§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Pope.]8.28 pm
§ Mr. Simon Burns (West Chelmsford)
I am delighted to have the opportunity to discuss the situation in the health service in north Essex, particularly in my constituency in the mid-Essex part of north Essex.
My constituents and I are justifiably proud of the fantastic health service that we have in mid-Essex. More than 60 per cent. of patients are members of fundholding practices. There are two main hospitals in my constituency—St. John's hospital and Broomfield hospital—which are staffed by excellent consultants, doctors and nurses, as well as some very good administrators who try to streamline their operations so that the maximum amount of money available can be spent on providing health care to my constituents rather than on excessive bureaucracy. The way in which all those staff look after my constituents is second to none, and deserves the highest commendation.
Over the past 10 years, we have witnessed the provision of successful health care and improvements in the services available to my constituents. Until the past decade or so, far too many of my constituents and others in north Essex had to travel to London or up to Addenbrooke's in Cambridge for specialist services. That obviously caused discomfort, not to mention expense, to the patients who had to travel for treatment, and to their family and friends who wanted to visit them while they were receiving treatment.
In the past 10 years, a plethora of enhanced services and new services has come to Broomfield hospital in particular so as to minimise that movement of patients down to London or outside the region for specialist care. The nationally famous burns and plastic surgery unit is being transferred from St. Andrew's in Billericay to Broomfield in Chelmsford—a move brought about not by cuts or financial considerations, but because it is such a centre of excellence that the site at St. Andrew's in Billericay was too small and the unit needed to move to a green-field site within the Broomfield hospital area to carry on its fantastic work in new premises.
I was particularly pleased about that decision, because there was at one time a possibility that the unit would not stay within the north Essex area, but would be transferred to the M25 area towards London, which I would have regarded as a retrograde step. In the past five years, as a logical flow-through of the reforms in the health service in London, more and more services have been coming locally to areas such as north Essex to serve its growing population.
We have benefited from enhanced cancer services in Chelmsford and in the constituency of my hon. Friend the Member for North Essex (Mr. Jenkin). There has been an improvement in breast cancer screening. The clinic in Chelmsford closed down for a few months last year, not for financial reasons, but because a member of staff resigned and another qualified member of staff could not be found immediately. The clinic has now reopened with an enhanced service, larger space and more staff to look after females in my constituency who need that important specialist care.
221 There has been an improvement in orthopaedics in the area. We now have our own kidney dialysis unit, thanks to the generosity of the people of mid-Essex who, through the work of Dr. Mike Weston, raised the funds to build the kidney unit which is now being run as part of the costs of the Mid-Essex Hospital Services NHS trust for the benefit of my constituents. No longer do they have to go elsewhere for kidney dialysis; they can receive treatment on the premises, close to their homes.
I am pleased to say that mental health care has also been greatly enhanced, with the building of the Linden centre on the site of Broomfield hospital, providing state-of-the-art premises with one or two secure rooms for patients who need to be looked after in more secure circumstances, rather than the old Victorian buildings that we associated with mental health care until recently.
St. John's hospital in my constituency offers primarily, although not exclusively, geriatric care, maternity care and children's services. The children's unit has been modernised, partly through the generosity of local people who raised funds a few years ago with the help of a campaign run by the local newspaper, the Essex Chronicle. Geriatric care has also been enhanced. Maternity care in the hospital is extremely good, although I am sad to have to report to the House that far too many of my constituents still complain that, despite the excellent medical care they receive when they go in to have their babies, the food at the hospital is bad. We should be able to improve the quality of food served in hospitals.
As a result of all those improvements, the service is vibrant. I am not so blinkered as to say that everything is 100 per cent. perfect. Clearly, in any service, especially one as sensitive as health care, where many thousands of patients—in-patients and out-patients—are treated every day of the year, there will be some problems and some mistakes. North Essex is not immune to that, but there is no point in harping on about the few problems that occur in such a service when, as a whole, the health care, it provides is excellent.
Regardless of whether there is a Conservative Government or a Labour Government, the occasional problem will arise and mistakes will be made, but they must be seen in the context of the vast majority of patients who receive first-rate treatment and care.
Of course, all the services cost money. Before the reforms and the establishment of the North Essex health authority, there was a serious problem in mid-Essex. Under the old North East Thames regional health authority, the Government of the day gave the regional health authority X hundred million pounds a year to distribute to the districts in its region.
It was not the Government, but the regional health authority, that determined how much money the district health authority received. That difficulty was compounded by the problems of the resource allocation working party system introduced in the late 1970s, which ran until the early 1990s. As a gross generalisation, it could be said that an affluent area with a rapidly expanding population was linked into a regional health authority with an area such as the east end of London, which had a falling population, social problems and problems of urban deprivation that do not occur in mid or north Essex.
222 Under the operation of RAWP, the east end of London, with a falling population, received a disproportionate amount of the funding each year from the North East Thames regional health authority compared with the Essex end of the region, which over the years had a significant impact on the level of funding for mid and north Essex. As long as that system operated, there was no way for them to catch up. There was a ratchet effect, and RAWP dictated how the money was be distributed.
§ Mr. Bernard Jenkin (North Essex)
I hope that I am not interrupting the detail of my hon. Friend's speech, but the situation was worse than he has described. Under RAWP, resources were allocated disproportionately to London health districts and, at the same time, money was allocated from the Thames region to other areas of the United Kingdom that had historically been underfunded. The home counties suffered a double whammy: money was squeezed from us and allocated to London, and money was squeezed from the Thames region generally. As a result, we were, by any standards, underfunded.
§ Mr. Burns
I am extremely grateful to my hon. Friend who, with his usual perspicacity, has anticipated my next point. He is absolutely right: it was a double whammy.
