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§ Mr. Richard Burden (Birmingham, Northfield)
I am grateful for the opportunity to raise with the House and with my hon. Friend the Minister important questions that face health services in England's second city. It is particularly appropriate that the debate takes place today, as Birmingham health authority is in the middle of a major review aimed at developing a strategic framework for health care in the city into the new millennium. In putting behind us the destructive, dog-eat-dog days of the internal market, the Government have urged health authorities to take on a strategic and visionary role. I welcome the fact that Birmingham health authority is attempting to do that and I emphasise the importance of a full partnership with the people of the city.
It is difficult to look to the future of health care in Birmingham when the legacy of the past hangs over us so much. In the last Parliament, I had several Adjournment debates on bungled reorganisations and financial scandals in the then South Birmingham health authority and West Midlands regional health authority. There were Public Accounts Committee reports on those authorities. My hon. Friend the Member for Birmingham, Selly Oak (Dr. Jones) was also very vocal on the issue. A climate of mistrust remains about any proposals for change and for the future of health care in the city. I understand that. As well as addressing my hon. Friend the Minister today, I address people in Birmingham. The time has come to put that mistrust behind us.
The services offered by health service staff in Birmingham are nationally and, in many cases, internationally renowned. The work of Birmingham Children's hospital and of the burns unit at the University Hospital Birmingham NHS trust, and that hospital's work on cancer and renal disease, are all internationally renowned. The University Hospital Birmingham NHS trust, Birmingham Women's hospital, Birmingham Children's hospital, Birmingham Heartlands hospital, the City hospital, Royal Orthopaedic hospital and Good Hope hospital are internationally and nationally renowned, and that remained the case throughout the scandals. As far as the health authority is concerned, those days of financial scandals and deficits are over. It was painful, but the problems were faced and dealt with.
Now pioneering work is being done in Birmingham on the local commissioning that forms the cornerstone of the Government's policy and is a consistent theme running through the recent White Paper and the Green Paper. Birmingham health authority, in conjunction with the voluntary sector and the city council, has recently made a bid for a health action zone.
We are getting things together in Birmingham, but our needs are still acute. The care provided by staff is second to none, but all too often it takes place in buildings and surroundings barely fit for this century, let alone the next. The last hospital built in Birmingham was Queen Elizabeth hospital. People in Birmingham sometimes think that the name refers to the present Queen, but it does not. The hospital was built in 1938.
I crossed swords with the former regional health authority on several occasions over its bungled reorganisations, but one matter about which it was right was Birmingham's major capital investment needs. 520 It estimated that about £500 million of capital investment was needed in Birmingham's health infrastructure over 12 years. We have seen between £120 million and £130 million of that so far. We still have no news about the rest.
Let us take the example of breast cancer services at the University Hospital Birmingham NHS trust. The services are first class and Calman accredited. An integrated approach is taken to breast care. However, if a woman goes for a mammogram in a hut at Selly Oak hospital and there are more patients than chairs in that hut at any one time, there is nowhere for her even to sit down. That is not appropriate in this day and age. If she needs a biopsy, that will be done the same day and she will get the results the same day. That is great, but she will probably have to sit in a corridor at what may be the most stressful and distressing time of her life. If she then needs breast surgery, she will go Queen Elizabeth hospital. She will be treated on a ward where the staff are first class, but there are simply not enough toilets for the patients.
The £200 million that the Government have made available to improve breast care is welcome. It will significantly improve radiotherapy services in the city and at the trust, but there is still a massive job to be done to tackle problems such as those that I outlined. Breast care is just one example. Many other examples could be given.
We need new investment; of that there is no doubt. We need a major programme of building refurbishment and replacement in Birmingham's hospitals. The health authority has some ideas and others have come from many quarters. I ask my hon. Friend the Minister to speak to his right hon. and hon. Friends in the Government and recognise the real needs in Birmingham.
On the framework in which any future investment will take place, I understand that the private finance initiative remains the cornerstone of major capital investments under this Government. Under the previous Government, there was one major problem with the PFI. Whatever else could be said about it, it did not produce any hospitals. At least under the new Government it is working far better.
However, the PFI can be a straitjacket to investment. In meeting investment needs not only in Birmingham but elsewhere, my hon. Friend the Minister must ensure that the needs of the service and of patients are put first and the investment framework is built around it, rather than trying to shoe-horn the needs of patients and services into a given investment framework.
Not only hospital development is important to Birmingham's health services. One of the strengths of the local health authority's review is that it places hospital development in a context and reinforces and embodies the vision in the White Paper. Unless primary care works, the rest of the health service cannot work properly or effectively. Pioneering work has already been done in Birmingham in developing locality commissioning. A multi-fund has been set up. Fundholders got together, even under the previous Government, perhaps to the embarrassment of the Conservatives, to work co-operatively and pool their resources in the interests of patients.
The problems that we face are still huge. In Birmingham, life expectancy is below the national average. We have one of the highest perinatal mortality rates in the country. We have one of the highest proportions of babies of low birth weight. We are in the 521 worst quartile for coronary heart disease. Birmingham is the seventh most deprived health district in the country. Integrated primary care and anti-poverty strategies are therefore vital. That is why I welcome the White Paper, the Green Paper and the new deal. That is why it is so important that we have a national minimum wage to tackle poverty. However, if those policies are to work, we also need to tackle the problems of the infrastructure of primary care in our city.
