HC Deb 14 July 1999 vol 335 cc538-46

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

12.23 am
Mr. Graham Brady (Altrincham and Sale, West)

I am pleased to have the opportunity to raise an important matter in the Chamber. There seems to have been a change of personnel on the Government Front Bench, and I compliment the hon. Member for Delyn (Mr. Hanson) on attaining the position of Minister.

Mr. Gerry Steinberg (City of Durham)

Get on with it.

Mr. Brady

The hon. Member for City of Durham (Mr. Steinberg) has obviously had an enjoyable evening, but perhaps he can contain himself while we proceed with the important matters relating to the future of the health service, particularly the rather chaotic situation into which the Trafford Healthcare NHS trust—

Mr. Philip Hammond (Runnymede and Weybridge)

Does my hon. Friend agree that it is rather a chaotic situation when there is no Minister on the Front Bench to listen to such an important debate?

Mr. Brady

I entirely agree with my hon. Friend. I was under the impression that a reshuffle had already taken place on the Government Benches, and I therefore congratulated the hon. Member for Delyn.

I am delighted to see that the Minister for Public Health is now in her place. When she kindly agreed to see me with constituents of mine who work at Altrincham general hospital, representatives of Unison and the Royal College of Nursing, she was not only courteous but had clearly taken the trouble to acquaint herself well with the case, for which I am grateful.

I sought a broader title for the debate not only to raise the chaotic handling of the future of Altrincham general hospital by the Trafford Healthcare NHS trust, but to consider what the episode tells us about the realities of the NHS two years into the Labour Government's tenure—a Government who were elected on lavish promises to reduce waiting lists and to improve pay and service provision in the NHS. They promised nirvana, but they are delivering chaos and cuts.

There is constant spin about extra billions supposedly being spent in the NHS, but that spin cuts no ice with hundreds of my constituents who are waiting longer than they need for treatment. It cuts no ice with the 850 constituents who have contacted me to express their dismay at the proposed closure of wards at Altrincham general hospital.

The spin cuts no ice with the 500 people who die every year unnecessarily because they have to wait too long for heart bypass surgery, according to Mr. Ben Bridgewater, a consultant surgeon at Wythenshawe hospital, which serves many of my constituents. Nor did the Prime Minister's rather flimsy and flippant answer to me when I raised that matter in the House a few weeks ago cut any ice with local people, or those throughout Britain who are concerned about the devastating problems which result from lengthening waiting times for treatment in the NHS.

The Government's spin does nothing to alleviate the suffering of the 456,000 people who are on the waiting list for the waiting list, an increase of 84 per cent, under the Labour Government. It does nothing to alleviate the suffering of the 153,000 who are now waiting more than 26 weeks on the waiting list for the waiting list, up 115 per cent, since the Government took office.

If I can bring the matter more specifically to my region in the north-west of England, the Government's spin does nothing to help the 79,000 people there who are now on the waiting list for the waiting list. Those are the Government's own figures, showing an increase of 76 per cent, since they took office. In the north-west, 29,000 people are now waiting more than 26 weeks to get on to the waiting list. That is up a staggering 263 per cent, since the Government took office. This is a Government who promised an improvement in health services, not just for my constituents but for people across the north-west and throughout Britain.

It is a remarkable day in the history of the NHS—a milestone under the Government—when we discover that four consultants at the North Hampshire hospital have today been found to be contributing money out of their own salaries to fund another consultant post at their hospital. That does not seem to tally with what we hear repeatedly from Ministers about additional funding for the NHS.

The picture, confirmed by the NHS Confederation, which surveyed its members in May this year, is depressing. It found declining confidence amongst health authorities and trusts about their financial health. Where are the extra billions when confidence is declining in the real world of the NHS—the confidence of the real people who are trying to manage an effective service for the benefit of patients throughout Britain? The survey also found that a number of important developments would be postponed. It said that the real impact of the problems would not be felt until 2000–01.

The cost pressures identified by the confederation's members included those caused by the meeting of pay awards, drug costs and higher pension contributions, and those caused by having to increase funding for additional staff as a result of the implementation of the EU working time directive.

The confederation went on to say that the problems were recurring, and that consequently there will be a legacy of unachieved efficiency savings and ongoing recovery plans". That does not present the rosy picture that Ministers repeatedly try to paint of what the NHS is currently experiencing under Labour's stewardship. It is not by any means what the people were promised by the Government. It is a rather sorry picture.