The situation improved in the early 1990s, when RAWP was removed and a new formula was introduced. In its dying days, the North East Thames regional health authority had the decency to admit, after many years of denial, that north Essex had suffered as a result of its distribution of Government money. From about 1993–94, the change brought genuine benefits to areas such as mid-Essex and to the constituencies of my hon. Friends the Members for Maldon and East Chelmsford (Mr. Whittingdale) and for North Essex, and to that of the hon. Member for Braintree (Mr. Hurst) and his predecessor, Lord Newton.
The new formula took into account areas with rising populations and the number of people in the district. In 1993, my hon. Friends the Members for Maldon and East Chelmsford, and for North Essex, and the former right hon. Member for Braintree, and I went to see the then Secretary of State, my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley). We explained, yet again, the problems that our areas suffered as a result of RAWP. My right hon. Friend gave a commitment that she would ensure that, as the reforms came through, areas such as mid and north Essex would begin to make up funding and narrow the gap between the money they actually received and what they would receive if the money were distributed differently.
To her credit, my right hon. Friend and her successors in the Department of Health delivered on that promise. North Essex has done extremely well in the past four financial years. The level of funding reflected the historic problems in our area—the government of the day made no bones about that. Year after year, we received significant increases in health funding over and above the rate of inflation. The gap narrowed and extra money was spent on the provision of patient care—the purpose for which it is intended.
The Government have just announced the funding allocations for next year. It does politicians no good to pick holes for the sake of it, so I say at the outset that we welcome the extra money that will be provided for health 223 care in north Essex next year. North Essex will receive £14 million, or 5.01 per cent. That is a real funding increase—given that the Government are using 2.75 per cent. as the inflation indicator—of 2.25 per cent. I hope that my maths is correct.
§ Mr. Burns
I am grateful to the hon. Gentleman for his assistance.
It would be churlish and foolish to criticise that allocation—and I have no intention of doing so. The least one can do is recognise the assistance that is being provided.
However, that does not mean that I am 100 per cent. happy with the situation. I shall not spoil my speech by beginning to carp, but I know the Minister is aware—his capable civil servants will have briefed him before the debate—that the Government have changed the formula for 1998–99. It has not changed radically—perhaps one could say that the Government have tweaked the formula. The change was forecast in a written answer to me on 8 July this year, and I was told that it would probably occur in time for 1998–99, so it comes as no surprise.
The tweaking of the formula has altered the change in needs formula and reduced the number of pay zones. That impacts on the amount of money that north Essex will receive next year. The situation is horrendously complicated, and the Minister can rest assured that I shall not rehearse the minutiae of the funding formula and its operation, which is open to interpretation. The bottom line is that, if the formula had not been tweaked this year and we had used the present formula, the North Essex health authority tells me that we would have received £1.2 million more. That money will now go to East London and The City health authority.
I do not want the debate to degenerate into a party political slanging match, but I ask the Minister, in all seriousness, to re-examine the changes that have been made to the formula. It would be unrealistic to expect the Minister to look at the operation of the formula next year and revisit those allocations. The Government have changed the formula, calculated the allocations to health authorities and announced those sums.
The Minister may argue, with some justification, that we are talking about a relatively small amount—it is small in monetary terms, but not so small in terms of health care provision next year—but if the formula continues on the same basis beyond 1999, the cumulative effect over several years could be a widening discrepancy. That is why I ask the Minister—he does not have to commit himself tonight to a final decision—to reconsider the tweaking of the formula for 1998–99 to see whether any improvements can be made in future.
The Broomfield hospital and the Mid-Essex Hospital Services NHS trust had a terrible problem last year and the year before over the thorny and difficult question of bed blocking. From my own experience, up to 1 May we heard the same old arguments: social services blamed the health trust or health authority, and the health trust or health authority blamed social services. In all too many cases, they were waiting to see who blinked first, as the one to blink first would probably pick up the bill.
It has been a problem for many years. The Department of Health is extremely concerned about it and a number of measures have been taken in the past two years to get 224 social services and health authorities to work closer together from the top down, but particularly lower down, so that there are no territorial battles, petty jealousies and so on and so that they do not try to avoid responsibility for taking decisions.
We had a serious problem. It has not gone away. The last figures that I have seen for bed blocking at Broomfield hospital is 91 beds. That is significantly more, if my memory is correct, than this time last year, when I think the figure was about 60.
The Government announce—late last week, I think—that there is an extra £300 million, which is being distributed to the health authorities and social services to help solve the problem and any crisis during the winter months. I am delighted to see that they are following the example of my right hon. Friend the Member for Charnwood (Mr. Dorrell) who, as Secretary of State for Health this time last year, and in February of this year, also provided extra money to help overcome problems with the winter crisis and bed blocking. We welcome the money that the Government have allocated to the health authority and to social services in north Essex. I genuinely hope that it helps to deal with the problems that could arise during the winter.
All of us are, of course, totally in the dark as to the extent of any problem, because by definition we do not know what the weather will be like over the next four months. I remember that the colder and more difficult it gets, the more strains and pressures are put on the health service and that a large proportion of the people affected are elderly. We welcome the money.
I shall appreciate it if the Minister will at least look at the formula again to see whether anything can be done in subsequent years to avoid the recurrence of a problem that we thought we had got rid of in 1993–94 but which seems to be coming back.
§ Mr. Alan Hurst (Braintree)
I am most grateful to the hon. Member for West Chelmsford (Mr. Burns) for securing this debate on a subject of great interest to hon. Members who represent the northern part of the county of Essex. I am also grateful to him for his historical sweep and panorama of the history of health services in the county and his skill with the abacus when trying to ascertain the precise financial calculations. It is a matter that bedevils hon. Members from north Essex.
