Oral Answers to Questions
Simon Burns Excerpts(14 years, 2 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
Revenue allocations post 2010-11 will be set following the spending review. From 2013-14, the NHS Commissioning Board will allocate the majority of NHS resources to GP consortiums on the basis of seeking to secure equivalent access to NHS services relative to the burden of disease and disability. Public health resources will be separately allocated to reflect relative population health need and to seek to reduce health inequalities.
Mr Bone
Under the Labour Government, Northamptonshire was the worst funded primary care trust in the country. That was because the Government never met the national capitation formula in full, denying Wellingborough a hospital, for instance. Will the Minister’s new proposals be fairer and encourage my constituents in the belief that they will get a better deal?
Mr Burns
I am grateful to my hon. Friend for that question, because he is right—under the Labour Government, Northamptonshire Teaching PCT was underfunded and is currently receiving 1.4% below its target allocation. That is why my right hon. Friend the Secretary of State and I are seeking, under the vision outlined in the White Paper, to free the NHS from day-to-day political interference so that the allocation of resources will be the responsibility of the NHS Commissioning Board which can seek to address the problems highlighted by my hon. Friend.
Mr David Hanson (Delyn) (Lab)
5. What recent discussions he has had with the Welsh Assembly Government on the effects of proposed changes to health services in England on patients living in Wales who use those services.
Caroline Flint (Don Valley) (Lab)
7. How many GPs in Doncaster have expressed an interest in establishing GP consortiums.
The Minister of State, Department of Health (Mr Simon Burns)
The Yorkshire and Humber strategic health authority has informed me that two existing practice-based commissioning consortiums are currently working on behalf of all Doncaster’s 45 GP practices. GPs in Doncaster are enthusiastic about the agenda and, in partnership with Doncaster primary care trust, have established a transition team meeting to oversee the process.
Caroline Flint
Yes, there is something called the “Doncaster commissioning consortium” in Doncaster, which provides clinical leadership to Doncaster PCT when it comes to commissioning. From what I understand from the Government’s proposals, as a result of these changes the Doncaster commissioning consortium, made up of the majority of GPs, will have to employ people, either from the PCT or other sectors, to do the budget and management of commissioning. Is this restructuring not just a rebranding to make the Government look as if they are being innovative in health care when in fact they are pouring money down the drain and conducting a restructuring that we just do not need?
Mr Burns
May I recommend that the right hon. Lady, who from her past ministerial career is familiar with health issues, study not only the White Paper that we have published, but the documents, particularly on commissioning, that flowed from that, because I am afraid that her interpretation of the situation is wrong? This is a great change from the PCT system, because it will basically ensure that commissioning will no longer be remote but be carried out by GPs at the forefront of dealing with patients’ needs and care, who know best how to ensure that patients get the finest and best health care possible.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
8. What plans he has to assist GP commissioning in rural areas.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
10. What steps he is taking to ensure the adequacy of resources allocated to hospital accident and emergency departments.
The Minister of State, Department of Health (Mr Simon Burns)
It is the responsibility of local NHS commissioners to plan and arrange adequate A and E health services according to the needs of their local populations. Attendances at hospital A and E departments are reimbursed through mandatory national tariffs.
Mr Sheerman
Is the Minister aware that my constituents in Huddersfield are very pleased with the improvements to their A and E services over recent years? They put that down to fewer people going to A and E because they have NHS Direct to take the pressure off A and E, and to the guarantee of being seen within four hours, and having the right to complain pretty vigorously—as we do in Huddersfield—if that does not happen. Are not the measures that the Government are introducing simply going to make A and E impossible again?
Mr Burns
May I reassure the hon. Gentleman’s constituents that they will be just as pleased with the responses that they receive from a 111 line, where professional advice and help will be given to people who need to contact it about their health needs? May I also reassure his constituents on the question of four-hour targets? The target that was introduced caused distortions; it was a political target. We are relying on clinical decisions and activity to ensure that people are seen as quickly and relevantly as possible.
Mr Stephen Dorrell (Charnwood) (Con)
Does my hon. Friend agree that in addition to the proper funding of A and E departments, it is also important to take steps to manage the demand on those departments? In particular in urban areas, that means that commissioners should accept the responsibility to look for improvements in the delivery of primary care so that patients have more easy access to less urgent care in the primary care context, thus reducing the demand on A and E departments.
Mr Burns
My right hon. Friend is absolutely right. It is, of course, not only a question of correctly identifying those people who should use A and E; the other assistance given through the health service is also important. We need a first-class and relevant out-of-hours service as well.
Hugh Bayley (York Central) (Lab)
11. What recent assessment his Department has made of the clinical effectiveness of facet joint injections; and if he will make a statement.
Mr Charles Kennedy (Ross, Skye and Lochaber) (LD)
12. What recent discussions he has had on the effectiveness of the National Institute for Health and Clinical Excellence’s procedures to review the cost-effectiveness of drugs; and if he will make a statement.
The Minister of State, Department of Health (Mr Simon Burns)
Ministers discuss NICE’s work from time to time as part of routine business. We attach great importance to the work NICE does in giving advice to commissioners and clinicians on the relative clinical and cost-effectiveness of treatments. The right hon. Gentleman will know that we also propose reforms that will better reflect the value of new drugs in the relevant prices paid by the NHS.
Mr Kennedy
In thanking the Minister for that helpful reply, I note that my question rather overlaps with the pertinent question just asked by the hon. Member for York Central (Hugh Bayley). Can the Minister give us any indication of where the Government, at this stage of their Administration, are on the proposed cancer drugs fund, particularly with reference to the drugs used for kidney cancer treatment, which NICE is still evaluating? Can these drugs be issued under the interim cancer drugs fund, not least given the terrible delays some patients face with the local PCTs, when by the time things are resolved it is sometimes, sadly, too late?
Mr Burns
May I reassure the right hon. Gentleman that we will shortly consult on the cancer drugs fund. On the question of Afinitor, in which I know he has a particular interest, I appreciate that there has been some concern expressed by families and patients about the issuing of the interim guidance. I would like to emphasise that the guidance is only interim, that the appraisal is ongoing and that we await the final guidance from NICE. I hope that he will be reassured that, since the publication of the draft guidance, the manufacturer of Afinitor has proposed a revised patient access scheme for the drug, which is now being considered as part of the NICE appraisal. In the light of that, we will have to await the announcement of the final decision.
Mr John Baron (Basildon and Billericay) (Con)
13. What recent representations he has received on the proposed one-year cancer survival measure.
Mr Philip Hollobone (Kettering) (Con)
T5. Kettering general is a wonderful hospital but recently its paperwork has got out of control. Some 30 occasional chaplaincy visitors from the local Catholic Church, many of whom are retired, have recently had to complete Criminal Records Bureau checks, employer references and an intrusive personal health questionnaire. Does the Minister agree that if we are to create the big society that the Prime Minister would like us to create, such bureaucracy must be minimised?
The Minister of State, Department of Health (Mr Simon Burns)
I have considerable sympathy with the problems that my hon. Friend’s constituents had. Although they are necessary, I would like to think that vital checks could happen through a process that is easy to manage for those who have to go through them. My view is that hospitals must ensure that checks on volunteers are proportionate and do not discourage good and well-meaning people from becoming involved in local care. I hope that my hon. Friend is reassured by the fact that my right hon. Friend the Home Secretary announced on 15 June that the CRB regime would be scaled back to common-sense levels. The Government will announce the terms of reference of the review shortly.
Keith Vaz (Leicester East) (Lab)
T3. Some 1,800 patients in the Belgrave area of my constituency have been left without their local surgery because it has closed. Will the Minister assure me that despite the scrapping of the primary care trust, the new Belgrave health centre will be built? If he cannot tell me now, it would be very helpful if he could write to me.
Miss Anne McIntosh (Thirsk and Malton) (Con)
T6. The Minister of State wrote to me on 25 August to say that all future service changes must be led by clinicians and patients. How can it be that, although all the clinicians and patients oppose the downgrading and possible closure of the Ryedale ward of Malton hospital, that can proceed? Will he please use his good offices to block any such change?
Mr Burns
I am very grateful to my hon. Friend and would like to tell her that I have been informed by NHS Yorkshire and the Humber that NHS North Yorkshire and York has proposed incrementally to alter the balance between resources in the community and the in-patient areas by slowly reducing the number of beds open for admission and slowly transferring staff into the community. We understand that that forms part of the PCT’s ongoing strategic plan for Malton. However, given my hon. Friend’s concerns, I would be more than happy to meet her to discuss the issue further.
Gloria De Piero (Ashfield) (Lab)
T4. When the Government say that the NHS budget will be ring-fenced, people might assume that whatever cash a hospital gets in this financial year will be matched next financial year. So could the Health Secretary explain why the King’s Mill hospital in my constituency has been told to expect its budget to treat patients next year to fall by 8.2% or £14.9 million?
Andrew Selous (South West Bedfordshire) (Con)
Leighton Buzzard is one of the larger towns in the country not to have a community hospital. What reassurance can my hon. Friend give me that the wishes of local GPs will be respected in deciding what services the proposed community hospital will have?
Mr Burns
I think I am in the fortunate position of being able to give my hon. Friend considerable reassurance. NHS Bedfordshire has the full support of local GPs, and they continue to develop a business case for the primary health care facility in Leighton Buzzard. They will go to full public consultation on the proposals. The centre is planned to open in 2012 and would be funded by NHS Bedfordshire.
John Mann (Bassetlaw) (Lab)
Some 36,000 of my constituents, who voted by ballot, and every single GP in both local authorities, all believe that Bassetlaw accident and emergency department should remain a full 24-hour service. Can the Secretary of State conceive of any reason why that might not be the case during this Parliament?
Mr Steve Brine (Winchester) (Con)
Many of my constituents, and indeed many practitioners, have grave concerns about the pending closure of Winchester ambulance station. Will the Minister assure the House that no changes to static ambulance bases will take place until local consortiums, when they are formed, are happy that a suitable alternative is in place?
Mr Burns
I am extremely pleased to be able to give my hon. Friend some reassurance. South Central strategic health authority has informed me that the service to the people of Winchester will not be affected, as there will be static provision for Winchester; ambulances will be deployed via a control centre in Otterbourne, 2 miles from Winchester. Those changes are set to take place in December, and the existing station will not be closed until there is new provision.
Mr David Lammy (Tottenham) (Lab)
A decision has been taken in the past few days, without any consultation at all, to transfer the out-of-hours service for 950,000 north Londoners from the GP-run co-operative to a private provider. Will the Secretary of State intervene to ensure that local people and GPs make that determination?
Hospital Services (North-East)
Simon Burns Excerpts(14 years, 4 months ago)
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Mr Iain Wright (Hartlepool) (Lab)
It is a pleasure to speak under your chairmanship, Mr Sheridan. The debate is about hospital services in the north-east, but I shall focus on services in North Tees and Hartlepool, so I welcome the fact that I can see here my hon. Friends the Members for Stockton North (Alex Cunningham), for Easington (Grahame M. Morris) and for Sedgefield (Phil Wilson), as well as the hon. Member for Stockton South (James Wharton). I am also pleased to see a good north-eastern Member in the form of my hon. Friend the Member for Wansbeck (Ian Lavery). As I said, I shall focus on North Tees and Hartlepool, but I think that the hon. Member for Hexham (Guy Opperman) will wish to catch your eye, Mr Sheridan, and widen the debate so that it has a more regional perspective. I thank him for writing me a note, asking to participate in the debate.
I welcome the opportunity to discuss hospital services in North Tees and Hartlepool again. We had an important but too short debate on 5 July, initiated by my hon. Friend the Member for Stockton North, in which many hon. Members hoped to contribute so that they could express their concern about, and seek clarification on, the Conservative-Liberal Government’s decision to cancel the £464-million new hospital that was to serve the populations of Hartlepool, Stockton, Easington and Sedgefield. I am indebted to Mr Speaker, who, after discussing the matter with me, granted this longer debate so that we could discuss more thoroughly the vital issue of health care and hospital services in my area. We also had a meeting with the Minister in the week following that debate.
The decision by the new Government—one of their first decisions on coming to office—to withdraw the £500-million investment from our area throws the vital issue of health care and hospital services back into complete confusion and mayhem. My constituents and those of my hon. Friend the Member for Stockton North, as well as those of my hon. Friends the Members for Sedgefield and for Easington, are worth much more than that and deserve much better.
It is especially important that there should be excellent health care in Hartlepool and the surrounding areas because the people whom I represent experience some of the worst health inequalities in the country. Much of that is due to our legacy as a former heavy manufacturing town, with industrial diseases and injuries. Much of it is due to the deindustrialisation of the 1980s and ’90s, and the failures of Government at that time to put in place an alternative economic model. Economic inactivity and health inequality go hand in hand, and we have in the past 30 years suffered from high levels of deprivation. Much of the health inequality has to do with poor and inadequate investment in primary health care in Hartlepool in the last half-century. For example, we have had a much lower ratio of GPs per head of population than we should have had for much of the time that we have had an NHS. As a result, we have had to rely on hospitals, whereas other areas may have had suitably high levels of GPs and primary health facilities.
