§ Mr. Nicholas Soames (Mid-Sussex)
Thank you, Mr. Winterton, for giving me the opportunity—for the second time, at your feet—to raise in Parliament the developments taking place in the health service in mid-Sussex. I am grateful to the Minister for giving up her time to respond to the debate today. My constituents have understandable anxieties about the plans. I had the chance to debate the matter with the Minister's predecessor on 29 November last year. At that time, I drew the then Minister's attention to the wholly unsatisfactory proposals of the Central Sussex Partnership Programme document, "Modern Hospital Services for Central Sussex—A challenge for us all".
My constituents and I believe that those proposals were reckless, foolish and wholly lacking in common sense. I pay tribute to the way in which the responsible authorities, the Minister and her Department paid careful attention to a tidal wave of public opinion. The proposals that were put forward subsequently in the second document, entitled "Strengthening Hospital Services in Central Sussex", contain much good sense and much that we accept needs to be developed for the future.
At the time, I made it plain to the Minister that some services would need to be shuffled between the Princess Royal hospital in Haywards Heath and the Royal Sussex county hospital in Brighton; that I would support such changes, provided that the professionals deemed them sensible; and that, inevitably, neither institution would be likely to have exactly what it wanted.
I reinforced that in my letter of 18 October to the present Minister, in which I further emphasised the requirement to consider the proposals in conjunction with the wider review that was taking place in east Surrey and north-west Sussex. Indeed, as the Minister knows, in light of the consultation now taking place, there is a serious debate about the location of, for example, breast care services, a matter that is, naturally, arousing a good deal of anxiety. There are and will be other areas of uncertainty as the plans are revealed.
The Princess Royal is a modern acute hospital with 328 beds in Haywards Heath. Under the proposals, the accident and emergency department—which was, ludicrously, threatened with closure—will be strengthened, which we all welcome. The decision has produced welcome reassurance locally. The department dealt with more than 30,000 patients last year, a number that has steadily risen since the late 1990s. Elderly people are expertly cared for on specialist wards, and the hospital also provides comprehensive surgical and orthopaedic surgery, including for all emergencies.
During the past year, 8,729 patients were admitted to the Princess Royal as emergency cases, and 3,673 were admitted for treatment as planned patients and stayed one or two nights. Last year, the busy out-patient department dealt with 75,258 patients. The hospital directly employs 49 consultant medical staff, 427 nursing staff. 218 technical support staff, 65 midwives, 71 junior medical staff and 343 support staff. The Princess Royal employs a total of 1,173 worthy and excellent people. As the Minister will appreciate, it is a busy and popular local hospital.
62WH The Government's main proposal is, effectively, that the Princess Royal hospital and the Royal Sussex county hospital in Brighton, supported by other local services, merge. The effect would be one major university hospital trust, centred largely on the Royal Sussex county hospital and including the Princess Royal. The plans would place all acute hospital services under one management and would bring together doctors, nurses and other clinical staff to work in a more joined-up and coherent way. All of us would welcome that, and although some understandable reservations about the proposals have been expressed, in making a judgment in the interests of my constituents, I generally support the plan. However, I draw the Minister's attention to genuine and increasing anxieties about the present and future funding of the merged trust, given the especially pressing current financial difficulties.
The Royal Sussex county hospital in Brighton failed in all its published performance targets, and it is said that there is some doubt about the state of its finances; and, indeed, some of its management. In the run-up to the proposed merger, the Princess Royal, through no fault of its own, projects a year-end deficit of £3.3 million. It has been consistently inadequately funded not only by the present Government, but by the previous one. As a result of the challenging level of demand and the ad hoc arrangements in several areas, it spends at least £538,000 a year on beds for which it has received no funding. That is clearly unsustainable for the future. As I said when the Minister kindly received a delegation that I led from my area, delayed transfers create a significant problem, and the continuing cost of treatment and nursing adds a further burden of at least £500,000 to the budget.
The Government have recently given some extra money to cope with the problem, for which we are grateful. However, the problem remains serious throughout the south-east and elsewhere, and the future looks unclear and worrying.
To the more than £1 million that I have mentioned, one can add a further £1 million of unfunded cost pressures that the trust has identified, which are not resourced by an already hard-pressed West Sussex health authority.
In addition, the Princess Royal hospital has to pay further sums to nursing agencies. The cost of agency nurses to the NHS—as you will know, Mr. Winterton, from your experience on the Select Committee—can be truly outrageous. During the August bank holiday last year, it was necessary for one ward to obtain a D-grade nurse for a 12-hour shift. The agency charged £1,019 for a single shift. Last year, the trust spent £310,000 on agency staff. At the end of this current financial year, it is predicted to spend £620,000 on such staff. Clearly, that is wholly unacceptable, unaffordable and symptomatic of the great difficulty in nurse recruitment and retention throughout the south-east. That is of special concern to my constituency.
