HC Deb 19 January 2000 vol 342 cc946-54

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

Mr. Deputy Speaker

Before I call the hon. Member for Northavon (Mr. Webb), I ask those right hon. and hon. Members who are not staying for the Adjournment debate to depart quickly and quietly.

10.26 pm
Mr. Steve Webb (Northavon)

I am grateful for the opportunity to raise in the House tonight the situation in the national health service in the Avon area, which is of grave concern to myself and my constituents. The matter is of particular note at the moment because of winter pressures.

May I say at the outset that I want to place on public record my appreciation and tribute to the NHS staff in the Avon area, who have performed remarkable feats in recent weeks. There can be no doubt that it is their dedication, devotion and hard work, which is well beyond the call of duty, that has enabled the health service in my area to keep going under extraordinary pressures.

The chairman of the North Bristol NHS trust, which serves my constituents, said in a letter to all hon. Members in the Avon area: Our nurses and physicians are working more than flat out and our surgeons are assisting them. Clearly, the staff in the NHS deserve our warmest thanks and appreciation, which all too often they do not receive.

It is because of the appreciation of the work that NHS staff are doing that it is particularly important that they are not taken advantage of. My concern is that the NHS is relying too much on the good will and hard work of its staff, and it may even be taking advantage of their good will. In many respects, the NHS is close to breaking point, not only this winter but at other times, and it is only the staff's dedication that prevents things from going seriously wrong.

I want to set out the background to what has been happening in Avon, to look back at events of recent weeks and to consider whether those might have been prevented or dealt with better. I want also to consider the health authority's future and the pressures that it faces. I am grateful to the health authority, to North Bristol NHS trust and to the chairman of my local primary care group for briefing me in advance of this debate.

We have been through a remarkable few weeks. In the two weeks after Christmas, emergency admissions in the Avon area were 14 per cent. above the levels in the preceding autumn, which were themselves relatively high. That is an average over the whole authority. In the North Bristol NHS trust, which serves my constituency, there were some days when emergency admissions increased by 40 per cent. Those are extraordinary pressures for the health service to bear.

How did the service cope? As far as we can tell, it coped remarkably well in the circumstances. The briefings from the health authority and the trust suggest that the planning for the general run of winter pressures, coupled with the good will and endeavours of the staff, meant that many of the worst possible outcomes did not materialise.

Having said that, things were extremely difficult—in my view, unacceptably so. To humanise the problem, I quote not the health authority statistics—valid though they are—but the letter dated 12 January from the chairman of the North Bristol NHS trust to Members of Parliament. She writes that the pressure began on 3 January, when people, suffering from the complications of flu, started to pour in…We have no doubt that the people who are being admitted need to be in hospital—they are very ill. There is no question that the admissions were not necessary. She says that on 7 January, the pressures were "particularly bad".

In Frenchay Hospital"— which is in my constituency— we even had to turn our day surgery units into holding bays for the medical patients we were admitting and cancel all day cases. By midday that day, out of the 654 beds in the hospital, only one was available. It had to be kept available because, by that point, Frenchay was acting as a receiving centre for neurosurgery, not just for Greater Bristol or for Avon, but for the whole of the south of England and the whole of Wales. Perhaps we should be having debates about the circumstances in which health services everywhere but Avon found themselves, given that our local hospitals were under such pressure, having to serve such a huge area. I am greatly concerned about the time it would have taken for someone from the far south of England or a remote part of Wales to reach Frenchay.

The chairman goes on, making a critical point: At this point we did something which we never had to do before. We made an arrangement with United Bristol Healthcare Trust and Royal United Hospital NHS Trust. They agreed that each hospital would, in turn, for a three-hour period, take in all further admissions in the area, except for "blue light" cases or those who turned up at casualty. That gave each hospital six hours to catch its breath and get things under control.

It shows the strain under which the health service was operating that, for six hours, Frenchay and other hospitals were effectively closed. It worries me that the trusts are running so close to capacity. Even though I acknowledge that there was a seasonal peak in demand—I do not want to argue about whether it was an epidemic—it was not beyond the bounds of possibility that such an event would occur. Hospitals had to close because we run the health service so close to capacity. I am worried that we reached the point where, despite the best efforts of staff, there was only one neurosurgical bed in the whole of southern England and Wales, and hospitals were effectively closed for six hours.

At this point, I should like to put in a plug for my local cottage hospital in Thornbury. The chairman of my local primary care group has pointed out that, without Thornbury hospital, there would have been significant extra pressure on Southmead/Frenchay. Thornbury has 24 beds, but only one of them was free and there was rapid turnover during the Christmas and new year period. Cottage hospitals have recently come under threat; I urge the Government, when considering their future, to bear in mind the important role that they play, especially at busy times.

