§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dowd.]
2.32 pm§ Mr. John M. Taylor (Solihull)I am naturally pleased to have been able to secure this debate on behalf of my constituents. I am also pleased that the debate will be answered by the Parliamentary Under-Secretary of State for Health, a man and a Minister whom I admire. He and I have had our exchanges across the Floor of the House from one polarity to another.
I should explain that while my constituency has the same name as the borough of Solihull—which, incidentally, is coterminous with the health authority—I represent only half of the borough by population, and rather less than half by area. The other Solihull constituency, Meriden, which together with mine makes up the entirety of the borough, is represented by my hon. Friend and colleague the Member for Meriden (Mrs. Spelman). Her diary of constituency engagements for today was already full when I learnt last week that I had been successful in securing this Adjournment debate.
My hon. Friend regrets that she cannot be here, but I want the House to know how keenly she feels about health services in the borough. I shall see her tonight at a meeting about Solihull hospital and let her know what the Minister has to say. Meanwhile, I have shared with her the essence of what I shall say this afternoon and likewise advised the Minister in advance so that he can give a properly considered reply in the expectation, naturally, that I will share it with my constituents.
I should make it clear that I have no personal medical expertise. My standing, other than the humbly important one of being their Member of Parliament, representing them in the matter of public services in Solihull, is the same as my constituents'. I am, like them, at all times a potential patient. There are just two interests that it may be prudent for me to declare: I am a BUPA policy holder and I have been chairman—unpaid—of the Solihull Institute for Medical Training and Research.
The House will not be surprised if I say that in anticipation of this debate I sought observations from the principal bodies charged by statute with providing, administering and monitoring health services in Solihull. They have been most helpful to me. I shall quote from them from time to time in the 15 minutes or so at my disposal, but I shall quote selectively. I could not say all that they have said to me, anyway. The responsibility for my remarks today rests entirely with me. I seek to speak to the House and the Minister about the anxieties of my constituents, their perceptions and their needs for reassurance.
I shall start with Solihull health authority, which has recently undertaken a major restructuring of its management, resulting in savings of nearly 30 per cent. of management costs in the past two years. It is now a small, highly focused health authority that might be regarded as a model for future health authority reorganisation.
For learning disabilities Solihull was funded on crude population, but it is now funded on a mental illness formula that involves a reduction of 19 per cent. for 1423 1998–99. Would it be possible for funding formulae to be needs-weighted, relating specifically to each broad service area?
The high number of GP fundholding practices in Solihull leads to concern within the practices that there should be a smooth transition to the primary care groups, without the creation of unnecessary upheaval and loss of morale. How can those practices be reassured?
Solihull healthcare trust would say that its three main concerns are, first, the need to find £900,000 cost reduction in 1999–2000, on top of a current £1.4 million reduction; secondly, the future of Solihull health authority in the light of the White Paper; and thirdly, the health authority's ability to maintain existing funding for mental health services.
The community health council has at least four concerns—the maintaining of accident and emergency services at Solihull hospital; mental health services—again—at the healthcare trust; community dental services; and the absence of clarity about the future role of community health councils in the White Paper.
Now, in no particular order, except that I am keeping the NHS hospital till last, I come to some observations from the BUPA Parkway hospital in Solihull. It asks to what extent the NHS, nationally and locally, has taken up the Secretary of State's recommendation that it work in partnership with the private sector to minimise the impact of the expected crisis in medical admissions this winter. In particular, is it being borne in mind that every self-funding or insured patient admitted to the private sector represents a free bed for a less fortunate patient? The private sector has an excess capacity in beds, as the majority of its work consists of day cases. Those beds can be made available at marginal rates and represent a cost-effective way of reducing the length of stay for surgical patients in NHS hospitals, allowing NHS trusts to carry out high-tech surgery and the private sector to take charge of the low-tech recovery phase. In some areas, the private sector can be cheaper than the NHS—for example, its physiotherapy rates for general practitioner fundholders are approximately £2 an hour less than those in the NHS.