The confederation says that the problems will be felt only in 2000–01, but in Altrincham people are already feeling the harsh realities of the NHS under Labour. The chairman of Trafford Healthcare NHS trust is a Trafford Labour councillor, one of 232 Labour councillors who have been given political appointments by the Secretary of State since 1997. Some weeks ago he presented proposals for the closure of two of the three wards at Altrincham general hospital. Before any Labour Members try to suggest that the scandal of political appointments in the NHS is a question of rebalancing the years of Tory appointments to the health service—

Mr. Jeff Ennis (Barnsley, East and Mexborough)

Hear, hear.

Mr. Brady

If the hon. Gentleman paid some attention to the figures supplied to me by the Commissioner for Public Appointments, I think that he might be a little less content. The commissioner's office tells me that of those appointed to health authorities and trusts who declare any political activity whatever, 546 declare political activity on behalf of the Labour party, while 149 declare activity on behalf of the Conservative party.

It is a scandal—what is more, it is a scandal that the Commissioner for Public Appointments has begun to recognise may have very damaging consequences for the management of NHS trusts. The commissioner's 1998–99 report—prepared by the previous commissioner, although published under the tenure of the new one—says that the trend of appointing Labour councillors to trusts and health authorities may lead to the loss of the wider management and professional skills and competencies which those holding office need to fulfil the responsibilities". That is a worrying indictment of the policy of stuffing the boards of health authorities and trusts with Labour councillors—people appointed for political reasons rather than because they have the management and professional skills and competence required for the execution of the important functions that fall to them.

A Trafford Labour councillor announced the plan to close two of the three wards at Altrincham general hospital on 10 May, one working day after local elections in the borough. Those elections were closely fought: Labour retained control of the borough council by just three seats. I suspect that the result might have been slightly different had there been proper consultation when the decision-making process was under way.

In fact, there had been no consultation at all before the announcement of ward closures. There had been no consultation with the public; the community health council had not been consulted or, indeed, informed; the trouble had not even been taken to inform Salford and Trafford health authority of the proposal. This constituted a major change in health provision for people living in Altrincham and Sale, but no one was allowed to know about it until one working day after the local elections were safely out of the way.

John Sargent, the chief executive of Trafford Healthcare NHS trust, told the chief officer of the community health council on the telephone on the day on which the closures were announced that they were needed because the Government had failed to fund the nurses' pay wards in full. One is prompted to wonder what damage the Government's recent announcements of £40,000-a-year super-nurses might cause to the health service. If the Government are not prepared to fund existing pay awards, what confidence can we have that they will fund any new proposals that they have introduced, although it is possible that they are just a gimmick and will not be brought into effect for any health service staff, meaning that they will make little difference to the provision of health services throughout the country.

I and Conservative councillors from Altrincham have joined staff at Altrincham general hospital to fight to preserve a much-loved local hospital and vital in-patient care, which is necessary for many patients with high dependency—patients who could not be cared for at home, even if the care programme were in place, which it is not.

We have pressed the health authority to insist on proper and full public consultation and to wait for the King's Fund Research Institute report, which had already been commissioned by Trafford South primary care group before the closure plans were announced. The institute's review concentrates on the whole area of provision of services for the elderly in south Trafford. It is nonsensical that the trust even contemplated going ahead with closure of important services for the elderly without waiting for the outcome of that review.

The trust, however, has continued to press for closure on the ground of supposed urgent financial need—a need that arose, it seems, a day after the local elections. That was the picture until this week. Those who occasionally question the importance of Parliament in national life may care to ponder whether there is any connection between this week's events and the fact that I had secured the debate.

Perhaps it is just coincidence, but yesterday I was informed by staff at Altrincham general hospital that the chief executive of Trafford Healthcare NHS trust was to be seconded for two years and sent to the regional executive. The supreme irony is that his brief at the regional executive is to develop a new performance assessment framework for the NHS. How would one assess the performance of Trafford Healthcare NHS trust, which has not had the decency to consult local people about a profound change in health service provision that directly affects them, and which has behaved in a manner that raises serious questions about the competence of those involved?

What are we left with if the chief executive is shunted off on to a two-year secondment? We do not know. When the provision of health care in my area is in the gravest doubt, we lose the chief executive of the NHS trust. According to the trust, we will gain an acting chief executive. We do not know who that will be. We do not know when the appointment will be made. We are left simply with more uncertainty, when what we need is someone to take a clear lead to sort out the mess in the provision of local health services.

