§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jon Owen Jones.]
§ 10 pm
§ Mr. Harry Cohen (Leyton and Wanstead)
I congratulate my hon. Friend the Minister on his appointment. I know that he has considerable abilities and his appointment is well deserved, but he is in a tough job, especially after 18 years of damage to our health service by the Tories. I wish him success. I also congratulate you, Mr. Deputy Speaker, and thank Madam Speaker for granting me this debate.
In the election, the most common complaint raised by my constituents was: "Do something about Whipps Cross." [Interruption.]
§ Mr. Deputy Speaker (Mr. Michael J. Martin)
Order. Would hon. Members leave quietly? An hon. Member is addressing the House.
§ Mr. Cohen
Thank you, Mr. Deputy Speaker.
Seven to eight-hour waits in the accident and emergency department are commonplace, with regular reports of 24-hour and longer waits. The impression is that Whipps Cross resembles a war zone, and that local people fear going there. My mailbag bulges with complaints confirming the findings of a table showing that Whipps Cross was second in the whole country for complaints; last year, there were 1,170 complaints.
Local newspapers regularly catalogue the dismal stories of long waits in the A and E department for patients on trolleys in corridors. For elderly people, left without regular nourishment, medical or nursing attention, physical deterioration is rapid, with the risk of pressure sores. There should be fast-track admission for elderly patients directly referred to the hospital by their general practitioner. They should not be repeatedly queuing for admission. [Interruption.]
§ Mr. Deputy Speaker
Order. The hon. Member for Buckingham (Mr. Bercow) had better be silent. I have heard some comments from Opposition Benches. He is in an Adjournment debate on an important matter.
§ Mr. Cohen
There has recently been the tragic death of 11-year-old Neil Askew from meningitis. Among the many unsatisfactory aspects surrounding his death is the suspicion that, if he had not endured a wait of many hours before his condition was identified, and if he had been transferred to the specialist hospital more quickly, his life might have been saved.
I draw the Minister's attention in particular to the long waits for treatment, especially on trolleys, that were particularly bad last winter. To prevent a recurrence, I ask him to accept that action needs to be taken before next winter.
In addition to the unacceptably high level of complaints, two separate performance indicators point to persistent chronic under-performance at Whipps Cross. The Government's official national health service performance guide, analysed by The Guardian on 3 July 814 last year, showed Whipps Cross second from bottom of all acute hospitals in England. Most recently, the Audit Commission report said:Waiting times are a serious problem at Whipps Cross Hospital, and are the result of a combination of factors. In addition to the increasing workload and inadequate staffing levels, a shortage of specialty beds and problems with current admission policies need to be addressed.The report found that Whipps had the worst waiting times out of the 17 London and south-east accident and emergency departments that it examined.
Those three indicators show that Whipps Cross is not delivering the same quality services as comparable hospitals elsewhere. That is unfair to local people. Waiting lists for hospital treatment have slipped back to 18 months, and a recent trust report shows that they will slip further. Staff tell me that some patients are actually being kept off the waiting lists. About 14,000 people are waiting for non-emergency operations.
The community health council said:Health services in Waltham Forest are worse than in other areas.For example, elderly patients currently have to wait six to nine months for a hearing aid as priority is given to the dying and the over-90s.
Some of the elderly acute wards are in a dreadful state without adequate toilet and washing facilities. The majority of those who die do so in ordinary wards, where the level of palliative care is inadequate.
Whipps Cross hospital is in deep financial crisis. Forest Healthcare NHS trust and Redbridge and Waltham Forest health authority, which are responsible for that, are in a financial mess. On 7 May, a report on the deficit said that thehealth authority is in a position where it has an underlying recurrent deficit of £3 million … It could be exposed to a £6.5 million deficit".The trust overspent by about £4 million.
On top of that, a £10 million reduction to Redbridge and Waltham Forest is proposed in the latest unfair funding formula adopted under the Tories. Last week's Wanstead and Woodford Guardian and Waltham Forest Guardian reported a "£20 million black hole" in health finances, quoting David Avis, the health authority's director of finance. The Ilford Recorder lists £13.1 million of debts on the health authority's loans.
I and fellow Members of Parliament for the area, some of whom wish to catch your eye, Mr. Deputy Speaker, have met local health officials month after month and year after year, only to be told that things are under control and getting better. Only Nick Leeson could believe that.
The management is in a state of permanent crisis. The top managers are not on top of the situation, and are disinclined to take responsibility. Middle managers struggle to cope with costly, repeated reorganisations. Some staff have had to apply three times in three years for their own jobs. Expensive outside consultants have been used, but their recommendations have not always been implemented, and then new consultants are appointed.