Does the Minister have any figures on the income received from the abolition of tax relief on private medical insurance for the over-60s versus the cost to the Department of Health of providing services to those over-60s who are now the responsibility of the NHS? Has the NHS received any of the extra notional income from the abolition of tax relief? Finally, would the Minister care to comment on the Heartlands-Solihull merger, and what lessons might be learnt for the future mergers proposed or anticipated in the White Paper?
The Solihull Council for Voluntary Service—to which I pay tribute—has said:
One knock-on effect of Solihull being a borough with a "manageable' population is that it becomes easier for staff in public and voluntary organisations to have close working relationships. There are, for example, excellent working arrangements between Solihull Healthcare NHS Trust and a range of voluntary organisations including Bereavement Counselling Service, Cancer Support Group, Crossroads and the Stroke Association. Although it is not automatically the case, such working relationships are likely to be less strong in larger population areas.Similarly, the fact that there are co-terminous boundaries for the Health Authority and the Local Authority greatly assists co-operation between health services, education and social services.1424 Having said those things, there will clearly be many cases where economies of scale are such that Solihull itself cannot provide certain specialist health services. However, as access to those services can be bought in through existing contractual arrangements, it would not seem to follow automatically that Solihull needs to be part of larger organisational arrangements as a whole.I turn next to the Solihull station of the West Midlands ambulance service, which has a good story to tell. In particular, it recognises that the nature of accident and emergency facilities at Solihull hospital requires a high proportion of patients—typically 60 to 65 per cent. in any month—to be transported to hospitals outside the borough. West Midlands ambulance service has positioned resources that have enabled response standards to be improved significantly during the past two years. Regular communications with Solihull health authority, Solihull metropolitan borough council and the community health council have built a joint understanding of needs and how they are best met.
I must add that I find it a little difficult to reconcile the comments of the ambulance service regarding accident and emergency at Solihull hospital with the statements by the Minister of State, Department of Health, the hon. Member for Darlington (Mr. Milburn), in his letter to me of 2 February 1998. However, I shall return to that matter by way of written questions or correspondence—or both if necessary.
That brings me to my conclusion, which must focus on Solihull hospital in the context of Birmingham Heartlands and Solihull NHS trust. Before I do so, I must dwell for a moment on the merits of co-terminosity—it is an awful word, but it has provident meaning. A not inconsiderable number of agencies, statutory bodies and voluntary organisations respond to the concept, culture, boundaries and identity of a place called Solihull. They relate to each other within that understanding. Solihull is also a magistrates jurisdiction, for instance. It is a unitary authority for local government purposes. Surely it has a critical mass with a population of more than 200,000. The Government should disturb those relatable communities only if they are absolutely sure that some good will come to the people, in this case my constituents.
I conclude by referring to the NHS hospital. It is a magnificent state-of-the-art building to which has been added recently a renal dialysis unit; ophthalmology services, including cataract surgery; magnetic resonance imaging—MRI—scanning; and other specialist out-patient services, such as treatment for diabetes.
The real issue is, and has always been, not just what further services we might expect at Solihull, important as they may be—orthopaedic services, perhaps—but what the Minister can say to my constituents about the scope and future security of accident and emergency services at Solihull hospital. My constituents want to hear about those services and, in particular, services for children.
§ The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)I congratulate the hon. Member for Solihull (Mr. Taylor) on securing time to debate a subject which I know is of importance to him and his constituents, and to which he brings a depth of knowledge, experience, wisdom and a commitment to the totality of health services in his constituency.
1425 In November, the hon. Gentleman asked me whether Ministers had any plans to visit Solihull to see at first hand the health services provided. I explained at the time that I had a commitment to visit the Birmingham Heartlands and Solihull NHS trust, which I fulfilled last Friday. I was enormously impressed by the professionalism of the staff to whom I was introduced. I had the pleasure of presenting an award to the nurses of ward 19 of Solihull hospital for their introduction of a new, non-invasive ventilation system for patients.