Today, staff at Altrincham general hospital have informed me that Trafford Healthcare NHS trust has issued a statement—it did not come to me directly, but it did go to staff at the hospital, which was an improvement on earlier performance. The statement sets out the trust's decision to defer any final decision on the proposed bed closure until at least the spring of 2000". I am relieved and delighted that those of us who care about Altrincham and Sale, about the NHS and about proper health provision have won at least a stay of execution, but I say emphatically: Altrincham and Sale needs its hospital not just until next year, but for good. There is a real need in the area for in-patient facilities. There is a need for such facilities to benefit high-dependency patients who cannot be cared for at home. There is a need for them to provide respite care. My constituency needs hospital beds, not sham provision—undelivered promises—of community services.

If I may, I should like to give the Minister a warning. In 1997, the Labour party did not promise the British people increased waiting lists, ward and hospital closures, or massive politicisation of the national health service. They did not promise people in my constituency, or anywhere else, that they would reduce resources and close facilities. Although the Government talk about new billions supposedly being made available for the national health service, they only run down our health service. If they continue doing so, they will pay the price.

12.40 am
The Minister for Public Health (Ms Tessa Jo well)

Form says that I should congratulate the hon. Member for Altrincham and Sale, West (Mr. Brady) on securing this Adjournment debate, but I think that his constituents will judge whether he has used the time available to him as they would wish. He has spent most of the time available launching a rather cheap and unpleasant attack on national health service staff and a campaign of general smear and innuendo.

I met the hon. Gentleman, and two nurses working at the hospital, to discuss what I took to be his real concerns about the future of his hospital, and we had a useful and productive discussion—which stands in marked contrast to his speech today. Nevertheless, in the time available to me, I shall try to deal with some points of substance, rather than the political smear in which he indulged.

The Government have backed up our commitment to the national health service with a real increase in resources. In our first two years in office, we provided for the NHS an extra £2.25 billion, which has allowed an unprecedented number of extra patients to be treated. This year is the first following the comprehensive spending review. As we announced in July 1998, in the next three years, £21 billion extra will be made available to the NHS. Consequently, in England, NHS expenditure will rise by 5.1 per cent.

Mr. Brady

Waiting lists will rise.

Ms Jowell

I shall address the issue of waiting lists later.

In Salford and Trafford, in the current financial year, the unified allocation is £310 million, representing a £19.5 million—6.72 per cent—cash increase. I should be very interested to hear from the hon. Gentleman if his constituents ever received such an increase when the previous Government were in office.

Mr. Brady

Will the right hon. Lady give way?

Ms Jowell

Let me finish this point.

Those resources will allow the NHS locally to treat steadily increasing numbers of people, meet the pay awards for doctors and nurses, and begin the modernisation process that all of us—Ministers, doctors, nurses, other staff, patients, managers and members of the public—so badly want to see.

Mr. Brady

If all that is true, is the right hon. Lady able to say why the Trafford Healthcare NHS trust should suddenly be in financial crisis? Will she also comment on the trust chief executive's view, expressed to the community health council, that the crisis had been caused by the Government's failure to fund the nurses' pay award?

Ms Jowell

I shall deal with that point in a moment.

As I said, in the current financial year, the Trafford Healthcare NHS trust received a 6.72 per cent, increase.

As part of our modernisation of the national health service, we are supporting the biggest hospital-building programme ever in this country. Since 1 May 1997, 31 major hospital developments, worth more than £2.9 billion, have been given approval to proceed under the private finance initiative. The PFI was much vaunted by the previous Government, but not a single hospital was started as a result of their PFI. [Interruption.]

Mr. Deputy Speaker (Mr. Michael Lord)

Order. I remind the hon. Member for Runnymede and Weybridge (Mr. Hammond) that Front-Bench spokesmen do not take part in half-hour Adjournment debates.

Ms Jowell

Two of our developments are very close to the constituency of the hon. Member for Altrincham and Sale. They are the Central Manchester Healthcare NHS trust and the Manchester Children's Hospitals NHS trust joint venture, which is being redeveloped at an overall scheme cost of more than £200 million, and the South Manchester University Hospitals NHS trust, which is due to be redeveloped at an overall scheme cost in excess of £100 million.

