§ Mr. Deputy Speaker (Mr. Nicholas Winterton)
Before I call the hon. Member for Witney (Mr. Cameron), I should advise the House that the hon. Members for Banbury (Tony Baldry) and for Henley (Mr. Johnson) have obtained the permission of the Minister, the owner of the debate, the hon. Member for Witney, and myself to make brief contributions.
§ Mr. David Cameron (Witney)
I am delighted to have an opportunity to speak about the problems in the national health service and social services in Oxfordshire. I am pleased to be joined by my hon. Friends the Members for Banbury (Tony Baldry) and for Henley (Mr. Johnson).
I have put in for the same Adjournment debate every week for one simple reason: the state of our health and social services is the subject that dominates both my postbag and my surgeries. We are poorly served in Oxfordshire, and it seems to be getting worse. However, the debate is not about point scoring; it is about asking the Minister what can be done to make things better. Having said that, I praise the magnificent staff in our hospitals and all those who work for social services. I spent a lot of time with them in the John Radcliffe hospital and the Witney community hospital last week. They struggle, often against the odds, to deliver their services. What I am about to run through may sound like a shopping list of problems, but I make no apologies for that because the shelves are bare in Oxfordshire.
I shall start with the most urgent problem, which is the buildings of Burford community hospital. The Government closed it in November 1999, but from the ashes of that dreadful decision came a group called the Phoenix trust. It had the excellent idea of saving the buildings to provide health services for the people of Burford. It put together a great plan involving voluntary bodies, charities and educational organisations, all of which are concerned with health and healthy living. It won the support of local people and the local council, and it won public funding as part of the leader plus bid.
The Phoenix trust won priority purchaser status from the South West Oxfordshire primary care trust, the body which owns the buildings, and it was offered a chance to acquire them for £500,000. Its plans fitted in with the Government's strategy of backing such healthy living centres. It raised the money, and after some negotiation it was ready to go. Last week, however, it heard that the district valuer had upped the value of the building to £700,000, and the health authority has said that its hands are tied.
Without any consultation, the primary care trust put out a press release stating that the buildings would go on the open market, in which they are likely to be snapped up by a property developer. I beg the Minister to intervene, even at this late hour, to put a stop to that nonsense. The goalposts have been moved at the last minute wholly unfairly against the Phoenix trust. People in Burford rightly feel that those are their buildings: the remains of their hospital that they backed and for which they raised money for decades. They should not be treated in that way. The original decision to close the 292WH hospital was wholly wrong because we should be trying to deliver health care, and particularly respite care, closer to people.
The next problem on my shopping list is blocked hospital beds, which is directly related to such delivery of health care. Managers at the John Radcliffe hospital told me last week that typically between 100 and 150 beds are blocked across the county at any one time, and I had that figure confirmed this morning. The social services department at Oxfordshire county council explained at a recent meeting in Woodstock that half its care homes are going to shut before 2007, when the new standards will come in. Without rapid and positive action that problem will get much worse.
I recently wrote to every general practitioner in my constituency, and their answers came back thick and fast. Sandy Scott from the Wychwood surgery stated:Residential homes are closing at a rate of knots; funding for beds via social services provides no profit to the operators. The problem will only get worse unless addressed immediately.I could quote from many similar letters. What actions will the Government take to ease that problem and ensure adequate care home places in Oxfordshire?
As well as a queue to get out of hospital, there is a queue to get in. Three related problems are the breakdown in the accident and emergency department of the John Radcliffe, the long waits for operations and out-patient appointments and the high number of cancelled operations. I have written to Ministers about individual cases. The overwhelming cause of those problems seems to be staff shortages. Before dealing with that, I shall explain what those symptoms mean for my constituents in west Oxfordshire. In A&E, the John Radcliffe has failed to meet the target for cutting 12-hour waits for admission to hospital; it has trolley waits. Such cases arise in my surgery and postbag weekly, and, as a doctor from the Woodstock surgery wrote in December:The JR has on several occasions been closed to admissions… Patients have been diverted as far as Northampton and Stoke Mandeville.As for waits for out-patient appointments, a doctor from Charlbury wrote to explain that the waiting times for some clinics are more than a year.
