HC Deb 13 January 2000 vol 342 cc528-36

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

7.27 pm
Mr. Nick St. Aubyn (Guildford)

I am grateful to the Speaker for choosing for debate the subject of the health service in west Surrey, just as I am to my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) and to my hon. Friends the Members for Runnymede and Weybridge (Mr. Hammond) and for Surrey Heath (Mr. Hawkins), whose constituents are as affected as mine are by the intolerable crisis that is threatening our region.

West Surrey is often described—it is so again in the latest documents from our health authority—as the healthiest and wealthiest part of Britain. Why then do we have a hospital with the longest accident and emergency admission times of any hospital in the country? If we are the healthiest and wealthiest, why do we have a health authority with the most people waiting up to 18 months, with many critical cases almost going over that period as I speak?

In west Surrey, we pay the highest taxes per head of any part of the UK, yet we have the lowest health spending per head of any part of the UK. We are not asking for special treatment, but we deserve a fair deal for the people whom we represent.

As I speak, the chief executive of West Surrey health authority is meeting doctors and nurses at the local hospital in Guildford to explain the latest round of cuts that are being imposed on our service as a result of the Government's attitude up to now and of the cuts that they are imposing on our finances. That cannot be due to wastefulness or inefficiency, because we have some of the United Kingdom's most efficient hospitals. Figures released last week by the NHS executive showed that both Frimley Park and the Royal Surrey were among the country's most efficient hospitals.

Mr. Nick Hawkins (Surrey Heath)

My hon. Friend has just mentioned Frimley Park hospital, which is in my own constituency. Does he agree that primary care groups in the West Surrey health area have particular concerns in addition to the ones that he has been describing? Will he confirm that he has met the chairman of the Camberley primary care group, Dr. Geoff Roberts—to whom I have spoken—who is particularly concerned that his pleas to the Prime Minister and the Secretary of State for Health to resist cuts—particularly a £500,000 cut—in local child health services have fallen on deaf ears?

Will my hon. Friend also confirm that there is particular concern that the number of district nurses is about to be cut, and that another £150,000 will be cut from district nursing? As they are the very people who deal with terminally ill cancer patients and administer influenza vaccinations, is that not of particular concern?

Mr. St. Aubyn

My hon. Friend has made the case extremely well. Dr. Roberts, many other doctors and nurses, and many of our constituents have been writing to west Surrey Members about the depth of their concern at the crisis we are facing.

We have outstanding staff and management in our local health service. They do an incredible job, but they are being asked to do it under impossible conditions. We have an accident and emergency unit serving a catchment area around Guildford of 250,000 people, but it is now under threat of closure. In the past two years, a quarter of the beds in our local health system have been scrapped. As my hon. Friend the Member for Surrey Heath (Mr. Hawkins) said, in the next 12 months, 16 of our full-time-equivalent nurse posts in the community will be taken away from us.

Recently, a vital study revealed how Croydon was affected by similar cuts, and made it clear that such cuts only store up more problems for the future, as carers at home realise that they cannot cope and ask that their family member be admitted to hospital instead.

In some cases, people waiting for critical heart tests have been asked to wait too long. X-rays for cancer used to be brought back immediately, but there is now a wait of up to two months, while patients develop complications. Physiotherapy—a preventive medicine—was always immediately available, but there is now an eight-week wait before it can be given. Although the situation is unsustainable, demand has been stable. The number of emergency admissions at the Royal Surrey has risen by only 3 per cent. in the past two years.

On a typical day at the Royal Surrey County hospital, nine or 10 elective cases are cancelled, many of whom have reached the 18-month maximum wait or are urgent cancer cases. Before the Christmas flu outbreak, I was given access to internal papers describing one typical day. On 2 December, 18 cases—10 cancer cases and eight long-waiters—were to be admitted for elective surgery, but only nine beds were available. So six long waiters and three cancer cases had to be sent home—in direct contravention of all the aspirations that Conservative Members always had for the NHS, and which we thought that we shared with Labour Members.

Does the Minister think that the patients who were sent home on that day were—according to her formula, which tells the Government that we are asking for too much in our area—part of the excess health demand in west Surrey? Is she happy that the Government are sending away 18-month and cancer cases—which the previous Government decided to pay for, although the formula told us that we should not? We felt that it was more important to listen to Surrey's doctors than to a formula devised, 10 years ago, by professors in York.

