HC Deb 01 November 1991 vol 198 cc188-94

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Nicholas Baker.]

2.30 pm
Mr. David Amess (Basildon)

I am grateful for the opportunity to mark the historic granting of trust status to Basildon and Thurrock health authority. I am pleased to see my hon. Friend the Member for Thurrock (Mr. Janman) in his place, and I hope that my hon. Friend the Member for Billericay (Mrs. Gorman) will join us in due course.

It goes without saying that the granting of trust status for our two hospitals has been achieved against a background of determined opposition by local socialist councillors and their friends. Just as we have noted nationally from Labour and Liberal Democrat Members in the House, locally the two parties have tried to scare our constituents and to spread alarm and despondency. They have tried to frighten our people about what trust status will mean and their anxieties have been worked up beyond belief. Far from trust status threatening their well-being, in Basildon, Thurrock and Billericay the quality of health care will continue to improve. How do we judge the success of the NHS? We look at the life expectancy of men and women, and that continues to increase. We look at the infant mortality rate, and that is decreasing. Babies are having a much healthier start to their lives.

The application for NHS trust status was submitted by Basildon and Thurrock general hospitals with a great deal of support from doctors, nurses and other members of staff. Of course, from time to time there have been criticisms of the care in our local hospitals. I and my hon. Friends accept no excuses from consultants, doctors or support staff if any of our constituents suffer from a lack of care and attention at our local hospitals. We accept full responsibility for our actions as Members of Parliament and we expect medical staff to do the same.

There is great enthusiasm for trust status in our area. I and my family are regular users of the NHS. We live just behind Basildon hospital. My children constantly seem either to be being delivered or being treated for odd ailments at the hospital, and they are extremely well cared for. The trust application was submitted so that the freedom and flexibility of trust status would enable us to provide a better range of services, locally based, to suit the needs of local residents. There is no doubt that the financial freedom would allow us to improve the physical environment of our buildings and to make them more welcoming.

Trust status will also enable the hospital to invest in new medical technology, which will in turn allow it to perform less invasive surgery and to reduce the length of time that patients will be required to remain in hospital. Patients will return to the community in a fitter state and it will be possible to treat more of them using the same number of beds. That will have the desired effect of reducing waiting lists and waiting times.

Trust status will allow the hospital to centralise its maternity services—of which my wife has taken advantage on five occasions, the most recent being just a few weeks ago. Basildon has a superb maternity service, but the technical advice is that centralisation will result in a safer and more comprehensive service for the future. The hospital will be able to offer a first class, 24-hour paediatric service, deploy its highly skilled staff more cost effectively, and provide a safer maternity service to mothers and their babies. Those plans went out to public consultation five years ago and were approved.

Trust status will also enable the hospital to provide a range of services to the acutely ill elderly on the Basildon site. At present, elderly patients admitted to Basildon hospital's accident and emergency department are transferred to St. Andrew's hospital in Billericay or to Orsett hospital. The provision of an on-site unit at Basildon for such desperately ill patients means that they will not need to be transferred unnecessarily and that high technology equipment can be used in investigating and treating their conditions. That will provide a higher standard of service to the elderly in the district. Those plans were also agreed in 1986.

Members of the trust team and consultant medical staff from the unit have visited or have arranged to visit every general practitioner's practice in the district. That is of fundamental importance. Too often, throughout the country, GPs and consultants have not worked in unison as they should to ensure delivery of the highest possible quality of health care. Such consultation is under way in my district and it will benefit the constituents that I and my hon. Friends represent.

The trust will have a strong working relationship with the purchasing district health authority and is working with it to ensure that the highest standard of care and widest range of services can be achieved.

The most significant achievement of Basildon and Thurrock health authority over the years is undoubtedly that of achieving the biggest overall reduction in its waiting list out of 15 districts in the region. It achieved a reduction of 57 per cent. in the number of patients waiting for general surgery; of 20 per cent. for ear, nose and throat surgery; of 22 per cent. for orthopaedic surgery; of 11 per cent. for oral surgery; and of 12 per cent. for gynaecology.

As to the number of patients awaiting admission to the hospitals for more than one year, as at June 1991 the figure was 375, compared with 954 a year earlier—a significant reduction of 60 per cent.

