§ Dr. Evan Harris (Oxford, West and Abingdon)I am pleased to launch the first debate on the national health service following the Budget and to draw attention to the crisis facing the NHS in Oxfordshire. The Minister will know from previous meetings and correspondence how bad the situation has become in Oxfordshire. My postbag, and those of other Members of Parliament in the county, has increased because of the gap between expectations raised by the Government and the services that the health authority has been able to deliver.
At the general election, the Government said that they had "14 days to save the NHS". There was no mention that that announcement would be repeated yesterday—nearly three years into the Labour Government's period in office. The funding announced yesterday would have been critical to preserving services in Oxfordshire during the first two years of this Parliament.
Local people, patients and elected councillors of all parties are upset to find that services that survived 18 years of Tory cuts have fallen victim to the Tory spending plans imposed on the county during the Government's first two years. The Minister will be aware of the cuts in Oxfordshire, but it would be helpful to recount some of them.
Two community hospitals—at Burford and Watlington—were closed, and 18 beds were lost at Abingdon hospital in my constituency. The trust and health authority admitted that the closures took place because there was not enough money to keep those hospitals open. The trust was in deficit and had to cut its budget. That can be disguised, using the language of "cost improvements" or "cost savings", but the fact remains that there were financial cuts. The community trust recognised that closing hospitals provided a bigger financial saving per bed than cutting beds generally, or cutting services, such as occupational therapy. However, those hospitals not only provided a local service, but helped acute hospitals by providing recuperation and rehabilitation.
The three Rs—recuperation, rehabilitation and respite care—so important to many elderly patients, have been seriously damaged by the Secretary of State for Health's decision to allow the closure of those hospitals in line with the health authority plan, and his failure to finance the health authority and, through it, general practitioner groups and the community trust, well enough to keep the hospitals open. Occupancy rates in those hospital beds were high. They served GPs, who could divert patients from acute hospitals to community hospital beds, and they enabled hospitals, such as the John Radcliffe, to discharge patients and make more cost-effective use of their beds, and to provide a more appropriate environment, especially for elderly patients who needed no longer to be in the hurly-burly of an acute hospital.
Will the Minister give an assurance that the funds announced yesterday for this financial year can and should be used to re-open those community hospital beds? The health authority and the Government have tried to disguise the closure of beds by talking about an additional hospital in Bicester and by changing the 251WH means by which patients are admitted to beds. However, that is irrelevant, and entirely separate from the number of beds closed in Oxfordshire.
We heard recently about the closure of the cardiac rehabilitation unit in Oxfordshire—a service for people who have suffered heart attacks, to enable them to recover and improve their quality of life. Sadly, that service has effectively ceased across almost all of Oxfordshire. Again that is due to a shortage of funds in the acute trust, which cannot obtain funding from other sources. We were told yesterday that money will be available from 1 April. A litmus test of the Government's commitment to the NHS would be whether such a service could be restored immediately. Many hon. Members who represent Oxfordshire constituencies have received heart-rending letters from cardiac patients who would expect to see, in line with the Government's health service policies, an improvement in rehabilitation services. They would not expect them to be cut.
The Minister will know that Oxfordshire's mental health care NHS trust has a severe financial deficit. It survived 18 years of Conservative Government, but in the third year of a Labour Government, it is facing a recovery plan that requires it to make significant cuts in clinical services for various patient groups. The trust has tried to make cuts that do not affect patient care, but the jargon of the trust recovery plan leaves me in no doubt that cuts will be made to occupational therapy, psychotherapy and psychology services. Those cuts could affect clinical and medical posts at a time when the Government say—indeed, they were elected on this platform—that we will have more doctors, nurses and caring professional staff, such as occupational therapists.
In light of the new money, will the Government confirm that the funds can, and, as mental health desperately needs additional funding, should, be used to ensure that the cuts do not occur? People in Oxfordshire will not understand the hype that surrounds a cash bonanza for the NHS if community hospitals remain closed, more community beds are closed, cardiac rehabilitation services continue to be affected and more cuts are made to mental health care services.
The John Radcliffe hospital faces a critical cash crisis. For many months, more than 100 beds have been closed because of a lack of nurses. Although it is not providing a proper service, people might think that it is saving money. But on 17 February, the Oxford Mail reported that the hospital had a predicted debt of £3.5 million by the end of the financial year, despite cuts in clinical services. On the radio this morning, prior to a health authority meeting, it was confirmed that that figure was an underestimate. The John Radcliffe hospital is in even greater financial crisis. Combined with the accumulated deficit in the ambulance trust and the mental health trust, and with continuing difficulties with waiting times at the Nuffield orthopaedic centre, Oxfordshire health authority can, at the end of the financial year, report only a deepening financial crisis.
