§ Mr. Boris Johnson (Henley)
I am pleased that time has been found for this debate, although I am sorry that no other Oxfordshire Members of Parliament have seen fit to attend the proceedings. Perhaps they will join us in due course.
Adjournment debates tend to begin with a whinge about health care, develop into a wail and wind up with a general howl of protest. Let me vary the routine and start with an unrivalled success story which I hope the Minister will appreciate. In about a month's time, the first brick will be laid of the new Watlington hospital in my constituency. It will be marvellous—the type of place in which all hon. Members might hope to wind up, spending our last days gently pottering around in its gardens, looking at the lovely flowers of south Oxfordshire.
There will be 60 beds—some national health service, some private. A quarter will be for the use of mental patients, a quarter for convalescence, a quarter for long stay elderly patients and a quarter for respite care—to give a break to disabled children's parents who are at the end of their tether. There will also be a brand new NHS GP surgery.
The whole project has NHS approval. I am sure that the Minister will be especially pleased to know that the project has so far been accomplished without spending' a penny of public money. Two and a half years ago, the Government closed the small cottage hospital in Watlington—a move bitterly resented by the local population. They have responded magnificently, thanks to the tireless work of Sir Charles Farrell and many others. Donations have been collected, both large and small, and the people of Oxfordshire have raised £1.5 million to reverse an ill-judged closure by the Government. I am sure that the Minister will want to join me in congratulating all those responsible for that achievement. At the risk of tempting him into a departure from Labour's approved ideology, I invite him to agree that it shows what private enterprise can do in the field of health care.
The real question is why the people of Oxfordshire felt so ill-served by their hospitals that they wanted to rebuild one at their own expense. I firmly believe that Westminster Hall debates are not a time for scoring party political points. I do not want to attack of undermine the many health care professionals in my constituency who do a fantastic job in difficult circumstances. However, one reason why it was necessary to build again at Watlington was the shortage of care home beds. We all know that care homes are closing throughout the country at a prodigious rate, thanks in large part to the detailed provisions of the Care Standards Act 2000. In Oxfordshire, half the care homes are predicted to close by 2007.
The closure of care homes is producing the phenomenon of bed blocking in our hospitals, when elderly patients cannot leave and impede the arrival of other patients. At the John Radcliffe hospital, the biggest and most important in Oxfordshire, 46 beds are currently blocked. A further 36 or so are blocked in Oxfordshire's various local hospitals.
54WH There are currently 80 beds in the John Radcliffe that are closed altogether, making it difficult to get in. One GP in my constituency told me yesterday that she had a patient with jaundice whom she could not get into the John Radcliffe. Although he was not, as far as she could tell, in imminent danger, he was in pain and distress and she wanted him to be seen. She could have put him on the cancer list because, according to Government rules, people with cancer must be seen within two weeks—if not actually treated, because one might have to wait a lot longer for that. However, she was not sure that he had cancer, so he had to wait and wait.
Another Oxfordshire GP, Dr. Tony Vernon of Wallingford, recently revealed that he had been unable to get patients into the John Radcliffe because the ambulances meant to be taking them there were not available—they were queuing up outside the hospital supplying trolleys because there was a shortage at the accident and emergency department. From January to March, 84 patients had to wait more than 12 hours in A&E at the John Radcliffe. Sometimes that service is closed, and people cannot get into A&E at the hospital—the biggest hospital serving Oxfordshire—because it is on what is called a divert. People are diverted to as far away as Stoke Mandeville.
When people like me make such criticisms of dedicated health care professionals, it is important that we take account of the problems that they face. A single explanation for the problems of the John Radcliffe may tell us why beds are not only blocked, but closed. We talk about a shortage of beds; the bed is physically there, but it is unavailable for use. The explanation is a shortage of nurses.
There is a 13.6 per cent. shortfall in the nursing strength at the John Radcliffe hospital. That is about 300 nurses short in a crucial hospital that serves many people in my constituency. Of the 1,250 nursing posts in Oxfordshire, 377 are unfilled. That is why beds are not only blocked, but closed. That is why general practitioners find maddening delays in putting patients into secondary care, and broadly why one in 20 planned operations is cancelled on the day of the operation. It is why the A&E seems to be in such a crisis.
The problem of recruitment is at its worst in the south-east, and retention of nurses is also difficult. One in eight registered nurses left the national health service in the year to March 2001 in the south-east region, the area most badly afflicted by wastage. Why is it so difficult to recruit and retain nurses in the south-east? Why is it necessary to try to recruit nurses from the Philippines and other countries, as the Radcliffe has been forced to do? As the Minister will have seen, that has prompted protests from some third-world countries, which have said that they are being denuded of health care workers.
