Health and Care Services

Kevan Jones Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Grahame M. Morris]

That is an excellent point. I am sure that Members across the Chamber will have experience of that. On Friday gone, we had a crisis meeting of the county MPs and senior politicians in my local authority area of County Durham to determine how to cope with a further tranche of cuts. The situation is becoming serious. It is said that the allocations have been ring-fenced, but the local authorities’ discretionary spend is all being absorbed into social care and expenditure for children and the elderly, and there is very little room for manoeuvre.

[Mr Kevan Jones (North Durham) (Lab)]

Will my hon. Friend give way?

[Grahame M. Morris]

I will give way to my hon. Friend.

[Grahame M. Morris]

Okay—

[Mr Jones]

Will my hon. Friend give way?

[Grahame M. Morris]

Am I allowed to give way to my hon. Friend, Madam Deputy Speaker?

[Grahame M. Morris]

With all due respect, Madam Deputy Speaker, I know that my hon. Friend was at the same meeting as me on Friday, and he will probably have a relevant point to make about that, so if you do not mind, I will give way to him.

[Mr Jones]

With respect to the Deputy Speaker, the point I wanted to make was that at the meeting last Friday we were told that Durham county council has to take £210 million out of its budget. Does my hon. Friend think that areas such as ours, which has a growing elderly population, will face more pressure than some others?

[Grahame M. Morris]

Absolutely. The pressures are becoming intolerable. Some of our great northern cities, such as Liverpool and Middlesbrough, seem to be shouldering a disproportionate share of the cuts, and it is a difficult task to try to balance the budgets and deliver the services that people require. There has been a discussion about whether the councils are in a position even to deliver their statutory requirements.

As the right hon. Member for Charnwood said, the NHS has been set productivity targets of 4% per year, as the Government seek to make savings of £20 billion over the lifetime of this Parliament. As the report identifies, the Government believe that those savings can be made in part by prioritising competition over co-operation. I find that questionable, and we need a cost-benefit analysis of the consequences in regard to the value for money of outsourcing. There has been a lot of criticism of PFI schemes, and questions have been asked about whether they provide value for money for the public purse. To date, efficiencies have largely been achieved by freezing staff salaries and cutting the tariffs paid to NHS providers. Neither of those is sustainable, and both fail to meet the spirit, if not the letter, of the Nicholson challenge.

There are signs of falling morale in the NHS, and that is due in no small part to the Government’s attacks on pay, pensions and conditions of service. It is not helpful that Ministers seek to blame NHS staff for problems caused by the Government’s cuts and reforms. These are not the innovative changes that we need to see from a restructured NHS. In the main, we are seeing the picking of low-hanging fruit. Some of the cuts are rash and damaging, and they are being made to satisfy the Government’s need for cuts across the board.

I understand that the current Secretary of State for Health has joined his predecessor in receiving a vote of no confidence from the health care professionals at the British Medical Association conference. I only hope that the next Secretary of State for Health will seek to work with health care professionals, not against them.

The NHS Confederation’s survey of NHS chief executives indicated that 74% of respondents believed that the NHS’s financial situation was either the worst they had ever seen or “very serious”. Despite the Government’s claim to have ring-fenced funding, which has been called into question, NHS executives are not confident that the situation they face is good for their organisations or their patients, with 85% expecting things to get worse in the next fiscal year.

There is no doubt—the figures are there in the report—that the NHS is facing the biggest financial challenge for a generation, as a result of unprecedented demographic changes, an increasing demand for health and care services, co-morbidities, and people living longer with chronic illnesses such as diabetes and dementia. The Nuffield Trust has warned that, unless we improve the way in which services are delivered, growing care needs will result in a shortfall of up to £29 billion a year in NHS funding by 2020.

The NHS faces new challenges in the 21st century. The last Labour Government corrected the chronic under-investment following 18 years of the previous Conservative Government. Investment in the NHS trebled under Labour. We built more than 100 new hospitals, replaced much of the ageing infrastructure, and developed the new walk-in centres, primary care centres and a new generation of modern community hospitals. There were extended GP opening hours, and more doctors and nurses than ever before.