Because of a consistent failure by the health authority to invest in the nursing infrastructure, the Princess Royal hospital has very low levels of funded establishments on many wards compared with other hospitals in the south-east. Indeed, while the Princess Royal employs 0.84 of a nurse per bed, the Royal Sussex county hospital employs 1.1 nurses per bed. Putting it bluntly, the Royal Sussex employs 20 per cent. more 63WH nurses than the Princess Royal. The Princess Royal estimates that increasing staffing levels at the hospital by 10 per cent., and providing adequate care and reducing agency nursing costs, would cost at least £1.5 million. Given the West Sussex health authority's increasingly difficult financial situation, it appears unlikely that that will be funded. I know that the Minister realises that steps will have to be taken to cover those obligations, which cannot long continue to be fulfilled without significant damage to patient care.
Some of the existing cost pressures have been funded, but not sufficiently to meet, for example, the iniquitous European Union working time requirements and the onerous current service demands. Furthermore, the regulation covering junior doctors' working hours has resulted in an additional eight posts across medicine, general surgery and trauma. To achieve compliance, the posts will cost a further £420,000 in a full year. Then there is the cost of additional work undertaken to meet the in-patient waiting time target—a further £750,000— and, as the Minister will see, there is a read-across to the cost of delayed transfers. There are also particular difficulties in the Princess Royal's excellent special baby care unit, where the nursing establishment is only just barely adequate to maintain a rota. Indeed, our heroic midwives are staffed at a level that is well below that of comparable units in Sussex.
The position is clear. While I cannot comment on the finances of the Royal Sussex, the Princess Royal is consistently and persistently seriously underfunded, probably to the tune of £4.5 million or £5 million annually. That is at the heart of the debate and must now be resolved. It is neither prudent nor sensible for the merger to take place without the financial affairs of both parties to the proposed merger being put straight. As the Minister may know, the newly merged Surrey and Sussex trusts started with a £4 million deficit, from which they have never recovered. It is grossly unfair to the managers of the hospital trusts, and the patients, that the deficits are not removed, as it puts everyone at a disadvantage from day one. I want the Minister to understand—I am sure that she does—that it would be improper and a serious failure of public policy for the merger to be launched without being fully funded, and thus unable to undertake the demanding tasks that it faces.
I would go one step further. Given the Government's rhetoric, much of which is admirable, on the health service, and their failure to deliver on the reform of much of the public service, it would be a grotesque deceit on Mid-Sussex and my constituents—and other constituents—for such matters not to be dealt with properly and honourably.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)
I congratulate the hon. Member for Mid-Sussex (Mr. Soames) on securing the debate about the funding of the Princess Royal hospital. I am aware of the concerns about health services in Mid-Sussex, and I am slightly better informed about them as a result of a visit that I received from the hon. Gentleman, local councillors and representatives of the local community health council. That meeting was 64WH informative, and gave me an insight into the situation on the ground in the community. That is important; it is easy for Ministers to look at papers and submissions, and to fail to have a sense of the practical issues.
The hon. Gentleman's choice of subject has pleased me—although he might not think that that is the case—as it gives me an opportunity to outline some of the additional funding that has been received by the Mid-Sussex NHS trust and the West Sussex health authority, and to explain some of the reforms that the Government are seeking to make to ensure that that extra investment has the maximum impact. The hon. Gentleman has generously acknowledged that his region has received additional support, and I understand his wish to secure an even better position for his local health services.
The funding allocation received by the West Sussex health authority has dramatically improved over the past few years; since 1997, there has been an increase of £231 million. That is a huge amount of extra investment in health for that community. The Government have also been able to provide health trusts such as the West Sussex health authority with three-year spending plans, providing forecasts and a degree of stability. That enables them to plan the growth that they intend to implement, instead of their being stuck on the annual revenue merry-go-round that previously made it difficult for organisations within the health service—and in the public sector in general—to try to plan the way forward.
However, the Government are acutely aware of the concerns that have been raised about the general funding formula in the health service. A wide-ranging review is underway, examining the formula used to make cash allocations to health authorities and to primary care trusts. As a result of the shift in the balance of power, primary care trusts will, in future, spend about 75 per cent. of the entire health service budget. Ensuring that we get the funding allocations right at the level of the primary care trust will be crucial to securing the delivery of acute services and specialised services at tertiary level. If we do not get things right on the ground floor, they might go wrong later on.
The hon. Member for Mid-Sussex acknowledged not only the increases in funding, but the need to try to ensure that the extra finance is accompanied by reform so that the way in which the whole system in our hospitals works can be improved. He has highlighted particular issues with regard to underfunding, but some of the comments that he has made also have more general application.
