HC Deb 30 June 1999 vol 334 cc320-6 1.29 pm
Mr. Simon Burns (West Chelmsford)

I rise both in sorrow and in anger to raise on behalf of my constituents the important issue of hospital waiting lists and ward closures at Broomfield hospital in the Mid Essex hospital trust area.

The Labour candidate in the general election campaign in West Chelmsford was a national health service consultant who spent a great deal of time criticising the previous Government's record on health care in West Chelmsford and elsewhere. I vividly recall a leaflet that was distributed, saying that he was proud to support new Labour's early pledges, one of which was to cut NHS waiting lists in West Chelmsford and the rest of the country.

I am devoting this debate specifically to my constituency and its problems. Some of my constituents were convinced by the rhetoric that new Labour would bring a new Jerusalem in health care and that if they turned up at Broomfield hospital for an operation, there would be consultants and doctors waiting at the doors, fighting to be first to operate on them. Sadly, that has not happened.

Over the past two years, the number of my constituents on in-patient waiting lists for 12 months or more has risen from 104 to 1,093. Too many of my constituents write to me to complain bitterly about operations being cancelled—in far too many cases not once but twice—because Broomfield hospital cannot provide the treatment as originally arranged.

There is a problem nationally that will come back to haunt Mid Essex with a vengeance in the current financial year, concerning what has happened to the 13-weeks-plus out-patient waiting list of people who need to see a consultant before even getting on to a hospital waiting list. In March 1997, there were 555 such people in mid-Essex; now the figure is 2,422, and I suspect that it is still rising.

The total waiting list figure has risen from 8,391 in March 1997 to 9,961 this April: a rise of almost 1,600 people. I asked the Minister then responsible, who is now Chief Secretary to the Treasury, what was the agreed waiting list target reduction for Mid Essex for 31 March 1999. His junior colleague the Parliamentary Under-Secretary of State for Health, the hon. Member for Barrow and Furness (Mr. Hutton) replied: The agreed waiting list target reduction for the Mid Essex Hospitals National Health Service Trust is to a list size of 9,738 at the end of March 1999."—[Official Report, 2 November 1998; Vol. 318, c. 416.] Unfortunately, the task force was not even able to ensure that that target was met. In March 1999, just over 200 people above the target were on the waiting list.

I accept that the total waiting list figure, having ballooned from 8,391 two years ago to more than 11,500, has come down to 9,961; but that is still unacceptably high. I even questioned the Prime Minister on the problem. I accept that the right hon. Gentleman is not expected to know the intimate details of every health trust in the country, but my constituents would have found it more helpful if he had said that he would look into the problem and get back to me.

Instead, the Prime Minister, as has become familiar under new Labour, came back with the soundbite on the wider scale, telling us what was happening nationally. Interestingly, he also said: we are putting in … more nurses, more doctors and more capital spending—everywhere, including mid-Essex".—[Official Report, 9 June 1999; Vol. 332, c. 648.] That sounded optimistic. I thought that perhaps the Prime Minister knew something that I did not know that was going to help my constituents.

I tabled a question to the Secretary of State for Health about those more nurses, more doctors and more capital spending in Mid Essex. His junior colleague the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), replied. I hope that I am not harming his career prospects. He said that capital spending in Mid Essex was £12 million in 1997 and £7.3 million in the current year. To me, that is a £4.7 million cut; but the Prime Minister considers it an increase. I look forward to his explanation when he replies to the letter that I have sent him.

More perplexing was the question about more doctors and nurses. The Minister gave me a figure for 1997, but he told me that the data for following years were not available because they had not been published and that data for 1999 had not yet even been collected. Again, I am puzzled about how the Prime Minister could tell me that there were more doctors and nurses; again, I look forward to his reply.

Part of the problem—I do not blame the Government—is the way in which Mid Essex and North Essex were funded under the old resource allocation working party system, with a disproportionate amount going to the east end of London at the expense of mid-Essex. That was unravelled in the early 1990s when my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) changed the funding system, and both the previous Government and the current Government in their first year recognised the problem by giving North Essex and, in particular, Mid Essex larger increases in funding.