Frankly, much of the inequality has to do with people’s lifestyles. One third of the population of Hartlepool smoke, as opposed to 24% across England. Some wards in Hartlepool have smoking rates of 40% to 50%. The rate for smoking in pregnancy is way above the national average. The proportion of women who breastfeed their baby in Hartlepool is half what it is across the country. Hartlepool is above the national average for the proportion of people who binge-drink, although I would like to point out that it is below the average for the Teesside area as a whole. Rates of early death from heart disease, strokes and cancer are significantly worse in Hartlepool than the national average, as is life expectancy. Although the gap in life expectancy between Hartlepool and the rest of the country has narrowed in the past decade, it remains the case that a man in Stranton ward has a life expectancy some 11 years shorter than that of a similar man in a more affluent area.
All that history—the lifestyles and the poor health outcomes—means that it is vital that we have the best possible health service for my constituents. Although progress has been made, it will take more sustained help and support, and reconfiguration of services, to narrow the gap still further. We have seen more investment in Hartlepool health in the past 10 years—actually, we have seen more investment in primary health facilities in the past five years than in the previous half-century—but the people of Hartlepool still feel battered and bruised when it comes to the future of hospital services.
Since the 1990s, there has been huge uncertainty about what shape the health services will take, and where they will be located. There has been review after review after review—the Tees services review, the Darzi review, the report from the independent reconfiguration panel—and now there is the decision to scrap the hospital at Wynyard. In that time, other areas have seen a reconfiguration of hospital services; in our neighbouring area south of the Tees, one of the best hospitals in Europe—the James Cook University hospital—has been built. Those of us north of the Tees deserve something similar.
While the uncertainty has continued for my area, the hard-working staff in our local NHS have not been provided with the clear vision and leadership needed. That has compromised their ability to provide world-class health care for our area. The uncertainty has led to a loss of morale and subsequent difficulties in recruitment and retention. The trade union Unison is to be commended in my area for proudly standing up for the people who work in hospitals, but the Government’s decision, together with other reforms that they propose, is placing strain on local services and threatening jobs. We need certainty and continuing investment, and the Government, in one of their first acts in office, have provided neither.
It is fair to say that many people in my area might consider the Government’s decision to scrap the proposed new hospital to be appropriate—indeed, welcome—and might think that with a hospital not being built in Wynyard, the University hospital of Hartlepool will stay open, and that services will migrate back to it. It surely defies common sense, as I have been told by some constituents, that a town such as Hartlepool, with a population of 90,000, cannot have a fully functioning district general hospital, with all the modern services that hospitals should provide. It is argued that the decision to scrap the proposed new hospital at Wynyard presents an opportunity to provide that, and will mean that the University hospital of Hartlepool will have a secure future.
That is an understandable stance, based on affection for the great service that Hartlepool hospital has provided down the years. The big events of life have occurred in the hospital for many thousands of Hartlepudlians, including me. I am thinking of the births of my four children, the death of my nana and the saving of my son Benjamin’s life twice—first when he contracted meningitis at the age of eight, and then at the age of 12, when he suffered a stroke. The dedication of people working in that hospital is second to none, and my family are very much testimony to that.
However, I fear that we will not see the return of hospital services to Hartlepool, and that we will have the worst of all possible worlds—hospital services will move away from Hartlepool and become more inaccessible to the people whom I serve, and we will not have a world-class facility in the borough of Hartlepool to replace them.
I fully accept and embrace the changes in health services. I welcome the technological advances that mean that whereas previously certain medical procedures required extensive stays in district general hospitals, those procedures can now be done safely and more cheaply in a local setting. Just a few years ago, high-quality internet use, for example, could be provided only by bulky and costly desktop computers; now, people can have internet access in the palm of their hand. In the same way, such advances are pushing more and more medical and surgical procedures into the community, into GPs’ surgeries and even into people’s homes. I welcome that.
We are certainly seeing that trend in Hartlepool. The Momentum programme is reconfiguring more and more services that were once the preserve of the hospital, putting them into the local clinic, closer to people. I met a man in Hartlepool recently who had had his toes amputated. Just a few years ago, that would have required an operation in a hospital and a lengthy stay there for recovery and recuperation. The man I met had had the procedure carried out in the operating theatre of his GP clinic in the Headland surgery, and he was home in a matter of hours. We shall see much more of that.
The newly opened One Life Hartlepool centre, built as part of the Momentum programme, is equipped to carry out minor skeletal surgery and will do orthodontic work that was previously the preserve of hospitals. GP surgeries increasingly take blood samples on-site rather than requiring the patient to attend hospital. Again, that is welcome.
However, we also have to admit that increases in medical specialisation, coupled with a wider and more miraculous range of things that can now be achieved through science and surgery, mean that many surgical procedures are now reserved for doctors and nurses with very specialised skills, as opposed to those in general medicine and surgery.
In preparing for this debate, I have been in contact with the Royal College of Surgeons of England, and I am grateful for its help. As part of its best clinical practice, for acute general hospitals that provide the full range of facilities, specialist staff and expertise for elective and emergency medical and surgical care, the college recommends a preferred catchment population size of between 450,000 and 500,000 people. However, the college estimates that hospitals of that size account for fewer than 10% of acute hospitals in England, and states that there is unlikely to be a significant shift to that size of hospital in the short to medium term. As it is, the majority of acute hospitals have, and are likely to continue to have, catchment populations of about 300,000. That is significantly more than the population of my constituency.
It is essential that MPs and all representatives listen to the professional advice of eminent surgeons. I do not intend to play fast and loose with patient safety and clinical excellence. As a politician, I realise that I do not know better than doctors, and I want the best possible health care for my constituents. I will fight to the last to achieve the best possible services for Hartlepool. They have to be safe and medically advisable, but if something is seen to be clinically essential by surgeons, it is right that my hon. Friends and I should listen. It is also right that Ministers should listen to eminent surgical and clinical advice, and I suggest that the cancellation of the proposed new hospital means that they did not. I hope that the Minister will do so today.
I believe that Lord Darzi’s proposals of 2005, under which Hartlepool hospital was to become a centre of excellence for women’s and children’s services, and the University hospital of North Tees was to become a centre of excellence for emergency surgery, were workable and feasible. Alas, it was not to be, as other parts of Teesside felt that they could not live with that. Although I thought that the subsequent independent reconfiguration panel review was unnecessary, I respect its decision, the quality of its evidence and its professionalism. I cannot argue with the overpowering weight of clinical advice on the matter.
In the IRP report, paragraph 4.8.5, entitled “Clinical views—the need for change”, stated:
“There was a common view across all staff that no change is not an option. Staff are keen to work with the Trust management and to embrace clinically-driven change”—
“clinically-driven change” is a hugely important phrase—
"that secures the best outcome for patients, staff and the Trust…There was widespread support for a new modern hospital, north of the Tees, concentrating on providing high quality hospital services that cannot be more appropriately provided in local communities”.
The IRP also stated:
“This is not simply a matter of recruiting additional staff. Specialist skills can only be acquired and maintained with sufficient ‘throughput’ of cases. Since safety standards can only be expected to rise in the future, the current model of service provision is unsustainable.”
In the concluding remarks in the report, the chair of the IRP—a GP and the chair of an acute NHS trust in Nottingham—stated in his personal recollections that:
“The clinicians were virtually unanimous in their desire to work on one site. This was not based on their personal convenience but on clinical evidence and a belief that a real and sustainable improvement in patient care would take place.”
I want the best possible services for Hartlepool. The ideal situation if I lived in utopia would be a hospital in the very centre of Hartlepool that provided the widest possible range of specialisms. In the real world, however, I realise that the desire to see a hospital serving the people of Hartlepool, Stockton, Easington and Sedgefield was driven by clinicians, based on clinical evidence and fuelled by a belief that patient outcomes would improve and health inequalities diminish as a result.
To be fair, I think that the present Government recognise that, too. In a recent answer to my written parliamentary question on whether he would implement the recommendations of the Darzi review, the Minister replied:
“The recommendations of the Darzi review of acute health services north of the River Tees were superseded by the advice provided by the Independent Reconfiguration Panel to the then Secretary of State for Health in December 2006. This advice formed the basis of the ‘Momentum: Pathways to Healthcare programme’ which was developed by the local national health service to provide a new health care system for the people of Stockton, Hartlepool, Easington and Sedgefield.”—[Official Report, 28 June 2010; Vol. 512, c. 407W.]
From that response, it seems that the Minister accepts that clinical pressures were driving and pushing this matter.
In that context, will the Minister confirm that the proposed new hospital entirely meets the criteria set out in a letter of 20 May from the NHS chief executive to Monitor—criteria that are about ensuring that all service changes are led by clinicians and patients, not driven from the top down? Taking that point further, will the Minister explain how the Secretary of State reconciles his policy of clinical-led decisions with the pledge made during the general election campaign that Hartlepool hospital would not close if a Conservative Government were elected and a Tory MP returned for the seat of Hartlepool? What clinical evidence was there to back that pledge? Is that not an example of top-down meddling by politicians, regardless of clinical evidence? Is it now Government policy for the configuration of health services to be contingent on voting behaviour, rather than clinical decisions?
Will the Minister provide further clarity about his written answer to me, to which I referred a moment ago, on whether Darzi should be implemented? If he believes that Hartlepool hospital should remain open, will he provide additional support and resources to ensure that it can remain open, and that services will return to it? However, this is not just about money; it is about the way in which services are provided and how they are linked.
Since the Adjournment debate of 5 July, and our subsequent meeting with the Minister, the NHS White Paper has been published. It rightly pledges to put patients at the heart of services and decisions regarding services. I welcome that. The phrase used in the White Paper is
“nothing about me without me”.
The White Paper also asks for an enhanced local voice; again, that is welcome. However, I would be interested to hear the Minister’s view on what should happen if there is a stark difference between what the professionals want and what the public want—if surgeons and clinical teams say that specialism requires a concentration of services on a central site, but local communities say, as they often do, that they like the status quo and that change is unwelcome? How does the Minister envisage such tension being resolved, given that such views are often polar opposites?
The Minister may say that the independent NHS board will be important when it comes to resolving tensions or contradictions, and that its decisions will be based on clinical views and free from political interference. That would be welcome, but does that mean that the NHS commissioning board will have responsibility for resource allocation? The White Paper certainly suggests so, saying that the board will
“allocate and account for NHS resources.”
In that context, I think that “resources” means revenue resources, but does it also mean capital resources? What would happen if the NHS commissioning board recommended that, for hospital services north of the Tees, it was clinically essential that the recommendations of the independent reconfiguration panel were implemented? Would the board’s decisions overrule ministerial priorities?
The Minister may respond along the lines that the independent NHS board will take decisions out of the hands of politicians, but the White Paper contradicts that. It states on page 33:
“The Secretary of State will have a statutory role as arbiter of last resort in disputes that arise between NHS commissioners and local authorities, for example in relation to major service changes.”
In other words, the reconfiguration of hospital services, which can cause bitterness and fear in many communities, as it has in mine, can still be decided by the Secretary of State. That does not take politics out of changes to hospital services at all.
I ask the Minister to address a number of other points. Does he accept that the manner in which the project was assessed within Whitehall—in both the Department of Health and the Treasury—under the Labour Government was entirely in accordance with appropriate procedures? Does he accept that the project was appraised by officials in an entirely appropriate and rigorous manner, and that that was not done a couple of weeks before the general election, but had been planned and prepared for several years? Hartlepool borough council has written to the Secretary of State on the matter. The letter was signed by the chairman of the council and the leaders of the Labour, Conservative and Liberal Democrat groups; they have yet to receive a response, so I would be grateful if the Minister could expand on what he said in the earlier debate.
Will the Minister publish the revised criteria and assessment considerations on which the project failed, so that we can see what is to be done to address the matter? Why are Hartlepool and North Tees rejected, when Liverpool and Epsom are not?
The Minister of State, Department of Health (Mr Simon Burns)
I might be able to help the hon. Gentleman on that point, so that he need not get confused. As he is a diligent Member, I need only remind him that in our debate on 5 July—in column 150 in Hansard—I went into great detail in answering that question. I am afraid that the situation has not changed since then. That was the accurate answer then, and it is the accurate answer today.
Mr Wright
I thank the Minister for that clarification. Some of my hon. Friends might probe him a bit further on that point, because we are unclear about a number of aspects. Let me return to the point about the appropriate and rigorous procedure that took place in Whitehall. My recollection might be incorrect, so the Minister may have to provide further clarification. Will he confirm whether a letter of direction, which would be needed if the permanent secretary was unhappy with the decision taken by the Secretary of State, was needed for the proposed new hospital? The decision has left Hartlepool and the surrounding communities high and dry. There will be no new world-class hospital, the plans for which were based on clinical decisions, and no money to upgrade existing facilities. I fear that we will soon have one hospital serving the people of my constituency, and that hospital will be in North Tees. That is completely unsuitable for the task, and for the people of Hartlepool, who will find it appallingly hard to travel to.