It would seem that the people of Solihull have firm grounds for confidence in the care that is available to them at the Solihull branch of the Heartlands and Solihull NHS trust. I say branch because one of the attractive things about that trust is the way in which two branches, two different sites, make one hospital. That was at the heart of the reorganisation of health services in the area, and the arrangement seems to be working extremely well.
In the past, I know that there was, as there inevitably is when two hospitals come together, a degree of uncertainty and concern on the part of the hon. Gentleman and his constituents about the merger. That merger took place during the previous Conservative Government of which the hon. Gentleman was a distinguished member.
When the brand new hospital opened in 1994, the people of Solihull were almost immediately presented with the threat of its closure due to a combination of financial and emerging clinical difficulties and the possible withdrawal of accreditation by the Royal College of Physicians for some senior house officer training posts. The hon. Gentleman knows all about the Save Solihull hospital campaign which followed.
The solution that was finally implemented after the report of a project group commissioned by the West Midlands regional health authority was a merger with Birmingham Heartlands, in accordance with the philosophy of one hospital on two sites. That provided for the protection of patient services, allowed for staff rotation to allow the culture of excellence to be spread, and ensured cover for smaller specialties. The reduction in management costs and the sharing of support services that resulted helped to eliminate Solihull hospital's financial deficit.
It would be helpful if I spoke about the improvement in services since the merger, because although it was accepted that the outcome of the merger was ultimately a reasonable one, local people had some understandable reservations about the perceived loss of identity to their local services.
The hon. Gentleman put great store on the distinct and unique identity of Solihull hospital. Some were concerned that they would be referred to Birmingham for treatments of any significance. I am glad to say—the hon. Gentleman will acknowledge this—that that did not prove to be the case.
Both the quantity and the quality of hospital health care provision have increased since the merger with Birmingham Heartlands in April 1996. Solihull hospital experienced many improvements after the merger. These include 24,000 more patients treated per year; the development of new patient services at Solihull, such as a £700,000 renal dialysis unit—during my visit to Heartlands and Solihull, I met staff who worked in and were responsible for the unit; a £500,000 ophthalmology unit and a £750,000 dedicated day procedures unit; 1426 the expansion of specialist services with clinics for paediatrics, diabetes, and vascular and thoracic surgery; the integration of planning for obstetrics and gynaecology services at both hospital sites within purpose-built women's units, providing the latest in medical expertise and technology; and the installation of a new £1.2 million MRI scanner, built and funded with the co-operation of the trust and the public.
As the hon. Gentleman knows, the list is longer still, and the improvements in services were very much part of his speech. The point is that Solihull hospital has flourished since the merger. In a written reply to the hon. Gentleman in November, we provided him with an extensive list of the full range of services available at Solihull. It is a quality service. The standard is high, and the reasons for that are clear to see: investment, the dedication of staff, and the confidence of patients.
The performance of the trust has been outstanding. It has increased its number of five-star wards in the NHS league tables from two, three years ago, to 37 in the latest edition. At the same time, waiting times have been kept consistently low, with only 13 people waiting more than 12 months for admission at the end of December.
The hon. Gentleman is concerned about accident and emergency services at Solihull. He knows that the previous Minister of State made it a condition of the merger with Heartlands that a 24-hour A and E service would continue to be provided at Solihull. The hon. Gentleman also knows that, despite the political backing for the continuation of that service, the Royal College of Surgeons took a close look last year at its approval for training accreditation of senior house officers for A and E. I hope that he will agree that the Royal College is, of course, completely independent of Government. It had every right to examine its legitimate concerns for the provision of a safe and effective service, and to ensure that the quality of training for its juniors was adequate.
Despite its concerns, the Royal College reached agreement last autumn with the Birmingham Heartlands and Solihull NHS trust on a way for the full A and E service at Solihull to continue. Training accreditation was confirmed until 31 July 1998, from which time the Royal College agreed in principle a pilot training programme involving A and E at Solihull, which would establish how recognition could be maintained in the merged trust configuration. I understand that negotiations on the training of junior doctors are still in progress with the Royal College. I wish them well.