The trouble is that the area never caught up with what it would have received if we had never had RAWP. Unfortunately, the previous Minister of State fine-tuned the funding formula for this and the previous financial year in a way that cost Mid Essex money. I know that the Minister wants to alleviate my constituents' problems. North Essex and Mid Essex urgently need more money to deal with what is clearly a problem of significant proportions that is causing undue suffering and distorting the service. I urge her to reconsider the changes in the funding formula and find ways of providing extra resources to an area that has historically had problems with financing because of its proximity to London.

Those problems are bad enough, but, just over a week ago, it emerged that the health trust is £2.4 million, and the authority just over £10 million, in deficit. One way in which they are trying to overcome that problem is by closing three wards at Broomfield hospital, saving £1.75 million; the rest is to be saved by improving management and bureaucracy. They are seeking to make those savings partly by removing about 80 bed blockers from Broomfield hospital. I fully endorse such action, as it is ludicrous for people to remain in hospital when there is no clinical or medical reason for them to do so. Not only is keeping people in hospital expensive but their quality of life deteriorates.

I had assumed, however, that those people would either be going home, with a care package, or into residential care. I was therefore surprised to hear that those options have not been chosen, but that most of those people will be going to St. Peter's hospital and to St. Michael's hospital—thereby incurring costs to the health authority and the health trust, so that the savings may not be as great as anticipated. Moreover, as social services do not have enough money to deal with the problem, I fear that closing the wards will prove to be a one-off and short-term solution, and that, perhaps in 12 months' time, we shall be confronted with another problem of bed blocking, when we shall not again have the option of closing wards to overcome a short-term financial deficit.

Similarly, when there are so many problems with people waiting for treatment, it is crazy that three wards—84 beds—should be taken out of the hospital system and left empty and redundant so that they cannot be used to help overcome the problems facing my constituents and those of other hon. Members in the area.

I therefore urge the Minister—who is a perfectly reasonable person—to recognise that there is a specific problem in mid-Essex. I ask her to recognise, too, that my constituents do not deserve the delays, heartache and problems that they are suffering as a result of having to wait ever longer for hospital and out-patient treatment, or the misery and shock of operations cancelled at the last minute—sometimes after they have already gone to hospital psychologically prepared for their operation.

I urge the Minister yet again to persuade the NHS executive to re-examine the problem in mid-Essex; to seek to direct more money into North Essex and Mid Essex to bring down waiting lists; and to ask the hospital to justify fully why it is closing the wards, whether there is a better alternative for achieving the same aim, and what will happen to staff working in those wards, who must be extremely concerned and worried about the consequences of the actions on their role in the health service.

1.42 pm
Mr. John Whittingdale (Maldon and East Chelmsford)

I thank my hon. Friend the Member for West Chelmsford (Mr. Burns) for allowing me to contribute very briefly to the debate. My constituency of Maldon and East Chelmsford is covered by the Mid Essex Hospital Services NHS trust, and, therefore, my constituents are experiencing the same problems and difficulties as those suffered by my hon. Friend's constituents.

I also congratulate my hon. Friend on securing this debate, and pay tribute to him for the assiduous way in which he has pursued the matter in recent months. He and I both know, from our postbags and surgeries, the distress being caused to an increasing number of our constituents because of the lengthening time they have to wait for operations. His efforts, however, have forced the Government and the hospital trust to publish the real figures, showing the huge increase in the number of people in mid-Essex who have to wait for an operation.

As my hon. Friend said, to be fair, there has long been a problem of underfunding and long waiting times in the North Essex health authority area. Nevertheless, the problem was being dealt with by the previous Government, who, in successive years, awarded North Essex an above average real-terms increase. Consequently, waiting lists fell to historically low levels. However, the progress has been reversed, and the figures quoted by my hon. Friend graphically demonstrated the huge deterioration in the situation in the past two years.

Both my hon. Friend and I have many cases of individual constituents who had been given operation dates, which were months in the future, but who—at the last minute, when the date had finally arrived, and sometimes after they had gone to the hospital—discovered that the operation had been cancelled. Subsequently, they were told that they would have to wait still more months before the operation could be rescheduled.

The Government were elected on a pledge that waiting lists would fall, but the fact is that, in mid-Essex, they have got steadily worse.