For cancelled operations, the official figures are that same-day cancellations were 5.7 per cent. of last year's total. That is a bald statistic, but it means one out of every 20 planned operations is cancelled on the day it was supposed to happen. I know that the Minister will agree that that is a dreadful way in which to treat people. The record has improved considerably since then, but the long term problem remains, and 80 beds across the trust are still closed. There is a clear connection between A&E problems, cancelled operations and long waiting times.
Mr. Bowman of Shipton-under-Wychwood received a letter from a consultant urologist from the John Radcliffe, who explained:We are working presently at 100 per cent. capacity on the wards and our operating lists. This has two effects. Firstly, if we have emergency patients on the wards or we are unable to discharge patients following surgery…the inevitable consequence is that patients awaiting operations will have to be cancelled. Once the cancellation has been made, there then comes the second problem namely that all our operating slots are booked up for at least 2-3 months in advance.293WH The individual has the great disappointment of a cancelled operation, then is told that nothing can be done for two to three months, or sometimes longer.
That difficulty is caused by capacity constraints more than anything else, the most obvious of which is staff shortages. During a recent visit to the John Radcliffe, I was told that there were more than 300 nursing vacancies. All told, some 14 per cent. of positions are unfilled. The problem is caused by national pay rates combined with the high cost of living and housing in Oxfordshire. We cannot recruit enough staff, and we cannot retain those we have. I heard from doctors that some 80 nurses are coming from the Philippines. They will be warmly welcomed in Oxfordshire, but they are not the long-term answer. Our nurses should be paid at least the same as those in London, where London weighting provides more than £3,000 extra. In the longer term, we want to see an end to national pay rates.
Next on the shopping list is the star system for judging hospitals. Unsurprisingly, the John Radcliffe got no stars under the Government scheme. However, is that the right way to manage? The problem in the John Radcliffe is capacity: it is constrained, and cannot hire enough staff. So what have the Government done? They have hung a sign that says "failure" on the hospital's door. We were told at the meeting that a total of 21 indicators have to be met, but they are being reviewed, so the hospital's management is not sure of the targets it is trying to hit this year. Will the Minister provide some clarity on those indicators?
I shall address social services. To put the problem in a sound bite—I must because time is running short, and my hon. Friends must have their bites too—we have a funding crisis in social services with cuts being made, charges going up and services being cut back. Again, we have the critical problem of hiring staff. The director of social services at Oxfordshire county council described the situation asa social care economy on the point of collapse".The long-term situation is worrying. People who care for loved ones at home are heroes and heroines, and they deserve our support. There are 67,000 of them in Oxfordshire. The institutional system will collapse if they cease to work their current wonders, and urgent action is needed to prevent that from happening. Oxfordshire spends over 15 per cent. more than its standard spending assessment. Its SSA is profoundly unfair, and is the sixth lowest in the country per head of population. Cuts are now reducing the overspend. Eligibility criteria determine who will and will not be assisted. I shall give the Minister a copy of the document that states that no assistance will be given forsevere illness or disability and likelihood of deterioration".Nor will assistance be given if there is apossible risk that an individual or carer is unable to maintain a safe environment".This is a brutal document, and I sent a copy of it to the Secretary of State. I have not received a response.
The new charging policy is a direct consequence of the dire financial situation. Mrs. Roberts of North Leigh copied me the letter that she sent to social services. Her husband, who has Parkinson's disease, receives help from two care workers. He was being charged £409 a month, and that will increase to £952 a month—a 294WH 140 per cent. increase. The two care assistants do a great job, but they help for only eight and three quarter hours a week. If the Minister does the mathematics, she will realise that that is an expensive charge. The staffing problem underpins that. Mrs. Tussie Myerson is a brave mother who struggles to cope looking after Emmy, her severely disabled daughter. When I took up her case, the reply from the social services could have been written by the NHS. They told me that they were havingextreme difficulty recruiting care staff for children".The problem is the same.