--- Later in debate ---

[Priti Patel (Witham) (Con)]

I welcome today’s debate and I, too, want to pay tribute to my right hon. Friend the Member for Charnwood (Mr Dorrell) for his comments. He clearly made some strong and valid points about expectations of the NHS and the required pre-requisite of expectation management. Yes, the debate is about funding and finance, but it is also about some of the significant challenges we face as a society and a country because of our changing demographics and our ageing population.

I pay tribute to the Government for prioritising investment in the NHS and in health and social care and for committing to increase spending on the NHS and health to more than £115 billion for the next comprehensive spending review period. I also welcome the measures they have introduced to focus resources on the front line and in particular to clamp down on NHS bureaucracy—my hon. Friend the Minister will know my views on that. I believe that the importance of making £20 billion of bureaucratic and efficiency savings should not be underestimated.

As we have heard, increasing demand on services requires more spending, but targeted specifically at the front line. In my constituency, a scandalous deficit in health care provision built up while Labour was in power as resources were soaked up by NHS bureaucracy. Across the former East of England strategic health authority, the number of senior managers doubled between 1997 and 2009 from 1,300 to 2,700.

[Mr Kevan Jones]

Does the hon. Lady think that there has been any sense whatever in the top-down reorganisation? I know that in many areas managers have taken large redundancy payments from primary care trusts only to be re-employed weeks later by GP commissioning groups.

[Priti Patel]

The answer to the hon. Gentleman’s question is yes. In the east of England, and certainly in Essex, there have been significant changes. The change to the structure has been specifically welcomed because resources are now going to the front line, which, for my constituents, is the most important thing.

The numbers of administrators and managers grew vastly in the PCTs that used to cover my constituency. I am afraid that we did not have one PCT—we had several. The number of managers and senior managers at the Mid Essex primary care trust and its predecessor trust increased tenfold from 10 to 102, while at the North Essex primary care trust the number went up from 25 to 84. By the time the Labour party was kicked out of office by the British public, the proportion of administrative staff had risen to one third, and between those two PCTs something like £25 million was spent on management costs alone—money that could have been much better spent on providing front-line services to my constituents and to constituents elsewhere in Essex and across the eastern region.

Although bureaucracy increased, health service provision in Witham town suffered as NHS managers completely neglected the area in favour of spending money elsewhere. As a result, Witham town’s GP surgeries are bursting at the seams. Almost 30,000 patients are registered across four practices with just 13.5 full-time equivalent GPs. That means that there are 2,200 patients registered per GP, nearly 50% more than the national average of 1,500 patients per GP.

My constituents report that they are struggling to register with a GP and are facing insufferable delays in getting appointments. One wrote to me, saying:

“Two doctors’ surgeries in Witham have refused to take me on, because the books are closed for new patients.”

Another said that they

“waited 12 days for an appointment with my GP. In the end, I was diagnosed with appendicitis.”

Unfortunately there will only be more such cases, exacerbated not just by our changing demographics but by housing growth, which creates greater pressures on existing practices. On Witham’s Maltings Lane estate, 1,700 new homes will be built, increasing the local population by more than 4,000. Other sites have been identified for development over the next decade, quite rightly bringing new homes and affordable homes to my constituents.

When Labour was in power, opportunities to bring in new medical facilities through section 106 agreements and other funding arrangements were completely spurned by the PCT managers, who neglected and ignored the situation and the strains of a growing population in the community. New GP practices could have been opened and new facilities to provide treatments and assessments could have been brought in to save my constituents from travelling to Chelmsford, Colchester or even Braintree, which involves considerable distances. That demonstrates how patients in my constituency were not being put first. It was bureaucracy that was being put first by the army of bureaucrats in charge of running the local NHS in my part of Essex at that time.

The Minister will understand the legacy of problems left to the town. I also pay tribute to him—like the Secretary of State, he has received a fair amount of correspondence and is well aware of the issues. One of the biggest challenges for the NHS today, with the increased investment that it has, quite rightly, received from the Government, is ensuring that the savings in bureaucracy that this Government are making are reinvested in providing new local health care services in Witham in particular. I hope that my hon. Friend will give a commitment to support our local efforts to increase health care provision in Witham, to ensure that my constituents of today and those of tomorrow, gained through new housing growth in particular, receive and benefit from a 21st century health care service.