We have no clear direction from the Government on the future of hospital services; there is only a vague sense of having been told, “You are on your own; you can do what you like.” That is part of a worrying pattern emerging in the north-east. First, there was the future jobs fund, then the working neighbourhoods fund, then the decision on the hospital, and then the scrapping of Building Schools for the Future. The people of Hartlepool and the surrounding areas are worth more than that and deserve better. I hope that the Minister will acknowledge that this afternoon and clarify how we will provide help, support and additional resources to improve hospital services in North Tees and Hartlepool.
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—
Diana R. Johnson (Kingston upon Hull North) (Lab)
I congratulate my hon. Friend the Member for Hartlepool (Mr Wright) on securing the debate this afternoon. He is a worthy champion of his constituency and the region, with respect to a range of matters including health, education and economic regeneration. He spoke passionately about the need to deal with the health inequalities that blight this country, and the problems in his constituency in particular, as well as the need for excellence in health care in the north-east, including the new hospital that is at the heart of the debate.
Like all hon. Members who have spoken, I pay tribute to the staff of the NHS, whose work for and commitment to the people of the north-east and the rest of the country is excellent. It was striking to hear the personal experience that my hon. Friend the Member for Hartlepool had in his local hospital, and what excellent care he and his family received. I pay tribute to all hon. Members who are present today, including my hon. Friends the Members for Stockton North (Alex Cunningham), for Easington (Grahame M. Morris), for Wansbeck (Ian Lavery), for Sedgefield (Phil Wilson), for North Tyneside (Mrs Glindon), and for North Durham (Mr Jones). I know that they all feel strongly and passionately about the issue.
I want to comment on the remarks of my hon. Friend the Member for Easington. He put patient care and safety, which is what the debate is really about, at the centre of his remarks. He set out his concerns about what will happen to patients who are left with the two hospitals, where they will now be treated. Will the abolition of targets affect care and safety? That is an important issue, which I hope the Minister will deal with. My hon. Friend also raised the important issue of finances and how they stack up. I would like to know in particular whether the difference in cost between building a new hospital and repairing and maintaining the two is £11,000 or £11 million. I am sure that the Minister will clarify that.
Mr Burns
If it will help the shadow Minister I shall clarify the point yet again. The reason the question ever came into the public domain was that on the morning of the previous debate the right hon. Member for Leigh (Andy Burnham) incorrectly put out a press statement saying that the building of a new hospital would be cheaper than the maintenance and upkeep of the two existing hospitals, over a 35-year period. The figures, which Hansard originally printed wrongly—hence the correction—showed a difference of £11 million. It was cheaper by £11 million to keep the two existing hospitals. The point was merely to show that the right hon. Gentleman was factually incorrect.
Diana R. Johnson
I am grateful to the Minister for correcting what he said earlier, when he talked about the figure of £11,000. We understand that the figure is £11 million. I suggest that in the great scheme of things, if the difference in cost between maintaining and repairing two hospitals and building a state-of-the-art new one is £11 million, Labour Members might think that it is £11 million that should be spent.
Diana R. Johnson
My hon. Friend makes an important point about the cost over 35 years.
My hon. Friend the Member for Stockton North, who I understand is a former non-executive director of the North Tees and Hartlepool NHS Foundation Trust, spoke clearly about the need for a new hospital. I know that he also tabled early-day motion 273, which attracted a great deal of support, to request a review of the coalition decision about the hospital. He, too, made an important case about health inequalities and why the hospital is needed. He also pointed out that structural upheaval in the NHS at a time when we are facing such financial problems is a recipe for chaos. What is the future for the people represented by him and our hon. Friends? Again, I look to the Minister to explain the coalition Government’s thinking about what will happen to the needs of communities in the north-east.
I do not wish to rehearse the history of this £464 million hospital project—my right hon. Friend the former Secretary of State made it clear that it was a top priority for the NHS, and agreed in March this year that it should go ahead—but it had been in planning for a long time. It was not just signed off close to a general election. As we have heard, the coalition Government decided to cancel the hospital project within the first few weeks of taking up their position in Government. It is clear that the Treasury and other Departments reviewed every significant spending decision made between 1 January and the general election on 6 May. The proposal for the new hospital scheme, which received Government approval only in March, was considered properly during that review, but there are questions about why that particular hospital project was cancelled and others were allowed to proceed when my right hon. Friend had made it clear that the hospital was a top priority for the NHS.
Diana R. Johnson
The Minister will be pleased to know that I took great pleasure in reading his response to that debate, but I am still not satisfied with the explanation given. There is room for further explanation why that particular hospital was chosen.
Diana R. Johnson
I am particularly concerned—I think that my hon. Friend the Member for Hartlepool mentioned this—about the clear view of all the clinical professionals—[Interruption.] I do not have the speech in front of me, but considering that the Secretary of State for Health talks continually about the need for doctors and clinicians to be in the driving seat when decisions are made in the NHS, and considering that, as my hon. Friend said, it is clear that the clinicians and health professionals involved were very centred on having that one hospital, why have those views been suddenly pushed to one side? Will the Minister explain that, given the coalition Government’s new approach of saying that clinicians are at the centre of decision making? If so, I will be pleased.
Also, on the cost of cancelling the project, how much money was spent getting to the point of preparing to proceed? What yearly maintenance and repair bill does the Minister think will now have to be paid for the two hospitals? What is the coalition Government’s plan for in-patient health facilities for that community? What does he see as the future for either a new hospital or a different style of health service provision in the area? What is his thinking? It is certainly not clear.
The Office for Budget Responsibility’s projections, to which one of my hon. Friends referred, show that the actual deficit was lower than was projected before the general election. We have also seen higher-than-expected growth figures this week, which hon. Members might find surprising. I ask the Minister to reconsider the economic impact of refusing to follow through on the decision to build the hospital, taking into account what my hon. Friend the Member for Sedgefield said about the potential for the hospital to be an anchor tenant to attract important private sector businesses and jobs. I know that the coalition Government are committed to helping the private sector grow us out of our present financial situation, so will the Minister reconsider? The range of Members present in the Chamber shows a clear commitment to ensuring that the people of the north-east get their fair share of resources and the kind of hospital service that they so richly deserve.
The Minister of State, Department of Health (Mr Simon Burns)
I congratulate the hon. Member for Hartlepool (Mr Wright) on securing this debate. As he and his hon. Friends will know—as the shadow Minister rightly said, they are here in force—we have had a briefer debate on this subject, and I have had the pleasure of welcoming most of the Opposition Members present to a meeting at my Department, where we had a useful exchange of views.
Before I address the main thrust of most of the contributions, which is North Tees and Hartlepool, I will give a brief overview of the health situation in the north-east and will refer to some of the comments made by my hon. Friend the Member for Hexham (Guy Opperman).
Earlier this month, as hon. Members know, we published our vision for the national health service in the White Paper “Equity and excellence: Liberating the NHS”, which signals the beginning of the most profound reform in the NHS’s 62-year history. By taking power away from Ministers and civil servants in Whitehall and handing it to patients and clinicians, we shall transform the health service from the ground up.
Diana R. Johnson
I am intrigued. I read carefully the coalition agreement, which said that there would be no top-down reorganisation of the NHS and mentioned having elected representation on primary care trust boards, which I understand are now to be scrapped. Will he explain why, in a few weeks, the Government have completely ditched that proposal, which was in the coalition agreement?
Mr Burns
I will certainly explain that when I get on to the specific point about Hartlepool because, unfortunately, as will be unveiled to the shadow Minister and the hon. Member for Hartlepool, their comments today are based on a false premise and show that they do not fully understand the previous speeches on the issue, or the meeting we had at the Department of Health. All will be unveiled shortly, and I hope that the shadow Minister will understand the reasoning behind the decision taken.
As I was saying, as part of the vision, and the moving forward on the White Paper, we want every hospital trust in the country to become a foundation trust. We want to direct every aspect of the national health service at delivering clinical outcomes that are as good as, or better than, any in the world. The north-east is already ahead of the game in many respects. In November 2009, it became the first and only region in England to have all of its NHS hospital and mental health trusts awarded foundation trust status. When the Care Quality Commission reviewed hospital services in the region last year, every single hospital trust and every ambulance service was rated either good or excellent for the quality of their services. That gave the north-east the highest score in England for the third year running.
Among those hospital trusts, Gateshead Health NHS Foundation Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust all received double excellent scores for both quality of services and the use of resources. The high quality of services across the north-east is down to the skill, dedication, creativity and sheer hard work of the thousands of NHS staff across the region. I want to take this opportunity to pay tribute to them and wish them well in their continued success in providing first-class care and services to the people of the north-east.
Alex Cunningham
Would the Minister care to help us get a hat trick, and to go from double to triple excellence, by having a brand new hospital for the people of North Tees and Hartlepool?
Mr Burns
I admire the hon. Gentleman for his persistence. If he could have a little patience, I shall talk about the points made by my hon. Friend the Member for Hexham, and will then come on to the hospital that has so dominated the debate.
My hon. Friend mentioned Northumbria Healthcare NHS Foundation Trust and its proposal to build a £75-million emergency care hospital in Cramlington. I am advised that planning permission is currently being sought for the proposed site and that further development work is under way. I hope that that goes some way to answering the point that he raised. I will make sure that I write to him during the next week or so on the other points that he mentioned to explain all the outstanding issues.
I shall now turn to the review of the hospital in North Tees and Hartlepool. The hon. Member for Hartlepool specifically raised the Government’s decision to cancel North Tees and Hartlepool NHS Foundation Trust’s proposal for a new hospital building. As I stated in the House in our last debate on this matter on 5 July, the original proposal for a publicly funded capital scheme received Treasury approval in March this year, in the run-up to the general election. In view of the shocking state of the public finances and the desperate need to reduce the £155 billion deficit, which I need not remind Labour Members was left to us by their Government, the Treasury and other Departments reviewed every significant spending decision made under the previous Government between 1 January 2010 and the general election on 6 May.
Mr Iain Wright
I appreciate the Minister’s explanation and analysis, but if the Conservative-Liberal coalition Government are concerned about the state of the public finances and want to help drive down the debt quicker, why was there not a moratorium on all capital spend in the NHS, similar to that which the Secretary of State for Education put in place with regard to Building Schools for the Future?
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.]
Mr Burns
I will now answer some of the Opposition Members’ questions. The hon. Member for Hartlepool asked whether there was an optimal population size for a hospital. I have consulted my officials, who tell me that they are unaware of whether there is an official optimal population size for hospitals, so I will look into the matter and write to him with a satisfactory answer as soon as possible, giving him any information we have.
I have already explained, including on 5 and 8 July, the decision that governed the withdrawal of approval for the hospital. On the hon. Gentleman’s question about the future of Hartlepool hospital, there are currently no plans to close it, and that will remain the case unless the strategic health authority and the PCT propose closure. There are no such proposals at present, as far as I am aware.
Mr Iain Wright
I thank the Minister for that clarity. Given the proposals to abolish SHAs and PCTs, what will happen after that?
Mr Burns
It is perfectly reasonable for the hon. Gentleman to express concern about and an interest in finding out what would happen. The answer is that that will depend on a combination of factors, including the national commissioning board that will be created, the GP commissioners and the decision of the local health community. If a local health community put forward any proposals to reconfigure health patterns in its area, it would have to go through all the procedures that are currently in place, and there will also be the changes that my right hon. Friend the Secretary of State will put in place to strengthen the community’s input into any proposed reconfiguration. The views and support of clinicians and GPs will be sought, and the focus will be on improving outcomes and affordability, and including the views of local populations.
The hon. Gentleman will know from reading the White Paper and the five related documents that have so far been published, which flesh out the details, that local authorities will have a greatly enhanced role in the provision of health services and the maintenance of health care standards in the local community, and will not be restricted solely to their current role in public health.
The hon. Gentleman asked whether the Government will implement the recommendations of the Darzi review on acute health services north of the River Tees. The recommendations of that review were superseded by advice provided by the independent reconfiguration panel to the then Secretary of State for Health in December 2006. That advice formed the basis of the “Momentum: Pathways to Healthcare” programme, which was developed by the local national health service to provide a new health care system for the people of Stockton, Hartlepool, Easington and Sedgefield. We understand that NHS Hartlepool and NHS Stockton-on-Tees will continue to work closely with North Tees and Hartlepool NHS Foundation Trust on delivering the wider Momentum programme, and will be discussing the options available with the trust. I hope that that goes some way towards satisfying the hon. Gentleman.
The hon. Member for Kingston upon Hull North mentioned the generality of the provision of health care, and new health care facilities, in the region, and I can reassure her by mentioning a number of initiatives that have taken place in the Stockton-on-Tees area in recent years.