The Government have made more funds available for the health service in north Essex. A very substantial sum, as the hon. Gentleman said, has been made available this winter to deal with what is crudely called bed blocking. That sum is now available. Indeed, very large sums are available for the coming year. The figure that I have in mind is £17.5 million for north Essex. In growth terms, £7.8 million is available for north Essex. I do not have the advantage of the instant mental arithmetic necessary to say whether those figures are right or wrong, but I am advised that they are correct.
Whatever the precise situation, the sums are very much greater than what was envisaged. Notwithstanding that, the health authority has initiated a consultation exercise entitled "Taking the Initiative". Unfortunately, many of my constituents regard that as a misnomer. The term that they would use is taking the mickey—not out of any 225 disrespect whatever for the health authority or the trusts. Up to the early part of this year, we were told that everything in the garden was rosy.
Further south than the area represented by the hon. Member for Colchester (Mr. Russell) and my hon. Friend the Member for Harwich (Mr. Henderson), things might be somewhat rosier. Indeed, the Mid-Essex Hospital Services NHS trust has spent very large sums on extending, to a very high standard—for which it is to be credited—the hospital at Broomfield. That hospital is on the north-west side of Chelmsford and is not in the Braintree, Colchester or Harwich constituencies. As a consequence, those who live in Braintree, or, indeed, other places, are now expected to go to Broomfield rather than their local hospitals. They have a much greater burden on them.
I am particularly concerned, as I represent Braintree. We have three hospitals, but one of them, Black Notley hospital, was marked for closure long before the present Government came to office. That hospital carried out elective surgery to a very high standard and was enormously popular but, unfortunately, many in my area would concede that the battle is lost. The document "Taking the Initiative" proposes that the health authority considers representations from the trust to close the remaining two hospitals—St. Michael's and, with great insensitivity, the William Julian Courtauld hospital.
The name Courtauld is probably known way beyond the confines of north Essex. The Courtauld family were very large weavers and millers in the towns of Braintree, Halstead and elsewhere up to the 1960s. They were very large employers of labour and were great benefactors to the town of Braintree. After the first world war, William Julian Courtauld donated the site, at the very least, of the William Julian Courtauld hospital. Thereafter, as I am advised by those more senior than I in the town of Braintree, the rest of the money was raised by public subscription pound for pound between the Courtaulds and those who worked for them. Hence the name William Julian Courtauld hospital.
Over the years, the William Julian Courtauld hospital has stood the town in very good stead indeed. At one time, operations and all manner of medical procedures were carried out there. It is right to say that the scope is more limited now, but many would say that it is probably one of the finest non-acute maternity hospitals in the county. Mothers who have had their children there will endlessly speak well of it, and will vehemently oppose its closure on that ground alone. What is even more ironic is that, at the beginning of this year, the Mid-Essex Hospital Services NHS trust, which now says that it cannot possibly afford to keep any of these hospitals open, spent £360,000 on the William Julian Courtauld hospital on improvements and renovations. That is less than nine months ago from the moment we speak.
The new extension was opened—proudly, with a fanfare—by the high sheriff of the county. The ceremony was attended by my predecessor, now Lord Newton. Only a few months later, however, the same health trust brought out "Taking the Initiative" —as it called it; the initiative was to close that very hospital.
I think that hon. Members can imagine the horror with which the move was regarded in Braintree. I am sure that my hon. Friend the Member for Harwich will say similar 226 things about what is proposed in Clacton. Very large public meetings have already been held in Braintree, in which the health trust has had to face its accuser—its accusers, of course, being the patients and people of Braintree.
I give the trust full marks for the courage and fortitude that enabled it to stand before 600 or 700 people, all of one mind, who say that hospitals in Braintree should be retained and people in that town should not be sent down to Broomfield—however wonderful it is—for everything that they need to go there for. Strangely enough, in the smaller print of the document that the trust chose to call "Taking the Initiative", further cuts are proposed in the transport provisions that the trust will provide.
Braintree is not a wealthy town. Many of those who live in adjoining areas inhabit small villages. Travelling to Broomfield is not an easy ride unless the traveller has a car. Travel by public transport is an expensive and time-consuming business. That will place further strain on, frequently, an elderly relative, if that person's husband or wife is in hospital recuperating after an operation.
It is accepted that serious operations will need to take place in Broomfield, but there is a great need for recuperation beds in patients' own towns and close to where they can be visited by their relatives. I say this on no medical authority and I am sure that it is not in Gray's "Anatomy", but I have no doubt that those who are close to home, visited daily by uncomplaining relatives, may mend that much faster than those who are in a strange place where their relatives are tired and irritated because the bus did not arrive or it was raining on the journey. I believe that there is a very good case—especially given the extra money that the Minister has provided for Essex—for the present services in Braintree to be retained.
Finally, I shall make a broader point that emerges from tonight's debate. It relates to the local administration of health services in the county of Essex and, I suspect, in the country as a whole. On 1 May, a different Administration were elected. I make no political point about that, but one of the crucial features of the programme of that new Administration was extra provision for health.
My colleagues in the Department have made large amounts of money available for health, but that money is now being administered by non-elected bodies, usually composed of people who are not naturally of a progressive persuasion in politics, advised by officers who may also not necessarily be of that view. There is therefore a danger that, unwittingly—I am sure that there is no deliberate intent on the part of those who serve on health trusts—such people will come into conflict with the Government.
As could be imagined, the health trust sought to justify the draconian closures that it initially proposed. It is fair to say that it has now backed off and proposes to close only one unit, although that involves taking away most of the services. It said, "We did not really mean to close them all to begin with" —but it is there in scripture: it is there in the document, for all to see.
