HC Deb 13 July 2004 vol 423 cc355-80WH

Motion made, and Question proposed, That the sitting be now adjourned.—[Paul Clark.]

9.30 am
Mr. David Cameron (Witney) (Con)

I am delighted to have the opportunity to open this debate on the national health service in the Thames valley. My remarks will focus mainly on my county of Oxfordshire, where the state of the national health service remains a huge concern to my constituents. I held a debate on the NHS in Oxfordshire more than two years ago in this Chamber, and rereading it today, the issues are depressingly familiar: the closure of cottage hospitals, problems at the John Radcliffe hospital, staff shortages and bed blocking. I am not going to make exactly the same speech again, but there will be similarities.

It would take a heart of stone not to repeat to the Minister the pledge that we heard so many times from Labour in 1997—"24 hours to save the NHS". In Oxfordshire and parts of the Thames valley, seven years on, it all sounds rather hollow. I shall put a genuine puzzle to the Minister this morning. There have been huge increases in spending on the national health service in Oxfordshire—no doubt the Minister will dazzle us with the statistics at the end of the debate—so the puzzle is why, with all the increased spending, the news flow about the NHS in Oxfordshire and the Thames valley is so bad.

Let us take a number of true stories from the past 18 months. They come from my postbag, my surgery, local newspapers and local doctors. The Witney minor injuries unit is to be shut in the evenings. Community beds are to be cut throughout the county, north and south. Ambulance stations are to close, including the two in my constituency, Witney and Chipping Norton. A new out-of-hours service is to be introduced, which will give less than the good service that we enjoy now. There are blocked beds, cancelled operations, financial problems and large deficits at the John Radcliffe, and substantial cuts are set to follow. As is the case across large swathes of the country, no NHS dentists take new patients except in emergencies.

If that sounds like a list of moans and groans, that is because it is. Those problems are all genuine and all inconvenient, and sometimes a lot worse, for my constituents. First I shall try to explain the three problems at the heart of the NHS economy and the health economy in Oxfordshire. I will then rewind and run through some of the individual problems that I have mentioned in more detail. I will finish with a few suggestions for the Minister on how to try to start to put the NHS economy in Oxfordshire back on track.

In the spirit of fairness, I should say that there is some good news—Thames Valley strategic health authority helpfully gave me a sheet entitled "Good News". Waiting times were 11 weeks on average at the end of 2003–04, compared with 14 and a half weeks the previous year. Accident and emergency waiting times were dreadful in Oxfordshire; we no longer have people waiting more than 12 hours for admission—but no one should ever have to wait in accident and emergency for 12 hours. We no longer have many four-hour waits in A and E, but sometimes waits are still very long.

I have spent quite a lot of time in the John Radcliffe hospital over the past couple of years with my son, who is severely disabled. We have had some long waits in accident and emergency, but recently it has got better. The care that we have received at the John Radcliffe—normally on ward 4C, known as Smallpiece—has been superb. I pay tribute to the wonderful caring nurses who have looked after us, and the excellent doctors and consultants. We have had our problems trying to get discharged, particularly with the right set of drugs. When asked, I always say that the John Radcliffe is hard to get into and hard to get out of, but it is wonderful while one is there.

To return to the mystery: what is wrong with the health economy in Oxfordshire? As I have said, at its heart lie three problems. First, Thames Valley receives low funding per head of the population—according to the head of the Thames Valley strategic health authority, whom I met last week, it is the lowest in the country. Of course we are a wealthy and, as a result, quite a healthy area, but the money is asked to stretch very far compared with what happens in other parts of the country.

The second problem, which is at the heart of all this, is the state of the finances of the Oxford Radcliffe Hospitals NHS trust. Last year, the trust faced a deficit of more than £40 million, and broke even only with £25 million of external support and housekeeping savings of £20 million. This year, it looks as if the situation will be even tougher. The external support will fall and there are additional cost pressures, which include the consultants contract, the pressure on the drugs budget, and NHS inflation. The Thames Valley strategic health authority financial performance report put it like this: The Oxford Radcliffe position is now £10m worse than the original plan: a £7m shortfall on the savings originally planned, £2m further costs of the Consultant contract … and £1m of other pressures (mainly activity-related). Overall, there is a potential deficit of up to £45m, to be reduced by the further savings plans that are being worked on.