Mr Burns
Yes, in recent years—there is no point in the hon. Lady sitting there and saying that because, to be frank, anyone who takes a sensible approach to such matters will not try to score cheap party political points. I recognise that for the past 13 years we have had not a Conservative but a Labour Government, and I am mature enough and comfortable enough within myself to recognise that during those years advances in health care were made. I am not one of those narrow politicians who say that, because there was not a Tory Government, everything was awful, or that everything done by a Tory Government is wonderful; it is a mixture of the two. One has to be mature enough to recognise that, as I do. The initiatives I will refer to took place in the past few years, so they were under a Labour Government.
As the hon. Lady will know, 26 of the 46 Momentum business service change projects are under way as part of the “Momentum: Pathway to Healthcare” programme. They consist of detailed service reviews, a revised pathway based on a map of medicine, a value impact assessment and a service implementation plan. Examples of pathways reviewed to date include those on diabetes, respirology, cardiology and haematology. There are also cross-cutting business service change projects under way in the areas of work force and education, IT, and communications and engagement. There is also an integrated care centre at Hartlepool, with which the hon. Member for Hartlepool will be familiar, and an integrated care centre at Billingham, which I expect the hon. Member for Stockton North (Alex Cunningham) and my hon. Friend the Member for Stockton South (James Wharton) will know.
Diana R. Johnson
I am pleased that the Minister has read out a list of initiatives introduced under a Labour Government, but I am interested in the coalition Government’s thinking on health service provision in the north-east. What initiatives do they have planned for dealing with the health inequalities that have been mentioned by Members today?
Mr Burns
I thank the hon. Lady for giving me the opportunity once again to tell her that those are all contained in the vision outlined by my right hon. Friend the Secretary of State in the White Paper that was published last week. It is a vision that puts patients at the heart of health care, so that they can have the best health care of the highest quality. It is based on the premise that there should be a local, bottom-up system, rather than one in which politicians and bureaucrats in Whitehall issue diktats and tell local communities with which they are unfamiliar what they should and should not do. That is the way forward for enhancing health care.
Our vision is based not on processes that are distorted for party political purposes, but on the need to improve outcomes so that people get better health care. The patient experience, whether in a hospital setting or when a patient visits their GP, should be tailored to their needs, rather than to what the state tells them that they should have. That move will be spearheaded by GPs, through GP consortiums, as it is they who are closest to patients, know the health care that they need, and know how patients can best access it. That will all be determined by improving outcomes and the patient experience in order to give the finest quality care that the country can provide—the highest in the world. That is the answer to the hon. Lady’s question.
Hospital Car Parking Charges (Hereford)
Simon Burns Excerpts(14 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Mr Simon Burns)
I begin by congratulating my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) on securing his first Adjournment debate—on the effect of NHS PFI costs on hospital car parking charges in Hereford.
Let me provide a little background on the trust before discussing my hon. Friend’s specific points about car parking. As he will know, Hereford Hospitals NHS Trust is the main provider of acute services across Herefordshire and for parts of Wales. The trust offers a wide range of services, including a dedicated cancer unit, which forms part of the three counties cancer network. I understand that funding has now been secured in partnership with Macmillan Cancer Support to develop a new cancer unit.
The most recent Care Quality Commission outpatient survey, released in April this year, showed that 19 out of 20 patients—95%—attending the Hereford hospital out-patient department rated the care they received as either “good”, “very good” or “excellent”. It also found that 89% of those asked stated that they were treated with dignity and respect at all times. This is very much to the hospital’s credit, and I pay tribute to the hard-working staff at Hereford hospital. It is through their dedication and expertise that my hon. Friend’s constituents benefit from such a high quality of care.
My hon. Friend has raised the important issue of parking costs at Hereford hospital. The quality of care inside the hospital is excellent. However, the service provided outside the hospital presents a real and pressing concern for patients, visitors and members of staff.
The Hereford county hospital development was, as my hon. Friend mentioned, part of the previous Government’s first wave of private finance initiatives. The County hospital PFI contract lasts for 30 years, from 2002 until 2032. In some respects, the Hereford contract differs from later PFIs, which utilised a standard form developed following the experience of earlier agreements.
In 2005, car parking charges for the period 2006-15 were agreed between the trust and Mercia Healthcare and incorporated in the main PFI contract through a legally binding variation, as my hon. Friend mentioned. Although Mercia owns the car parks, CP Plus operates them on a day-to-day basis via a subcontract with Sodexo, which runs all food and facilities management services on the site. I am told, unfortunately, that the cost to the trust of buying back the car parking element of the contract to 2032 has been calculated at some £7 million, a sum that my hon. Friend will agree is deemed prohibitive by the Hereford Hospitals NHS Trust.
The contract also switched car parking charges from pay and display to pay on exit. That change was introduced to discourage people using the hospital car park when shopping in Hereford city centre, cutting the number of spaces available for patients and visitors to the hospital. The hospital offers concessionary parking for different types of user. For example, a range of discounts is available to those who use the car park frequently, to the disabled and to a wide range of people on benefits or low incomes. In addition, when the length of stay exceeds certain local waiting targets, the cost of parking is reduced to the target wait. For example, if initial treatment is not given within four hours at accident and emergency, the cost of parking is reduced so that a patient pays only for four hours. Also, parents of children staying overnight in the hospital have their parking costs discounted to the two-hour rate of £3.
However, there is a real issue about people not knowing that those concessions exist. Although they are clearly displayed on the trust’s website, the internet, as my hon. Friend will probably appreciate, is not usually the first place to look for information when one drives into a car park. The clear and prominent display of the discounts and concessions available is a common complaint of patient groups throughout the country and one with which I have a considerable sympathy. I am told that the current car parking charges are in fact a little lower than those originally agreed with Mercia and reflect the trust board’s decision to subsidise the tariff by 50p an hour over the past two years. The annual cost of that subsidy is £88,502.
The strategic health authority has informed me that the trust board has taken a number of measures to ensure that car parking charges are reasonable. It has committed to reducing progressively the costs of on-site parking for patients and, eventually, to eliminating those costs all together. To pay for the reduction, charges for visitors and other users will be increased in line with the existing 10-year tariff plan. The trust is also investigating alternative transport initiatives to encourage staff and patients to use public transport.
The strategic health authority informs me that Hereford Hospitals NHS Trust is reviewing its car park policy. The aim is to develop proposals for charges and concessions for patients’ parking at the hospital, covering the hourly rates charged to patients and the availability of revenue to develop alternative arrangements. The review will also consider the range and appropriateness of current concessions. The trust hopes to complete its review of car parking charges by the end of this month, and the next increase to car parking charges, now due, is on hold pending the outcome of it. I also understand that the trust has already agreed a package of measures to improve car parking arrangements for patients receiving chemotherapy. These include the allocation of further free car parking spaces and better advertising of concessions.
Individual patients and advocate groups such as Macmillan Cancer Support and the Patients Association regularly raise the issue of car parking charges. Macmillan has highlighted how a lack of awareness among users and the poor promotion of concessions by some trusts lead to low take-up among long-term patients. We are giving those concerns serious thought. The Department of Health recently conducted a consultation on car parking charges, and I can assure my hon. Friend that we aim to publish a response to that consultation in September.
Unfortunately, though, whatever one’s views might be on the subject of NHS car parking charges, given the dire state of the public finances it is simply not possible to abolish them. Within a very difficult economic climate, this Government are committed to delivering health care outcomes that are among the best in the world. As part of this, power is being devolved to the front line like never before. As my hon. Friend will appreciate, when we came into government in May we inherited a deficit of £155 billion. Some tough decisions are having to be taken because my right hon. Friend the Chancellor of the Exchequer rightly makes it a priority to reduce the huge debt that we inherited, which is causing so many problems for our general economic well-being.
I am sure that my hon. Friend will appreciate that, as I said, it is simply not possible to abolish car parking fees at the moment, because the ethos of our policy towards better provision of health care, as outlined by my right hon. Friend the Secretary of State for Health in his White Paper last week, is that we believe that it is crucial to put patients at the forefront and the centre of health care. We must have bottom-up provision of health care that meets local needs to improve services and ensures the finest quality health care that the health service can provide in such a way that we do not have politicians and bureaucrats dictating a top-down approach.
Gavin Williamson (South Staffordshire) (Con)
Does my hon. Friend agree that many of the problems that we face in Hereford and in many other towns across the country are down to poorly negotiated private finance initiatives agreed by the last Labour Government?
Mr Burns
I am grateful to my hon. Friend for making that cogent and powerful point. As we have all found out since we came into office, the economy was left in a dire state, and we are now having to pick up the pieces, as we did in 1979, to sort out the mess that the previous Government left us. That is the challenge that we are facing, and that is why we are having to take some tough decisions for the general better welfare of the economy as a whole and the people of this country, as tends to be traditional when we come to power after a Labour Government.
Where car parking charges make it difficult for staff to do their jobs properly, where they damage patients’ access to services, or where they prevent family and friends from visiting, hospital trusts have a responsibility to look again at their charges and policies. As my hon. Friend knows, a review is currently under way at Hereford hospital. I trust that he and all his constituents who are concerned about the level of car parking charges at the hospital are contributing to that review and ensuring that their views and concerns are known as regards the impact that those charges may be having on them. I also believe that it is crucial, not only in Hereford but throughout the country, that greater publicity and prominence be given to the fact that some people may qualify for a reduction in car parking charges due to their individual circumstances. That must be drawn to the attention of the client group that might benefit, because one suspects that too often, there is too little publicity and awareness of those discounts, which would provide genuine help to those who find car parking charges genuinely onerous to pay for.
James Wharton (Stockton South) (Con)
I should just like to have it recorded in Hansard as a point of important note that while we are talking about the people who are the most disadvantaged by the charges that are so often levied in hospital car parks, not a single Opposition Member is here to hear the debate. I hope my hon. Friend agrees that that is an important point that should be recorded and registered.
Mr Burns
I congratulate my hon. Friend, who has certainly succeeded in achieving what he intended. No doubt tomorrow, when Hansard is published, his cogent point will be marked. The only disappointment is that as there are no Opposition Members here, they will not be aware of his intervention, but I am sure he will use his skills to ensure that his point is given a wider audience.
Matthew Hancock (West Suffolk) (Con)
Before my hon. Friend concludes, will he address the point about renegotiating the PFI? Will he take up the offer of my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) and try to squeeze some more value out of the PFI, and to help? He has made an eloquent case about how tight the money is.
Mr Burns
I thank my hon. Friend for that extremely helpful intervention. I am grateful for his kind offer for me to try to intervene and use my good offices to facilitate a renegotiation. It is late at night, but I do not want to be churlish and I do not want to upset my hon. Friend. However, gone are the days when politicians and bureaucrats sitting in Whitehall interfere and micro-manage local health services. The Government’s vision, new policy and ethos is for a localised health service, responding to local needs, not hamstrung by interfering Ministers, including—I know that my hon. Friend will find that difficult to believe—me. I must therefore say that it is a local matter, which would have to be taken up and sorted out locally, though, from my extensive knowledge of the position, I would not, were I a betting man, put a considerable amount of money on the suggested course of action being adopted.
Having said that, during a review of car parking at the hospital, it is important that all those with an interest or a concern about the charges play a full part. Ultimately, as I hope that my hon. Friend the Member for West Suffolk (Matthew Hancock) will appreciate, it is for the NHS trust to manage its car parking to suit best the needs of its patients, the visitors and staff.
However, I hope that, given the campaign of my hon. Friend the Member for Hereford and South Herefordshire and my hon. Friends in the surrounding constituencies, who have played their part not only in recent months but for a considerable time in representing their constituents and trying to get a good deal for them, they will continue to open dialogue with the local trust and do all they can to pursue the matter and ensure that they get a better and fairer deal, which is mutually satisfactory to the trust, the PFI and my hon. Friend’s constituents.
Question put and agreed to.
Frenchay Hospital
Simon Burns Excerpts(14 years, 4 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Kingswood (Chris Skidmore) on securing this debate. I know that local health services are a top priority for him, and I am sure that his constituents will appreciate all he has done in fighting for better health care provision for them. I also congratulate my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) on his contribution, given the constituency interest that he has in the future provision of health care in this area. I pay tribute to the NHS staff, both in Kingswood and across the whole of Bristol and south Gloucestershire, who provide such excellent care for my hon. Friends’ constituents and those of other hon. Members.
My hon. Friend the Member for Kingswood has outlined the strength of feeling in his constituency for the retention of as many services as possible at Frenchay hospital, following the expected completion of the new hospital at Southmead in 2014. I understand that he would like clarification on the Bristol private finance initiative scheme. The Government recently conducted a review of all major public spending commitments made between 1 January 2010 and the general election on 6 May, to ensure that they are affordable and consistent with this Government’s priorities, given the horrendous economic situation that we have inherited and the staggering level of debt, which, we rightly believe, we should bring down as a priority because of its implications for the economy as a whole.