The fear is that the trust is justifying what appears to be an absurdity. The more money it is given, the more closures must follow. It will say, "Look to your Member of Parliament to explain the answer; ask the Government why it is," but it is the Government who are providing the money and the services. 227 We should think long and hard about the future administration of health locally, and the trusts should be accountable not only to the Government who provide money, but to the residents whose wishes and needs they are there to serve.
§ 9.3 pm
§ Mr. Bernard Jenkin (North Essex)
I hope that unelected individuals who have worked long and hard for the health service will win the trust of the hon. Member for Braintree (Mr. Hurst). I realise that he may have found the early months of this Parliament somewhat bruising, given the prospect of so much change in the health service in his constituency. He laments the fact that unelected individuals may come into conflict with the Government, but that seems to show that individuals appointed by whatever party are doing their job to the best of their ability. The usual criticism of appointed individuals is that they are never prepared to come into conflict with the Government, who appointed them.
I notice a little conundrum in the hon. Gentleman's criticism, and I reiterate that people in health authorities and those who run trusts are doing a good job. They are working extremely hard for the health service, and in some respects are the unsung heroes. It is easy to pay tribute to nurses, doctors and consultants, but it is more difficult to pay tribute to administrators. They get the flak: they are down with politicians, journalists, estate agents and ad men in the public's esteem. I suggest tentatively that politicians have lumbered them with this job, so we should be grateful to them.
In particular, I should like to pay tribute to Nigel Offen, the chief executive of Essex Rivers Healthcare trust. He suffers the indignities of being in public life and is subject to public scrutiny. If he were in the private sector, he would command a considerably higher salary. He is committed to public service, and he deserves more public support from us than he gets, although I am not criticising the hon. Member for Braintree for that.
I congratulate my hon. Friend the Member for West Chelmsford (Mr. Burns) on securing this debate. It is a luxury to have such a long time to debate the north Essex health service. I pay tribute to him, because he has brought to the Chamber not only the Minister, but my hon. Friend the Member for Maldon and East Chelmsford (Mr. Whittingdale), and the hon. Members for Braintree, for Harwich (Mr. Henderson) and for Colchester (Mr. Russell). This is where decisions are made, and where it matters.
I have been critical of one or two of our Essex colleagues for attacking those who are carrying out the decisions that are made by the House instead of bringing their complaints to the Chamber. I am pleased to see that so many Essex colleagues are present, so I withdraw that criticism. They are showing their commitment to the proper political process.
§ Mr. Ivan Henderson (Harwich)
One of my criticisms of North Essex health authority concerns its finances. Its draft business plan of October 1996 showed uncommitted capital for 1997–98, but all of a sudden it was £6 million in debt. It should have shown more expertise in forward planning, and should not have left it until six months later to decide that it was £6 million in debt. I have asked the Minister's Department to look into that issue, because it 228 worries my constituents. As a result of that deficit, a review of my two local hospitals was started last April. Questions need to be asked, and we deserve answers from the health authority.
§ Mr. Jenkin
The hon. Gentleman is entitled to answers, but I am confident that, if he speaks to North Essex health authority or to the health trusts in his constituency, he will get those answers.
One of the features of NHS finance about which the Labour party was a little unsympathetic, if I can put it that way, was that NHS finance is extremely difficult to manage. One of the reasons why North Essex health authority has regularly had deficits is that Essex Rivers Healthcare hospital—the Colchester general hospital in the constituency of the hon. Member for Colchester—regularly treats far too many patients. I say that not because those patients do not need treatment, but because the hospital treats far too many in terms of its budget and forecasts. That is particularly the case in the accident and emergency department.
It is one of the unexplained phenomena of modern health care that there has been an exponential increase in the number of people who walk into accident and emergency departments every day, to the extent that, during my time as a Member of Parliament for a north Essex constituency, the number of people being treated in accident and emergency departments by Essex Rivers Healthcare has virtually doubled. That is not because more people are having twice the number of road accidents or falling down stairs; it is simply a matter of rising expectations.
The excess of capital is the result of delays in capital projects. It is something that we struggled with in government, trying to introduce the private finance initiative into the health service to maximise the use of capital. I have no doubt that the Labour Government will have similar difficulties, but I hope and pray that they will be successful.
In response to the hon. Member for Braintree, I would say that there is a general philosophy in the health service. It starts in the Department of Health; it is replicated in the management outposts, which are in effect vestiges of the old regional health authorities; and it continues throughout the whole culture of the service. That philosophy is that big is beautiful.
Big is what administrators like; big is what consultants like, because it means that they spend less time driving from hospital to hospital; and big is also what accountants like. However, as my right hon. Friend the Member for Wokingham (Mr. Redwood) discovered when he was Secretary of State for Wales, that philosophy often results in expensive readjustments to health capacity and the closure of smaller units. We should ask quite openly—the hon. Member for Harwich should pursue this with regard to the Harwich hospital—whether that is the right philosophy. If it is not, are we right to expect health trusts, which are essentially general hospitals, to deliver small-unit, local hospital care, or should we be more imaginative and find alternative methods of delivery such as GP fundholding?
Why not extend the principle of GP fundholding beds into the community? Many GP fundholding practices are hungry and ambitious to do better for their patients. They would look after day patients, or even overnight cases, 229 perhaps much more effectively and nearer patients' homes than a general hospital could. That would also free up capacity, and such practices could bring in more private capital. I do not want to get bogged down in the usual ideological arguments across the Floor of the House, but we have to be open-minded about such ideas, as they might help the hon. Members for Harwich and for Braintree.
§ Mr. Bob Russell (Colchester)
When the Minister replies, will he take due account of how the Essex Members of Parliament across the political divide are all singing the same song? Mention was made of small neighbourhood hospitals. Colchester is indeed blessed with a new hospital, for which we must thank the previous Government. My concern is that it is on a cramped site. Various arms of the national health service, which is one of the largest landowners in Colchester, are busily selling sites at the expense of the general hospital's future. If the neighbourhood hospitals in Clacton, Harwich and, indeed, Braintree were closed, it would have a serious effect on the Colchester hospital.