The trade union talks of "destabilisation" of the work force, which puts the blame on the staff who have left and creates a climate of fear so that employees cannot speak their mind. The hospital staff, to whom I pay tribute for keeping the service going in awful circumstances, have been treated unfairly. Their morale is at rock bottom.
815 The privatisation contract with Tarmac Servicemaster, for cleaning, portering, transport and switchboard services, has been disastrous. There has been a failure properly to appreciate basic hospital hygiene. For example, initially one mop was used to clean toilets, wards, treatment rooms, sluices and kitchens—what a risk of cross-infection and MRSA, or methicillin-resistant staphylococcus aureus. This is the madness of privatisation, which ends up costing a lot more. I have photographs to pass to the Minister showing the shambles of that contract.
New Labour's election promise was that the internal market will go and that 100,000 more patients will be treated by cutting £100 million from the bureaucracy budget. We will also act on the scandal of long waits on trolleys. From the case that I have outlined, I am sure that the Minister will agree that Whipps Cross sorely needs the benefit of that programme.
There are huge funding deficits in the health authorities and trusts across London. I ask the Minister to re-examine swiftly the capitation formula, of which a quarter is not weighted for deprivation. A full weighting for deprivation is recommended by the Select Committee on Health, and by the King's Fund. Out of 402 boroughs, Waltham Forest is 23rd from the bottom and Redbridge is in the bottom third, according to the Jarman indicators of deprivation.
The health authority and the trust have adopted a joint strategic change programme with transitional funding of £4.4 million, dependent on cash efficiency savings of £3.7 million being achieved. Because of the scale of the deficit, however, the programme will simply spread the debts and cuts over a number of years. As the Audit Commission confirmed, new disinvestments—many of which are desperately short-term—will exacerbate the appalling problem of delays in the accident and emergency ward.
A recent trust report on acute services recommended a reduction of 183 posts and 27 beds, and downsizing theatre sessions by 10 per cent. On 7 May, Lister ward—the female surgical ward—closed, despite the trust's assurances in April to the Waltham Forest Guardian that no changes would be made in the 1997–98 financial year. Cost-effective programmes, such as interim care, have been abandoned, and have resulted in higher readmission levels. Quality of care, best practice and good ideas have been jeopardised.
Currently available money could be better spent, and wasteful spending on inefficient private contractors and consultants must be ended. The joint strategic change programme must be drastically improved, because it is currently the only game in town. The local health authority and trust managements have failed to take effective action and assume responsibility for the various on-going crises and for the overall crisis.
Department of Health monitoring and support is necessary. I ask the Minister to scrutinise and reorganise the structure and personnel of the trust and the health authority. There should be local authority staff representation.
The health authority and the trust have failed to agree on this year's contracts, in which there is a £6.5 million gap. Redbridge and Waltham Forest health authority costs more than £4.8 million per annum, primarily in managing 816 the internal market. That sum could be slimmed down considerably, in line with Labour policy. Management of patient care is our primary objective.
Help is also required in recruiting key staff—particularly A and E consultants, nurses and midwives—to work at Whipps Cross hospital. The Government could play a role in reshaping funding, and in encouraging staff to go where they are most needed.
I am confident that the Minister agrees that there must be widespread and sustained improvement at Whipps Cross hospital. Its users—my constituents—deserve better, and I am sure that they will benefit from Labour's new health policies.
§ Mr. Mike Gapes (Ilford, South)
I welcome you, Mr. Deputy Speaker, to your new position. I am also very grateful to have an opportunity to say something about Whipps Cross hospital, because many of my constituents depend on it for services in some specialisms.
Over the past five years, some of my constituents have waited 30 hours in hospital, and others have had operations cancelled several times. It is quite clear, however, that the situation facing both trusts—Forest Healthcare NHS trust, at Whipps Cross hospital; and Redbridge Healthcare NHS trust, at King George hospital, which is in my constituency and within the Redbridge and Waltham Forest health authority area—is now very serious.
My hon. Friend the Member for Leyton and Wanstead (Mr. Cohen) mentioned last week's reports in the local press. The Ilford Recorder reported a £13 million deficit, and explained the implications of that deficit for waiting times, cancelled operations and care for local people. It is perhaps ironic—given the leadership of Redbridge and Waltham Forest health authority—that, immediately after the general election, the authority announced that it had a problem and that it could not set a budget for this year until July, thereby deferring everything for two months.
It is interesting that the authority's management did not reveal the problem in April, or in any of the many meetings that we have had with them in recent months and years. They told us that us that everything was under control, and that any problems were completely the fault of the hospitals' inefficiencies.