Will some of the cash bonanza that the Government announced yesterday be available to obliterate those deficits without further cuts in clinical services or cuts in planned growth in services for the next year? 252WH Oxfordshire people will want to know whether their services match the hype surrounding the Government's comprehensive spending review and yesterday's announcement of significant extra funds for the health service.
The situation is drastic for people who want to gain admission to the Oxford Radcliffe hospitals. General practitioners in my area are for ever being sent letters explaining the difficulty that the trust is in. On 25 January, the Oxford Radcliffe Hospitals NHS trust sent a letter to GPs stating:
Dear Colleague … At 8.30 this morning we had 26 patients waiting for admission in the A&E Department; all our cubicles and corridors were full—the assumption being that today's NHS fills corridors. It went on to say:
We had in excess of 20 patients waiting for admission to a ward from our GP Referral Unit and also Edward Buzzard Ward.Level 3 of the escalation policy was called at 5pm last night. This states that "all cubicles in A&E are full and the number of patients on trolleys in corridors is so overwhelming to the extent that patients cannot readily be taken off the ambulances.Coming at a time in January significantly after the increased activity caused by the flu epidemic, what sort of a comment is that on the Labour Government's stewardship of an NHS, which, with all good intentions, they promised in April 1997 to save?
Mr. Michael Jabez Foster (Hasting and Rye)What always surpises me about the comments of the hon. Gentleman and other Liberal Democrats is that although one can understand their concerns, one cannot understand what solution is being proposed. Is the hon. Gentlemen suggesting that significantly more funds should have been made available earlier on, and if so, where does he think the money should have come from, beyond putting 1p on income tax?
§ Dr. HarrisI am grateful for that intervention because it enables me to explain what we would have done. There is no reason why the Government should have stuck to Conservative spending plans during their first two years in office; during that time, real-terms growth for the NHS was still the lowest for the past two decades, even taking into account the additional funds provided by the Government. As we made clear, we thought that the Chancellor should have opened his war chest much earlier than he did, and should have eschewed an income tax cut earlier in the Parliament in favour of putting money into public services.
The Liberal Democrats stood on a platform of putting 1p on income tax to go towards education, if it was necessary, as we believed it was. We also made it clear that, if the Government would not do that, they should not cut taxes for the better off at a time when the NHS was desperate for funding. If that money were directed into the NHS, Oxfordshire's share of the income tax cut would be about 1 per cent. of the total amount available, which would be about £26 million if all the funding was allocated on a weighted capitation allocation through the hospital and community health services budget this year. That money would have eradicated all the deficits in Oxfordshire and would have permitted some growth in services.
253WH As a result of his departmental responsibilities, the Minister will know of the very important mix between social services and health services. Some of the cuts in the Oxfordshire health service would not be so bad if social services had not been clobbered year after year under successive Conservative Governments and then again under this Government. The Government capped Oxfordshire county council, which meant that it could not spend what it wished to spend on social services, which made the crisis in NHS provision even worse for the health authority.
I joined an all-party delegation to see the Minister at the Department of the Environment, Transport and the Regions to plead with him, in the light of the squeeze on health services, not to cap Oxfordshire county council, but to allow local people and the representatives of the four parties on the council to improve social services, as the Labour party said that it would before it was elected. Under this Government, two care homes for the elderly in my constituency have been closed. Care homes for the elderly that survived 18 years of Tory cuts were closed under this Government's stewardship. I receive more letters about the closure of Oseney court than on any other matter. Indeed, Labour councillors joined Liberal Democrat and Conservative councillors to plead for Oxfordshire to be allowed to spend the money that it requires to improve services and not to cut services.
Therefore, I should be grateful if the Minister would explain why, two years into a Labour Government, we are facing cuts in all the services that I have mentioned. Will he also explain why the cash bonanza that the NHS is about to receive is coming only now? Are the Government saying to the people of Oxfordshire, "Do not be sick, ill or infirm, except in the pre-election year of a Labour Government"? The people of Oxfordshire cannot understand why, having voted for a Government who pledged to save the NHS, all they have seen is cut after cut. When the Minister replies, I hope that he will either say that the cuts will be reversed by the new funding or at least apologise for the Government's failure to deliver the improved health services in Oxfordshire that they pledged.
I am, of course, aware of the inheritance received by the Minister and his Government, and that it takes a long time to train the nurses and doctors that the health service needs. I accept that, and have not called for the staff to be conjured up overnight. However, if the funding for which most people felt that they were voting had been put in place at the beginning of the Parliament, Oxfordshire would not be in its current situation.
The Government pledged to save the NHS. They might also have pledged to stick to Tory spending plans, but we in Oxfordshire know that the two pledges were incompatible. They decided to keep their pledge to the better off and to stick to a tax-cutting agenda, rather than funding the health service to meet their pledge to the elderly, the ill and the infirm. That is sad for patients and their relatives in Oxfordshire.