We have high house prices and a high cost of living in our area, but we must stick to national rates. I e-mailed the Minister about some of those issues, as I want her to engage with the problems. The bald statistics back up the anecdotal evidence. In the Oxfordshire health authority, fewer operations were carried out in the last financial year than in the financial year before. The number of in-patients treated has gone down by 3,000. Oxfordshire health authority is soon to be no more, so that is the final element on my shopping list. Will the Minister guarantee that consistent figures will be published, so that we can keep taking the temperature of the health and social services in Oxfordshire on behalf of our constituents, and see what progress is being made? My constituents and I look forward to her reassurance about the difficult problems that we face in Oxfordshire.
§ Mr. Deputy Speaker
I make a plea to the two hon. Gentlemen whom I intend to call to be succinct, to allow the Minister time to reply.
§ Tony Baldry (Banbury)
I promise to be succinct, as my hon. Friend the Member for Witney (Mr. Cameron) made all the points clearly.
I have had the Minister's responsibility, and I know that one can get frustrated at what may seem like an inordinate amount of special pleading from different parts of the country. We are not making any special pleading about social services, and I ask the Minister to visit Oxfordshire on behalf of hon. Members who have Oxfordshire constituencies. We are all concerned about the John Radcliffe hospital and its persistent nurse shortages. It would be helpful if the Minister could talk to the managers and staff, as there is a growing problem.
In its recent annual review of the performance of Oxfordshire social services, the social services inspectorate found that Oxfordshire has maintained a creditable level and quality of service provision despite significant budget difficulties. My hon. Friend talked about eligibility criteria. In Oxfordshire, many elderly and frail people no longer receive support from the county council and social services. Many people living at home on their own have no contact or social support. I spent time before Christmas visiting elderly people in their homes, at the suggestion of Age Concern. I was genuinely disturbed at how little support many of those people receive. They are often unnoticed, but they are in considerable need. As my hon. Friend said, we do not want to score political points; there is a problem and we would welcome the Minister spending some time with us. It would help to reinforce her argument that social services provision needs more money when she and her hon. Friends see the Chief Secretary to the Treasury, and others who hold the purse strings.
§ Mr. Boris Johnson (Henley)
I, too, will be brief, as many of my points have already been made.
I thank my hon. Friend the Member for Witney (Mr. Cameron) for securing the debate. I echo everything that he said, especially about the shortfall in social services spending in Oxfordshire, which is having an adverse effect on some of the most vulnerable people in society. Week in and week out, hon. Members meet people in their surgeries who are at the end of their tether. They deal with severely disabled and elderly people who are being kicked out of nursing homes that are on the point of closure.
My hon. Friend elucidated the problems facing those nursing homes, such as the minimum wage and the additional standards imposed on them, and the problems faced by hospitals in the area, especially the John Radcliffe hospital, in recruiting and retaining nurses. I shall be interested to hear the Minister's response to the point about national pay scales for nurses. Is there any prospect of that rigid system being made more flexible? It is at the heart of the problem.
Bed blocking is a huge problem in my constituency. My hon. Friend quoted some statistics, and there are others. Last year, on any given day, there were 22 cases of bed blocking in Oxfordshire. People have to be over 75 even to be mentioned in the statistics. Sometimes, people are driven to try to rectify matters themselves, as they did in the case of the Watlington hospital, which was closed by the Labour Government. Local people decided to rebuild it by public petition and public subscription, and I hope that the Minister will congratulate them on their success.
The Secretary of State for Transport, Local Government and the Regions has not made many notable decisions in his tenure of office, but he did one good thing: he did not call in the Watlington hospital for approval and did not object to it. I congratulate him at least on that decision, and I hope that the Minister will, too.