The hospitals have also introduced a number of initiatives. All waiting lists are routinely checked to ensure that those who are on them still need an operation. Medical staff have been increased in problem areas. For example, a consultant oral surgeon, shared with Southend health authority, started work last August and new consultant posts in neurology and plastic surgery were created in April. Those posts have resulted in increased numbers of patients being treated. Short-notice waiting lists are held for filling last-minute cancellations by patients. Appropriate notice is given of admission to ensure that cancellations by patients are kept to a minimum. Three consultant surgeons blitzed problem areas on the waiting lists and held special day-case sessions. A community care team has been established to reduce the number of patients in hospital by getting them back home with proper support so as to free the acute beds more quickly.

New clinical techniques have been introduced to increase the use of day-case surgery. Significant developments have been achieved on waiting list funds. Basildon and Thurrock general hospitals have obtained from the North East Thames regional health authority waiting list initiative funds of £0.5 million to build and equip a dedicated day surgery unit, £12,000 to purchase special arthroscopy equipment, used in examining joints, £28,000 for a hysteroscope to enable gynaecological surgical procedures to be carried out on an out-patient or day-care basis, and £30,000 for keyhole surgery equipment to remove gall bladders, substantially reducing the average length of stay for such procedures and reducing the trauma of the procedure, too.

Out-patient waiting times are currently being examined to achieve similar improvements for people waiting to be seen as out-patients following referral by GPs. In the first few months after the introduction of the new GP contracts there was a big increase—about 45 per cent.—in the number of smears undertaken by local GPs. The acute services unit has managed to absorb that workload and the turn-around time for routine—that is, asymptomatic—smears is now 10 days, and for urgent—that is. symptomatic—smears two days.

Some of my hon. Friends and I were present at the opening of the new accident and emergency department at Basildon hospital. It was opened by His Royal Highness the Duke of Kent. I believe that it is the finest accident and emergency unit in the country, and about 200 patients a day are being treated there.

I have already mentioned the maternity unit at Basildon. The Basildon and Thurrock general hospitals trust will start work in April 1992 on a £1.6 million capital development to centralise maternity services within Basildon and Thurrock. As I have said, that will improve the service to local residents, as it will concentrate staff and facilities. As part of a regional plan to set up improved intensive care services for new-born babies, Basildon hospital will open five new cots this year, which will provide a service not only to the residents of Basildon and Thurrock but also to babies from outside the district.

In Basildon and Thurrock we have a first-class national health service—there can be no doubt about that. I have demonstrated its achievements over the past 18 months. I know that you, Mr. Deputy Speaker, are interested in the hospice movement. In Basildon we have the magnificent St. Luke's hospice—the subject of an Adjournment debate which I initiated about six years ago. That hospice was opened by the Duchess of Norfolk. More than £1 million has been raised and many patients are now receiving first-class treatment in the hospice. I have no doubt that, when the trust comes into being in April 1992, my constituents will continue to enjoy ever-increasing standards of health care in Basildon.

Mr. Tim Janman (Thurrock)


Mr. Deputy Speaker (Mr. Harold Walker)

Does the hon. Gentleman have the consent of the hon. Member for Basildon (Mr. Amess) and the Minister?

Mr. Amess

indicated assent.

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

indicated assent.

2.44 pm
Mr. Tim Janman (Thurrock)

I thank my hon. Friend the Member for Basildon (Mr. Amess) for allowing me to say a few words on a matter that is so important to my constituents and to his. I echo his remarks, supported by some impressive statistical evidence, about the way in which the national health service in Thurrock and Basildon is improving and treating more people.

It is worth remembering that Basildon and Thurrock health authority now treats 11,000 more patients in hospital each year than it did when it was first created in 1982. As I have said in the local press, my only sadness is that we were not afforded trust status a year ago. We could then have enjoyed benefits such as those evident in Southend—where there has been a 9 per cent. increase in patients treated since trust status was granted—a year earlier.

We now have trust status, however, and I take this opportunity to congratulate the team on its application. I have a great deal of confidence in the management team on the clinical side at Basildon and Orsett. That application, which, thankfully, was approved by the Secretary of State, has received a lot of support from the medical profession and from people working in the health authority. Moreover, it was not the subject of opposition among the public at large.

My hon. Friend the Minister may like to know that the local Labour party circulated 50,000 or 60,000 leaflets, with voting slips attached, right across the borough, which has a population of 130,000 people. It received only about 3,000 returned forms, although there were about 6,000 votes because I understand that there were two votes on each one. The vast majority of people in Thurrock took my advice and put the silly leaflet in the bin. There is no local opposition to trust status because people are beginning to understand that trust status means the devolution or delegation of decision-making power to those who are in the best position to make the decisions about how local hospitals should be run. Those people are local managers sitting at desks in those hospitals, not bureaucrats sitting in a tower block in Paddington at the North East Thames regional health authority offices.