The north Bristol PFI scheme was considered as part of that review, and it was allowed to proceed. After final approval was given by the Treasury in February 2010, the scheme contracts were signed and construction is now under way. As my hon. Friend mentioned, the NHS would incur significant costs were it to cancel the contract, and I am afraid, therefore, that I have to tell him that cancellation is not a feasible option. The new Southmead hospital is going ahead, and is due for completion in 2014.
Both my hon. Friends are absolutely right that the decisions flowing from the reconfiguration in this part of Bristol and south Gloucestershire are the direct result of the actions of the outgoing Labour Government. They are not Conservative decisions. They were taken by the previous Labour Government and, as my hon. Friends will appreciate, it is too late to reverse them, and to prevent the implications for their constituents.
The business case projects that, due to a range of diagnostic tests being performed in the community and a greater number of out-patient appointments, there will be some 45,000 fewer acute hospital visits per year in the area. That will mean a far more convenient service for my hon. Friend’s constituents.
I shall set the issue in context. My hon. Friend will be aware that, following a public consultation in late 2004 on the proposals to develop health services in Bristol, north Somerset and south Gloucestershire, the NHS agreed to centralise acute hospital services for north Bristol and south Gloucestershire at Southmead.
In June 2008, as part of the Bristol health services plan, work began to plan community health services that would provide more care closer to home in general practitioner surgeries, community health centres and community hospitals. The Frenchay project board developed recommendations for commissioning community services at Frenchay, which were presented to the boards of the NHS South Gloucestershire and NHS Bristol primary care trusts at the start of 2010.
At the beginning of this year, the project board shared its recommendations on how services could be developed with local GPs, the then Members of Parliament and a range of community groups. The board has now shared its draft options with the overview and scrutiny committees of South Gloucestershire and Bristol councils. As my hon. Friend will know, local authorities will have a key new role in helping to join up services across the NHS, social care and public health. Overview and scrutiny committees will consider the project board’s final recommendations before they are presented to the boards of NHS South Gloucestershire and NHS Bristol in December 2010 and January 2011 respectively.
Let me explain to my hon. Friends the principles of reconfiguration. I recognise that, in the past, local people have felt that changes to local services have been handled badly. However, given the changes that my right hon. Friend the Secretary of State for Health has made to the criteria for judging reconfigurations, that is a thing of the past, although it is of little consolation to my hon. Friends. If the final recommendations differ significantly from what was agreed as part of the Bristol health services plan, NHS South Gloucestershire will proceed with a formal public consultation that will follow the four crucial tests on service changes set out by my right hon. Friend the Secretary of State.
I understand that, to date, the process meets the new criteria for the involvement of the public and clinicians, because the overview and scrutiny committee has accepted that the correct procedures have been followed by the project board. Indeed, only last week, it commended the PCT on the process that it had undergone.
Although the new Southmead hospital is going ahead, I have been assured that any future consultation on community health services at Frenchay hospital will closely involve GPs, local authorities, local people and local MPs to ensure that any new developments meet the needs and requirements of the local population and satisfy the new criteria laid down by my right hon. Friend. I have also been assured that the project board has completed a needs assessment, taking into account travel requirements, transport routes and population growth.
I can inform my hon. Friend the Member for Kingswood that no decision has yet been made on the location of the brain injury rehabilitation unit that is currently at Frenchay. Recommendations on the service will be put forward for consideration by the end of the year. However, detailed negotiation will be required, as the unit is subject to a private lease.
I am sorry that I have to tell my hon. Friends the Members for Kingswood and for Filton and Bradley Stoke that the burns unit will move to the Southmead acute hospital, as set out in the outline and full business cases in February. In-patient paediatric burns and in-patient paediatric neurological services will be centralised, along with all children’s in-patient services, at the Bristol Royal Hospital for Children. In-patient neurological services for adults will be based at the new Southmead hospital.
On other local services, the NHS treatment centre in Emersons Green opened in late 2009. It provides procedures for ear, nose and throat services, general surgery, gynaecology, minor orthopaedics surgery, ophthalmology and urology. It increases the choice of provider for my hon. Friends’ constituents and reduces their need to travel to larger acute sites in Bristol. The PCT has assured me of its commitment to working with local GPs and patient groups to ensure that services are accessible to my hon. Friends’ constituents. Minor injury services are already provided by a GP-led health centre in Kingswood and at a minor injuries unit in nearby Yate. Another minor injuries unit is due to open at Cossham hospital in 2012.
I applaud the determination that my hon. Friends have shown in championing their local health services. Their constituents, like those of all hon. Members, deserve local health services that have the full support of local GP commissioners and of local people themselves. By empowering local clinicians to decide how best to achieve the right outcomes for local people, this Government will ensure that the residents of Kingswood are provided with the very best NHS services now and in the future.
It is a pity that that attitude—the regard for local people and the bottom-up approach, rather than a top-down one—was not adopted by the previous Government. If more attention had been paid to the interests and concerns of my hon. Friends’ constituents, we might not be in the position that we are in today. As both of them rightly said, this is not—I repeat, not—a decision that has been taken by the current Administration. The coalition Government were not party to the proposals, which are a leftover from the Labour Administration.
As my hon. Friend the Member for Kingswood said, despite all the work that was done by a range of people, including him, to try to save services at his local hospital at Frenchay, their views were disregarded by the previous Administration and in the procedures for considering such things. He finds himself in a straitjacket because of past decisions. However, the new criteria set by my right hon. Friend the Secretary of State will apply to future such decisions, and far greater attention will be paid to the wishes and needs of local people.
My hon. Friend has an important part to play in continuing to engage with the local NHS on the community health services planned for Frenchay hospital, and I am sure that he and my hon. Friend the Member for Filton and Bradley Stoke will do all they can to continue to fight for the interests of their constituents, to ensure that they get good, high-quality NHS provision in their local community.
Minor Injuries Services (Devizes)
Simon Burns Excerpts(14 years, 4 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Devizes (Claire Perry) on securing this important debate. I know that local health services are a top priority for her and that she campaigned vigorously before coming to the House, and has done so since, as we have heard today, on behalf of her constituents to ensure that she obtains the best health care provision for the people she so ably represents. I admire her dedication and determination in fighting that battle for her constituents. I pay tribute to the NHS staff in Devizes and throughout Wiltshire for the excellent care and dedication that they provide day in, day out when looking after my hon. Friend’s constituents and those of other hon. Members in the county.
My hon. Friend is aware that my right hon. Friend the Secretary of State has launched our White Paper on liberating the national health service. It is our vision for freeing the NHS from the shackles of politicians and bureaucrats in Whitehall, giving power to people locally, and working with clinicians and general practitioners to provide those services that local communities in Devizes, Wiltshire and the country need. It is a vision for making the NHS more accountable to patients, whether my hon. Friend’s constituents in Devizes or people elsewhere. We want to free staff from excessive bureaucracy and top-down control. We want patients to be at the heart of everything that the NHS does and we want local people to have more choice and control than they have ever had and a greater say in their treatment, their needs and their health requirements. People in Devizes and the other small towns and villages that my hon. Friend mentioned will be in charge of making decisions about their care and provision of health requirements.
My hon. Friend has outlined the strength of feeling in her constituency for local minor injury services, and the support for the NHS generally. The minor injury units for Devizes and Marlborough at Savernake community hospital closed in September 2007, and my hon. Friend and her constituents were, understandably, disappointed at the decision, and have been frustrated by the difficulties and delays that have resulted from it. I am aware that people living in different parts of her constituency access different minor injury units, including those at the community hospitals at Trowbridge, Chippenham, Andover and Newbury, and that minor injury treatment continues to be available at the A and E departments in the acute hospitals in Salisbury, Bath and Swindon. As my hon. Friend rightly said, transport access causes problems for some of her constituents. I have considerable sympathy with the points she made about that.
I am also aware that my hon. Friend’s constituency covers a large rural area. She gave some interesting figures and comparisons with other rural constituencies when making her point so powerfully. I understand her desire for local minor injury units that are accessible as quickly as possible to her constituents. But I must be frank with her. Given where we are at the moment and the processes that have taken place in her county and constituency on reconfiguration of services, I am unable to ask the NHS to open previously conceded processes, or to halt those that have passed the point of no return. I know that that will disappoint my hon. Friend, but I am afraid that at the moment we are where we are because of previous decisions and the degree to which they are in process.
My hon. Friend asked what could be done, and whether pilot schemes could be introduced as a forerunner to the abolition of PCTs in 2013, and she suggested other ways of working with outside interests. I want to give her as clear a steer as possible, and unfortunately, until the PCTs are closed and cease to exist in 2013, due processes and proper procedures must be adopted to move forward. Until they are phased out from 2013, the PCTs will continue to have the same responsibilities that they have now for the provision and commissioning of health care in the areas for which they are responsible, including Wiltshire.
Guy Opperman (Hexham) (Con)
I pay tribute to my hon. Friend the Member for Devizes (Claire Perry) for carrying on the work that we have all been doing for a considerable period on hospitals in Wiltshire. I spent three years of my life trying to keep them open. The Minister is saying that in reality, whatever the situation, despite the Health Secretary saying in 2007 that clinical need should justify closure, despite this being fundamentally an accounting measure, and despite decisions apparently not being reviewed before 2013, people are desperate for a hospital to reopen that is pre-existing, prepaid and sitting there—
Guy Opperman
It is a long question. I apologise, Mr Streeter, but the hospital is still there, and capable of being used. With the greatest respect, I fail to see why it is not being used.
Mr Burns
I am grateful for my hon. Friend’s intervention and I fully appreciate his frustration at the situation. I also appreciate the greater frustration of my hon. Friend the Member for Devizes, because her constituency is directly affected by the issue that we are discussing. I repeat: we are where we are. We have a vision of a health service that works from the bottom up rather than the top down. However, until the changes occur, we are in a straitjacket because of procedures currently in place that have to be adopted.
Before the intervention by my hon. Friend the Member for Hexham (Guy Opperman), I was responding to the question from my hon. Friend the Member for Devizes about the way forward. I hope to give her a glimmer of hope and I will give her some advice about how I see the situation, both as a constituency MP and as a Minister. As long as we are in what is effectively an interim period since the publication of yesterday’s White Paper, with the PCTs still commissioning services and having the lead role, I advise her to continue her spirited and dedicated campaign to get what she seeks for her constituents. She should continue seeking to persuade the PCT, local clinicians, GPs and the local community to stay onside in the desire to establish a minor injuries unit, and ensure that the other care services she mentioned are instigated for her constituents. At the moment, that route is the only way forward because the PCTs are the commissioning agents.
I urge my hon. Friend to continue her campaign in the hope that during the interim period over the next three years, she will see a change of heart if that is possible. If it is not possible, when the changes come in, she should use the new system to seek to persuade those in charge of reconfigurations and the provision of services to reinstate the services that she so passionately and rightly believes are needed and deserved by her constituents. That is my advice. It may not be as palatable as she would hope, but I know that she will appreciate and understand that under current circumstances, we have not yet changed the system. That vision was announced yesterday and it is a vision for the future.
Claire Perry
By 2013, if we get our ducks in a row, get our clinicians onside and our draft contracts drawn up, will we be able to present that business plan—in whatever forum we are in—to the national commissioning body and have some chance of success? Is there hope that within a three-year period before the next election we might get those services back under a new contract commissioned by the central body?
Mr Burns
Obviously, I cannot give a commitment that my hon. Friend would be successful. I wish her well in her endeavours, but it is not for me to prejudge what might happen. She is certainly right that if she puts all her ducks in a row—as she put it—with a business plan for what she believes her constituents need, she can present it to the national commissioning board and to GP consortiums in her area. Everybody will then work together, and make an overwhelming case for what my hon. Friend wants to see delivered for the local people of Devizes and her constituency.
As my hon. Friend will accept, “The times they are a-changin’”. The Government’s approach is different from the top-down approach taken by the previous Government. We believe that local decision making is essential to improve outcomes for patients and drive up quality. We will do more than just talk about pushing power to the local level; as the Secretary of State’s White Paper shows, we are going to do it and make the dream a reality. That will be of considerable help to my hon. Friend in her campaign.
Given my hon. Friend’s experiences during her ongoing battle, she will agree that we must move away from having Whitehall dictate how care should be delivered in Devizes, Westbury or any other town or village in Wiltshire. We believe that change must be driven from the bottom up, and that the patient must be the heart of health care provision. The patient must be put first; their interests and quality of health care is the No. 1 priority, not the decisions, ramifications and shenanigans of politicians and civil servants.
In future, all service changes must be led by clinicians and patients, not driven by Ministers such as me, or civil servants from the Department of Health. Only then will the NHS achieve the quality improvements that we all want to see.
Duncan Hames
In his search for local accountability in decision making, it would be helpful if the Minister advised hon. Members where in the process the public’s demand for these services will be heard. Is there a role for locally elected politicians to secure influence in determining outcomes through the health overview and scrutiny committees of our local councils?