Could those events have been foreseen or prevented? Management plans were in place, but was there enough preventive work? Was there a sufficiently energetic inoculation programme in the autumn? My impression is that there was some effort, but not enough. Will more effort be made next year, or will we run the risk of the same thing happening again? Is the NHS running too close to capacity? My feeling is that the financial pressures being put on the health service mean that it is, with the result that when circumstances such as a severe flu outbreak arise, its facilities are stretched close to breaking point.

We must look forward and ask what will be the legacy of those winter pressures during the coming weeks and months. It is obvious that there will be pressure on waiting lists. The letter from the chairman of the North Bristol NHS trust states: I know you will appreciate that, with this pressure on our services, we are not able to keep up with the planned reduction of our waiting list. We are now falling back by about 40 operations a day. If and when the emergency demands reduce, we will do our best to catch up…but our staff will be very tired and we must not push them beyond the limits of safety. Over the Christmas and millennium eve period, many staff put in extra time that they would not normally have put in, and they expected a new year break in return. That has not materialised and it is not clear how the waiting list backlog can be cleared without substantial support from central Government.

The trusts face two substantial pressures, the first of which is the additional costs that they have incurred in dealing with flu and the winter crisis. Will the Government meet these costs or will the money have to be found from the trusts' budgets? The money was not budgeted for, so will that mean cuts in other NHS services?

The chairman's letter from which I have been quoting concludes: My Board has spelt out clear priorities for the Trust; firstly, to treat emergencies; secondly, to meet the in-patient waiting list targets and thirdly to meet financial targets. In my view, that is the right sequence—patients first and money second. However, in the modern NHS the trusts are businesses. If the Government do not help them with the additional financial pressure that they face as a result of the winter crisis, how will they cope? How will they reduce waiting lists? How will they improve NHS services and not merely stand still?

The second funding pressure that I fear they will face is from the pay award announced this week. I understand—I hope that the Minister will correct me if I am wrong—that the money that has been promised to nurses and others, which is entirely welcome, must be found within existing NHS planned and present budgets. In other words, there is no new money to match the new pay award. If the trusts are finding money to cope with the winter pressures that they did not have in the budget and if next year they have to find money for salaries that was not in the budget, what will be cut? If the Government will not meet these shortfalls, what will the trusts have to cut?

I shall look ahead and set out what might happen if the winter pressures, and the financial pressures that have followed from them, are not dealt with. I received an e-mail from a constituent—to preserve her confidentiality, I shall call her Mrs. A—who e-mailed me within minutes of seeing the news about the lady from the north of England who had cancer treatment repeatedly postponed. The story has appeared in the media. Mrs. A tells a heart-rending tale of the state of the NHS and of the problems that will not be dealt with if the trusts do not have the necessary money. She states: We are prompted to write after hearing about the cancer patient…My husband has been fighting cancer for 17 months now and has first hand experience of the desperation waiting lists can cause. He had to wait six weeks for radiotherapy that his consultant really wanted him to have immediately after an intense course of chemotherapy. He has since been told he is terminally ill and we can't help but wonder what difference that waiting time would have. We are disgusted that the national health service has been allowed to be grossly underfunded when, as we have learnt, health is all that matters and that without your health you have nothing. We beg of you to hound government ministers responsible to stop looking at short term voting gains and put the income tax up and the money where it is needed. The final line of her e-mail reads: By the way, my husband is … 32 years old and will leave three children fatherless. I naturally responded promptly to that communication, and I received a further message from Mrs. A, which re-emphasised the pain that she has felt and her distress about the health service. I shall read part of her message to me. She states: On the day my husband was asked if he wanted to give one last, new treatment a go (or else have six months to live) the nurses on the ward were using up 'favours' between the departments to get him a C.T. scan. They could only wrangle an X-ray!! This obviously is just a split moment in our lives that caused desperation on top of desperation. The nurses, no wonder, probably feel such desperation daily, again because of what boils down to lack of funds. What would a penny on Tax be to everyone and how many lives and families could that keep going? When Liberal Democrat Members say that more should be spent on the NHS, we are sometimes asked where it should come from. I make no apology for the fact that I have called for extra spending on the NHS. I have called for the trusts to be reimbursed for the costs of the winter pressures, which were unforeseen. I have also called for the Government to meet the costs of the pay rise that were not budgeted for. Above all, when situations arise that affect people such as Mrs. A and her husband, I cannot believe that the NHS is properly funded all year round, let alone during the winter.

The Government have a chance to do more than what the Prime Minister promised, which was to reach an acceptable funding level in five years' time. They could start this April. They could go beyond their published spending plans and not cut the standard rate of income tax by 1p in the pound. That would raise well over £2 billion, which our health service needs now. The Government seem to be saying that it will take years to find the necessary money, yet they are handing over £2 billion to taxpayers who, all the evidence suggests, want that money to be spent on the health service that they and we treasure.