It is acknowledged that the health service throughout the country has a problem with the recruitment and retention of its staff, its most important resource. That problem is particularly acute in London and the southeast. There are several reasons for that, not the least of which is the buoyant economy in that region. Spiralling house prices make it difficult for public-sector workers of any kind, but nurses and therapists in particular, to get access to the housing market and, therefore, to take up jobs locally.
§ Mr. Howard Flight (Arundel and South Downs)
A daughter of a constituent of mine qualified as a nurse from Edinburgh university, and then arrived in Brighton and applied for a job there. Her application 65WH took three months to deal with and it was six months before a job was offered to her, by which time she had found employment in the private sector. I took that matter up with the West Sussex health authority, as the process of recruiting nurses in Brighton did not seem to me to be as efficient as it might have been. At a grassroots level, that is worth investigating.
§ Ms Blears
The hon. Gentleman makes an important point and I shall look into the matter. Our procedures need to be as efficient as they can be if we are to maximise people's skills and talents.
I am pleased to tell the hon. Gentleman that despite the difficulties of recruitment and retention, there are 17,000 more nurses working in the health service than there were in 1997; we are making considerable progress, but there is a great deal more to do.
I am pleased to be able to tell the hon. Member for Mid-Sussex that as part of the working lives initiative— a raft of measures to try to recruit and retain more staff—West Sussex health authority received £400,000 to enable it to pay the cost-of-living supplements for nurses in the area. That has made quite an impact in keeping people in the service. The initiative is at the forefront of the new schemes to provide affordable housing for key public sector workers. Mid-Sussex has 10 places on starter homes schemes, which means that staff earning less than £35,000 a year can get on the first rung of the housing market, something that everyone will welcome. I am pleased that Mid-Sussex is at the forefront of those new and innovative schemes.
We introduced an organisation called NHS Professionals 12 months ago to try to deal with the widespread use of agency nurses. It is the national health service's in-house agency, providing work for people who want to work on a part-time, temporary or casual basis, and at different times of the week, perhaps to fit in with childcare responsibilities. NHS Professionals provides extensive services, especially in the south-east, so that trusts do not have to meet exorbitant costs, as in the horrifying example quoted by the hon. Member for Mid-Sussex. NHS Professionals is an innovative way of plugging the gaps at times of peak demand when the service needs greater capacity.
The hon. Gentleman is convinced that the trust is under-funded, but at the beginning of the year it forecast a break-even financial position. It is not under-funded in an ongoing, systemic way; the problems can be addressed by the recovery plans now being put in place, although there may have been some weaknesses in financial controls in the in-year management of the budget. There may perhaps have been some weak monitoring of the in-year cost pressures on the system. We must be rigorous and robust in ensuring that the performance improvement arid recovery plans agreed with the region are monitored and followed through; if there are issues that are completely beyond the control of the trust, we must ensure that we address them.
We cannot allow cost pressures to arise in any system without trying to bear down on them and to explore whether different ways of providing and organising the service can give equally high quality NHS services to local people.
The hon. Member for Mid-Sussex was generous in saying that he supports some of the inevitable service reconfigurations that will result from the merger. They 66WH will enable the trust to achieve better standards in each of those sites than it does now. They will also enable some doctors to specialise more in their particular expertise, and they will raise NHS standards for local people.
The financial picture is more complex than it appears. In the past year, there has been a lot of investment to increase capacity at the Princess Royal hospital. There is an extra consultant psychiatrist, gastroenterologist, orthopaedic surgeon, anaesthetist, radiologist, accident and emergency consultant and additional diagnostic facilities and staff. There is a commitment to ensure that the Princess Royal can offer top-quality services to the local community. As the hon. Gentleman said, there is confirmation that full accident and emergency services will be provided 24 hours a day, seven days a week on that site, which has reassured the local community.
Extra resources have been allocated this year to Mid-Sussex from a couple of nationwide schemes. Last week, the Secretary of State announced the strategy on reforming emergency care, which is designed to deal with some of the pressures at the front end of our accident and emergency departments, which are operating under tremendous pressure. The members of staff are doing a marvellous job, but we believe that if organisational changes were made to care delivery, they would be able to see more patients and give them the right care at the right time in the right place.
Reorganising accident and emergency into streaming systems will mean that patients' ailments are cared for by appropriate and relevant staff, so that more simple matters are dealt with by nurse practitioners and more complex matters by consultants, so we can get through the waiting list much more quickly. That strategy is backed up by a considerable amount of money; £118 million will be invested nationally, and the West Sussex health authority will receive an additional £780,000 from that to help it implement the changes.