Mr Burns
If the hon. Gentleman refers to current arrangements, he will no doubt be aware that in late May, the Secretary of State announced changes to the criteria that need to be taken into account in any reconfigurations currently under way—providing that those reconfigurations are not so far advanced that it would be impossible to reverse them—and any future reconfigurations. The main priorities include taking into account the views of local people, clinicians and GPs and ensuring that health care is relevant for the local area.
If the hon. Gentleman is asking what will happen after the changes in the White Paper, let me say that once the PCTs are wound down and abolished, there will be a transfer of powers to the national commissioning board and all that flows downwards from that. Provision and responsibility for the commissioning and delivery of health care in a local area will be linked to local authorities, and accountability will be through local authority input with locally elected representatives. Public health is currently dealt with through the input from the primary local authority level in each area. That is where the accountability will be. The predominant point is that because one must have a locally driven health service, the wishes of the patient—not only in their individual care but in the requirements of the local community—must be fundamental to the decision about units or configurations. I hope that the hon. Gentleman and my hon. Friend are reassured by that.
In conclusion, I once again pay tribute to my hon. Friend for her commitment and dedication in fighting so hard for her constituents, not only before the election but afterwards. She has been in the House for about eight weeks, and she has already made her mark fighting for her constituents on the issue that she promised, during those long days in April, to take to Westminster. She is now in Westminster and has brought the issue to the debate today. I have every confidence that she will continue to use the means available to her in the House to pursue her agenda, and that she will mobilise support in her constituency to ensure that the issue does not go away. She will be determined to get what she believes to be the best health care for her community, and I wish her every success.
NHS (Cornwall)
Simon Burns Excerpts(14 years, 4 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
May I say, Mr Deputy Speaker, what a particular pleasure it is to have you in the Chair this evening for this important and interesting debate on the NHS in Cornwall? I pay tribute to my hon. Friend the Member for Truro and Falmouth (Sarah Newton) for securing her first Adjournment debate on this subject, which is important not only to her constituents but to the constituents of all other hon. Members and hon. Friends from Cornwall. I know from an earlier debate in Westminster Hall with my colleague the hon. Member for St Ives (Andrew George) that he has long-term concerns about funding for the NHS in Cornwall.
The comments of my hon. Friend the Member for Truro and Falmouth about my right hon. Friend the Secretary of State’s announcement on the White Paper, “Liberating the NHS”, and the way it has found approval in her county are replicated throughout the country. That is, as she rightly said, because of the freedoms and liberation that the Government are giving to the NHS, not only in Cornwall but throughout England, so that we do not have an NHS that is distorted by targets and in which clinical decisions are taken not on clinical grounds but to meet deadlines. We will not have politicians and civil servants in Whitehall seeking to micro-manage the NHS throughout the country.
Next to reducing the deficit, the NHS is the Government’s top priority. That is why we have decided that, despite the dire state of the public finances, the sick should not have to foot the bill for years of living beyond our means. We will increase NHS spending in real terms for each year of this Parliament. As today’s White Paper sets out, that money will be accompanied by a radical shift of power away from the centre and down to the front line. For the first time, NHS staff will have the responsibility and the resources to improve outcomes for patients, free from the shackles of central Government, and patients will be given more power over their care and treatment than ever before.
The White Paper shows that the NHS can become a truly world-class service that is easy to access, that treats people as individuals and that offers care that is safe and of the highest quality. We have published a revised operating framework for the NHS as a first step in delivering those priorities. The framework is putting in place a zero-tolerance approach to infections, setting out how we can move from process targets to evidence-based measures of quality, developing payments for performance geared to results and moving towards a service that empowers clinicians and makes them more accountable for achieving the best outcomes for their patients.
The NHS in Cornwall has made important strides in the past 12 months and I pay tribute to NHS staff across the whole county, who are already improving the care given to my hon. Friend’s constituents. For example, in 2008-09, the Care Quality Commission’s annual health check gave the Royal Cornwall Hospitals NHS trust a “weak” designation for quality of services, but with the hard work and dedication of staff, it obtained registration without conditions with the CQC for 2010-11. On 1 March, the Cornwall Partnership NHS trust became Cornwall’s first foundation trust. It has consistently achieved good ratings from regulators and I know that its services are well regarded by patients and commissioners.
The PCT is working hard to move services closer to home for patients, with several services being brought back into the county, including those on surgery to widen blocked or narrowed coronary arteries, breast reconstruction, treatment for wet, age-related macular degeneration and services for weight management. In the past two years, the PCT has moved care closer to home for more than 19,000 people and it is committed to moving a further 10% of services out of district general hospitals and into the community. It will also work with the local authority to improve patient transport services in order to improve access for the constituents of my hon. Friend and of other hon. Members who are present.
The NHS in Cornwall is involved in some innovative pilot schemes. The whole systems demonstrator pilot is enabling more than 1,000 people to be cared for while remaining independent and in their own homes. That is the biggest pilot of its kind in the UK. The Newquay integrated care pilot is changing the way that people with dementia are cared for. A new purpose-built health centre has just opened in Truro alongside the two existing GP practices. It provides a wide range of services, including family planning, podiatry, physiotherapy, speech and language therapy and social care. The scheme is the result of collaboration between local GPs, members of the public, the local council and other stakeholders.
My hon. Friend mentioned the situation at the Royal Cornwall Hospitals NHS Trust. Although it received a “weak” designation in 2008-09, the CQC annual health check showed that significant improvements have enabled it to obtain registration without conditions with the CQC for 2010-11. After an independent review of management and governance, and recommendations reported in 2009, the strategic health authority carried out a six-month review of the trust’s progress, followed by monthly follow-ups until the end of the last financial year.
At that point, the trust was able to confirm that it had achieved all the recommendations. The PCT and the SHA are arranging a formal meeting with the Royal Cornwall Hospitals NHS Trust further to review the trust’s performance against the recommendations. At its board meeting on the 30 June, the trust agreed the updated chairman’s progress review action plan, which continues to be monitored through the trust’s monthly chairman’s meeting. Progress reports have been shared with the PCT, and clear progress is being made.
My colleague the hon. Member for St Ives (Andrew George) discussed the election of members to PCT boards—a proposal which, as he now knows, is somewhat past its sell-by date. As a result of discussions with the coalition, we have determined the right way forward. In addition to abolishing strategic health authorities—that was in his manifesto—the whole reform package in the White Paper on PCTs and the transfer of commissioning to GP practices makes his proposal redundant. The idea of locally elected PCT members will therefore not be pursued.
Andrew George
I am grateful to the Minister for his response. As he says, things have moved on in a few weeks on the commitment directly to elect PCT boards, but a vacuum has been left, and not just in Cornwall, because we must make sure that finances are adequate for future need and because the local community cannot be represented through the GP commissioning boards. It needs a role in the shaping of services.
Mr Burns
I am extremely grateful to my hon. colleague. As he reads the White Paper in conjunction with other documents that will flow from it in the next few weeks, he will come to understand that all the pieces are in place to deal with the concerns that he has expressed. We as a Government are committed to providing a strong local voice for patients through democratic participation. As he and my hon. Friends will appreciate, the nub of the White Paper announced today for Cornwall and for the rest of England is about putting patients at the heart of our reforms, so that their desires and health care needs drive the reformed NHS. No longer will the NHS be told from the top what has to be done throughout our local communities, both in Cornwall and elsewhere. It will be driven by a bottom-up, rather than a top-down, process. To meet that objective, PCT commissioning functions will be phased out and transferred to the NHS commissioning board.
My hon. Friend the Member for Truro and Falmouth asked about the time scale for these reforms. The time scale for phasing is between now and 2013. We propose to replace PCTs with an enhanced role for elected councillors and local authorities to boost local democratic engagement in the NHS. Given the way in which the whole system is to be held accountable, they will increase their responsibilities from their existing role in the public health sphere.
I now turn to my hon. Friend’s point about information. If we are going to create a national health service that is driven by patients, for patients, they must have the information that qualifies them to make the decisions and the choices that are all part of our vision for a patient-led NHS. I can give her this commitment: information across the whole of the health sector will be made available to all patients and members of the public so that they will be able to access it and then make a judgment based on their health requirements as to their choices of consultants and hospitals. That informed decision making can be provided only by enhanced information for those people. I can assure her that that information will be made available so that they can make those decisions and choices.
My hon. Friend mentioned whistleblowing. As she will know, my right hon. Friend the Secretary of State is a strong supporter of holding the NHS to account when it fails or could do better to ensure that we have the finest health service that does not concentrate on processes, as it has for too long, but is driven by outcomes, which is the important thing that matters the most to our constituents. My right hon. Friend has already stated that he is going to strengthen and protect the position of whistleblowers, to use the old-fashioned phrase—I am not convinced it is the best one, but it is certainly the most obvious—so that people who see things that are wrong or things being done that should not be done have the protection and the confidence to be able to draw them to the attention of the authorities so that we can right the wrongs and make the improvements without those individuals fearing for their jobs, future careers and commitment to the NHS. I hope that my hon. Friend is reassured by that.
My hon. Friend mentioned the inspection and regulation regime and the Care Quality Commission. Let me tell her, although she will certainly know the basic principles, that the role of the CQC as the regulator of all health care providers will be strengthened by a clear focus on essential levels of safety and quality. All providers of regulated health care and adult social care will be registered against essential levels of safety and quality, and the CQC has the power to take action against providers that do not meet these standards. The CQC will carry out targeted inspections of providers against the essential standards.
As my hon. Friend will be aware from the White Paper, GP consortiums will commission the majority of health services in place of PCTs, and the NHS commissioning board will authorise consortiums and hold them to account for their performance. The CQC will no longer have a role in assessing commissioning. On the involvement of patient and clinical experience of services in the regulation and inspection regime, instead of focusing on the measurement of processes or targets, the CQC now places the experiences of the people who use health and social care services at the very heart of its work.
The CQC actively seeks the views of people who use health and social care services when making assessments of the quality and safety of that care. When inspecting a care provider, it asks to see evidence of outcomes and evidence that patients experience effective, safe and appropriate care. Rather than looking at policies, it speaks to people experiencing care, to their families and to staff to find out what the quality of care is like in practice. The CQC also actively seeks the views of clinicians, who play a crucial role in improving the quality of care. When there is a problem, it works with them to work out the best way to solve it and to improve care. Clinicians’ expertise in service delivery and design is invaluable, as I am sure my hon. Friend will agree.
In addition, the CQC works in partnership with a range of professional regulators, such as the General Medical Council and the Nursing and Midwifery Council, to ensure that its assessments of a provider are informed by their views on clinical best practice. Integration with HealthWatch, as announced in today’s White Paper, will give patients in Cornwall and throughout the country a greater public voice, providing a greater connection between their views and the actions of the regulator.
I reassure my hon. Friend, my colleague the hon. Member for St Ives and all other hon. Members from the great county of Cornwall that we are determined to improve and enhance the quality of care in the county and throughout the whole country. We want to ensure that the improvements are experienced by patients, because patients are at the heart of the new NHS that we envisage. Only by taking into account what they want and their patient experience within the NHS can we make the improvements necessary to ensure that we have a great NHS not just for the next five years but thereafter.
Question put and agreed to.
Paediatric Cardiac Surgery
Simon Burns Excerpts(14 years, 4 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I congratulate the hon. Member for Leicester West (Liz Kendall) on securing this important debate on the national review of paediatric cardiac surgery. I pay tribute to the dedicated national health service staff who work in paediatric cardiac care. It goes without saying—hon. Friends will agree—that during the course of their working day they do tremendous and fantastic work looking after critically ill and vulnerable children.
As the hon. Lady said, this is a complex and understandably emotional area. In 2008, the NHS management board asked the national specialised commissioning group to explore whether a reconfiguration of paediatric cardiac surgery services in England could improve levels of safety and sustainability. There had not been a problem at a particular centre, but surgeons, other clinicians, parent groups and the media had raised concerns over the risks posed by the unsustainable nature of smaller surgical centres.
The national review aims to ensure that paediatric cardiac services deliver the highest standard of care, regardless of where patients live or which hospital provides their care. All 11 centres in England that currently provide paediatric cardiac surgery, including Glenfield hospital in Leicester, are being assessed as part of the review. The objective of the review is not to close paediatric cardiac centres—I assure the hon. Lady that this is not a cost-cutting exercise.
Surgery may cease at some centres, but they would continue to provide specialist, non-surgical paediatric cardiology services for their local population. The review seeks to ensure that as much non-surgical care as possible is delivered as close as possible to the child’s home through the development of local paediatric cardiology networks. I emphasise that no recommendations have yet been made about which centres should continue to undertake surgery.
Recommendations on future services will be published for the three-month consultation in the autumn this year. The trend in paediatric cardiac care is towards increasingly complex surgery, which requires large surgical teams that provide sufficient capacity to train and mentor the next generation of surgeons. The focus of the review is to develop services that are clinically appropriate, sustainable and safe.