As part of developing consistency and care based on the best available evidence, providing the context in which care in new buildings will be delivered, the national service framework for older people will focus on those parts of the NHS that are especially important to elderly people. The issues raised by the hon. Gentleman specifically focus on the quality of care for elderly people. Above all, we believe that older people want to retain as much independence and dignity as possible; as members of the external reference group, the views of older people and those who care for them will be taken into account during the development of that framework.

However, services must evolve and change to keep pace with local demand. In some places, that might mean new hospitals; in others, it might mean closing old ones, changing their use or using hospital facilities in new and innovative ways. It may involve transferring services that have traditionally been provided in hospital into the community, closer to where people live. Indeed, I believe that that was one of the original intentions of the proposals advanced in 1996 for the people of Trafford South, to which I now come.

Altrincham general hospital is one of four hospitals that make up the Trafford Healthcare NHS trust. It is not a district general hospital in the conventional sense. The hospital provides a range of out-patient services, a minor injuries clinic and three wards with 42 dedicated rehabilitation beds for the elderly.

In 1996, under the then Government, Salford and Trafford health authority carried out a full public consultation exercise, at the request of the Trafford Healthcare NHS trust. Its purpose was to canvass public opinion on proposed changes to the hospital and to some community services for the population of Trafford South.

Mr. Brady

I shall be brief. The purpose of that consultation was to assess opinion on the proposal to build a new community hospital. It had always been promised that Altrincham would not lose Altrincham general hospital unless and until that new community hospital was built.

Ms Jowell

I shall continue to deal with the substance of this debate.

The health authority received and considered a range of responses to these proposals. At its meeting in November 1996, it approved the provision of a new community hospital at Broadheath. It also accepted that there were genuine concerns about the overall reduction in the number of available in-patient beds, and deferred a decision until a review of rehabilitation services for older people in that area could take place.

More recently, and against a background of having to balance a forecast end-of-year deficit of £2.2 million, the trust identified savings of £1.4 million. As part of its proposals to address the remaining deficit of £800,000, the trust proposed closing two of the three wards at Altrincham general hospital and increasing its investment in community-based rehabilitation services for older people.

Regrettably, the trust's proposals for achieving its financial balance had not been formally discussed in advance with the health authority or members of the local health and social care community. Instead, on 4 May, they were agreed in a closed session by the trust board. Salford and Trafford health authority was advised by fax on Friday 7 May of the trust board's intentions.

I fully appreciate and share the concerns of the hon. Member for Altrincham and Sale, West about the manner in which the trust has sought to achieve a substantial change in service provision. Understandably, the plans agreed by the trust board, and the way in which they were developed and announced, did not receive the support of the health authority or the community health council.

On 18 May, in response to a question tabled by the hon. Gentleman, my hon. Friend the Minister for Health confirmed that the regional office of the NHS executive had instructed the trust and health authority to agree a joint approach on the future of in-patient services at Altrincham general hospital and on the future shape of its community-based services.

As a result, the trust board withdrew the decision that it had previously made on 4 May. However, at a public trust board meeting on 1 June, it once again endorsed proposals that involved the closure of two wards at Altrincham general hospital.

The hon. Gentleman is aware that, at its meeting on 10 June, members of the health authority were unable to support the decision taken by the Trafford Healthcare trust. Instead, the authority noted the trust's decision and agreed to consult with key stakeholders about the nature, availability and adequacy of alternative services before agreeing to any closure of wards at Altrincham general hospital—a point raised by the hon. Gentleman.

The authority agreed also to take legal advice to determine the need for further public consultation and to review the full range of the trust's proposals for achieving financial balance, including the need for public consultation. I hope that the actions taken by the health authority address the hon. Gentleman's concerns and I understand that, in any event, no decision will be taken by the trust or health authority on the future of the elderly care wards at Altrincham general before spring 2000.

Furthermore, this time scale will coincide with the publication of the national service framework for older people, which I mentioned earlier.

The chief executive of Salford and Trafford health authority has indicated that the authority will want to consider also the report being commissioned by the primary care group on services for elderly people, along with other relevant information, before taking any formal action to determine the future pattern of care.

Hon. Members will find offensive the hon. Gentleman's claim about political bias in appointments. It is our determination to make sure that the best people are chosen to represent a wide range of community interests. As someone who has overseen the process and ensured that all appointments comply with the guidelines issued by the Commissioner for Public Appointments, I hope that the hon. Gentleman will consider withdrawing that remark—

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at seven minutes to One o 'clock.