for 2011-12, NICE has recommended a new indicator to encourage more GPs to talk to women with epilepsy about the drug risk during pregnancy. I hope that that will focus on the point that the hon. Lady has rightly raised.

Patients should be able to check up on local services right down to the performance of individual consultant teams, so that they can, if necessary, vote with their feet. That not only gives patients more control, but it exerts pressure on different parts of the NHS to make continuous improvements. On a professional level, it is important to ensure that there is better recording and sharing of information about services.

My hon. Friend the Member for Southport and the hon. Member for Pontypridd (Owen Smith) talked about the lack of information about neurological services at local level. I can tell them that the Department has developed a reference data set for local commissioners to use. That will give them a standard set of information to request from local providers about the different stages of care for someone with a neurological condition. Reference has been made to a dearth of data. I can tell hon. Members that there are data relating to the primary reasons for hospital admissions, readmission rates, average lengths of stay, out-patients, first to review rates and programme spend for neurology through the payment by result rates. All that information is on NHS Comparators, which is part of the NHS website. It is an online tool that presents all that information in a way that is accessible not just to professionals, but to the third sector. One of the challenges that I pose to hon. Members and to organisations with an interest in this field is to make more use of NHS Comparators, because it is a valuable tool for challenging commissioners and holding them to account and for ensuring that there is competitive localism—a real sense of comparing one area to another to ensure that we drive up standards and learn from the best.

[Priti Patel]

We have heard in the debate that epilepsy is a very subjective condition—it affects people in many different ways. We have also heard about the data challenges, and the Minister has kindly given us some insight into what comparators are out there. The fact is, though, that if someone is a sufferer, is on their own and is in desperate need of care and access to information, hearing about data comparisons is not necessarily of practical help. What practical measures exist for sufferers and for organisations that can give genuine support and guidance to epilepsy sufferers?

[Paul Burstow]

The hon. Lady makes a very important point. I was talking about using the data to improve standards, but we also need to ensure that, through NHS information prescriptions, we provide better and more timely information to people. Further work is also necessary in that area.

A message that comes through strongly is that commissioning is key to better epilepsy care. We believe that placing decision making much closer to the patient through general practice consortiums will unlock new opportunities and lead to more sensitive and responsive decision making about care and treatment pathways. Some patient groups and some hon. Members in this debate have expressed concern about the experience and knowledge of GP commissioners in designing epilepsy services. Let me say a little more about that.

The NHS commissioning board will have a vital role to play in supporting consortiums. It will set commissioning guidelines based on clinically approved standards developed by the National Institute for Health and Clinical Excellence. In addition, the long-term conditions delivery support team will work closely with new directors of commissioning, their commissioning boards and GP consortiums to build skills and awareness. For example, the team has already developed a new commissioning pack, bringing together information that commissioners will need to design good epilepsy services.

My hon. Friend the Member for Southport has asked me, within about four days of the close of consultation on the White Paper, to describe in full and complete detail every aspect of the new accountability regime for the new system. I will not do that in the debate today, because that would not do justice to the 5,000 respondents to the consultation. The Department is in the process of properly considering the responses to the consultation and we shall give a considered and proper response. What we have done so far is set out clearly the direction of travel and reform. I think that my hon. Friend has conflated two or three things in his test of accountability: professional accountability, accountability to the public and accountability to other organisations. We will make clear, when we set out the next steps to the reforms that we have proposed in the White Paper, precisely how each part of the accountability conundrum that he posed is properly addressed.