On the general situation in Thames Valley, the report says: The overall level of savings needed to give breakeven would be £154m, equal to an average 7.6% of PCT allocations. There is £14m of planned support available towards this, which still leaves a requirement for £140m of savings, which is almost 7% of allocations overall. This level of required savings creates significant financial risk, reflected in the deficits currently forecast.

There are also significant risks that there would have to be substantial cuts in NHS services in order to meet those deficits. That is what the Minister has to focus on. We can all look at the Thames Valley SHA report and see the reductions in services that will be needed in our own health areas.

For Oxford Radcliffe Hospitals NHS Trust, even the earlier figure mentioned as the amount needed for savings—£35 million—is 8.7 per cent. of its income. That would mean making substantial reductions. I meet the new team at the Oxford Radcliffe Hospitals NHS Trust regularly, as do colleagues, and it seems to me that Sir William Stubbs, Trevor Campbell Davis and their team are trying to get to grips with the real problems. However, the size of the deficits make it likely that there will have to be significant cuts, including redundancies. Given that we are endlessly being told that the health service is expanding rather than contracting, that seems extraordinary. I hope that the Minister will look into the matter carefully.

My hon. Friend the Member for Banbury (Tony Baldry) has been raising the issue consistently. As a former Minister, he does not cry wolf, and he has looked into the matter carefully. However, the problems continue, and he has written an endless number of letters to the Department of Health about them. I appeal to the Minister to take some time to consider the Radcliffe, try to understand what is wrong, and make sure that front-line services do not suffer.

The Oxford Radcliffe Hospitals NHS Trust towers over the rest of the health economy in Oxfordshire. Its problems and deficits have caused problems for all other trusts. The reductions in the rest of the budgets set out in the Thames Valley SHA plan may look small, but one has to remember that the primary care trusts are very small, and have little discretionary spend. Most of their money is already allocated to GP practices and to commissioning in the health service, so any cuts that they have to make will hit the extra services that they have been funding, such as community health services.

Part of the issue is funding, and part is the fact that the health system seems to have a problem with a hospital as complex as the John Radcliffe. It is a district general hospital, a specialist referral centre and a teaching hospital. That can give it something of an identity crisis. More to the point, the system does not seem to reward it adequately for all that it does. The John Radcliffe strategic review is now under way, and we hope that it will settle some of the issues. I hope that the Department of Health will engage in that process.

Both the strategic health authority and the John Radcliffe have mentioned to me the way in which research and development is funded under the trust. They believe that there is a shortfall of some £7 million to £10 million. I would like the Minister to look into that, and perhaps write to me after the debate.

Matters are made worse by the third problem at the heart of the health economy of Oxfordshire, and it is a problem that also applies to the rest of the Thames valley—the high cost of living for our constituents and ourselves. House prices in parts of Oxfordshire are well above those in parts of London, so the temptation for nurses and doctors—just as for teachers and police officers—is to train in Oxfordshire and then go to lower-cost areas of the country. That partly explains the high level of vacancies in Oxfordshire. There is a 10 per cent. vacancy rate at the Oxford Radcliffe Hospitals NHS Trust, and that helps to explain the truly frightening figures for the use of agency staff. We all know that use of such staff is a tremendous waste of money, when we should have permanent staff.

The high local costs have been, and still are, a problem, but I believe that they are about to become even more of a difficulty. The Government are moving the NHS towards a tariff system for costing operations and a concept of payment by activity and payment by results. A cynic might say that that sounds a little like the internal market that they abolished with such a fanfare seven years ago, but we will let that pass.

The new problem for the tariff, as I understand it, is that the costs of some London hospitals will be adjusted by 30 per cent., but the cost of the John Radcliffe hospital and other Oxford hospitals will be adjusted by only 3 per cent., even though the costs in Oxfordshire, as I said, are very high. Indeed, this tariff derailed the one piece of good news that the Government hoped to announce about the Oxfordshire health economy—the fact that the Nuffield orthopaedic centre, or NOC, had applied for foundation status. The way in which the tariff system will work is one reason why NOC's application for foundation status had to be rejected, so the thousands of hours of work and the thousands of pages of paper that it produced for the application were all in vain.