As I said earlier, paediatric cardiac services are complex, and it has taken time to set up a transparent review structure that takes into account the views of patient and parent groups, and relevant professional societies. As part of the review, the commissioning group has held 10 stakeholder events. The invaluable contributions from parents and NHS staff will inform future stages of the review process.
The commissioning group has set a series of service standards, developed by experts, that take into account the contributions of parents and professionals. The standards cover the whole of paediatric cardiac services and emphasise the need for networks of providers to ensure a coherent service for children and their families. The current centres have been asked to assess themselves against those standards, and an expert panel chaired by Professor Sir Ian Kennedy has visited and independently assessed each centre. The standards will be subject to public consultation this autumn together with the recommendations for change.
I shall now deal with the standard for the numbers of procedures and of surgeons to which the hon. Lady referred. Questions have been raised about the evidence that underpins the standards for the minimum number of paediatric cardiac surgical procedures per year, and for minimum staffing levels. The recommended level of activity—between 400 and 500 procedures a year—is based on the level needed to provide good quality care around the clock while enabling ongoing training and mentoring of new surgeons. The professional consensus is that having four surgeons in each centre should enable services to avoid the risk of surgeons performing only a small number of some of the more complex procedures, which may not be enough to maintain their skills. Transforming a service from adequate to optimal requires sufficient volume, expertise and experience to develop what Sir Bruce Keogh calls “accomplished teams”.
Liz Kendall
Will the Minister provide the source for the recommendation of four surgeons and 400 to 500 patients a year? Which peer-reviewed journal provides the clinical evidence for that?
Mr Burns
As I said a minute ago, that recommendation is the consensus within the professional bodies. However, I am more than happy to give the hon. Lady a commitment that I will write to her after this debate to elaborate, providing as much extra detail as I can, if she believes that will be helpful.
Turning to the other criteria, the review will also take account of surgical centres’ physical location relative to others and the impact of reconfiguration on other important services, including the highly regarded ECMO or total life support service at Glenfield hospital in the hon. Lady’s constituency, which she described with such eloquence in her remarks. The final part of the review will involve centres’ ability to attract key clinical staff and their families. I hope I can reassure the hon. Lady that transportation options and travel distances will be evaluated, including travel times specifically. The Paediatric Intensive Care Society has advised on the issue, and we continue to investigate and seek advice. I appreciate fully the importance of the issue and the concern that it causes many families.
Nicky Morgan
Will the review also consider the impact on other services? For example, at Glenfield, there are two intensive care units for children in the city, and I understand that one team covers both. If the centre were to be closed—this might also apply to other centres—it might destabilise other services within the hospital.
Mr Burns
The short answer is that I cannot make that commitment myself. As my hon. Friend will appreciate, the review is independent and will be carried out at arm’s length from the Department of Health and Ministers. I do not have a role, and it would not be correct for me to seek to interfere in the process. However, having said that, I am confident that my hon. Friend’s point will be considered as part of the review, because it will be comprehensive and across the board, considering all aspects of this highly specialised and important health care provision. I hope that reassures her.
The available research evidence suggests that larger surgical centres deliver better clinical outcomes. As cardiac expertise is available round the clock, they can perform a wider range of complex procedures, meaning fewer transfers between centres. Larger centres can still provide a personalised service. The service standards make it clear that tailoring services to the needs of each child is critical. That is an extremely important factor that I know the hon. Member for Leicester West understands and accepts fully.
I also assure the hon. Lady that any changes to local health services will not be driven from the top down. The review has strong support from external organisations. It has been instigated at the request of parent and patient groups, clinicians working in the service and professional associations, including the Children’s Heart Federation, the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the British Congenital Cardiac Association and the Society for Cardiothoracic Surgery in Great Britain and Ireland. It is important to understand that any recommendations on the future number and location of surgical centres will be made not by any central body but by the 10 specialised commissioning groups working with local NHS commissioners. The review will consider access to services for the whole country.
The national specialised commissioning group was asked to lead the review because of its co-ordinating role across the 10 specialised commissioning groups. I am sure that the hon. Lady will agree that that was the most sensible approach to take when the review was devised and set up just over two years ago in 2008. The group was ideally positioned to engage with commissioners and clinicians from across the country.
I reiterate that the review is being undertaken in response to the concerns of parents and professionals about the future capacity and capability of paediatric cardiac services. It will be an open process; I assure the hon. Lady that the outcomes are not predetermined. It is a genuine review seeking genuine answers in order to maintain the highest standards of quality in a specialised and difficult area of patient care. The national specialised commissioning group will set up a consultation process on its recommendations and standards this autumn. We must wait and see what the review says and then go through the consultation process, during which anyone will be able to input their thoughts, recommendations, comments, criticisms or praises of the review’s findings, before any final decisions are taken.
I thank our external partners and their patients for their input to the review so far. I find it encouraging that the review has broad support across the board. As the hon. Lady will accept, children deserve the best possible care. The Government are determined to provide the best paediatric cardiac care possible after the review and consultation processes have been concluded and the final decisions reached.
Question put and agreed to.
Newark Hospital
Simon Burns Excerpts(14 years, 4 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Newark (Patrick Mercer) on securing this important debate on the future of Newark hospital. As he said, I was fortunate enough to visit the hospital last week. I was extremely grateful to have the opportunity to do so and I was particularly struck by the enthusiasm and dedication of all the staff and management I had the privilege of meeting during that visit. I fully understand my hon. Friend’s desire to ensure his constituents have the best possible health services. My visit last week proved extremely useful in understanding the issues there.
I would like to take this opportunity to outline briefly the Government’s approach to service reconfiguration. We believe that the best decisions are local decisions, and that change should be driven by local clinicians, not imposed by politicians or decided by managers behind closed doors. The Secretary of State has identified four crucial tests that all reconfigurations must now pass. First, they should have the support of GP commissioners; secondly, arrangements for public and patient engagement, including local authorities, should be strengthened; thirdly, there should be greater clarity about the clinical evidence base underpinning any proposals; and fourthly, any proposals should take into account the need to develop and support patient choice.
To ensure the long-term future and sustainability of health service provision in Newark, a range of NHS services in the area have been reviewed. Those include unplanned and emergency care as well as in-patient dementia care. I understand that clinicians from primary and secondary care are in unanimous agreement that Newark hospital cannot provide a full accident and emergency service—I am grateful to see my hon. Friend nodding in agreement to that. They have concluded that, for the sake of patient safety, the hospital should no longer care for patients with acute medical conditions. The hospital should also be named more accurately to avoid public confusion, ensuring that patients go to the right place first time and are not put at additional and unnecessary risk by going as a first destination to a unit that is not able to look after their degree of injury.
The main reasons for that are as follows. First, every tier 1 accident and emergency department needs an intensive care unit, emergency operating theatres and 24/7 anaesthetics to provide back up for the A&E and acute medical conditions. Unfortunately, Newark does not have those and has not had them. Secondly, acute emergencies require specialist skills, which are not and have not been available in Newark. Thirdly, doctors agree that avoidable transfers are associated with poorer health outcomes and worse patient experiences. In 2009/10, the PCT reports, a significant number of patients had to be transferred, many due to a deterioration in their condition.
The local NHS ran a consultation exercise earlier this year to garner the views of local people. The majority were in favour of changes to urgent and emergency services at Newark hospital. I know that there is a view, expressed by some campaigners, that the consultation was rushed, too small to be properly representative of the local community’s views and that the full implications of the review have not been sufficiently drawn out. The NHS must not take local support for granted and must continue to engage fully with clinicians, the public and the council’s overview and scrutiny committee. If a consultation is inadequate, it must be improved and should provide as much relevant information as possible. The overview and scrutiny committee continues to review the implementation of planned changes, which is essential to help to ensure democratic scrutiny.
The strategic health authority has told me that Nottinghamshire County PCT engaged with the overview and scrutiny committee throughout the Newark review and that evidence of that engagement was presented at the PCT board meeting on 17 June. Yesterday, the PCT met with the overview and scrutiny committee to decide the next steps. I understand that it does not intend to refer the proposals to the Secretary of State.
I will turn now to one of the problems with the reconfiguration: the naming of the unit that will deal with injuries, which my hon. Friend mentioned. It is of course important that the facility at Newark hospital is appropriately named. I know that some people would prefer it to be known as a minor injuries-plus unit, while others would prefer to call it an urgent care centre. As he will appreciate, it is not for me to intervene in that issue in a top-down manner. The choice of a name must be agreed locally and should clearly reflect the nature of the facility, so I hope that the matter can be resolved locally through ongoing discussions.
On A and E services, I understand that Newark hospital has never had a full A and E department. Confusion has arisen in part because there is an A and E sign outside the building, but that does not reflect the nature of the services provided inside. Having a local A and E department on one’s doorstep can feel reassuring, but the reality is that receiving the best care does not always mean being taken to the nearest hospital. Some patients might be treated at the scene and others might be taken to Newark for treatment, but those who have suffered major trauma will be best served by being taken directly to specialist units, receiving care en route to the hospital that has the most suitable facilities.
The proposed changes aim to solidify the existing protocols on diverting acute patients to more appropriate hospitals, ensuring that patients go to the right place the first time and are not put at additional and unnecessary risk. I understand that the parents of a young child recently turned up at Newark hospital A and E, incorrectly assuming—understandably—that it was a full A and E department, and the child’s care was delayed as a result. I stress my earlier point about the importance of naming the unit correctly so that local people can understand easily what it does and does not do. I am pleased that during October and November there will be a public education process in Newark to explain exactly what the unit does and where patients should go in the first instance, either to Newark or to another hospital, for appropriate treatment when injured.
Patrick Mercer
Would the Minister be kind enough to inform the relevant authorities that I would very much like to be involved in that work? The whole process has been marred by poor communication and bad consultation, so I would be happy to help in any way I can.
Mr Burns
I am extremely grateful to my hon. Friend and am sure that there is a role for him to play in helping his constituents in the education process and explaining fully the role of the unit so that it receives appropriate admissions in future.
On the running down of services at Newark, we must be careful not to do the local NHS a disservice through idle talk about the future of the hospital. The proposals focus on giving patients access to safe care for urgent conditions. The people of Newark will continue to access Newark hospital if that is the most clinically appropriate place for their treatment. There will be an increased availability of same-day or next-day outpatient appointments for patients who GPs believe require urgent assessment. If a diagnostic test such as an X-ray is required, that will be done at the same time.
There is also scope for Newark hospital to undertake more planned surgery, such as hip and knee replacements. I know that that is being explored by the Sherwood Forest Hospitals NHS Foundation Trust and the PCT. It is also important to note the important role that Newark hospital plays in rehabilitating patients who are well enough to leave the facilities at Lincoln and Nottingham and can continue their care closer to home. Those proposals would also see an out-of-hours GP service available on site, which I hope my hon. Friend will welcome, as patients who wish to see a GP after midnight currently have to travel up to 20 miles to see one in Mansfield.
I am aware that the local press have reported that Newark hospital is being downgraded. The trust has made it clear that there are no plans whatever to downgrade the hospital. Rather, the plan is to make it fit for purpose and safe for patients. The trust also assures me that it is fully committed to Newark hospital and has no plans to close it. Rather, it sees the hospital as an integral part of local health services. I hope that that goes some way towards reassuring my hon. Friend and his constituents.
He also mentioned Friary ward, which was temporarily closed by Nottinghamshire Health Care Trust to assess how it can best be used in future. I gather that demand for the ward, which has 15 beds, had dwindled to two patients. More people need to be cared for in their own homes, as I suspect many patients would prefer, if that is medically and clinically feasible. I will certainly write to him with more details on what is happening at Friary ward and what will happen as a result of the trust’s assessment of the future of that part of the hospital’s activities.
On the concerns about the public consultation, the evidence I have been given indicates that there was a full engagement with the local community about the proposals that were put out to consultation prior to decisions being reached, although there will always be differences of opinion. I have no evidence to show that that was not a satisfactory and wholehearted consultation, even though I accept that some people remain unconvinced by the proposals before the trust.
In conclusion, local health services will need to evolve and become more efficient, in line with current Government policy. If we want to take people with us, we must ensure that they have full confidence in the decisions being taken and feel that their voices are properly heard. That is what the new arrangements are about. That will not always be easy, but if it is clear, transparent and led locally by clinicians, and if it listens and responds to the voices of local people, it will help to reduce the anxiety my hon. Friend has spoken about today and on which he has so eloquently campaigned over the past few months for the people of Newark. The commitment and tenacity he has shown in fighting for local health services is commendable, and I know that he will continue to engage constructively with the local NHS to ensure that his constituents’ concerns are properly heard.
I trust that something can be done through continued dialogue between all parties, including my hon. Friend, to resolve satisfactorily the differences of opinion on the name of the unit so that there is no confusion about where his constituents should go if they or their family members are involved in an accident and that they get the quickest and finest health care possible in the most appropriate setting.