We know how the previous Health Secretary, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), skewed the formula even further against our area. Nine years ago, Gateshead and Guildford had similar per capita funding. Now Gateshead is funded at 30 per cent. more than Guildford. I do not resent for one moment the benefits that that is producing for the people of Gateshead—one of the poorest areas of our country. I am however asking the Minister and the Government to recognise that, in the fast lane of Britain's economy, we have our own health pressures and our own health needs which must be seen to.

The overspending, as it was called, that we have lost in Surrey over the past four years amounts to £8 million a year. It came to more than that in some years. We broke even in one year—1998-99—but that was the year when waiting lists got ever longer and we simply stored up more trouble for the future. Our case is that the £8 million so-called overspend reflects the true level of demand in our area. We need an immediate adjustment to the Government's figures to reflect the real needs of the people whom we represent.

Yesterday in the House, the Prime Minister accused the Conservatives of hatching a policy that means that anyone facing one of a number of non-urgent operations, including cataracts … will be forced to take out private health insurance."— [Official Report, 12 January 2000; Vol. 342, c. 275.] I have a letter from a constituent whose wife waited so long for her cataract operations that she went blind in both eyes. That is when he was forced, with no insurance policy, to go private and have the operation done for her. That is how the Government are forcing people in our area to go private.

Mrs. Virginia Bottomley (South-West Surrey)

I can strongly confirm what my hon. Friend is saying. When a woman has to wait four months and two cancellations before vaginal cancer is detected, when someone has to wait almost 18 months for a hysterectomy, when we find that the out-patient wait just to see an orthopaedic consultant has gone from three or four months to nine months, when people are waiting in casualty not for 24 hours, but for three, four or even five days, local people ask what the message is. If the Government are forcing people to go privately by stealth, let them at least have the courage to say so. People are facing a sharply deteriorating service. They are frightened for themselves. Professionals are in despair. Things have gone far enough. It is time the Government listened and realised the damage that is being inflicted on people throughout our area.

Mr. St. Aubyn

I am grateful to my right hon. Friend for reminding us that people are being forced to go private and it is the old, the sick and the very poor who bear the brunt of the Government's policies because they have no alternative. At least when we had a policy of encouraging private care we did it through a tax incentive, which this Government took away. We warned at the time that that would create the greatest pressure in the areas of greatest take-up. That is what has happened in west Surrey in the past two years.

Our local health authority is still saying that at every opportunity local specialists should encourage people to use the private sector. Item 5 of the latest NHS document states: People who have other entitlements to health care should make maximum use of them. That is the Government's answer to the health problems of west Surrey—they are telling people that they can all afford to go private. Not all our constituents can afford it, however.

We provided an incentive to expand the private sector. This Government are providing a penalty. Tragically, in some cases it is a death penalty. Andy Williams was 29 years old when he developed a serious heart complaint. His specialist at the Royal Surrey hospital wrote to me to say that two years ago it would have been diagnosed within three months. Because the waiting times for that diagnosis have gone up to nearly a year, Andy died before he could be dealt with. His parents live in South Africa. His father wrote to me to say: fortunately in Durban our medical set up at the present time is still very good. The cardiologists here with rooms at a hospital have access to this equipment, and this facility is available to all. Truly, in west Surrey, as in some other parts of the country, we have sunk to a third-world service for our constituents.

I could cite many other cases. Many people have written to my colleagues and me. The Government's desire to achieve their targets for waiting lists has resulted in a long list of people who have suffered, some of whom are no longer with us.

That is why I have three key demands for the Minister. First, will she make it clear that the Government will safeguard the future of the present accident and emergency units at Frimley Park and the Royal Surrey in Guildford, as well as the excellent new facility at St. Peter's, in the constituency of my hon. Friend the Member for Runnymede and Weybridge? That would relieve a great deal of anxiety about the effects of such a closure.

Secondly, is she prepared to waive the £18 million so-called deficit from the time of the previous Government, when we recognised the need for health care in Surrey based on what the doctors were telling us, rather than on the formula? How can it be right that patients this year should pay a penalty—in the form of having to repay that money—just because previous patients were properly looked after under a Conservative Government? Thirdly, out of the many extra pots of money that the Government have given themselves to make discretionary payments, will the Minister authorise the money that we need to get our real waiting lists and waiting times in line? She may be aware that a new admissions unit at a budget cost of £250,000 is due to be opened in the next few weeks. We very much hope that she will be the first Minister this Parliament to visit the Royal Surrey and our health region and hear what is going on. When she does so, will she make sure that the new unit does not have to close at the beginning of the next financial year, as according to the latest document from the health authority, absolutely no money is available to fund it? Allan Willett, chairman of the South East of England development agency, confirmed to me again today that that organisation recognises the vital importance of a proper health service to keeping our local economy thriving and attracting inward investment. We ask the Minister to act not just in the interests of our constituents, but so that we can continue to pay our very large share for the services that are required up and down the country through the taxes that we pay. If Surrey is to continue to be the powerhouse of the British economy, we must have the support services that we need to maintain ourselves under the pressures that that creates.