With more money than ever being invested in the NHS, it is essential that those who are responsible for spending decisions and run our local NHS are also held to account. Accountability and transparency are key. We in the east of England have had from our ambulance trust the worst ambulance service in the country. It was run by a board of non-executive directors who failed to provide the trust with the leadership, skills and expertise required to address endless shortcomings and delays in ambulances attending to patients. Lives were put at risk, but despite the failures, a damning governance review and a “failing” report from the Care Quality Commission, the board bit the bullet and resigned only last Friday morning, following substantial pressure from MPs in the east of the region, including my hon. Friend the Minister, and a Westminster Hall debate last week. The situation was shameful and scandalous, because the board refused to go until the pressure became too much for them.

None of us can avoid the need for accountability and transparency. We have seen in Mid Staffordshire with the Francis review, in Cumbria, in the East of England with our ambulance trust, and now with the Tameside hospital trust—I think the chief executive resigned this afternoon—what can happen when NHS managers and directors get it wrong. They have to be accountable for their failures. Transparency is required. I recognise that the Government are taking this seriously and hope that at the end of the debate my hon. Friend the Minister will give details of steps that will be taken to remove failing directors and managers and, importantly, to replace them with people who have the skills and capabilities to put patients first and to deliver value for money. A huge amount of taxpayers’ money is used to pay for the NHS. It is only right and proper that all of us, including the public, should feel confident that the money is being well spent.

[Dr Phillip Lee (Bracknell) (Con)]

The nature of this debate is such that one can talk about anything to do with the NHS, be it local or national, in the context of the estimates of costs. The figures in the documents are immense—£1 billion here, £50 billion there; perhaps we need to plant some money trees in this country—and will only increase, as we all know. It has been interesting to listen to Members on both sides of the House this afternoon. Everybody accepts that demands are rising. Obesity is increasing—26% of adults are obese and the proportion is rising—and our population is ageing, so that by 2030 almost 25% of the population will be over 60. On top of that, there are advances in medical technology and the costs thereof to deal with—today’s cancer drugs can cost upwards of £5,000, £6,000 or £7,000 per month per patient.

Given those demands and costs, maintaining the current service will inevitably become nigh on impossible. I sense, even in the Chamber, and certainly outside it, that the public are beginning to realise that. I will say a few words about that before going local and discussing some of the things I have been suggesting in my region, and “region” is the key word here, rather than constituency.

The figures are really quite shocking. It has been suggested that by 2025 around 25% of the NHS budget will be spent on type 1 and type 2 diabetes alone. Only this morning a colleague told me that he had been diagnosed with type 2 diabetes. It affects all groups in society. Around 21% of the population smoke and around 28% of the adult male population drink too much—the figure is about 20% for women.

The number of prescriptions in 2009 was 886 million. The total cost of the NHS drugs budget in 2009 was between £13 billion and £14 billion, and it increases by £600 million each year. We are getting cleverer at inventing new drugs and classes of drugs, so I suspect that those costs will continue to increase, because it is human nature for someone to want the very best drug, the drug that will cure their cancer or extend their life.

Cases of dementia are set to double over the next 10 years, which will have a profound impact on health and social care. There will be a huge impact on the economy, as families will increasingly have to spend more time looking after the vulnerable, rather than going to work. The ramifications are immense.

I have detected some recognition in the Chamber today, particularly from my right hon. Friend the Member for Charnwood (Mr Dorrell), that there needs to be some cross-party agreement on this. I suspect that we will be arguing over the next 10 to 15 years about how we pay for health care. I have been brave enough to suggest that relying solely on general taxation to fund health care is not practical in the medium to long term. It is difficult politics—trust me, I saw my Twitter account explode at that point—but I think that we are likely to have a debate on that, and an argument, across the House, and that is as it should be.

However, where we should not disagree is about the way health care is structured in this country. I think that for both parties—it is a plague on both houses—the introduction of the market into hospital health care and the use of private finance initiative contracts, particularly over the past 10 years, has made it extremely difficult to reconfigure hospitals in certain parts of the country, which is unfortunate.