Local people should not be expected to rebuild their own hospitals to rectify the problems that the Government are causing social services in Oxfordshire. I hope that the Minister will give some comfort and succour to many of my constituents who are suffering grievously.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)
I congratulate the hon. Member for Witney (Mr. Cameron) on securing the debate; his persistence finally paid off. I agree with him that the matters he raised are extremely important to his constituents and to people throughout the country. I acknowledge that health and social services in Oxfordshire are operating under tremendous pressure. I was pleased that the hon. Gentleman paid tribute to staff in social services and the NHS who manage to do a first-class job for many of their patients and clients, sometimes in very trying circumstances.
I am grateful for the contribution of the hon. Member for Banbury (Tony Baldry) and a little less grateful for the partisan way in which the hon. Member for Henley (Mr. Johnson) put his case. However, I am delighted to 296WH join him in congratulating the people in Watlington on the work they have done. I hope that there will be a successful outcome to the proposals for Burford, which I shall mention in due course. It is an important matter for the hon. Member for Witney.
First, I shall deal with issues relating to social services. The standard spending assessment for social services in Oxford and the eligibility and charging criteria are matters of great concern. The Government take the work of social services very seriously. We are beginning to see much closer working between the NHS and social care in local communities. Our constituents are not bothered whether the NHS or social services provide their care: they want a seamless transition to meet their needs.
Nationally, resources for social services have increased in real terms by 3.1 per cent. a year over the past few years. That contrasts markedly with the 0.1 per cent. per annum increase between 1992 and 1997. I do not want to make partisan remarks, but recent increases have been considerably higher than in the past. That does not mean for a moment that all the pressures have been met and that services are not under any strain. I fully recognise that.
Oxfordshire has benefited from increased investment. It received a 9.3 per cent. increase this year, including a 6.5 per cent. increase in the personal social services SSA. That will increase by a further 5.6 per cent. next year. It will also receive significant increases in grants paid directly by the Department. The children's grant will increase by 11 per cent., the carers' grant by 22 per cent. and the building care capacity and deferred payments grants will double. Significant additional investment is therefore going into social services in the area.
I recognise that Oxfordshire faces local budget problems. It has an overspend from last year carried forward to this year. The new chief executive has appointed a specific person to examine the budgeting processes within the county to ensure that its expenditure leads to best value and effectiveness. I commend that robust approach to financial management at local level.
I acknowledge that funding for the national health service is significantly more generous than funding increases for social services. Under the joined-up system, the extra money invested in the NHS may sometimes have a more marked effect on social services in that the more people treated in hospitals, the more people need care on discharge and in the community. We have to try to match the two parts of the jigsaw for future funding.
I understand hon. Members' concern about eligibility criteria and charges, particularly when, as a result of changes, people previously eligible for free care suddenly find that they have to pay. I would like to highlight one forthcoming change that will improve the position of many constituents. Under the council's current charging regime, residents start to pay if they possess £12,000 of resources, excluding the value of their home. From October this year, that will be changed in line with national policy and the threshold will be increased from £12,000 to £19,000 before charges are payable. Many more people in Oxfordshire will then be able to access services without charge.
297WH Supporting carers in the home is also important. Sometimes the whole debate about caring for elderly people is focused on residential care and nursing home places. I understand the reasons for that, but we must also understand that many people want to be cared for in their own homes for as long as possible. That often depends on the good will, energy and stamina of people who are often elderly themselves and care for their elderly partners. We sometimes forget that many carers are not young, fit and full of energy, but are people in their 60s, 70s or even older who have to provide care 24 hours a day, seven days a week, with all the commensurate strains that that puts on them and their families.
The Government view that problem as a priority. That is why we increased carers' grants for Oxfordshire by 40 per cent. last year. In 2002–03 the grant will be worth £85 million nationally, and Oxfordshire should receive £680,000. I am delighted that Oxfordshire is using its grant in several innovative ways, including extending the relief to carers to all client groups.