Ten years ago, the previous Government introduced a new allocation of funds favouring Labour areas at the expense of Conservative ones. We are asking the present Government to be equally bipartisan and to recognise that the effects of that formula have gone too far and need to be reined in. In the interests of justice, fairness and the reputation of the Minister and the Government, I ask her to listen.

7.42 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I congratulate the hon. Member for Guildford (Mr. St. Aubyn) on securing tonight's debate on NHS provision in west Surrey.

Conservative Members are doing the national health service and those working in it a great disservice by continually criticising those who tirelessly and on a daily basis work hard for their communities. Just to put the record straight, let me take the opportunity to thank everyone in the NHS, including those in west Surrey, on behalf of the House for their tremendous work over the winter period. They coped with extra pressure due to flu and the extended holiday over Christmas and the millennium. That needed to be put on record.

The Government are committed to a high-quality NHS wherever our citizens live. Our principle is that the very best should be available to everyone. The previous Government did their very best to dismantle and erode that principle.

Tonight's debate is about west Surrey, but I cannot reply without at least in part drawing on the national picture. In 1997, we inherited a disgraceful state of affairs. There were record waiting lists, which were rising, and debts were being built up year after year. Nationally, they amounted to £450 million and a £20 million deficit had built up in west Surrey. The number of nurses training had been cut and investment in building was the lowest in 10 years. The system set doctor against doctor and hospital against hospital and the pay system was archaic and inflexible.

Mrs. Virginia Bottomley

If the hon. Lady is right, having praised NHS staff, why is she now challenging their credibility? I have here letters from doctors throughout the area saying that waiting times have increased dramatically since her party came to power. It has shut 111 beds and there are more than 300 nurse vacancies. If the situation was so bad and is now so good, why should all those doctors be writing with such strong feelings and why have we had unprecedented numbers of complaints from patients and their families who are in despair?

Ms Stuart

If the right hon. Lady would care to listen to the rest of my speech, I will answer some of her questions. She has on previous occasions raised individual cases in the House and I have invited her formally to follow up those cases, but she has not written to me. Similarly, accusations were made earlier about waiting times in casualty departments of four to five days. If that has happened, perhaps she would do me the courtesy of writing to me about such cases.

Mrs. Bottomley

On a point of order, Mr. Deputy Speaker. I gave the Secretary of State for Health the details of those cases when I met him before Christmas—

Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. The right hon. Lady knows that that is a point of debate. This is a half-hour Adjournment debate raised by the hon. Member for Guildford (Mr. St. Aubyn) about a specific matter relating to his constituency and everyone would do better to direct their thoughts and words to that subject.

Ms Stuart

Thank you, Mr. Deputy Speaker. Things are starting to change after the disgraceful situation that we inherited. Investment in accident and emergency has increased, waiting lists are lower than they were in 1997 and falling. Waiting times will improve. We have seen the highest level of nurse recruitment and an expansion in the role played by nurses. More money has been made available for suspected cancer patients and cardiac patients. We have a 10-year programme.

Great concern has been expressed forcefully tonight by hon. Members about the situation in west Surrey. West Surrey health authority has spent more than its allocation. It had to be bailed out two years ago when it ran up a huge deficit to the tune of £18 million, and that has to be repaid because this Government are interested in a sustainable and long-term investment.

The current funding allocation for West Surrey health authority for 1999-2000—the hon. Member for Guildford said that he wanted a fair system—is £371 million, which is a cash increase of £19.3 million, or 5.48 per cent. That is £8.5 million, or 2.35 per cent., more than the fair share target. The allocation per weighted head of population in west Surrey is £643, but the national average in England is £629. For 2000-01, the south-east region will receive £5.4 billion and west Surrey will receive £394 million, which is a cash increase of £23.2 million or 6.2 per cent.

Mr. St. Aubyn

Does the Minister understand that all those weighted figures go back to the same flawed formula that said that Surrey was overspending when it was simply meeting core health needs? Does she further understand that by demanding back that £18 million she has not put any new money into the system?