§ The Minister of State, Department of Health (Mr. Hutton)I would like to congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing the debate on NHS provision in Oxfordshire.
I reassure the hon. Gentleman that the Government are fully committed to a high-quality national health service for all the people of the country, including those 254WH living in Oxfordshire. Our principle is that the best services should be available to everyone, no matter where they live. The hon. Gentleman will be aware that we have set a modernising, radical agenda for transforming the NHS that will, in time, deliver year-on-year improvements in health and social service provision.
The hon. Gentleman has chosen to highlight the problems in Oxfordshire. Although the Government fully recognise that the NHS faces considerable pressure in meeting its challenging agenda, it is only right that I take the opportunity to focus on the positive progress being made in his area. He completely failed to acknowledge such positive progress and developments.
I begin by reminding the hon. Gentleman about how much money we are investing in the NHS—investment is higher than ever. In December, my right hon. Friend the Secretary of State for Health announced total funding of £34 billion for England's health authorities for next year. That represented an average cash increase of 6.9 per cent., which is a rise of 4.2 per cent. in real terms.
The hon. Gentleman will be aware of the Chancellor's statement in the House yesterday that national health service spending will rise by 6.1 per cent. each year above inflation until 2004. An extra £2 billion of new money will be available to the NHS from 1 April this year. The investment is sensible and sustainable and will continue the Government's drive to modernise the NHS, and help to create the fast, fair and convenient health service that people expect.
I should say to the hon. Gentleman and to his Liberal Democrat colleagues that the significant increases in NHS funding dwarf the commitments made by his party at the election. I read his party's manifesto today; it said that it would increase health service spending by £540 million a year. That would have been a completely inadequate response to the crisis that he attempted to describe.
§ Dr. HarrisWill the Minister give way?
§ Mr. HuttonI shall not give way. The hon. Gentleman had a chance to make his speech; it is now my chance to set the record straight.
The allocation for Oxfordshire health authority is £327 million this year. Next year, we shall be backing up our commitment to provide year-on-year increases for the health service by allocating the authority £357 million, which represents a cash increase of £23.6 million, or 7.09 per cent. The increase is higher than the national average.
We have not stopped there. We recognise the need to support local services if we are to expect them to keep pace with out modernisation agenda. That is why Oxfordshire health authority has received £6.3 million in special assistance funding since April 1998 to support the modernisation programme and reconfiguration of services across the county.
Oxfordshire has received not only that additional investment. I remind the hon. Gentleman that the authority received an extra £10.8 million in 1999–2000, which we provided to support our modernisation programme. To cut hospital out-patient waiting times, £300,000 was allocated. An allocation of £200,000 was 255WH made to support the booked admission scheme at Oxford's John Radcliffe hospital. Oxfordshire received £1.9 million of extra money from the Government's accident and emergency modernisation fund. A sum of £850,000 has gone to support the upgrading of that hospital's accident and emergency and intensive care departments. An extra £100,000 will be invested to improve cancer out-patient services and more than 100,000 to help to tackle lung cancer. I could continue.
The additional investment has made a real difference. For example, in-patient waiting lists have been reduced. Between March 1998 and January 2000, waiting lists in Oxfordshire went down by more than 2,000. More people in Oxfordshire are being treated by the NHS than ever before, and 5,000 more people were seen in hospitals in Oxfordshire in the second quarter of this financial year than in this quarter last year.Those are the latest statistics.
In December 1999, the Oxford Radcliffe Hospitals NHS trust met the required target on waiting times for cancer patients—a 100 per cent. success rate that should be celebrated. Unfortunately, the hon. Gentleman failed to do that. The upgrade of facilities at the John Radcliffe hospital will result in the expansion of treatment areas and an increase in the number of high dependency beds from 12 to 16.
With that additional investment, we shall be reducing waiting lists, modernising every casualty department that needs it and investing more money in key areas such as cancer and coronary heart disease treatment. The hon. Gentleman said that the coronary rehabilitation unit was closing. He is wrong. It is not closing; the health authority has put it on the priority list for funding in the coming financial year.
Not only are we supporting the services that patients receive, we are starting the biggest hospital-building programme in the history of the NHS. The hon. Gentleman failed to refer to it, but a £80 million redevelopment is taking place at the Oxford Radcliffe Hospitals NHS trust, which will mean patients being treated in modern, purpose-built accommodation. Services will no longer be split between sites, which will reduce the need to transfer patients, removing also the problems that that can often cause. Staff will not have to waste time travelling between sites. Access for patients and visitors will be improved.