There is another piece of evidence to suggest that there is not hostility. Only about 60 people turned up to a recent candle-lit vigil outside Orsett hospital supposedly a protest against trust status being given. Subtract from those 60 people members of the Labour and Liberal parties and the odd left-wing GP and I doubt whether there would be anyone left.

The majority of people in my constituency are either totally in favour of trust status or are prepared to say, "Let's give it a try. Let's give the Government the benefit of the doubt and see whether they are right." I know that we will be proved right and that trust status will be good for my constituents and for those of my hon. Friend the Member for Basildon.

It is certainly true that, a few years ago, waiting lists in North East Thames area were among the worst in the country. We had some particularly bad waiting times in our own district. However, as my hon. Friend the Member for Basildon so lucidly explained, we are making great progress in reducing those waiting lists. It is worth noting—and I say this for the benefit of my hon. Friend the Minister if for no one else's benefit—that there has been a great deal of hyprocrisy on the part of the Labour party in Thurrock and Basildon concerning the centralisation of casualty services at Orsett. Although my hon. Friends the Member for Billericay (Mrs. Gorman) and for Basildon and I had certain concerns about the overall reorganisation proposed—my hon. Friend the Member for Billericay and I expressed them very forcefully, as my hon. Friend the Minister knows—we took exactly the same line as the community health council on the centralisation of casualty. Our CHC did not oppose the centralisation of casualty at Basildon and the Labour district and borough councillors from Basildon and Thurrock who served on the CHC did not demur from that position. Privately, those Labour councillors knew what was going on and why, and that the vast majority—if not 99 per cent.—of doctors and surgeons in the two hospitals involved supported the change. Therefore, they did not demur. It was left to other more prominent and vocal members of the Labour party to stir up people's fears with irrelevant and inaccurate claims about the consequences.

I have been delighted to have the opportunity to add to what my hon. Friend the Member for Basildon said. I know that we have an excellent management team which will take the trust forward. Some organisational changes have been made already. For example, 12 clinical divisions have been created, with 12 cores of people committed to making everything happen. Over the next year or so, my constituents will see tremendous improvements, on top of what has been achieved during the last 12 to 18 months in terms of the quality and quantity of health care that they will receive from the Basildon and Thurrock NHS trust.

2.49 pm
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

I congratulate my hon. Friend the Member for Basildon (Mr. Amess) on taking this opportunity to raise in the House the granting of trust status to the Basildon and Thurrock hospitals and on providing the House with the opportunity to mark the granting of trust status. I am grateful to him for pausing for a second, at the end of a busy day, to take note of and observe the great benefits to his constituents and those of my hon. Friend the Member for Thurrock (Mr. Janman) as a result of the establishment of the new trust.

Like my hon. Friend the Member for Basildon, before considering trust status may I refer to what has already happened to his constituents and to all the other residents in the Basildon and Thurrock health authority. My hon. Friend gave impressive evidence regarding the improvement in health care for his constituents. I shall add a little more evidence. My hon. Friend did not refer to the increase in the number of in-patients treated in the district during the last 10 years. It has increased by 40 per cent. Moreover, the number of day cases treated in the district has increased by 64 per cent. during the last 10 years. That is slim evidence of cuts in the national health service if we are treating more than half as many again day cases and 40 per cent. more in-patients than 10 years ago. It is evidence of a growing service that offers a wider range of facilities to a growing number of patients.

I remind the House of the benefits that will come to Basildon and Thurrock as a result of the Government's commitment to introduce weighted capitation. Both of my hon. Friends know that their constituents live in an area which for generations has had health care that has been relatively less generously funded than that provided in the central London parts of the Thames regions. The Government's commitment, through the weighted capitation mechanism, is to ensure that NHS resources reflect population densities and the health needs of those populations, and is an important commitment to the constituents of my hon. Friends. It will ensure that the growth that we have established over the last 10 years in terms of the range and volume of health care facilities continues under future Conservative Governments, partly because we are committed to ensuring a fairer distribution of resources within the NHS, which will secure benefits for the constituents of my hon. Friends, and partly because of the commitment given from this Dispatch Box yesterday by the Prime Minister—that under a Conservative Government the national health service will have its real resources increased year by year—something which the last Labour Government were unable to do. They are the only Government in recent history to have cut the real resources available to the NHS in a particular year. The constituents of my hon. Friends have a considerable amount to gain from weighted capitation and from the commitment to ensure that the total resources available to the NHS continue to grow year by year.