In the next 10 years, between 35 and 40 per cent. of general practitioners who serve the most deprived areas of our city will retire. Unless we tackle that problem, we cannot develop the type of primary care that we need in our city. The health authority, GPs and other health professionals are adopting imaginative and innovative approaches to developing primary care, but they need support. They are getting that through the White Paper and the Green Paper, but they need infrastructure support and resources.
I shall deal briefly with the way in which resources are allocated in the health service and the problems that that creates for Birmingham. Sadly, the current resource allocation formula does not meet Birmingham's needs. As I said, the city suffers from multiple deprivation. The great flaw in the resource allocation formula is that age-related need is not related to deprivation in the city.
The formulas are rather complicated, but the effect is real enough. As we know from the days of the Black report onwards, if substantial parts of the population are poor, that means lower life expectancy: people die in greater numbers before they reach old age. The current allocation formula can mean that such a city gets relatively fewer resources, rather than more. The result is that in Birmingham the health service gets about £533 per resident, which is less than many other cities and less than Kensington and Chelsea, and Westminster.
Studies undertaken by Birmingham health authority show that if the age and deprivation measures were taken into account in the same formula, the city would get an extra £17 million in resources to support its health care.
I welcome the Government's approach to the national health service. We are putting the days of the internal market behind us. The Government have shown that we are prepared to put more resources into health care and to give the NHS the priority that it needs, which is especially appropriate this year, the 50th anniversary of the NHS.
In Birmingham there is a climate of mistrust and problems from the past, but we as a city must come to terms with them. We must come to an agreement about the kind of health care that we want and how to develop it. We are making a start and looking towards a primary care-led national health service, with clear pathways to quick diagnostic treatment where that is appropriate, and stays in hospital for the necessary time, without keeping people in hospital if that is not the most suitable place for them to be. The necessary support must be provided, whether through intermediate care or home support. Where medical conditions require specialised treatment, we have the people in Birmingham who can provide that in tertiary centres in our magnificent hospital services, but the buildings are not up to scratch.
We need to develop innovative plans to take those services into the next century. We are prepared to do that, but we need support from Government. I hope that my hon. Friend the Minister will study closely what is 522 happening to the health service in Birmingham. We welcome the reviews that are taking place, but we recognise that for those reviews to result in agreement among Birmingham people and to overcome the climate of suspicion that has lasted too long, the resources must be made available to ensure that we have the primary care networks that will be vital to health services in the future, and the investment in our hospital services that Birmingham needs.
§ Dr. Lynne Jones (Birmingham, Selly Oak)
My hon. Friend is right to refer to the climate of mistrust that has developed in Birmingham whenever we consider proposals for the reconfiguration of our health services. That is largely because people feel that change is finance driven to make savings and cut hospital resources. If we are to overcome that mistrust, it is essential that the health authority brings people along with its plans. Because of the perception that private finance is the only way to get capital resources into the health services, only schemes for which private finance is obtainable will be promoted, rather than schemes that are genuinely needed. That problem must be addressed if we are to get confidence in Birmingham—
§ Mr. Burden
My hon. Friend makes an important point. The debate around private finance will go on.
It is important for my hon. Friend the Minister to hear what I am about to say, and for it to be heard outside the Chamber. The climate of mistrust is understandable, as my hon. Friend and I have acknowledged. As the debate continues, people must listen to what is being said, whether by the health authority, the trusts or the other stakeholders, rather than the worst possible construction immediately being put on every document and submission. That results in trench warfare that sends all the wrong messages to Government and does not move the health debate forward in Birmingham.
My hon. Friend the Member for Selly Oak has adopted a highly constructive and positive view of health services in the city and has worked on that for a long time. My other hon. Friends in the Birmingham group of Labour Members have also done so. It is important that, as a city, we get ourselves together, work out what we want and go for it. If we do that, I am sure that we will get support from the Government.
§ The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)
I congratulate my hon. Friend the Member for Birmingham, Northfield (Mr. Burden) on securing time to debate this very important subject. In a health authority area that encompasses seven acute trusts, two community trusts and two mental health trusts, and spends over £500 million annually on health services, it is critical that the long-term strategy for those services is robust. My hon. Friend's interest in the matter and his contribution over a number of years enormously assist us in taking forward the health interests of Birmingham constructively, as does the involvement of several of my other hon. Friends from Birmingham in the debate.
523 It is important to note that the debate—the tenor of which we got this afternoon—and the discussion are far from over. The conclusion of Birmingham health authority's recent public consultation on 2 March was an important starting point in developing a long-term strategy. The term "starting point" is probably a misnomer, because, as my hon. Friend mentioned and as anyone who takes an interest in the matter will know, there is a lively history of such reviews in Birmingham.
We must make sure that we do not end up with a bungled or botched job. That characterised the activities of the previous Government in relation to the health service in Birmingham. We must move to a sustainable and sustaining settlement of the outstanding issues.