The hon. Gentleman mentioned mental health services. In September 1999, I had the pleasure of visiting the brand new medium-secure unit on the Littlemore mental health centre site. A £9 million private finance initiative funded unit will provide 30 mental health beds, and a further 10 beds for people with learning disabilities. The establishment of that unit is good news for the NHS and for the people of Oxfordshire. It is another part of the Government's modernisation programme for the NHS, which will provide safer and more secure care for people with severe mental illness.
The hon. Gentleman will be aware of Oxford's excellent reputation as a world-class centre for innovation and teaching. We want to encourage that. That is why £4.2 million will go to the brand-new Oxford centre for diabetes based at the Churchill 256WH hospital. It will be linked with the drug company Novo Nordisk and Oxford university, renowned for its academic excellence, to develop research facilities for diabetes and related problems.
Since 1998–99, the health service in Oxfordshire has benefited from more than £34 million of new and targeted Government modernising funding; that is on top of the general increase in health authority funding. That investment will continue in future years.
The hon. Gentleman referred to community hospitals in Oxfordshire. It is true that my right hon. Friend the Secretary of State had to make some difficult decisions about the future of those hospitals, but he made the right choice. I assure the hon. Gentleman that such decisions are not taken lightly, but we need to ensure that the right balance of services is available for all hospitals in the county.
The changes are part of a modernisation programme for community services in Oxfordshire and of a coherent development programme for health services in the area. The changes provide an opportunity to redress the inequity of access to community hospital in-patient services. They will also secure the development of increased and more flexible community-based services, which will enable more patients to be treated in or near their homes. That is what patients want, and it is completely in line with the Government's thinking.
We need to make more of the link between community hospitals and intermediate care. Some services will be given in specially designated hospital wards, some in step-down facilities, and some improved care services will be given in the home. For instance, the intensive community support services scheme in Watlington and Wallingford is an innovative approach to providing support services for the local community.
The hon. Gentleman referred to the brand new 30-bed community hospital that is to be built in Bicester. He said that it was irrelevant but it is not. It is part of the modernisation of community services in the county. In an expansion of facilities, the current 12-bed unit will be replaced. There will be more beds to provide equity of services for the county's anticipated population growth. I remind the hon. Gentleman that, as part of the process, the 18 beds earmarked for closure at Abingdon hospital in his constituency will remain open until the new facility at Bicester hospital has been expanded. The hon. Gentleman failed to mention that, when my right hon. Friend the Secretary of State announced his decision, he rejected proposals to close beds at Wallingford, Wantage and Witney community hospitals.
The uncertainty surrounding community services in Oxfordshire is over. The changes will help to shape local health services. The aim is to develop modern, effective, dependable services so that all patients in the county can benefit from the latest in community health care services. All parties have already begun to work closely together to manage that transition.
The hon. Gentleman referred briefly to staffing shortages and pressure on NHS beds generally, and, to be fair to him, he said that those problems would not be solved overnight. We accept that and have always made that clear. We are tackling those matters. Work is progressing on some of the historic recruitment and staff retention problems of the NHS in Oxfordshire. Some of the investments that I have outlined today will help to 257WH deal with wider pressures affecting the service in the hon. Gentleman's part of the country. However, what he described in his speech bore no resemblance to what is really happening in the county. It made no acknowledgement of the hard work of Oxfordshire NHS staff, who work tirelessly for patients. It is incumbent on Members of Parliament to try to provide an accurate picture—[Interruption.] I will not give way to the hon. Gentleman. Hon. Members should attempt to give an accurate assessment of what is happening before presenting the national health service in their part of the country as being in complete collapse. That is a travesty. The hon. Gentleman did himself and his party no favours in trying to caricature the problem.
We are the first to recognise the county's problems. The hon. Gentleman has spoken about them at length today—eloquently and articulately—and on other occasions. That is his job as a constituency MP, which I know he takes seriously. However, a fuller and more balanced depiction would have served his constituents better than the hatchet job that he tried today.
Some of the historic deficit problems that the hon. Gentleman mentioned are being tackled. However, he and those like him who want, for political reasons, to portray the national health service in their constituencies as being in a state of collapse will have 258WH been slightly embarrassed by the timing of today's debate. We are beginning a record investment programme for the health service, which will substantially modernise and improve the services that the hon. Gentleman, you, Madam Deputy Speaker, and I expect for our respective constituents. We are embarking on a 10-year modernisation programme. The results will be clear for the hon. Gentleman's constituents and others to see.
If, as we need to do, we are to assess the national health service and analyse its problems, that must be in the context of the current change and new investment, the new doctors and nurses and the refocusing of services so that patients' needs and interests always come first. We are beginning to work through some of those changes in the national health service. I am confident that, with the continuing fantastic work of Oxfordshire NHS staff, the range and quality of services will improve year on year. We shall all be able to take confidence and pride in the fact that the national health service, about which we feel so strongly and passionately, is providing modernised health care into the new century.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Two o'clock.