The problems are deep-seated, and they need radical solutions—one of which will be to restructure the health authority and to clean out many of the people working for it, so that we can replace them with people who are more responsive to local communities and to the needs of my constituents and those of my hon. Friend the Member for Leyton and Wanstead.
I hope that, when he replies, the Minister will recognise the wider issues that threaten our part of north-east London, one of which is the potential knock-on consequences for Whipps Cross and King George of the closure of the accident and emergency unit at Oldchurch hospital. I believe that all those issues are linked, and that it will be disastrous for us all if the Tory closure programme for London hospitals continues. I thank my hon. Friend the Member for Leyton and Wanstead for allowing me to make this contribution.
§ Mr. Neil Gerrard (Walthamstow)
I am grateful to my hon. Friend the Member for Leyton and Wanstead (Mr. Cohen) for allowing me to take part briefly in this debate.
I have no doubt that my hon. Friend the Minister will hear from many hon. Members throughout the country about problems in their local hospitals. It is, however, important to emphasise that I and all the Members of Parliament for the area around Whipps Cross—this is true irrespective of party—believe that there are particular problems in this trust and this district health authority.
I do not trust the league tables we have had over the past few years. They measure things that are measured easily, such as how long people wait before their name and address are taken in accident and emergency. On that basis, Whipps Cross meets the patients charter standard, although we know that there are immense waiting times. What the tables do not, of course, measure is quality of outcome, and there are many concerns about Whipps Cross in those terms. Whatever the league tables measure, there is something wrong when a hospital is at the bottom of every league table except the league table of complaints, in which it is up at the top.
My hon. Friends the Members for Ilford, South (Mr. Gapes) and for Leyton and Wanstead have mentioned the problem of the budget being deferred and of the deficit, so I do not want to go over that point. One of the most important points, however, for Members of Parliament has been the difficulty we have all had in trying to establish exactly what is going on. As a result of the internal market, the trust and the district health authority blame one another, and, from one meeting to the next, it is extremely difficult to pin down what has happened to the budget. Horrendous figures suddenly appear about which we have not been told before.
There is a strong case for looking at the question of openness—at the way in which budgets are decided, when they are decided and how open that process is. There is no doubt about what is happening to services, irrespective of the true figures for the deficit.
I know that the trust has historical problems. The original application for the trust to be set up was a disgrace. With such financial information, it would have been impossible to borrow anything from a bank, yet, on the basis of that totally inadequate information, a large chunk of national health service assets was handed over to the trust. I also believe that creating a trust covering not just a hospital but all the services in the area was a big mistake. All that is history, but it has left the present management, who are making serious efforts to address the problems, with an impossible job.
I ask the Minister, when he looks at solutions for the hospital and at the review of the health service in London, to consider special assistance, particularly special management assistance, for trusts that are having such problems.
I heard yesterday that my hon. Friend the Minister for School Standards has decided that one of the schools in the Waltham Forest area should be on the list of those that are to be the subject of special measures. For most of my constituents, putting Whipps Cross hospital rather than a very small school on such a list would be of far greater interest. We need to consider how we can take hold of hospitals, trusts and district health authorities that 818 are clearly failing their communities, and do something to turn them around. On that there would be unanimous support from local Members of Parliament.
§ The Minister of State, Department of Health (Mr. Alan Milburn)
It is a pleasure to reply to the debate, and to congratulate you, somewhat belatedly, on taking up your new post, Mr. Deputy Speaker.
I thank my hon. Friend the Member for Leyton and Wanstead (Mr. Cohen) for his kind remarks, and the courteous way in which he presented his concerns. I know that he takes a keen interest in local health service issues, and that he and my other hon. Friends who have spoken this evening have some pressing concerns about the state of the NHS in their part of London.
What I have heard this evening is saddening, but perhaps not surprising. It shows how much needs to be done to rebuild the health service in this city and throughout the country. I was particularly pleased to hear my hon. Friend's positive comments about the service provided by the dedicated staff who work so hard at Whipps Cross hospital. The problems faced by the local health service are no reflection on such people, who work tirelessly to provide patient care.
Whipps Cross is not alone in facing such difficulties. I know from the discussion that I have had with many colleagues during my brief time as a Minister that such problems are repeated all too often in hospitals up and down the country. The legacy that we inherit is profoundly challenging.
As my hon. Friend took us through the litany of problems at Whipps Cross, I was struck by two trends in his remarks: the unnecessary pain and suffering caused to vulnerable individuals by problems in the national health service, and the extent to which improving the situation finds common ground with our manifesto commitments for restoring our national health service and the work that we have already started to put things right.