§ Mr. Deputy Speaker (Mr. Michael J. Martin)
Order. I remind hon. Members that interventions should be very brief, and not be speeches in themselves.
§ Mr. Jenkin
I am grateful for that admonition, Mr. Deputy Speaker. I shall take it to heart myself and be as brief as I can. The Minister heard what the hon. Member for Colchester said, and I hope that he will respond positively.
As my hon. Friend the Member for West Chelmsford said, spending pressures will have an effect across the north Essex health area, not only on the constituency of the hon. Member for Colchester but on my own constituency—thereby increasing pressure on demand for services at Colchester general hospital and, more directly, affecting residents at places such as St. Osyth and Tendring, in the east.
Those effects will be felt because, under the Government's new adjusted formula, we are still short by about £8 million. On the original formula, we would have been £19 million short.
Yesterday, I received from the Minister a written answer in which he said that it is futile to make hypothetical calculations on the basis of a formula that is no longer used. However—without getting involved in party political argument over the size of any increases—the current allocation leaves us £19 million short of what we would have received under our formula.
We have never been fully funded, and we have always complained that we were not fully funded. The depressing aspect of the matter is that we are going backwards. Whereas, over the years, we were gradually catching up in our formula allocations, the net effect of the formula change is that we are falling behind. As my hon. Friend the Member for West Chelmsford said, the Minister should re-examine the matter.
I wrote to the Secretary of State for Health to ask whether he would meet a delegation of north Essex Members to discuss the formula. In much the same way that hon. Members had constructive and non-cantankerous 230 meetings with the previous Secretary of State, my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley), we should like to have similar meetings with the new Secretary of State. Although I wrote that letter on 30 October, I have not yet had a reply to it. I know that he is a busy man. I hope, however, that the Minister will take it on board that I made the request on behalf of north Essex Members and that, eventually, we shall be able to meet the Secretary of State.
The bed blocking issue hangs over us. As my hon. Friend the Member for West Chelmsford said, we are enjoying extremely mild weather, but there is bound to be a cold snap. That is when accident and emergency departments will fill up with extra patients, and bed blocking will worsen. More beds are clogged this winter than at any time since I have been a Member of Parliament. Despite the extra money, therefore, the situation could become more serious than it has ever been before. Unless we deal with the fundamental problem of how resources are allocated, the bed blocking problem will keep recurring.
I very much welcome the debate and hope that, in the long term, we can resolve the problems. I again congratulate my hon. Friend the Member for West Chelmsford on securing the debate
§ Mr. John Whittingdale (Maldon and East Chelmsford)
It is a pleasure to follow my hon. Friend the Member for North Essex (Mr. Jenkin). Before the election, my constituency straddled two of the former health authorities in north Essex—the north-east Essex area and the mid-Essex area—and I echo his remarks about the managers who work for our local health service. He is right to say that they often do not receive the recognition that they are due. I join him in paying tribute to all the people who work for the health service, including the managers, in north Essex.
I congratulate my hon. Friend the Member for West Chelmsford (Mr. Burns) on obtaining this Adjournment debate, which is of great importance to my constituents and, of course, to all the constituents of hon. Members who have spoken. I thank my hon. Friend for allowing me to make a brief contribution. He has already described in some detail the history of underfunding that North Essex health authority has suffered. I do not want to cover the same ground that he has already gone over, but suffice it to say that—for the five years that I have been in Parliament—my hon. Friends and I have regularly banged on the doors of Health Ministers to plead the case for north Essex.
As my hon. Friends have described, the situation is not new, because north Essex has suffered from underfunding for some time. In the past, our case has been recognised, and the fact that North Essex health authority has suffered a greater shortfall in the amounts actually received compared with the target allocation has led North Essex to receive one of the biggest increases of any health authority in the country. It is for that reason that the change in the formula is so worrying to us.
I join my hon. Friend the Member for West Chelmsford in welcoming the extra money that has been provided this year, both in the allocation that has been made for health authority spending and the extra that has recently been announced to tackle the specific problem of emergency
231 admissions this winter. However, the target allocation for the health authority has been reduced as a result of the change in the formula that the Government have made. That means that north Essex can no longer look forward to increases on the same scale that it has enjoyed in the past. For that reason, North Essex health authority has really had no choice but to contemplate reductions in facilities and services.
My hon. Friends and other hon. Members have referred to some of the likely consequences of any reductions. I wish to concentrate on the specific implications for one hospital—St. Peter's hospital in Maldon in my constituency. St. Peter's is a community hospital, in that it serves people living in the district of Maldon. It has extensive out-patient facilities, as well as 58 elderly persons beds, eight general practitioner beds and a maternity unit.
All those facilities are greatly valued by the people in Maldon, which is a large district with a scattered community. In particular, those living in the Dengie peninsula are a long way from the main general hospital at Broomfield, which has already been mentioned. St. Peter's hospital is therefore essential, so that patients living in my constituency can receive treatment without having to travel an unreasonable distance.
In seeking to make savings, the Mid-Essex Hospital Services NHS trust originally put forward a proposal that would have led to the closure of St. Peter's hospital. I am pleased to say that that option has been rejected by North Essex health authority. Although it would have released some £2 million in savings if the whole closure programme had been implemented, the health authority has said that it is not a realistic option. I warmly applaud that decision, which is admirable common sense. However, there is still a proposal on the table to close the GP beds and the maternity unit at St. Peter's.