North Tees and Hartlepool NHS Foundation Trust
Simon Burns Excerpts(14 years, 4 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
I begin by congratulating the hon. Member for Stockton North (Alex Cunningham) on securing the debate on the future of the North Tees and Hartlepool NHS Foundation Trust and its hospitals. I join him, with the greatest pleasure, in congratulating clinicians, GPs, ancillary workers and all those who work so hard on Teesside, in the north-east and in the rest of the country to provide a first-class quality health care service for the people of this nation.
The decision to cancel the North Tees and Hartlepool NHS Foundation Trust proposal has to be seen within the context of the wider economic climate. This year’s budget deficit of £155 billion—inherited, I gently remind Opposition Members, from the previous Government—illustrates the scale of the economic challenge facing this Government. As part of this Government’s determination to face that challenge head on, the Treasury and other Departments have reviewed every significant spending decision made between 1 January and the general election on 6 May. As the proposed new hospital scheme at the foundation trust received the previous Government’s approval only in March, the North Tees decision formed part of that review.
In these tough economic times, it is essential that all major hospital building schemes be affordable. On 17 June, as the hon. Member for Stockton North rightly said, my right hon. Friend the Chief Secretary to the Treasury announced to this House the decisions of the Government’s review of spending commitments. The review cancelled 12 projects throughout Government and considered four major NHS capital investment schemes with a total capital value of more than £1.2 billion.
The size and funding of the schemes were considered in relation to the nature of the organisations concerned. The aim of granting foundation trust status is to give such bodies greater financial independence. As well as being able to keep any internally generated resources, foundation trusts have greater freedom to borrow from either the public or the private sectors, and, by requiring an allocation of public dividend capital from the Department of Health of more than £400 million, the proposals were not consistent with that financial independence.
Mr Iain Wright
What local clinical advice did the Minister and his ministerial team take prior to the decision to scrap the new hospital?
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—
Alex Cunningham
I have just one question. Will the funding for those two centres in Stockton and Billingham be guaranteed?
Mr Burns
As I understand it, the finance is in place, and I assume that the measures will proceed on that basis.
Any new proposals to develop local NHS services must be affordable, but they must also now take into account the further criteria on service reconfiguration recently set out by my right hon. Friend the Secretary of State. I believe that it is vital that any proposals focus on improving patient outcomes, are based on sound clinical evidence, increase choice for patients, and have the backing of GP commissioners. I, like the hon. Gentleman, his hon. Friends and everyone else in this country, want a high-quality NHS that is accountable to patients and led and controlled locally. This Government have been elected on a platform of real-terms increases in the NHS budget for every year of this five-year Parliament. But hand in hand with that, we must have an NHS that puts patients at the centre of high-quality care and delivers care that is efficient, productive and, importantly, affordable. This must be the case nationally; it must also be the case locally, including for the people of Stockton North and Teesside.
Question put and agreed to.
Oral Answers to Questions
Simon Burns Excerpts(14 years, 4 months ago)
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Derek Twigg (Halton) (Lab)
2. What assessment he has made of the effects on NHS waiting times of NHS targets in the last 10 years.
The Minister of State, Department of Health (Mr Simon Burns)
Targets focused the NHS on bringing down waiting times, but also put process above clinical judgment and patient choice. Changing the way in which we manage waiting times will empower both patients and clinicians. NHS targets have dictated clinical priorities and harmed patient care. Focusing on long waits has meant less progress on reducing average waits than could otherwise have been achieved.
Derek Twigg
I noticed that in his answer the Minister did not say that any assessments had taken place. How many representations has he received from clinicians, people working in the NHS and the public demanding the removal of the 18-week target, for instance? Targeting is about making people better and getting them seen more quickly, so is not the real reason for dropping targets the fact that the Minister wants to undermine the NHS again?
Mr Burns
I am sorry, but the hon. Gentleman, for whom I have considerable respect, is just plain wrong. There have been a number of representations over the last seven weeks or so. In addition, as my right hon. Friend the Secretary of State and his shadow team went round the country over the past five years, they were constantly told by GPs and clinicians from hospital to hospital that politically motivated targets were distorting clinical decisions and patient care.
Mr Stephen Dorrell (Charnwood) (Con)
Does my hon. Friend agree that by far the most important way of improving the service delivered by the NHS is to focus on the three key indicators of clinical outcomes, patient experience and value for money? Can he assure the House that the Government will pursue those, particularly against the background of increasingly scarce resources, in order to deliver the objective we all have: a better-quality NHS?
Mr Burns
I am extremely grateful to my right hon. Friend, who is absolutely right, and I can give him the categorical assurances he is seeking, but I would also like to add one more: we need information to empower patients, because if patients are going to be at the heart of the NHS they must have the information to take the decisions that are important to their health care.
Mr Speaker
Order. May I gently ask the Minister to face the House? I am sure that Opposition Members will want to see his face.
Andy Burnham (Leigh) (Lab)
We do, Mr Speaker, very much; we want to see him squirm.
First, let me say that we welcome the Minister back to the Department of Health; he was a Minister in the Department 13 years ago. As I have said before, we trust that he finds the NHS in much better condition than when he left office. Last week we had an independent verdict on those 13 years. The independent and respected Commonwealth Fund said that the NHS was one of the best health care systems in the world, and, indeed, that it was top on efficiency: a ringing endorsement of Labour’s stewardship of the national health service. That verdict reflects the huge progress on waiting times that has been made over those 13 years. So does not the abolition of the 18-week target, which the Minister announced last week, put all that progress at risk? Will he today give us a straight answer to this question: can he guarantee that waiting times will not rise, and that patients will still be treated within 18 weeks?
Mr Burns
I thank the right hon. Gentleman for the kind comments at the beginning of his remarks; things went downhill thereafter, but that is politics.
The right hon. Gentleman needs to understand that patients have to come first in a national health service, and the trouble with the approach he took was that he wanted politicians and bureaucrats to micro-manage it from the top down, rather than having a bottom-up system that listened to local people. One of the key aims is to ensure that people get the finest and best treatment possible, and I am afraid that his approach—a straitjacket of targets in certain areas—did not work then, and will not work now.
Andy Burnham
I shall take that as a no, because the Minister did not answer the question; he could not give that guarantee. He says that we must put people and patients first, yet at a stroke he has taken power away from patients and handed it back to the system, turning the clock back to the bad old days of the Tory NHS. Let me quote some comments by Jill Watts, chair of the NHS Partners Network, which represents private providers. In the Financial Times on 18 May, she is reported as saying the following about the loss of targets:
“Waiting times will go up and if people want a procedure they have a choice: they can wait or they can look to pay”.
Is that not always the Tory choice on the NHS: wait or pay?
Mr Burns
The right hon. Gentleman is not right. We have not taken that attitude; we never have taken that attitude. We want to have a system whereby the health service is not in a straitjacket of targets that disrupt and distort clinical decisions. We want to empower clinicians and GPs to take decisions about who should be treated when according to their clinical judgment.
Toby Perkins (Chesterfield) (Lab)
3. If he will take steps to increase the number of dentists providing NHS services in Chesterfield; and if he will make a statement.
Clive Efford (Eltham) (Lab)
8. What recent representations he has received on the new community hospital for Eltham; and if he will make a statement.
The Minister of State, Department of Health (Mr Simon Burns)
The Department of Health is in contact with strategic health authorities regarding ongoing community hospital programme funding. This includes contact with the London SHA for Eltham and Mottingham community hospital and other schemes in the region.
Clive Efford
I am grateful for that answer, as far as it went—but there is a great deal of expectation in the community in Eltham that that project will be delivered. It has been in the pipeline for quite some time and will provide 40 respite beds, diagnostics such as blood tests and X-rays and, I hope, dialysis at a local level, as well as a GP-led walk-in urgent care centre. May I urge the Minister to revisit the project, and when I ask a future question, to come back with a better answer?
Mr Burns
I am a bit perplexed by the hon. Gentleman’s comments, because I have answered the specific narrow question that he asked—but let me try to cheer him up, if I can. We understand that he has been a redoubtable campaigner for the hospital, and we support the principle of community hospitals. The Department, as the hon. Gentleman knows, allocated £4.58 million to help the community hospital in Eltham and has already given about £1.9 million to NHS Greenwich, the primary care trust, for it. I hope that the hon. Gentleman will not have to come back to me with another question, because I trust that I am now going to cheer him up: I can announce today that the balance of the money will be paid and made available during the current financial year.
Mr David Evennett (Bexleyheath and Crayford) (Con)
I congratulate my hon. Friend on that announcement, which will bring considerable pleasure to people in south-east London. He is well aware that proposals are being made within our area of south-east London to reorganise health provision, which are causing considerable concern. Will he ensure that vital services are maintained in our area for patients?
Mr Burns
I am grateful to my hon. Friend. As he rightly says, I am aware of the situation. As he will be aware, we believe that local people, local clinicians and local GPs should have an input into any reconfiguration of health care provision. As my right hon. Friend the Secretary of State said when he announced the changes to the criteria, there will be an assessment of whether they apply to the reconfiguration to which my hon. Friend refers. Once that has been done and decisions have been reached, we will be able to move forward in the proper way.
Jim McGovern (Dundee West) (Lab)
9. What plans his Department has for health warnings on labels of alcoholic drinks.
Helen Jones (Warrington North) (Lab)
15. What percentage of patients at Warrington Hospital were treated within 18 weeks of referral in the last 12 months for which figures are available.
The Minister of State, Department of Health (Mr Simon Burns)
At the Warrington and Halton Hospitals NHS Foundation Trust, in the 12 months up to April 2010, 93.2% of patients admitted to hospital for treatment and 97.8% of patients whose treatment did not require admission to hospital waited 18 weeks or less from referral.
Helen Jones
I am grateful to the Minister for that reply. What percentage of patients does the Minister now believe will be treated within 18 weeks, and which people exactly does he think deserve to wait longer than that?
Mr Burns
May I reassure the hon. Lady that in my lexicon no one “deserves” to wait longer. What I want, and my right hon. and hon. Friends want, is a first-class health service that makes decisions based on clinical reasoning and gives treatment swiftly and relevantly to those who need it. My right hon. Friend the Secretary of State has made some changes to some of the targets to ensure that clinicians and clinical decisions dominate, not political decisions by politicians and bureaucrats.
Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)
16. What progress he has made on establishing his proposed commission on funding long-term care; and if he will make a statement.
Duncan Hames (Chippenham) (LD)
T7. What encouragement is the Secretary of State giving to primary care trusts to restore minor injury services to towns such as Melksham in my constituency? It saw its minor injuries unit close under the last Government.
The Minister of State, Department of Health (Mr Simon Burns)
I am very grateful to the hon. Gentleman for that question. It is up to local communities and local health providers to identify what they believe are the local needs of their communities and then go through the procedures, measures and mechanisms to seek to achieve what they want—in this case, that could be a new A and E. It is not for Ministers to promise such provision; there are proper procedures, from the local area upwards, for achieving such aims.
Julian Sturdy (York Outer) (Con)
T9. I am sure that the Secretary of State will remember visiting my constituency earlier in the year and listening to constituents’ concerns about the withdrawal of spinal injections on the NHS. Given that the PCT’s decision is set to become another example of the postcode lottery in the health service, will his Department consider the ongoing debate about spinal injections in York and support the attempts of my constituents as they seek to shape local health services around their specific needs?
Mr Burns
I am a bit confused as to where to look. [Interruption.] Right, I will look forward.
My right hon. Friend the Secretary of State well remembers his visit in April to meet the York and District pain management support group. He made it plain at the time that it should be for GPs and their patients to decide what treatment should be given, as opposed to a decision by the PCT to veto spinal injections for all sufferers of long-term chronic back pain. We will, in due course, set out our proposals to put more power in the hands of patients and GPs.
Vernon Coaker (Gedling) (Lab)
T3. Does the Minister agree that it is crucial for patients to have information if we are to make a reality of choice within the NHS? In that respect, does he agree that if we are to give people a real choice as regards the choose and book system that GPs operate, there is a need to ensure that patients have the information about the success rates of different hospitals, and different surgeons, as regards operations?
Robert Halfon (Harlow) (Con)
Will the Minister review the problem of highly priced patient lines and introduce competition so that patients in Harlow and elsewhere no longer pay extortionate prices to watch TV or make phone calls?
Mr Burns
I am extremely grateful to my hon. Friend for raising an issue that I know is of concern to many people. Although I cannot make promises about the outcome of any review, he has my assurance that we will be looking into this, and that we take on board the concerns that have been expressed over a number of years.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
The Secretary of State has halted the reconfiguration of services in south-east London, which was clinically led, the subject of detailed public consultation and approved by the reconfiguration panel. The outcome is to leave my PCT and hospital trust acutely troubled about their ability to deliver the improved health services that were promised under “A picture of health” and to meet their financial targets. What does that say about the Government’s commitment to evidence-based policy making?