A previous plan developed in the late 1980s, entitled "Building a Healthy Birmingham", failed because of the sheer scale of the capital investment that was required and its tendency to exclude primary care. It required an investment of £550 million, mainly for acute services, and a significant increase in acute beds. The previous Government's obsession with the market, the introduction of capital charges and the way in which health care was developed meant that the scale of the investment required became unsustainable.
My hon. Friend graphically described the need to invest in Birmingham, not least in a respect dear to this Government—the importance of ensuring that we tackle the scourge of breast cancer in a way that does not add to the suffering and pressures of those experiencing this condition. There is a need for more investment and to take forward proposals capable of commanding the support of the entire community.
The debate in Birmingham is taking place against a background of what my hon. Friend described as mistrust and suspicion, but we must look at the positive aspects. The relocation of the cramped and rundown Birmingham Children's hospital to the site of the former Birmingham general hospital—which will be completed in May 1998, and forms an investment of some £30 million—is good news and will deliver health gains.
There have been achievements in terms of the reprovisioning of the existing single-specialty hospitals on to acute hospital sites, where they would have all the clinical and support service back-up needed for modern health care. This has taken place after public consultation and—excluding the Royal Orthopaedic hospital, where special considerations applied—has been achieved with success.
The newly merged health authority in Birmingham must ensure that momentum is not lost, and it will ensure that steady development, year on year, keeps pace with the changing NHS. Birmingham health authority held a series of stakeholder conferences in June and July last year, each one based in the catchment area of one of the cities for main acute trusts. The contribution from those conferences formed part of the strategic planning which culminated in the consultation document.
The document sets out a number of choices, each reflecting an aspect of health care and looking at the effects of social deprivation on health. My hon. Friend is right to draw attention to Birmingham's specific problems. We have seen a positive change in the 524 introduction of the needs element of the weighted capitation formula. Birmingham was the eighth highest gainer in the country and is now within 0.03 per cent. of its weighted capitation target.
My hon. Friend referred to the problems associated with providing high-quality primary care and the reliance on single GP practices and aging GPs, and the retirement which inevitably follows. Those will require careful managing. Inevitably, that must take place within the key principles laid down in the White Paper. The emphasis is very much on partnership.
The days in which the NHS was bedevilled by the obsession with competition and the market, which characterised the previous Government, are over. The emphasis in the new NHS is on co-operation and collaboration. That is good news. We want to maximise care for patients and shift the focus on to the quality of care, so that excellence is guaranteed to those patients.
§ Ms Gisela Stuart (Birmingham, Edgbaston)
Will the Minister take account of the lack of GP recruitment within Birmingham? Simply saying that that "needs careful management" may not be adequate, given the tremendous need in some parts of the city—particularly around the city hospital.
§ Mr. Boateng
My hon. Friend speaks with authority on these issues, and she is right to draw the attention of those with responsibility for recruitment in Birmingham to the need to ensure that the requirements she has highlighted are taken on board.
In responding to the needs of the times, we must look at a number of models for primary care and the possible creation of ambulatory care and diagnostic centres. We must examine acute assessment, emergency admissions and intermediate care facilities for rehabilitation. The consultation document addresses those issues, which are important—particularly to the care of the elderly. We want to make sure that the lives of elderly people in Birmingham are improved in terms of their capacity to contribute actively to the community.
§ Dr. Lynne Jones
On rehabilitation services, there is a worry in Birmingham that the use of nursing homes and other facilities for care which was previously provided in hospital could lead us down a slippery slope towards charging. Will my hon. Friend assure us that the Government will reject that approach?
§ Mr. Boateng
I am anxious to make sure that we have a mixed market. We must recognise the contributions of the voluntary and private sectors, and we need to make sure that managers are innovative and prepared to look at new ways of delivering rehabilitation and recuperation. I strongly urge Birmingham health authority and the local authority to think boldly and imaginatively. They must work together to meet the needs of this vulnerable section of our society.
We have issued guidance to the health authorities as part and parcel of the White Paper principles and how we intend to implement our proposals. The integrated programme of action that we set out in "The New NHS" and those elements of the Green Paper "Our Healthier Nation" is where early progress needs to be made. That is the background against which decisions will be made about health care in Birmingham.
525 My hon. Friends will understand that it is not my place, or that of any other member of the ministerial team, to comment on the health authority's specific proposals. There may come a time when that is necessary, but it is not now. The Government expect all strategic plans to take forward the interest of patients and health and social care, and to take into account the principles outlined in the White Paper. We want to make sure that we work together in a way that puts the patient at the heart of all that we do. The primary care groups and their development are important, and we must make sure that the local authority and the health authority work ever closer together.
On a recent visit to Birmingham Heartlands, I was enormously impressed at the way in which the NHS and the local authority are working together, and the real contribution that is made by social workers and clinical professionals alike. It is in that spirit of co-operation and collaboration that we will best serve the interests of all the people of Birmingham.
I am grateful to hon. Members who have contributed to the debate, and to my hon. Friend the Member for Northfield for taking the lead in bringing this important matter to the attention of the House.