In the year to March 1997, 189 deliveries took place in the maternity unit at St. Peter's. That may not seem very many, but it must be borne in mind that the alternatives available to expectant mothers living in the Maldon district are to have their babies at home or to travel to St. John's hospital in Chelmsford. St John's hospital is some way away, particularly for those mothers in some of the more distant villages in my constituency, such as Bradwell or Tillingham.
There is also a proposal on the table that, in the long term, St. John's hospital will no longer be available. Eventually, maternity facilities may be concentrated at Broomfield hospital. The hon. Member for Braintree (Mr. Hurst) referred to the difficulties that his constituents have in reaching Broomfield, on the north-west side of Chelmsford. My constituents in the further reaches of the Maldon district will find it even more difficult. They may face journeys of up to an hour to get to the hospital.
In 1993, the Government published a document entitled, "Changing Childbirth", which stated Government policy on maternity services. The document says:Maternity services must be readily and easily accessible to all. They should be sensitive to the needs of the local population and based primarily in the community.That document was produced by the previous Government. I wrote to the Minister about that. His reply of 5 October said: 232I can confirm that the Government fully agrees with the principles of women-centred maternity care, as outlined in `Changing Childbirth'.That document still represents Government policy on maternity services. If that is to be a reality and if the Government are to meet the objective of serving the needs of the local population by basing care primarily in the community, closing St. Peter's maternity unit would be a great step backwards.
The proposal to close the maternity unit at St. Peter's has understandably led to considerable protest in the Maldon district. Two local mothers, Nicky Crisp and Caroline Anderson, have put together a campaigning organisation called MOMMS-Mothers Opposed to Maldon Maternity Shutdown. In just a few months, they have collected more than 7,000 signatures on a petition, which I hope to be able to present to the House in the near future.
I am encouraged by the assurance of the chief executive of North Essex health authority that the current consultation period is genuine and that no final decisions have been taken. I hope that that is the case, and that there is still an opportunity for the decision to close the maternity unit to be reversed. If St. Peter's is to have a long-term future, the only real solution will be money. That is why I come back to the points made by my hon. Friends the Members for West Chelmsford and for North Essex.
North Essex has enjoyed large increases in the past because of the extent to which funding has fallen short of the target level. If the Government's change to the formula means that the area can no longer look forward to the same level of increase that we have enjoyed, I am pessimistic about the future of St. Peter's. I therefore echo the appeal of my hon. Friends to the Minister to reconsider the issue, to see whether the formula can be adjusted to reflect the genuine needs of my constituents and the constituents of other hon. Members who have spoken in the debate.
§ The Minister of State, Department of Health (Mr. Alan Milburn)
I am delighted to have the opportunity to respond to the debate. I congratulate the hon. Member for West Chelmsford (Mr. Burns) on securing time for it. The fact that so many hon. Members from both sides have contributed to this full debate is indicative of the seriousness of the issues raised. I pay tribute to him.
I also support the tributes that have been paid to all national health service staff. They do an extremely good job, often in difficult circumstances and under enormous pressure.
It is especially appropriate to record our thanks at this time of year, with winter pressing. One thing is certain in the national health service—that winter inevitably brings additional pressures, not only in Essex but throughout the country. The people who will be on the front line of coping and of delivering high-quality services are the staff who work on our wards and in the community—and yes, those in the offices, too. NHS staff perform a vital function, and it is right and proper that hon. Members on both sides of the House have recorded their thanks to them.
233 I assure the hon. Member for West Chelmsford that the Government share his desire to see high-quality health care available to people in all parts of the country. He went out of his way to make the House aware of many of the developments that have taken place in and near his constituency over recent years, and clearly those developments are welcome to his constituents.
In framing our national policy as a Government, we must ensure that the same advantages that have accrued to the hon. Gentleman's constituents are available to all. As he knows, the national health service was founded on the principle that the best health care should be available to everyone on the basis of need alone; I am sure that that is a principle that all hon. Members share.
However, the national health service that the Government have inherited is not always providing the best care in all circumstances at all times. Many people within the NHS—the very members of staff whom the hon. Gentleman praised—have become increasingly concerned in recent years about some of the unfairness that has crept into the delivery of care. There are concerns about accessibility and variations in quality—and, of course, there are concerns about the fact that sometimes the NHS has become rather too burdened with unnecessary bureaucracy and red tape.
However, as the hon. Gentleman will be aware, the new Government have already taken several steps to remedy that situation. I am sure that he and others will bear with me for a moment if, before dealing with the specific situation in north Essex, I briefly mention some of those developments—not least because many of the policy developments that we have instituted over the past few months have a direct bearing on the situation facing his constituents and those of other hon. Members.
As the House will know, a wide range of action is in progress, or has already been taken, designed to replace the internal market in the NHS. Guidance has been issued to introduce common waiting lists for non-urgent cases, and to move the health service away from the market mentality that has developed in recent times towards a more co-operative approach to commissioning health services.
Management costs in the current financial year have been reduced by £100 million, and that money is being applied to front-line patient services. I noted with interest the hon. Gentleman's support for such developments in his opening remarks. I am sure that such support will be welcome both in the Department of Health and elsewhere.
Only last month, my right hon. Friend the Prime Minister announced an extra £300 million for the national health service. The hon. Member for West Chelmsford rather cheekily claimed that that followed the precedent set by the previous Secretary of State.
§ Mr. Milburn
It is true that the previous Secretary of State allocated extra cash for the winter months last year, but I must remind the hon. Gentleman that, although his right hon. Friend did that on two occasions, he allocated a total of only £25 million. Of course that money was most welcome in many constituencies, and proved a real 234 bonus for the NHS—but I must point out that it is somewhat dwarfed by the £300 million invested this year by the present Government.
§ Mr. Milburn
I will gladly check the figure—it was two tranches, one of £20 million and another of £5 million. I am happy to write to the hon. Gentleman if that is helpful.