I appreciate my hon. Friend's serious concern about the financial plight of Forest Healthcare NHS trust. Despite the staffing reductions that he described, and other measures to contain costs and improve efficiency, it is a real concern that the trust is ending the financial year 1996–97 with a forecast £4.4 million deficit. Of equal concern is the continuing gap between the trust and the health authority in the current financial year.
A joint strategic change programme has been agreed between the trust and the health authority to redress the deficit over two years. The plan includes further efficiencies and cost reductions, but it is not all bad news. For example, there are programmes in place to improve accident and emergency services by recruiting additional consultants. Plans are in train to deal with the frail elderly population when they enter hospital. I hope that my hon. Friend will welcome those developments.
The quality and timeliness of the care delivered to patients are crucial. I hope that my hon. Friend will take some reassurance from the fact that improvements in 819 patient quality standards are a declared principle of the Government—a principle shared with the programme being implemented by the trust. I shall ensure that the NHS executive monitors progress on the programme extremely carefully.
§ Mr. Iain Duncan Smith (Chingford and Woodford Green)
I apologise to the hon. Member for Leyton and Wanstead (Mr. Cohen), but I should like to make a very brief intervention on a non-party political basis as one of the Members for the area who uses Whipps Cross hospital.
I associate myself with the request of the hon. Member for Walthamstow (Mr. Gerrard) that the executive examine the problem. Before the election, I had conversations with the Minister's predecessor about this. If he could ensure that and publish the results, at least to establish some confidence locally that things are being done, it would help tremendously to improve relations with local people.
§ Mr. Milburn
The hon. Gentleman raises a pressing point about local confidence. As my hon. Friend the Member for Leyton and Wanstead made clear, there are many real concerns in the community, particularly after what happened last winter. I intend to keep a close eye on developments, particularly the implementation of the change programme which I shall ask the NHS executive to undertake on my behalf.
I understand that financial management has been a weakness within the trust. I hope that it is now being addressed seriously by the new director of finance, who was appointed about eight months ago.
A major challenge for Forest Healthcare, and for the NHS, is to meet the demand for emergency care, while at the same time reducing waiting lists for planned operations. At times, Whipps Cross was stretched to the limit last winter, as my hon. Friend graphically illustrated.
I appreciate the call from various quarters, including from my hon. Friend this evening, for additional resources to meet the growing demands and expectations at Whipps Cross and other hospitals. Frankly, had money not been squandered on bureaucracy and the internal market, we would not be in this position. Inevitably, it will take time for the resources to be released as we undo the damage, but in due course there will be more money for front-line patient care.
In the meantime, Forest Healthcare has established a major project to improve its ability to respond to the pressures of next winter. It has also confirmed that meeting the demand for emergency care remains a top priority, and it continues to negotiate with Redbridge and Waltham Forest health authority about the funding required to reduce waiting lists.
820 I give hon. Members on both sides of the House an undertaking that I shall keep a very close eye on developments. I hope to see satisfactory plans in place before too long to avoid the problems faced by patients last winter.
More generally, the key to rebuilding the health service is not another wholesale reform, which is the last thing the NHS needs, but taking positive, progressive steps towards ending the absurd internal market that we have put up with for far too long. We are already taking action on bureaucracy, fair waiting and ending the endless paperchase. We must make sure that a greater proportion of every pound spent on the national health service goes towards patient care rather than bureaucracy. We shall also be looking at the distribution of resources to ensure that they fully reflect local population needs and operate as fairly as possible.
I know that my hon. Friend's health authority has some concerns about the weighted capitation formula. It feels strongly that, compared with some other authorities, it is not fairly funded for the services it has to provide, when variations in local pay and prices are taken into account.
The work that the authority is putting in hand to grapple with this issue may well be useful within our overall aim of ensuring a fair and equitable distribution of resources throughout the NHS. I am sure that my hon. Friend will encourage the authority to work alongside the NHS executive in that endeavour.
In conclusion, through no fault of the doctors, nurses and other staff at Whipps Cross, who are as dedicated and devoted as everyone else who works in the NHS, the service provided by the hospital does not always live up to the standards we had in mind when we set up the NHS almost 50 years ago.
We are in the process of restoring the NHS. The problems at Whipps Cross so eloquently described by my hon. Friends speak volumes about the state of the NHS and of other hospitals in the city of London and elsewhere in the country. I assure my hon. Friends the Members for Ilford, South (Mr. Gapes) and for Walthamstow (Mr. Gerrard) that we shall release details of our planned review of London's health services in due course. We shall certainly look into the concerns that they have expressed this evening.
The changes that we intend to make to the health service will be properly thought through and tested, and will be introduced sensitively. They will ensure that hospitals such as Whipps Cross will be able to provide a proper health care service in tune with our founding principles for the NHS.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Ten o'clock.