I had the permission of my constituent to read that extract in the House tonight, because she contacted me in desperation about the state of the health service. People who work in the health service have shown yet again this winter their dedication, skill and devotion. Advantage must not be taken of them. When the Government have money to spend on the health service, they should spend it on the health service, not on tax cuts. I hope that the Minister will go to the Treasury tomorrow and relay that message to the Chancellor in the strongest possible terms.

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

I congratulate the hon. Member for Northavon (Mr. Webb) on his success in securing this debate on winter pressures on the NHS in Avon. I am grateful to him for choosing that subject, because it provides me, as it provided him, with an opportunity to acknowledge the extraordinary success of the Avon health community and all its staff in coping with pressures which were undeniably extreme. There were greatly increased demands on health services. I believe that the hon. Gentleman will agree that Avon has shown by its planning and dedication that when we attempt to meet unprecedented demands, it can be done. It was done in Avon.

We must pay tribute to the staff, who have shown themselves to be extremely flexible, who were recalled and sacrificed their Christmas holidays and the millennium period. Despite the exceptional demands, those who needed care received it in Avon. I hope that the hon. Gentleman will acknowledge that.

We must acknowledge the contribution of managers and clinicians, as well as that of the nursing staff and ancillary staff, who are often forgotten. They have all played their part in those efforts.

That the NHS in Avon was under intense pressure is undeniable. In December the Avon ambulance service trust dealt with 14 per cent. more emergency responses than in the previous year, and so far this month the number of ambulance activations is 28 per cent. higher than in January last year.

Overall, on average, 254 people were admitted to hospitals per day as emergencies during the period from 27 December to 9 January, compared with 222 emergency admissions per day during the previous period. United Bristol Healthcare NHS trust admitted 726 emergencies between 26 December and 12 January, with the number of medical emergencies!an important point!showing a rise of 36 per cent. over the same period last year.

At the hon. Gentleman's local North Bristol NHS trust, too, the number of emergency admissions rose. He cited the figures. On a number of occasions the extra demand led to isolated problems, with a number of long trolley waits before admittance at United Bristol Healthcare NHS trust.

I acknowledge that the individual cases raised by the hon. Gentleman show that the service was under pressure. I appreciate the distress caused for the patients and families concerned. I in no way underestimate that distress, but it does not show that the NHS in Avon was unable to meet the demands imposed on it by the extended Christmas and millennium holidays or the influenza outbreak.

There is certainly much in the media about the pressure on critical care services—that is, intensive and high-dependency care. Although there was great pressure on those services, all Avon patients who needed intensive care received it locally. That was achieved by the carefully planned use of theatre recovery areas and by extending high-dependency care on to general wards to enable patients to leave intensive care units.

The increase in capacity to deal with peaks in demand was provided by asking regular staff to work extra hours, as well as by using bank and agency staff. Far from being in crisis locally, the intensive care arrangements in Avon were such that the health community was able to provide assistance to other areas, as the hon. Gentleman acknowledged. It was able to take a number of patients requiring intensive care, as well as dealing with patients transferred into the area for specialist and tertiary interventions requiring intensive care afterwards.

It is further to the credit of staff, as we should acknowledge, that the NHS in Avon coped with the demand without the additional help of NHS Direct, which is available to over 60 per cent. of the population in England. I am sure that the hon. Gentleman knows that NHS Direct will be available in Avon by October this year.

I want to comment on planning, because I do not want us to believe that the system coped by accident: it coped through careful planning, which began with establishing local winter planning groups. They first met in April last year to co-ordinate health and social care services over the winter and the millennium holiday. It is important to acknowledge that, for the first time, we have pulled together health authorities, social services, NHS trusts, primary care groups, out-of-hours and deputising services, police and fire services, the voluntary and private sectors, community health councils and local authority departments. The complicated organisation of Avon health authority, which comprises 10 NHS trusts, 12 primary care groups and four unitary local authorities led to four local plans, based on the four local authority boundaries.

We must acknowledge that Avon health authority represents a tremendous success story. Its plans were assessed by the south-west regional office of the NHS executive and social care regional staff who considered them comprehensive and robust. The millennium executive team visited the local winter planning group in October. It identified some points that required further work, but it generally agreed with the regional office's assessment of the plans The planning has built on the record extra resources that the Government made available to the NHS. I shall explain that in more detail. Unlike previous years, when money was provided late in the day, in 1999 planning started early, and the resources for contingency arrangements were made available early. In the comprehensive spending review in July 1998, we made additional resources available to the NHS. We made a three-year commitment, which allows for planning. Overall, it was the biggest injection of cash in the history of the NHS.

Avon health authority received £582.5 million, which represents a cash increase of £36.5 million, or 6.69 per cent. Next year, Avon will receive £629.4 million, a cash increase of £40.7 million. At 6.9 per cent., that represents the highest growth in the south-west region.