Ms Stuart

Conservative Members continually call for more money for their constituents, but do not vote for more money for the NHS and they call our proposals to increase cash for the NHS reckless. We want long-term, decent investment in the health service. I fully agree that future allocations should be fairer, but they must be fair for everyone.

We are reviewing the weighted capitation formula because we want it to be fairer, but it must provide for the NHS of the future. At the moment, the review is at an early stage and further changes are frozen until 2002 because we want some stability and certainty in the system. Even with the generous funding for west Surrey, change is still needed. Conservative Members portray the situation as driven simply by financial needs, but that is not the case. We expect the health authority to fulfil its statutory duty to live within its means, but other changes need to be made in west Surrey to bring the service up to date, and to take into account changes in medical practice, technology and the training needs of doctors The health authority needs to live within its means and changes are needed to achieve that quickly. That means some hard choices, because west Surrey deserves a service that is modern, sustainable and affordable and that meets the needs of the people of west Surrey. A number of proposed changes are in hand.

Mr. St. Aubyn

Will the Minister say on which of the nine cases that I described there has been overspending?

Ms Stuart

Changes in the service structure have to be made to deal with such matters. West Surrey does not have a sustainable health economy. Consultation on some of the long-term changes is already complete. I have taken careful note of the objections made by the community health council to the changes at the Ashford hospital and at St. Peter's hospital, and an announcement will be made soon.

I see that the right hon. Member for South-West Surrey (Mrs. Bottomley) has a copy of the document "Ensuring a Sustainable NHS—Phase II". That document asks for comments, and I hope that all hon. Members affected by the consultation process will respond. We are also in the process of setting up an independent advisory panel, which will help to ensure local consensus on the changes.

Somehow, the good news seems to escape the consciousness radar of Conservative Members. I shall describe some of the investment that has been made in west Surrey. Between June 1997 and October 1999, the number of day cases and the in-patient waiting list fell by 13 per cent. Between 1996 and 1999, there was a 21 per cent. increase in the number of out-patients attended to. An extra £3 million was devoted to reducing in-patient and day cases. A further £351,000 has already been spent to reduce out-patient waiting times, and £1.2 million has been invested in local accident and emergency departments. The Royal Surrey hospital received £276,000 for a new admissions unit.

Those changes in the provision were necessary to achieve a sustainable health service. Frimley Park hospital received more than £500,000 for new X-ray and IT equipment. The Ashford, St. Peter's and Frimley Park hospitals, in conjunction with local GPs, took part in one of the pilot projects for on-the-spot booking. Under that system, when patients visit out-patient clinics, doctors are able to book dates for operations. In addition, GPs are able to make out-patient appointments, with the result that dates are arranged to suit the convenience of patients.

A new primary care centre serving Weybridge and Woking is now operational. Investment of about £4 million has been made in health centre facilities and community hospital services. A pilot for a primary care walk-in centre is being developed in Weybridge, and NHS Direct is already available in south-west Surrey. Conservative Members smile at NHS Direct, but it has had a huge impact in the area.

Mr. St. Aubyn

The core of the NHS are the acute and nursing services. Will the Minister address the question of how they are being decimated in the area?

Ms Stuart

Fundamental changes have to be made to the health economy. We are putting in extra money to accomplish those changes. Claims that west Surrey never gets the extra money that it applies for are not substantiated, as the list that I have given proves. Hospitals have made tremendous progress in recruiting nurses. The previous Administration slashed the numbers of nurses in training. We are providing extra training places and recruiting extra nurses.

Eighteen months ago, the vacancy factor at the Royal Surrey hospital was 17 per cent., which meant that the hospital was lacking 310 qualified nurses. By next month, the factor will have fallen to 10 per cent. That huge improvement must be recognised. At its recent open day, the hospital recruited another 11 nurses who wanted to return to work.

Social services spending in Surrey has increased by 4.9 per cent., compared with a national average of 4.4 per cent. The claim that west Surrey does not get its fair share of money simply does not stand up when we look at the figures.

I should like to take up the hon. Gentleman's invitation to come to west Surrey. I know that accusations have been made in the House that Ministers never visit west Surrey, but I am very happy to do so. More to the point, I thought that it was very fitting to choose St. Valentine's day, 14 February, to visit the hon. Gentleman's constituency.

Question put and agreed to.

Adjourned accordingly at five minutes to Eight o'clock.