I have set out the problems of the overall funding situation, the special position of the John Radcliffe hospital, and the costs in Oxfordshire and the Thames valley, so I shall go into a little more detail about some of the key health issues that now affect the county in general and my mainly rural constituency in west Oxfordshire in particular. First, there are the community hospitals—an issue that is close to the hearts of many of us here today. We in west Oxfordshire are scarred because of the experience with Burford hospital, a much loved hospital that was closed after 1997. We were told that money would be reinvested in the area, and that there would be new community hospitals in other parts of the county, but so far we have been very disappointed.

Cottage hospitals are in a very strange position in the modern NHS. Patients love them, and write to me and to other Members about the wonderful intimate care that they receive in them. Local GPs like them, and the fact that they can visit their patients as they get ready to go home. Local communities adore them, and work their socks off to raise money to equip and endow them. The only people who seem not to treasure the cottage hospitals are those in the local NHS.

The most recent threat comes in the shape of the southern locality plan and the northern locality plan, whose raison d'être appears to be to reduce the number of beds in community hospitals. Whenever one asks why it is necessary or desirable to reduce the number of beds, one is pointed towards a study on the shifting balance of care and the White Paper entitled "Shifting the Balance of Power", which is all about trying to ensure that people are treated in the right setting. As my hon. Friend the Member for Banbury said, it should be called not "Shifting the Balance", but "Shifting the Blame", because the local emphasis has been on trying to save money in the Oxfordshire health economy to cope with the deficits at the John Radcliffe hospital.

I have four points to make about that. First while 100 to 150 beds are still blocked at the John Radcliffe hospital, it seems perverse to be trying to close beds in community hospitals. I should add that representatives of the John Radcliffe hospital gave me those figures in my meetings with them; I did not make them up.

Secondly, representatives of the John Radcliffe hospital argue that Oxfordshire has too few beds, not too many, so we must ask why their view is different from that of the PCTs. Thirdly, if Oxfordshire health chiefs want people to believe that more care can be delivered at home rather than in a hospital, they must first prove it. Given our natural scepticism, it is not good to say, "We'll all be fine and there will be much more treatment in the home," when we know from our postbags that social services cannot currently deliver that care in the home. After everything that has happened, we are sceptical, which not surprising.

Fourthly, work needs to be done to determine whether the community hospitals operate at or near full capacity. There seems to be some disagreement about that, as the hon. Member for Oxford, West and Abingdon (Dr. Harris) said in his Adjournment debate some weeks ago. If they do operate at full capacity, and it is my understanding that some of them do so much of the time, it seems hard to believe that the number of beds should be reduced.

The next point in my list of woes on the Oxfordshire health scene is about the way in which the Witney minor injuries unit has been managed. There have been two announcements that the unit would have to shut in the evenings. The first was because the John Radcliffe hospital was withdrawing staff from the unit so that it could meet its own four-hour waiting limits at its accident and emergency department. That is targetitis gone mad: one set of targets is met by shutting provision elsewhere. No one needs to worry about missing targets at the unit because, hey presto, it has shut—and if it is not open, it cannot have a four-hour waiting time. That is madness. Then the minor injuries unit was threatened with evening closure because the emergency nurse practitioners were hired by the PCT responsible for the Witney hospital to run the out-of-hours doctors service at Abingdon hospital. I hope that that will not appear in the manual of how to practise joined-up government.

West Oxfordshire district council stopped the closure by bravely taking the PCT to the High Court for its failure to consult, and reason now seems to be prevailing. However, I repeat the message that patients, staff and their communities at large value their community hospitals, and we should consider ways of building on them. They, too, suffer from the difficulties of recruiting and retaining staff, and the problems with the minor injuries unit prove just how thin the cover can be: if one nurse is off sick, the whole service can be threatened.

Wanting community hospitals to succeed is part of the solution. West Oxfordshire district council would help with key worker housing if the staff kept some of the rural facilities open. That is only right and natural, and the council would be doing its job of looking after local services. The health authority should be talking to the council.

I cannot stress the rural factors enough. We are often told, "The ideal size for a hospital is 60 beds, so your small cottage hospital just won't work." However, if people in rural areas were offered a choice between the perfect hospital 50 miles away and their present hospital, they would choose to keep what they have. To put it bluntly, in rural areas, living a long way from a hospital can mean death. We would rather keep what we have in Witney and west Oxfordshire than have the ideal hospital—or courthouse, or care home—somewhere else.