Mr. Webb

When I spoke to the chair of my primary health group this week, he said that while the Government talk about growth money, it is eaten up by, for example, salaries or the flu bug, and that services cannot be developed because people are running to stand still. The Minister may talk of "growth money" and "record figures"—after two years of near freeze or sticking to Tory plans—but is it not true to say that, on the ground, the NHS cannot expand?

Ms Stuart

Not quite. The extra money is being provided, but in a targeted manner. Some extra money was for local planning. I shall discuss the implementation of such planning shortly. However, I want to highlight the fact that we are considering not simply extra money but modernising the service, changing some of the practices and the ways in which we use beds and deal with admissions. Avon has been excellent at finding innovative ways of doing that.

Last year's total included £4.92 million from the modernisation fund, specifically targeted at waiting lists. I know that the hon. Gentleman is worried about waiting lists and that he secured an earlier Adjournment debate on the subject. Of the additional £5.58 million that the health authority received, funding was targeted at, for example, staff recruitment and retention—again, that paid off—mental health, cancer waiting times and nurse prescribing.

However, we must not neglect the fabric of the NHS. As part of the largest capital programme in the history of the NHS, it is forecast that the total capital spend in Avon will be more than £38.5 million. That includes £2.6 million from the modernisation fund to improve the accident and emergency departments in all the major acute trusts in Avon. Avon health authority and the local trusts will have allowed for the extra spending needed to cope with the expected additional pressures when planning for winter. Making financial arrangements was part of the winter planning.

The hon. Gentleman referred to the increases awarded to nurses. Again, significant account was taken of them in the extra health allocations, which were announced recently. Although all NHS organisations in the Avon area took steps to increase their capacity to deal with winter pressures, I want to highlight the particular measures taken by the South Gloucestershire planning group, as they will be of the most concern to the hon. Gentleman's constituents. North Bristol NHS trust staffed and opened an additional 44 beds and had a further 14 on standby. Those measures included opening 18 medical beds in Elgar House at Southmead. At Frenchay hospital, the trust opened an additional ward with 17 beds to serve as an overflow facility as well as a further four medical beds on existing wards and six low-dependency beds at Blackberry Hill hospital. In addition, the trust has opened a further 62 beds this month to cope with the record number of emergency admissions.

The trust has continued its expansion of the "hospital at home" scheme and placed particular emphasis on early intervention. That has increased the scheme's capacity to take referrals from general practitioners and hospitals, reducing the need for—or cutting down the length of—hospital admissions. The health authority also made a separate non-recurring allocation of £100,000 to North Bristol NHS trust to help with winter pressures. That money has been used to provide occupational therapy, physiotherapy and home-loan equipment and to meet the extra costs of ambulance transport to assist with prompt discharge from hospitals.

The local primary care group was closely involved in planning for the winter. It put in place a number of initiatives including extra surgeries without appointments, nurse-run dressing clinics, newsletter information to patients, extra contraception clinics and influenza and pneumococcal vaccination clinics. It also planned for emergency provisions in the case of widespread utilities and systems failures. Thankfully, the last measure was not needed, but although the system failures predicted for 2000 have not happened, those plans were extremely valuable and that should be recognised.

The hon. Gentleman raised concerns about elective surgery. It is part of normal NHS planning on dealing with waiting lists to take account of the expected close-down over the holiday period and reductions in activity caused by winter pressures. We always expected less elective activity to take place during January. North Bristol NHS trust, to deal with some of the extra pressures, entered an agreement with St. Mary's hospital—a local charitable organisation—to carry out routine surgery there. The doctors carrying out that surgery will be NHS staff working in NHS time. The trust is consulting patients about whether they wish to be treated at St. Mary's. Those arrangements will mean treatment for more than 200 patients, and it must be emphasised that the use of private facilities will not lead to any charges to any patient.

Mr. Webb

I raised the case of my constituent, Mrs. A, who would want the Minister to respond to her tragic circumstances. I hope that she will be able to do so.

Ms Stuart

When a particular case is raised it is only right that I mount a proper investigation and I should be grateful if the hon. Gentleman contacted me after the debate. I shall investigate the circumstances. This is a serious case and he deserves a serious answer.

It is important to say that, although the success of such planning has been shown in Avon, the future of the NHS is extra funding, which the Government are providing. By modernising our services, we can build on the structures that we have and build capacity. I could go to the Treasury tomorrow to ask for extra money, but that would produce not one extra nurse or one extra doctor. The capacity building that we are undertaking with capital investment and training programmes, combined with an examination of the way in which we deliver services, means that we shall improve the way that we cope with winter pressures. Avon coped with unprecedented demands, and coped well. I want to acknowledge that tonight.

Question put and agreed to.

Adjourned accordingly at six minutes to Eleven o'clock.