My hon. Friend the Member for Basildon gave clear evidence of the improvement in waiting lists for his constituents and for those of my hon. Friend the Member for Thurrock. He also listed the capital investments that have been made to improve health care in his constituency. The record of the NHS in the Basildon and Thurrock health authority over the last 12 years is one of which both my hon. Friend and all those involved in the NHS have every reason to be proud. It clearly substantiates this Government's commitment to ensuring that we maintain a national health service that is the envy of the world and that we continue to improve upon it.

As I have already mentioned, the record of the NHS over the last 12 years in the constituencies of my hon. Friends is good, but we are not complacent. We recognise the need to do even better in the future and we want to meet that need. That is why we have invented the concept of trust status, which gives us the opportunity to entrust to local people—those who work in the hospitals—a greater discretion and influence over the way in which resources are used in their institution.

Occasionally people say to me that the Government are seeking to turn health care into a business. That is completely wrong. We understand that the delivery of health care is not a business. However, our oppponents fail to recognise that we have a great amount to learn from those in business who have developed techniques to ensure that large organisations improve their efficiency and deliver their objective more effectively than was the case.

I am not seeking to make health care into a business, but I make no apology for seeking to employ business techniques in the health service in order to deliver the central objectives of the health service more effectively than in the past.

My hon. Friends will recognise that there is no conflict between the commitment to care and that to run the health service efficiently. The two objectives are designed to achieve the same end. If one wants to deliver a caring service one will deliver a better caring service if one manages it efficiently and uses the resources committed to it by the taxpayer to the maximum possible extent. The alternative is to tolerate waste; to see taxpayers' money go off hospital sites in skips. We are opposed to that. We are committed to using the resources available to the health service to treat the maximum number of patients and to offer them the highest possible quality of health care.

The inescapable conclusions from studying the management practice in large organisations, including the health service, in the past 40 years is that management is best carried out as close as possible to the chalk face. That is why we are committed to provide the opportunity afforded by trust status and to grant it to those health care units that seek it, where they can show that they will use the freedoms that that status involves. The motivation behind the introduction of trust status is the desire to localise management and to create a greater sense of ownership and pride in the service delivered. My hon. Friends are right to emphasise that that status operates within the NHS.

Earlier this week I debated the management of the health service with Mr. Bruce Kent. He took to task a nurse from Guy's hospital who interrupted him to say that those at the hospital were improving the quality of the health care they delivered. Mr. Kent replied that the nurse was wrong to talk about the staff improving the quality of health care. He sought to represent trust status as an invention of the management. That nurse was absolutely right. Trust status engenders in staff a sense of pride and commitment to the service delivered. It is precisely for that reason that trust status will be a more successful means of managing the health service. It is the blinkered approach typified by Mr. Kent's response to the nurse that we want to eliminate from the NHS.

What are the people in the new trust for Basildon and Thurrock, be they the managers, doctors, nurses or porters, committed to do? I can do no better than to quote from the trust application document. My hon. Friends' constituents should be aware of the exact commitment made by those who are to manage the trust once it is established on 1 April 1992. All those working within the trust are committed to: Reduce waiting lists and waiting times. It will seek to ensure that all priority patients are treated within three months and that nobody should wait more than twelve months for treatment. To help achieve this, the proposed Trust would aim to give all patients a date for admission to hospital when first placed on the waiting list. That is an important assurance and it stands four-square with the patients charter that we published earlier this week.

The second commitment from the trust states that it will Complete the agreed building works to bring all Maternity and Gynaecology services together on the same site as Intensive Care for newborn babies and the Special Care Baby Unit at Basildon Hospital. The trust also makes a commitment to Develop a purpose built ward for Day Surgery at Orsett Hospital. That means that the trust will be able to improve on the successful record for day surgery that the hospitals established in the past 10 years and to which I referred earlier.

The hospitals that are the subject of the trust status already offer a record of success. The trust status will ensure that that record of success continues into the life of the next Conservative Government and the one after, just as we established that record during the lifetime of the previous three Conservative Governments.

Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.