The money that has been made available—the extra £300 million—is not just to deal with the immediate pressures of the winter, which we recognise. It will help to raise the foundations for long-term developments that will deal with some of the issues raised tonight—the problems which bedevil the delivery of services between the health and social care systems. My right hon. Friend the Secretary of State describes this as a "Berlin wall" and we are determined to break down that wall.
The people who suffer when the interface fails to deliver are the most vulnerable patients—people with mental health problems, disabled people and the elderly. We are determined to improve that situation.
My right hon. Friend the Chancellor of the Exchequer's Budget allocated an extra £1,200 million to the NHS next year, and we brought forward the allocation to the end of last month, to allow health authorities to plan over an 18-month period.
Finally on the subject of money, the hon. Member for North Essex (Mr. Jenkin) talked about the problems which have bedevilled the private finance initiative. There have been problems with the PFI, but they are problems of the past. This Government have taken decisive action to unlock the gridlock in the PFI. As a consequence, we were able to announce a few months ago an additional capital investment for the NHS, though the PFI, of £1,300 million for 14 new hospitals. Since then, we have been able to announce a new hospital to be funded through the PFI, which will be built at Greenwich.
§ Mr. Jenkin
My hon. Friends refrained from wandering down the path of party political comparisons, because we wanted to discuss a particular issue, and I hope that the Minister will not use all his time making comparisons. We could all join in that game, but that is not the point of this debate.
§ Mr. Milburn
The hon. Gentleman will be aware that I am coming to the issues in Essex, but it is important to place in context the issues that Opposition Members have raised. Many of the issues raised tonight have been questions of funding.
Since the election on 1 May, the Government have invested an extra £1,500 million in the NHS for revenue purposes, and more than £1,300 million for capital purposes. Those and other policies which we will produce in due course will enable health authorities throughout the country—including those which serve the constituencies of Opposition Members—to provide better care for everyone.
I listened with great interest to the comments of the hon. Member for West Chelmsford about the level of funding and the changes to the funding formula for next year and beyond. I listened also to his historical discourse
235 about the problems which he imagines have been endured by his part of the world. As he knows from his time at the Department, the funding formula is a fiendishly complex issue, and I thought it might be useful to him and to others if I explained briefly the three main changes to the formula we have made for the next financial year, beginning on 1 April.
First, we have extended the needs adjustment from 86 per cent. to 100 per cent. of expenditure, in line with advice that the Government received from the expert committee which served under the previous Government. Secondly, we have improved the market forces factor by reducing the number of pay zones from 61 to 51. Thirdly, we have introduced a geographical cost adjustment for the emergency ambulance service, partly in recognition of the need of shire areas. Under that element of the changes, North Essex is a gainer, and I am sure that Opposition Members will welcome that.
We are making the changes as part of our commitment to making the distribution of resources fairer, in support of our objective of reducing both inequities in access to health services and inequalities in health. The changes will not be the end of the matter.
I can give an undertaking that the Government will consider further changes to the formula. Indeed, we have established a new advisory committee on resource allocation to do specifically that. Its programme for next year will include a special focus on the market forces factor, which, as the hon. Member for West Chelmsford knows, has been the subject of much controversy in the national health service. I shall also ask the committee to consider whether the existing method of counting the population in health authority areas is accurate, as there have been some concerns about under-counting of particular groups in the population.
The changes are not the end of the matter, but they are a start. We want resources to be more fairly distributed across both primary and secondary care. For 1998–99, beginning on 1 April, every health authority in the country will receive a real—terms increase in its allocation for the delivery of local health services. There will be a minimum growth in allocation of 1.35 per cent. in real terms.
North Essex does rather better than that, receiving 2.2 per cent. in real terms. That makes it the 26th biggest gainer out of 100 health authorities. We have changed the formula, and that results in changes to health authorities' target shares. I can give an undertaking that we will move health authorities, including North Essex, to those targets over time.
There was a fundamental misunderstanding at the heart of the comments of the hon. Member for West Chelmsford, about the implications of the changes in the formula. As he knows, the matter is fiendishly complex and difficult, but it is simply not the case that North Essex has lost out, for the straightforward reason that we apportion growth according to the distance from target of health authorities as a whole. We cannot view North Essex or any other health authority in isolation. We consider the composite picture.
Certainly, if there had been a different formula, there would have been different distances from target. As a consequence, there would have been a different apportionment of growth. The hon. Member for North Essex—I think that it was him—queried my answer about hypothetical situations, but it really is impossible to 236 compare like with like in the straightforward way that he wants. Perhaps we shall have to confront that problem, but that is the nature of the formula that we have inherited from the previous Administration.
We have changed the formula and made it fairer, and North Essex is a net gainer this year, especially in comparison with other health authorities.
§ Mr. Whittingdale
I understand what the Minister is saying, but our point is that, under the previous formula, North Essex and South Essex were the two authorities furthest from target, and were, as a result, the first and second biggest gainers in allocation of funds. Because the target has been changed and North Essex is no longer the furthest away, it is now, as the Minister said, only the 26th biggest gainer, rather than the first or second.
§ Mr. Milburn
North Essex got a 2.2 per cent. real-terms increase, compared with the English average of 1.9 per cent., and I can give the hon. Gentleman the historical context.
Our allocations for next year, giving a cash increase of 5 per cent., as opposed to the 2.2 per cent. in real terms, are higher than the average for the previous five years. So, the argument that Opposition Members are advancing that somehow—[Interruption.] If the hon. Member for North Essex will calm down and resist the temptation to make the statistics squeal until they confess and look at the figures objectively, he will see that the increase of 5 per cent. for next year is bigger than the average for the previous five years. I should hope that Opposition Members would have welcomed that. It is a real benefit to his constituents and to those of other Opposition Members.