As for the longer-term future, I am afraid that I cannot in good conscience provide the hon. Gentleman with any guarantees. The NHS is inevitably and rightly a constantly changing environment, and adaptation to that change, though sometimes difficult, is a necessity. In the circumstances, it would be rash for me to speculate about the future for Solihull hospital, or any other unit in the health service. As I have already said, I have confidence in the trust, its chairman and chief executive, with whom I have discussed these issues.
§ Mr. John M. TaylorWill the Minister make it clear that, as he cannot see into the future or give guarantees, Solihull hospital is no different in that respect from any other hospital?
§ Mr. BoatengI am happy to clarify that. I cannot see into the future. The NHS is a constantly changing 1427 environment and it must adapt to changes in circumstances. That applies to all units of the health service. One of the matters that affect the future of A and E at Solihull is the negotiations with the Royal College. They are clearly of utmost importance, which is why I wanted to make it clear in the debate that I want those negotiations to reach a satisfactory conclusions and I wish them well. I cannot, however, determine their outcome. That is a matter for a totally independent body—the Royal College.
I know that the staff are first rate and that the chairman and chief executive have my full confidence and that of the staff and the local community in the service that they seek to provide.
In the remaining minutes, I want to pay tribute to the contribution of the other trust in Solihull, the Solihull Healthcare NHS trust. It, too, has attained a level of excellence that is reflected in the achievement of two five-star awards for short out-patient waiting times. The trust provides learning disability, mental health and community health services to a population of more than 200,000. The trust has a reputation for providing good quality services.
I note the hon. Member's concern about funding for mental health services. That must be a matter for Solihull health authority. Increasing the resources available for one part of the health service inevitably has an impact on another part. Local people will have an opportunity to influence this decision and contribute to the debate and the decision-making processes, as one would expect. There will be renewed debate when the health authority publishes its commissioning intentions each year.
The hon. Gentleman brought up the issue of needs-weighted allocation formulae. We are committed to a fully needs-based approach to resource allocation. Changes to the weighted capitation formula for the 1998–99 health authority allocations were recommended by the national resource allocation group. On the basis of the available evidence, the RAG recommended that we should apply the current psychiatric needs weightings to services for people with learning disabilities. The RAG also recommended that the blocks of expenditure for administration and other hospital services should be weighted for need.
1428 We made those changes as part of our commitment to making the distribution of resources fairer. That is in support of our objectives of reducing both inequities in access to health services and inequalities in health.
The health authority recovery plan has required the working up of a recovery strategy, which has been carefully implemented, but it will obviously have a knock-on effect on the level of health services in the Solihull area that can be afforded. I am satisfied that the health authority is making every effort to ensure that the effects of that financial recovery on service provision are appropriate, and I know that it hopes to appoint a new chief executive soon to assist it in the process.
The health authority has made very significant progress in reducing its management costs and in developing a constructive and energetic GP commissioning council, which will be able to spearhead the developments proposed in our White Paper. I hope that the GP fundholders in Solihull, to whom the hon. Gentleman referred, will work closely with the commissioning council to help ensure the smooth transition for which he wished.
The Secretary of State has made the position clear in terms of the private sector. It is for the local health authority, the trust and other local bodies to decide the most effective pattern of services and how those should be delivered. That will normally be achieved by making the best use of NHS facilities, which is what we have encouraged in our 1998–99 planning guidance. However, it is a matter for them how they apply the resources at their disposal—and I have no doubt that they will take seriously what the hon. Gentleman has said.
I am grateful to the hon. Gentleman for raising those important issues. I hear what he says about private medical insurance premiums, but let us be in no doubt about the fact that we have enormously assisted by diverting the resources from the previous tax reliefs to reducing VAT on fuel. That helps the most vulnerable, including the elderly.
In terms of the resources available to it, the NHS has been massively improved by the additional spending that the Government have provided—an additional £1.2 billion, not to mention the extra money for winter pressures, which has been well used in the hon. Gentleman's constituency.
§ Question put and agreed to.
§ Adjourned accordingly at Three o'clock.