I turn now to the proposed out-of-hours service to cover for doctors. I shall then deal with the ambulance service and the proposals for Chipping Norton hospital, before making suggestions for the future. We all understand that out-of-hours cover was proposed because of the new GP contract, but my constituents want a simple answer to one question: will the new service be at least as good as, or better than, the existing service? At the moment, it is hard to believe that the answer could be yes.

In the South West Oxfordshire PCT, which covers about half my constituency, doctors' practices run a co-operative system, under which a doctor is on call. That is to be replaced by a service run out of Witney hospital, under which a paramedic will be on call. Anyone needing a doctor will have to go to Abingdon, which will become the hub of the service, with Witney as a spoke. For those who live in the countryside—in Leafield or Charlbury, for example—getting to Abingdon can take about an hour. People will not go to Abingdon; they will get in their car, drive to the John Radcliffe hospital and further fill up an already overcrowded A and E department. If the money being put into services is intended to improve them, it would seem logical to make Witney a hub, like Abingdon, because that is what it is to our villages. The service should also provide cover by a doctor as well as a paramedic.

With ambulance stations, I accept, as I am sure my constituents do, that it is the level of service, not the bricks and mortar, that matters. We should not be too sentimental about bricks and mortar, but people are sceptical about the level of service that they will receive when the ambulance stations in west Oxfordshire close. They are used to seeing the stations in their communities.

There is, however, a simple answer to that problem; I hope that colleagues will join me in recommending it, and I press the Minister to take it up. At the moment, the ambulance service is required to meet the eight-minute response time 70 per cent. of the time. However, that is calculated on a county-wide basis, so if the service concentrates on meeting its targets most of the time in urban areas such as Oxford, it does not have to worry so much about the rural parts of the county. Why not have a new stipulation that the eight-minute response time must be met 70 per cent. of the time in every part of the county, including rural areas? One could ensure that that it was met in every postcode area. That would be a neat solution to the problem: it would give people in rural areas a real feeling that they were being listened to and that the level of service that they received mattered.

In a way, Chipping Norton hospital presents a microcosm of the problem that we face in Oxfordshire. Retired doctor Sheila Parker wrote to me, saying: This hospital which was started by public subscription is part of our town and belongs to the citizens of Chipping Norton. Not to the Primary Care Trust who have the task of administering it. I am afraid that she is probably wrong: the hospital probably does now belong to the primary care trust. However, her letter shows that people really feel that the hospital is theirs. The preferred solution is for the primary care trust and Oxfordshire county council to build a new care home, and for the health service to have some rehabilitation beds in that home. Under that plan, however, there would be no X-ray unit, although there is one now, no minor injuries unit, although there is some form of unit now, and fewer beds. People are left asking, "If all this extra money is going into the health service, why are we going to get less?"

Graham Pike, a nurse in Chipping Norton, wrote to me saying: Closure of the minor injuries unit … will also affect waits in the EDs"— the emergency departments— The PCT claims that it is not well-used enough to be economical. I have lived in Chipping Norton for three years, yet I did not even know we had a MIU until I worked a shift at Chipping Norton Hospital. If people don't know about it, it will not be used. Far better, surely, to advertise the service better—thus taking a load from the EDs". The primary care trust does not advertise or promote those services enough.

I shall end on what I believe the Government need to do for the health economy in Oxfordshire and Thames Valley. First, we need a proper explanation of the overall funding pattern, and of why the funding per head in Thames Valley is so much lower than in other parts of the country. Secondly, we need a proper Government-inspired look at the John Radcliffe hospital's finances and funding. To judge from my experience of looking at the issue—I am sure that my hon. Friend the Member for Banbury would agree with this—that seems to be at the heart of the problem. The big deficits at the John Radcliffe hospital cause a lot of problems elsewhere.

Thirdly, we need to take another look at Oxfordshire social services. It is no good saying that we will be able to have fewer community beds, when Oxfordshire social services already spend way more than the standard spending assessment, and yet are under so much pressure. Fourthly, we need greater moves towards flexibility on local pay. I do not see how our hospitals will ever be able to recruit and retain the necessary level of staff unless they have more flexibility on pay.