The pat answer is the cost of housing. It is certainly difficult to live on a nurse's wage in Oxfordshire. Does the Minister agree that there is not only too little pay, but too little flexibility in pay? The south-east region has a discretionary weighting of between £400 and £600. That hardly competes with the London weighting of £3,000 for a nurse.
Oxfordshire certainly needs more money. In 2001, the Department of Health instructed Oxfordshire to make cuts in its hospital budget of £7 million. The cuts that we 55WH are all aware of in Oxfordshire social services have a knock-on effect on our hospitals, as I have tried to explain. Is it not also true that the NHS trust could be given more freedom to recruit and reward nurses without having to use the "one size fits all" national pay scales?
Does the Minister agree that, in a diverse economy, with house prices fluctuating wildly between Oxfordshire and Renfrewshire, it does not make sense to give nurses the same basic pay across the board? Does he agree that it is time to start to move away from national pay scales? I hope so. It is unfair to impose consumerist disciplines on the NHS without giving it the freedom to respond. For instance, Tesco has answered the housing crisis in the south of England and Oxfordshire by building housing for its workers. Should the NHS also have such freedom?
Funding is a problem in Oxfordshire, but it is not the only problem. The John Radcliffe has been told by the Government that it is officially a failing hospital on their Egon Ronay or Michelin-style survey of performance indicators. It scored nul points—it got nought. That was demoralising for the people working in the hospital. Whatever the failings of the John Radcliffe, it does not make sense to stigmatise a hospital in that way and to blame its managers, unless they have the freedom to solve the problem. They should have more freedom to recruit nurses, and more flexibility in pay.
I conclude with an angry correspondence between a GP and a consultant. The consultant is a constituent of mine, the GP is not, and I shall keep their identities private. The GP has written a furious letter about a patient who suffers from osteoarthritis. I shall quote long extracts from the exchange, because they give a flavour of what is going on in the NHS in my constituency. The GP wrote:I would be grateful if you would urgently look into the case of this now 60 year old man, and explain to me why progress in his care has been so slow. I referred him to you on 10 April 2001. He had significant osteoarthritis affecting both hips, 'unusual for a man of this age'. He was offered his first appointment with you in March 2002. That is 11 months after the original referral and well outside I believe any reasonable guidelines. As I was so concerned by this I wrote to you on 15 June last year and he was seen by your physiotherapist in December. She confirmed my findings, noted his 'considerable disability', and agreed with me that he 'warrants surgical intervention'. He has heard nothing more. In summary therefore I have a relatively young man with major bilateral hip disease, barely able now to walk, and seen in the 13 months since I referred him by a person who, whilst extremely skilled in her field, was only able to confirm my initial view, that he requires surgery. Such patient management makes a mockery of NHS waiting list guidelines and I would be grateful if you and your Chief Executive could explain to me what has happened. For the sake of my patient, I would be grateful if he could be called in immediately for your assessment and that he waits no longer for his surgery than as if he had been seen in Outpatients after no more than the usual delay.That is a stinging letter for a GP to write to a consultant, and the consultant was very wounded. He wrote a long reply, defending the delay and trying to explain what went wrong. It would be to our advantage to hear his concluding paragraph:I cannot tell you how depressing it is replying to letters such as yours. You state, 'Such patient management makes a mockery of NHS waiting list guidelines and I would be grateful if you and 56WH your chief executive could explain to me what has happened'. Surely you must realise that 'NHS waiting list guidelines' make a mockery of patient management. Ridiculous and unachievable 'targets' set for political gain place an unsustainable strain on everybody involved in patient care in this Trust. In that I include not only all those who interface directly with patients but also our excellent management team who have to produce figures showing that we have met the 'Targets', or face dismissal. You must appreciate that meeting 'Targets' diminishes clinical flexibility. The harder we are driven to meet 'Targets' the less able I am to treat someone such as your patient quickly because we cannot risk not treating someone else within a specified time.There we have two angry health care professionals—a GP blaming the consultant for the delay in seeing his patient and the consultant blaming the system of targets and quotas that gets in his way and prevents him from dealing with patients according to need.