In December 1998, one of my constituents, who lives in Great Baddow, wrote to me, saying that her husband was house-bound and facing a 12-month wait for a quadruple bypass operation. She wrote: I know we don't count for much in the system of things but we are as important to our families as you are to yours … Please keep the promises that are made. I don't want my husband to die waiting. For that one constituent, I could name another 100 who have written to me to describe similar cases.

Our constituents in the mid-Essex area deserve more from the Government. I ask the Minister now to spell out exactly what action the Government are planning to take to ensure that the situation is not allowed to continue.

1.45 pm
The Minister for Public Health (Ms Tessa Jowell)

I congratulate the hon. Member for West Chelmsford (Mr. Burns) on securing this debate, on a matter in which he has taken an active interest. I am sure that his constituents appreciate his concern.

I should begin with the figures, as they were one of the issues central to the hon. Gentleman's concern. At the time of the general election, a total of 8,391 people were waiting for in-patient treatment at the Mid Essex Hospital Services NHS trust. Mid Essex was not immune from what my right hon. Friend the Secretary of State for Health has referred to as the supertanker effect, and, in the following year, the number rose to 8,360. Since then, the number has dropped, and, at the latest count, stood at 9,961.

Mr. Burns

I think that the Minister has given the wrong figure. When the previous Government left office, the figure was 8,381; in the following 18 months, it rose to just over 11,500, but then dropped to 9,967.

Ms Jowell

I apologise to the hon. Gentleman; I misread the figure. To be absolutely clear, at the previous general election, the figure was 8,391. Subsequently, it rose to 11,360. At the last count, it had fallen to 9,961.

As the hon. Member for West Chelmsford will be aware, waiting lists have shrunk across the country. However, the situation in Mid Essex differs from the picture nationally in that it has more people waiting than it did when the Government took office—which is a matter for concern. The case cited by the hon. Member for Maldon and East Chelmsford (Mr. Whittingdale) provided a clear illustration of why reducing both waiting lists and the suffering that they cause is our No. 1 priority.

Neither the trust's local management nor the NHS executive are willing to tolerate the situation. However, as the hon. Member for West Chelmsford made it clear, the trust has financial problems. At the end of the previous financial year, its deficit was £1.8 million. The trust has now identified savings of £1.7 million, and, this year, is planning for a deficit of £1.6 million. The trust has robust plans for next year, including further savings of £700,000 in management costs, and it expects to achieve financial balance.

The eastern region of the NHS executive has been deep in discussion with the trust about implementation of its recovery plan. Today, the regional office, the health authority and the local trust are meeting to agree the plans. There is a total commitment to achieving those plans without adversely affecting services to future patients. To that end, a group—comprising local primary care groups and social services, as well as the health authority and trust—has been formed to contribute to the plans.

That brings us to the question of ward closures. As the hon. Member for West Chelmsford knows, part of the savings central to the trust's plans arise from its proposed switch of services from St. John's hospital to Broomfield hospital and the accompanying closure of three wards at the Broomfield site. We recognise that waiting lists, budgets and ward closures are obviously interdependent.

The trust's proposals entail a complete relocation of services from St John's to Broomfield by 2002, and the sale of the St John's site. The trust believes that providing all its acute services from a single site will deliver better and safer care to all its patients, and achieve significant savings.

Mr. Burns

Is the Minister aware that one of the wards being closed was refurbished last year so that it could accommodate some of the services transferred from St. John's?

Ms Jowell

Clearly, the trust is making these proposals because it judges that they constitute the best use of available resources, and that they will protect standards of patient care. I expect that the trust took the hon. Gentleman's point into consideration when it made the proposals.

The first stage is the transfer of 86 patients from Broomfield to settings that are deemed to be more appropriate to their needs. Some patients will go home and will be cared for in the community: others, as the hon. Member for West Chelmsford said, will go into alternative community hospital care. That will allow three wards to be closed, saving £900,000 this year and twice that amount in a full year, thereby freeing up resources for investment in other, locally based services.

Perhaps naturally, the hon. Member for West Chelmsford jumps to the conclusion that fewer wards and beds will mean longer waiting lists. That is not what the trust expects. It believes that, because the beds are blocked now, their removal will not have an impact on the number of people that the hospital can treat. However, the onus is on the trust to make that case in the consultation that will follow as the strategic plan develops.