I have also heard that the introduction of competition law and its possible implications with regard to reconfiguration is also looming large in the national health service. Government Front Benchers might want to look at that, because I am persuaded—I have spoken about this on many occasions—that in future we will need fewer acute hospitals but more community hospitals. The majority of care will increasingly be offered closer to home, or indeed in the home, but the clever stuff, such as the life-saving stuff shown in the television series that the BBC is currently broadcasting on Thursdays, cannot and will not be offered in the number of district general hospitals that we currently have. Anybody who thinks that it can be does not understand. I suggest that it is increasingly becoming good politics to save lives, not to defend the indefensible, and I think that Members on both sides of the House should reflect on that.

One example from that television series was a nasty accident involving a head-on collision 30 minutes north of Addenbrooke’s hospital. The injured did not go to the local hospital, which had recently opened, because it could not care for them; they went 30 minutes down the road to be treated at Addenbrooke’s. In other words, a hospital that had been built in the past few years was already not fit for purpose. We should reflect on that.

Reconfiguration is essential, and it has been shown—not least in respect of London stroke services—to save lives and improve care. That should be replicated across the country.

[Mr Kevan Jones]

The hon. Gentleman is speaking a lot of sense. The stroke unit in the north of County Durham has just been specialised, and the results are already showing the benefits, although in parts of the region there was a lot of opposition to the move.

Does the hon. Gentleman think that long-term health should be managed not only by doctors but by pharmacists and others, who can play a key role?

[Dr Lee]

I am pleased that services are improving in County Durham; as the hon. Gentleman knows, I have family roots in his part of the world that go back centuries. I am not persuaded of the role of pharmacies, although I am persuaded of the role of pharmacists. I distinguish between the two because I personally think that all GP surgeries should be dispensing drugs. I do not see why the taxpayer should be subsidising pharmacies.

It is no surprise to me that Boots was the biggest ever private equity buy-out in the history of British industry, given that the taxpayer is outside the front door: “Come here for your amoxicillin, and while you’re here you can get your shampoo, conditioner and royal jelly.” I am not convinced about the role of pharmacies in the longer term; pharmacists most certainly have a role and should be included. Community pharmacists should be checking drugs, particularly when patients have polypharmacy—when they have a multitude of medications, another pair of eyes is always appropriate.

To return to the reconfiguration, in my locality we have a number of district general hospitals. Historically, Bracknell itself has been under-served by acute services since it was created in the late ’50s or early ’60s. We have seen services diminish in the area for a variety of reasons and under Governments of both parties, and we are sensitive about that.

Before I was elected as Member of Parliament for Bracknell—I stress that it was before I was elected—I suggested as part of my campaign that we needed to close hospitals in the area and consolidate to improve clinical outcomes. I am not aware that my result at the election was adversely impacted by that. Having worked in the area as a GP for a number of years and looked after 50,000 patients, I guess that people trusted what I was saying, and I recognise that.

I was trying to argue that we could consolidate acute services on a single site and improve community hospital services in appropriate locations around the region. I stress the word “appropriate”, as the problem is often that, for a variety of legacy reasons, hospitals are in inappropriate locations. They are not often on motorways, but on land bequeathed before the war. In my part of the world, the Astor family bequeathed the land for Heatherwood hospital. The local farmer outside Slough bequeathed some land because his daughter was looked after well. People thought, “Okay, we’ll build a hospital in the middle of a farm field nowhere near the population that it seeks to serve.”

There is a legacy problem. There is some need to close and relocate, while in some parts current locations can be enhanced. In my locality, there is the problem with Heatherwood hospital. I must put on the record something bizarre that frustrates me. It is “blue on blue”; if I was in a defence debate, it would be called friendly fire. The Royal Borough of Windsor and Maidenhead has called for a judicial review of the relocation of a minor injuries unit just three miles down the road, would you believe, to Bracknell—an urban centre in a better location and away from a place opposite the Royal Ascot racecourse. That judicial review will delay the move and cost money. I find that baffling and bizarre. It is evidence of the problem that I guess all colleagues of both political colours experience in local politics with regard to health care and trying to change services for the improvement of clinical outcomes, because it is not about cost, although obviously that is a factor, but about improving clinical outcomes. That frustrates me, and I will certainly be dealing with it robustly in local terms. At the moment, it is in the best interests of the general public to have fewer acute hospitals.