Carers often feel that they do not have the prospect of a break or a glimmer of light at the end of the tunnel. They may want just a couple of hours off to do their shopping or to be by themselves. Carers hugely appreciate that, so making sure that respite and relief care are available is very important. Most carers desperately want to give the best care possible to the people who depend on them. The relatively small investment that we make in giving carers a short break is repaid tenfold in the extra energy that they bring back to the task that faces them.
There will be more respite care. More short-term breaks will be offered to carers of people with physical or learning disabilities, who are important clients and a demanding group of people to care for. There will also be breaks for carers of people with mental health problems. We tend to think of carers as people who help people physically to dress, wash and look after themselves, yet caring for someone with a mental health problem is probably one of the most intense jobs that anyone can do.
Three new care managers will carry out assessments throughout Oxfordshire. The Government introduced the right to assessment by carers themselves, rather than just the people being cared for. Carers are considered in their own right as individuals with needs.
This year, the promoting independence grant has replaced the previous set of grants. The new money has been spent on promoting independence through new patterns of service, which try to provide care close to home and help to prevent re-admission to hospital or residential care. Many authorities now provide outreach teams, and many places have fall clinics. One of the main reasons for the admission of elderly people to hospital in the first place is that they have had a fall because they are unsteady on their feet. They are also more likely to suffer a severe fracture that takes longer to heal. They go into hospital, lose their independence and have to stay in residential care. Elderly people do not want to enter that vicious circle of decline. The simple action of analysing the reasons why elderly people have falls in the first place can prevent tragedies, so we need to put more resources into the front end of 298WH the system. The medication taken by elderly people often makes them more likely to lose their balance and have a fall, so that is also important.
Pay issues have been raised. Pay rates are a matter for local negotiation, but since April Oxfordshire has had a cost-of-living supplement of £600 for qualified nurses of grade C and above. A great deal of work has been done on child care facilities, returning to work, family-friendly policies and flexible working. I am acutely conscious of the recruitment and retention problems in the south-east. The cost of housing is high, and people find it difficult to survive on the wages that are paid in this area. That problem affects not only the health service, but teachers, police officers and the whole public sector. There are innovative schemes to provide people with access to housing. I believe that Oxfordshire is at the forefront of providing low-cost housing. The John Radcliffe is leading a scheme that will result in some 130 housing units becoming available.
§ Ms Blears
I shall press on, because there are only two minutes left and I want to deal with the Burford issue. I know that a group of local people has raised a great deal of money, which is welcome, and wants to provide a healthy living centre. There is an issue concerning how much information they have provided about what services would be on offer in the centre. It is important that that information be fully available so that the primary care trust can decide whether it wants to support the development and whether it would be of value to the community. I urge the group to be as open as possible. I will certainly urge the region to continue negotiating and to be fully engaged in the process.
I understand that the rise in the valuation that occurred quite recently resulted from a proposal by the Phoenix trust for part of the site to be used for residential development. Clearly, in an area with high land prices, such as Oxfordshire, the introduction of the residential element has been the trigger for an increase in the valuation. If the centre is to provide a service that is of great value to the NHS, there is a basis for further discussion about how local people can share the benefit. I ask all parties involved, including the officials in the region, to get together and ensure that we make progress as fast as possible. They are bound by public probity issues and must ensure that they act in accordance with proper rules for public funds.
§ Mr. Cameron
I should be grateful if the Minister would ensure that the officials do not put the building on the market until they have had the conversations to which she referred.
§ Ms Blears
I told my officials this morning that this is an important project and that they should have discussions and get information so that they can make a proper assessment of what will be put on the site. That is very important.
Finally on the health service, I recognise that local people will be concerned about the fact that their local trust has a zero star rating. However, it is beginning to improve and do a good job, and I will be visiting because I want to talk to the staff and everyone involved.