No reundancies are planned as a consequence of the closure, although the trust should be able to cut back its use of agency staff, so nurses on those wards could instead treat patients who need to be in hospital. The trust also expects to move its cardiac services to better facilities, to expand renal services so that fewer patients have to travel to London for treatment, and to increase its capacity to treat patients on a day-care basis. The trust treats fewer patients on that basis than other comparable trusts, and we hope that the number so treated will be increased.

The trust believes that, even after the proposed reduction, it will be better placed to meet the needs of the local population and it intends to refurbish the wards as part of its longer-term strategy.

I believe that I have given an accurate summary of the trust's plans, which I understand have the support of Essex social services, the health authority, other local trusts and primary care groups. As the hon. Member for West Chelmsford may know, the community health council is reserving its judgment on the immediate ward closures until it is convinced that the plans are achievable. In the interim, it has agreed with the health authority to hold a public meeting in Chelmsford on 21 July, when all the agencies will explain their plans to the public. In addition, the health authority is planning a full public consultation on the whole strategy later this year.

With that in mind, I hope that the hon. Member will understand if I do not give the plan the ministerial seal of approval—or disapproval—here and now. What I can promise him and his constituents is that, if called on to arbitrate, my right hon. Friend the Secretary of State will be guided by the one principle that always guides him in these matters—the best interests of the patients, and their care.

I mentioned the financial problems facing the trust. It might be relevant for me to say something briefly about the financial support that this Government have made available to the North Essex health authority, which largely funds the trust.

Two years ago, North Essex health authority was 3.7 per cent, or £13.8 million, below its capitation target. Today it is only 0.7 per cent, or £3.4 million, below target. This year alone, it received a cash increase of £31 million, and a real-terms increase of £18.7 million. The Mid Essex trust has also benefited directly from an £845,000 share of the accident and emergency modernisation fund. I assume that the hon. Member for West Chelmsford will welcome all that. That funding and the trust's own recovery plans are freeing resources for practical action to help patients and drive down waiting lists.

The trust is now putting together a scheme for the new day-care centre to which I have referred. It expects the centre to make a real contribution to reducing the number of people waiting for elective surgery without the need for additional beds. I wish to make it clear that neither I nor any of my colleagues underestimate for a moment the sheer misery caused by cancelled operations.

Meanwhile, the local primary care groups have been studying the patterns of referral by general practitioners. They have produced guidance for GPs that is being piloted by the local primary care group and acute hospitals to help improve the consistency and appropriateness of referrals.

The regional office of the NHS executive will continue to monitor the trust's waiting list performance, and it has been helping to identify where bottlenecks may cause delays in getting patients treated. The local waiting list task force has also been actively working with the trust.

This debate is about one NHS trust, but my response would not be complete without some reference to the national picture and what the Government are doing to cut waiting lists in the Mid Essex trust area and the rest of the country. I do not want the hon. Member for West Chelmsford or anyone else to be in any doubt about the priority that the Government and the NHS give to beating waiting lists.

Through a stupendous effort, the NHS, supported every inch of the way by the Government, has delivered a record reduction in waiting lists to below the level inherited from the previous Government. That is the action that has been taken to deliver our pledge to bring lists down by 100,000 from the level that we inherited. We have made it clear that no patient should have to wait more than 18 months for hospital treatment once on a waiting list, and I am glad to say that the Mid Essex trust has consistently delivered on that.

We have often been told that it was wrong to concentrate on the length of lists, and that we should care only about waiting times. We always believed that both could be shortened: now, average waiting times are down to below three months and are below the average that we inherited. The hon. Member for West Chelmsford must accept that, nationally, waiting times for patients waiting 12 months or more are down by one third.

I mentioned that one of the fundamental problems facing the Mid Essex trust is the number of patients ready to be discharged but waiting to be given social services support. We are taking big steps in improving joint working between health and social services, and taking action to get rid of the constraints in the existing system to providing the right services in the community.

Finally, I repeat my earlier assurances to the hon. Member for West Chelmsford and to the people in the Mid Essex trust area. The trust is expected to bring waiting lists down further, and will get the advice and support that it needs. We are determined that the hon. Gentleman's constituents and people throughout the country will enjoy the benefits of a new, modern and dependable NHS.

It being Two o'clock, the motion for the Adjournment lapsed, without Question put.

Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.

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