§ Mr. Burns
Of course the Minister is right, but let us look at the figure. He said "five years", and he did so for a reason, because the first year was the last year of RAWP, when the percentage cash increase was 2.7 per cent. In the remaining four years, until this year, it was between 4.5 per cent. and 6.4 per cent., and that is why the average is so high. Using the first year has brought the average down. If the Minister had given the average over the past four years, it would have been higher. Our point was that that was done to catch up because of what had happened under RAWP until 1992–93.
§ Mr. Milburn
I understand the hon. Gentleman's point—it is pretty straightforward—but, however we look at the statistics, North Essex is doing extremely well. Its growth for next year is greater than that allocated for this financial year by his Government when he was a Minister in the Department of Health. I do not want to make a party political point about that. I merely want to make it clear that the Government are committed to the fair distribution of resources, which includes looking after the needs of residents in North Essex on a fair basis, and ensuring that they have the health services they deserve.
I am aware that there has been a problem in North Essex because of the financial position of the health authority and a number of the trusts, about which several hon. Members have raised concerns. An overspend of about £6.9 million was incurred by the health authority in 1996–97. As a result, it commissioned an investigation by an external agency into its financial planning and 237 management systems. The report identified certain shortcomings, and made recommendations to remedy them.
I understand that the health authority has implemented all the recommendations in the report, and that that has added a robustness to the authority's financial position. However, I recognise, as do other hon. Members, that the authority is facing a complex set of interdependent issues.
As hon. Members know, it is simply not possible to extract one hospital or one bit of the health authority area from another. Nowadays, the national health service works increasingly as one. Indeed, my hon. Friend the Member for Braintree (Mr. Hurst) made some of those points about the flow of patients and the fact that care is delivered on a more holistic basis than it has been.
The ultimate goal is to ensure that sustainable, high-quality clinical and cost-effective services are provided in modern facilities in all parts of the country. Although the consultation to which I will refer shortly will take time, those processes should ensure that whatever solution emerges is based on informed debate among the public and professionals.
A further financial problem was presented by three of the trusts in North Essex, which got into trouble recently and reported significant financial deficits. Those were carried forward into the current year, but, following work carried out by the trusts, the health authority and local general practitioner representatives, they have been considerably reduced, and are expected to be eliminated completely within the next two years.
However, I have asked the NHS executive's north Thames regional office to continue to monitor the situation closely. The last thing I want is for the national health service to enter the next financial year in the parlous state in which it entered this year, with record levels of debt.
My hon. Friend the Member for Braintree and the hon. Member for Maldon and East Chelmsford (Mr. Whittingdale) referred to the consultation on the subject of changes to acute and community services in north Essex. I have listened to their concerns and the case they outline, and I am aware of the strong local feelings on the proposals. It is vital that plans for service development are determined in a democratic manner and implemented sensitively and appropriately.
However, as that consultation is still in progress, it would be inappropriate for me at present to express an opinion either on whether or not consultation has been undertaken properly, or on the substantive issues it raises. The hon. Member for West Chelmsford will be aware that, if there is an objection from one of the local community health councils, the issue will end up on Ministers' desks, and it will be for Ministers to decide. I must and will keep an open mind until then, but I have listened carefully to what has been said this evening.
I will say that it is especially important to have local accountability, which my hon. Friend the Member for Braintree mentioned. The way services are run and the way they develop must be properly in tune with local 238 needs and views, and it is extremely important that all those involved in running the NHS should remember that it is a public service. The NHS does not belong to them any more than it belongs to me; it belongs to the local community.
All those engaged in the processes of consultation and service development should take that as their yardstick. That is what the Government expect, and we will judge proposals accordingly. I can assure hon. Members that there is no fait accompli. We have a statutory responsibility to consult publicly, and we shall weigh the results both fairly and carefully.
A major challenge faced by the NHS in north Essex at present is that of managing the pressures that are always present in the health service during the winter. Those are being exacerbated in Essex by the large number of people who are waiting in hospital, despite being medically fit to be discharged—a point raised by the hon. Member for West Chelmsford. That backlog of people waiting for discharge constitutes a severe pressure on acute services.
As I said, the Government have allocated an additional £300 million to the NHS to help the services to manage winter pressures. North Essex health authority has proposals, jointly drawn up with Essex county council and the local trusts. As a consequence, I have agreed that £2.8 million will be given to North Essex health authority this winter. More than 60 per cent. of that money will be spent on social care initiatives, which should considerably alleviate the delayed discharge problems by enabling people to be discharged from hospital into more appropriate care.
I have listened extremely carefully to the concerns expressed by the hon. Member for West Chelmsford and other hon. Members this evening. This and other debates will inform the Government of the changes we will need to make to restore the NHS to a proper condition.
I give the House the assurance that those changes will be properly thought through and introduced sensitively; but changes there have to be, to ensure that local hospitals are able to provide a proper health care service in tune with our founding principles of the NHS. It is particularly important that we restore local accountability. The way services are run and the way they develop must be properly in tune with local needs and local views.
I recognise that the NHS in north Essex, like the service everywhere, is facing challenging times. The Government have recognised the problems, and have moved to help the local NHS by allocating the extra £7.8 million for the next year and the additional £2.8 million this winter. That should enable the NHS in North Essex to rise to the challenges it faces.
I share the determination of the hon. Member for West Chelmsford that high-quality treatment and care are available to the people of his area. I am sure that the trusts in North Essex and the North Essex health authority share those commitments. Whether the proposals before the public will assist that process is a matter on which I shall certainly keep an open mind. I will consider the results with great care.
Question put and agreed to.
Adjourned accordingly at six minutes to Ten o'clock.