If we are to improve health care services in Oxfordshire, we cannot rely on the charity and beneficence shown by the people of Watlington in rebuilding their own hospital at their own expense. We also need a fairer spending assessment for south Oxfordshire and we should stop castigating health care professionals, such as those in the John Radcliffe, without giving them more freedom to run their own lives, to recruit nurses as they see fit and to treat patients according to need, not according to some Whitehall-imposed system of targets and quotas. I thank the Minister for listening to me so patiently and in such splendid isolation this afternoon. In the absence of any other Oxfordshire Members to make the case for health care in my constituency, I look forward to hearing his response.
§ The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)
I congratulate the hon. Member for Henley (Mr. Johnson) on securing today's debate, during which he has brought his usual robust and avuncular style to the Chamber.
The issue of health provision in Oxfordshire is vital to the hon. Gentleman and his constituents. I am pleased to be here today to put on record the developments in the Oxfordshire health system and improvements that have been made since the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), last debated this subject in February, on which occasion I know that the hon. Gentleman also contributed to the debate.
As the hon. Gentleman will be aware, this Government introduced the NHS plan and the initiative "Shifting the Balance of Power". Our policy of devolution has positioned the NHS, for the first time since its inception, in such a way as to allow local service providers to meet local needs and demands without unnecessary interference from centralising agencies. The hon. Gentleman should acknowledge that initiative, as well as the fact that we are devolving power to local primary care trusts, as some of his comments give the impression that there is nothing but central diktat from Richmond house. That is not the case, and I encourage the hon. Gentleman to look at the documents, if he has not already done so.
PCT management teams have specific local knowledge and expertise, and are now responsible for improving health, securing the provision of all health 57WH services and integrating health and social care. They will become the cornerstone of the NHS—local organisations that are best placed to ensure that the local health service really reflects the needs of the local community. I hope that the hon. Gentleman will agree that that amounts to a considerable shift from the days when, if a bedpan fell on the floor in an NHS hospital, its echo could be heard in the corridors of Whitehall.
I understand the hon. Gentleman's eagerness to ensure that there is continued support for the John Radcliffe hospital in Oxford, and I am keen to echo his sentiments. He raised the issue of spending, and one would have thought that he would have voted for increased investment in the NHS in Oxfordshire during the passage of the National Insurance Contributions Bill. However, when I checked this morning, I was surprised that the hon. Gentleman voted against extra investment for the NHS in Oxford.
§ Mr. Johnson
Perhaps I should clarify my remarks on spending, because the Minister may not have been attending as closely as he should have been. My point is that Oxfordshire has been ill-served compared with other parts of the country. The spending on health in Scotland is about £1,100 a head, compared with £450 a head in Oxfordshire. That is gross discrimination against the people of south Oxfordshire. I am not necessarily calling for a vast increase in public spending. I am merely saying that there is bias against an area that is unjustly perceived as well-heeled. The area includes many pockets of deprivation, but the standard spending assessment is skewed against Oxfordshire.
§ Mr. Lammy
The hon. Gentleman nevertheless raises the issue of investment and shows that he does not believe in extra spending on public services in his constituency. That is important, because when the Government came to power in 1997, spending in the Oxfordshire health authority was set at £236 million. The figure for 2002–03 was £445 million, which represents a massive estimated real-terms increase of 77 per cent. The per capita figure in 1997 was £449 Spending is now £805 per head of population in the area
I accept what the hon. Gentleman said about regional variations in funding, but it is important to the people of Oxfordshire that extra money should be made available year on year. Over time, and with the necessary reform, that will alleviate some of the problems that he mentioned.
I return to the John Radcliffe hospital in Oxford. I appreciate that people living in Oxfordshire would have felt alarmed when they saw their local hospital receiving, a zero rating in September last year. I accept that in some cases that may have been demoralising for the staff. I understand why the hon. Gentleman raised that issue, but the Government feel that it is important that patients know the manner in which their local acute hospital is performing and where there is room for improvement. I do not believe that it is some form of Michelin or Ronay restaurant guide; it is much more important than that. I want to take the opportunity to reassure the hon. Gentleman that the Government an committed to supporting the Radcliffe through increased funding and with the advice and support of 58WH Government organisations such as the NHS Modernisation Agency in tackling the specific areas identified for improvement. This is not just rhetoric. We have backed our statements with real increases in funding specific to that hospital, which has seen an increase from £167 million to £312 million.
§ Mr. Johnson
I am terribly grateful to the Minister for giving way, but since there is no one else to whom to give way I hope that he will not mind too much if I intervene. It is common ground that there is a case for more health care spending in Oxfordshire. Will he say whether he thinks it is a good idea to allow flexibility in nurses' pay and will he answer the consultant's complaint about targets and the unreasonable way in which his clinical priorities are being distorted?