Pressures creep through the whole hospital system once people move on from accident and emergency departments. The hon. Member for Mid-Sussex raised the question of delayed discharges, which have caused huge problems throughout the national health service in the past year. He will be aware that, three weeks ago, my right hon. Friend the Secretary of State announced an extra £300 million over the next three years to deal with the problem. It is a problem not simply for the hospital service that beds are occupied by people who no longer need to be there, but for the people in those beds. Once their acute medical care has finished, it is not in their best interest to remain in an acute hospital. More appropriate care should be found, whether that is in the nursing home or residential care sector, or through support with domiciliary care packages that maintain patients' independence at home. The programme is important, both in terms of freeing up capacity in hospitals and ensuring that people get the right care in the right place.
I am delighted to be able to inform the hon. Gentleman that, because of West Sussex's particular problems, it has received a disproportionate amount of the £300 million to be allocated. That recognises the particular challenges that it faces. Some £300,000 has already been invested to transfer patients into nursing homes and residential care, with a further £100,000 being made available immediately; more allocations will 67WH be made as the year goes on. Those two schemes have already had the combined effect of releasing 22 beds in the hospital, which represents a 50 per cent. reduction in the number of blocked beds. I am sure that the hon. Gentleman will agree that that is a welcome development.
The challenge for us is to sustain that position and ensure that the number of delayed discharges does not rise again, which is why the money is also connected to a rigorous cash-for-change programme. There must be a change in the way the system works; otherwise we will simply return to the same position year after year. Unless we reach a position in which local social services work hand in hand with the health service to put in place domiciliary and residential care packages, the changes we are making now will not be sustained. That will be in no one's interests; whether that is the acute patients who need their elective surgery or those who need more appropriate care. I hope that the hon. Gentleman will accept that the increased investment must he followed by changes to the system to ensure that we maximise our investment.
§ Mr. Soames
I am grateful to the Minister and I acknowledge that considerable extra sums are being invested. However, that was not the point that I was trying to make. It is true that a number of new posts have been established, but that merely reflects the demand with which the Princess Royal hospital has to cope. I agree that the trust's affairs must be properly run and the value must be got from every pound. Does the Minister agree that it would be wrong to launch the merged trust even with extra investment in people, facilities and everything else? The Princess Royal hospital has been underfunded over the years, although it may now have received more money. However, does she agree that it would be wrong to launch the merged trust without addressing the yoke of considerable deficits that hang around the necks of both parties to the transaction? If that is not dealt with, there will inevitably be a bad start.
§ Ms Blears
Much as I would like to agree with the hon. Gentleman, I cannot agree that wiping the slate clean must be a precondition of the changes that must occur in the health community. The service reconfigurations, which the hon. Gentleman acknowledged will bring improvements, will mean that the trust works more effectively and efficiently, and in the best interests of patients. There will be savings because of the reconfiguration, but that is not the prime motive, which is to raise standards and to ensure that the right services are in the right place in the local community. We should not have a precondition of removing the deficit completely. It is important that we 68WH can achieve the recovery plan that was agreed with the region; that shows a clear way forward in ensuring that the trust breaks even and balances its books while not compromising the services available to patients. Over the next few months, we must ensure that the plan is monitored. If unforeseen pressures that are not in the recovery plan cannot be dealt with, that is a matter for reconsideration. The trust can get off to a good start by implementing some of the changes.
The hon. Gentleman performed a great service by raising these matters so that they are in all peoples' minds. It is challenging—an overused word in this place—and realistic to manage our way through and to ensure that extra investment does not create further problems down the line, but instead improves the service imaginatively and creatively and reduces in-year pressures. That can be done and it will result in better services for the hon. Gentleman's constituents. That must be the overriding concern of all hon. Members'. Any process changes that are put into effect should not just shuffle pieces on a draughtboard but improve the outcome and services for local people.
I am aware that the hon. Gentleman raised a wide range of matters, including staffing and new investment. He also mentioned compliance with junior doctors' hours; that is a further pressure on the health service, but it is right. The Mid-Sussex NHS trust has worked towards compliance and recruited eight additional doctors in general medicine and general surgery. A further four grade F nurses have been recruited and trained. They perform some duties that medical staff performed previously. That is a new way of working to get maximum benefit. Those nurses are perfectly capable of carrying out such duties and enjoy the full support of doctors and consultants when performing them. We want more value from our investment. The Mid-Sussex NHS trust is taking on board the new agenda that people can work in different ways, have a wider skill mix and undertake duties that we would not have previously dreamt of being undertaken by nurses. However, nurses do that well, with full regard for their patients' safety and security.
I am optimistic that the trust can go ahead with its proposals. It is important to examine the proposals in the context of the wider review, which the hon. Member for Mid-Sussex forcefully impressed on me. I shall ensure that the matter is not dealt with simply in isolation. The whole community must feel that its health services are the best that can be provided for local people. It must have confidence and trust and feel that people listen to its point of view when making fundamental decisions. I give a commitment to ensure that we do that, that we take on board all of the issues that the hon. Gentleman raised and that we try to ensure that finances reflect the true situation.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Two o'clock.