§ Mr. Lammy
The hon. Gentleman raises the issue of targets, and I understand much of what was said in that letter, but I repeat that it is democratically important that the people of Oxfordshire should know about the state of local services and whether there is room for improvement. Establishing that a hospital has a zero rating can be done only by assessing the various services, and that sometimes includes setting targets. That assessment shows us where the hospital needs to go; it helps the Government, the local health authority and the primary care trust to assess need, and I therefore believe that it is democratically necessary.
It is important when talking about health provision in that area to mention the good things that are going on, and I know that the hon. Gentleman would have done so if he had had more time. For instance, the hospital's A&E department has been redeveloped at a cost of £9.5 million, and it is due to reopen in April 2003. The hospital has purchased a new magnetic resonance imaging scanner, which is due to be operational this summer. We have expanded the hospital's capacity. There is a new trauma unit, and £7.5 million has been invested to provide an extra eight beds for trauma services. Another £1.8 million has been spent on the intensive care and high dependency units. It is important to raise issues specific to that hospital.
We need also to mention the other things that are going on there, including the private finance initiatives. For instance, the Nuffield orthopaedic centre has a PFI of £23.6 million, and the Radcliffe infirmary another of £25 million. They should be on track by 2007, along with the £8.5 million physical disability unit at the Nuffield orthopaedic centre. That is happening in the area surrounding the hon. Gentleman's constituency in west Oxfordshire, alongside the problems that exist in the hospital.
§ Mr. Johnson
My constituents in Watlington would be very cross with me if I did not extract some word of congratulation from the Minister. He spoke of the many wonderful scanners and the new A&E that were provided by the NHS. All hon. Members would support those. Might he not thank the people of Watlington for having overturned the Government's senseless decision to close its cottage hospital, and rebuilt it at their own expense?
§ Mr. Lammy
To dabble too much in such decisions. If the local people have chosen to have a hospital in that area, I wish them the best of medical services in the years ahead.
The hon. Gentleman raised the important issue of the recruitment and retention of nursing staff. I am aware of the challenges faced by local health systems and—ultimately—the Government in that regard, especially in the more prosperous south-east. It is not all doom and gloom. Between September 1999 and September 2001 there was a net increase of 20,740 nurses working in the NHS, which met the NHS plan target three years ahead of schedule.
The hon. Gentleman condemns targets. Only by introducing targets can we ensure that nurses are recruited and sent to places that need them. Between September 2000 and September 2001, the number of qualified nurses working in the NHS rose by 4.3 per cent., the biggest increase on record, and the number of qualified allied health professionals rose by 4 per cent., a higher increase than in the previous year. The number of NHS consultants has risen by 5.7 per cent., the largest increase on record.
Under the NHS plan every member of staff in the NHS is entitled to work for an organisation that can provide and demonstrate its commitment to a range of flexible working conditions, including flexible working patterns, team-based self-rostering, annual hours and 60WH flexitime. The "Improving Working Lives" standard, launched in October 2000, sets out a model of good human resource practice against which NHS employers will be kite-marked. The Oxford Radcliffe Hospitals NHS trust is confident of reaching that standard within the next few months.
Working within departmental guidelines, steps have been taken by the trust to recruit nursing staff from the Philippines and other parts of south Asia. Since February 2001, 320 nurses have been recruited from overseas and a further 100 are expected from the Philippines later this year. Those nurses have needed time to adapt to life in this country and the trust rightly offers additional language support. The extra nurses will be an invaluable resource to help to reduce the pressures faced by the local health system. They have proved to be a huge success and many are progressing—
§ Mr. Johnson
Will the Minister address the question of moving away from national pay scales, which are such a bar to flexibility?
§ Mr. Lammy
I have made it clear to the hon. Gentleman that this is about local arrangements. It is about shifting the balance to local need and it is right that such decisions are made locally by primary care trusts and the strategic health authority, not by central diktat from Richmond house. That is the thrust of Government policy, and as the nurses come in and settle down, the hon. Gentleman will find that there are improvements in his constituency.
The Government recognise—in turn, the hon. Gentleman must recognise that we do so—that the high cost of living in the south impacts on the ability of NHS organisations to recruit and retain staff. That is why we introduced the "cost of living" supplement, which nurses in Oxfordshire have received since April 2001. Other innovative schemes are in place to give health professionals better access to housing, and a great deal of work has been done to support family-friendly policies and flexible working.