In order to restore the confidence of my constituents and others, I would also ask that the plan to reduce the community beds be shelved. The northern locality plan and the southern locality plan have been met with a hail of bullets, as it were, from MPs and others in our community, who simply do not believe that the argument has been made. If we are thinking about freedoms for hospitals to manage themselves—the Government are, and my party certainly is—we should give them to all hospitals, not do as the Government have proposed. We need a pledge from the Government, and all those involved in the health service in Oxfordshire, that if the deficits must be dealt with within a year—I am not at all clear why that should be the case—the axe will fall on bureaucracy, not on front-line services. On that note, I look forward to hearing the rest of the debate and the Minister's reply.

9.52 am
Tony Baldry (Banbury) (Con)

The Chamber will be grateful to my hon. Friend the Member for Witney (Mr. Cameron) for having initiated this debate and for describing the issues so excellently. The Oxfordshire health economy is in serious difficulties. I understand that the Oxford Radcliffe Hospitals NHS trust is expected to be overdrawn by at least £40 million next year, and there is speculation that the figure could be even higher. This is not the first time that that has happened. It also happened last year, when disaster was staved off only by using the proceeds from the sale of the Radcliffe infirmary to pay off the trust's overdraft, instead of recycling them back into new capital build in the NHS. That was not a particularly sensible way of using resources.

In part, the problem reflects the unfair formula by which the Government allocate money to health authorities across the country. It has never been properly explained why funding per head in Oxfordshire is so much less than elsewhere in the country. In part, that reflects the fact that there is no local cost of living allowance in Oxfordshire, which means that the trust has to pay premium rates to recruit and retain such staff, but has no budgetary provision for that. For example, the National Institute for Clinical Excellence guidelines for post-operative radiotherapy treatment for women who have had operations for breast cancer specify four weeks. By comparison, the period in Oxfordshire is 24 weeks on average, even with the trust paying radiotherapists a 30 per cent. premium on their salaries.

In part, the problem arises because no one has ever really got to grips with the nature of the John Radcliffe hospital, what part of the budget should be allocated to it as a district general hospital, what part should be allocated to it as a teaching hospital and how it should be rewarded for the research done there. That is not a new problem; it is ongoing, and has been so for at least the 20 years for which I have been fortunate enough to be an MP for an Oxfordshire constituency.

May I suggest that the time has come for an independent review, perhaps by an organisation such as the King's Fund, of what actually happens at the John Radcliffe, to ensure that it is fairly rewarded for the work done there? It cannot be right for a district general hospital to be substantially overdrawn year on year. Over the past 20 years, John Radcliffe hospital has experienced a sort of cyclical crisis: either the chief executive or the chairman is sacked or removed, and then there is a new internal review or a suggestion that the hospital has an internal problem. What is needed is an external objective investigation into the complexities of the way in which a district general hospital, a research hospital and a centre of excellence are organised together in Oxford.

The overspend has implications across Oxfordshire. One of the consequences is that primary care trusts are asked to make savings on their budgets but are not allowed to pass on the cost of making those savings to the Oxford Radcliffe Hospitals NHS trust budget. That makes nonsense of the concept of commissioning. Cherwell Vale primary care trust, for example, will have to find a £2 million saving this year. That may not seem a significant sum, given the totality of the budget, but because most of the budget is ring-fenced for GPs and others, that saving has to come out of just £9 million, most of which is for community health—so it is likely that nurses will be withdrawn from schools, the number of health visitors will be reduced and there will be other cuts in important front-line services.

Disturbingly, those reductions in primary care trust community budgets come at a time when the strategic health authority is trying to reduce the number of beds in community hospitals on the grounds that patients can better be treated at home. That is being done as a consequence of a White Paper called "Shifting the Balance of Power". As my hon. Friend the Member for Witney said, it should be entitled "Shifting the Blame", because it seems to be a rather cack-handed exercise. The NHS is shifting the responsibility for community health from community hospitals and the NHS budget to social services and the county council budget.

My constituents will never see the new 30-bed hospital at Bicester of which the right hon. Member for Darlington (Mr. Milburn) spoke when he was Secretary of State for Health. That is just not going to happen, and people in Bicester feel betrayed. They were promised a community hospital, and they are not going to get one. There are many other instances of the downgrading of local services. For example, it is clear that we will end up with, at most, two mental health in-patient beds in Banbury. Once Orchard Lodge closes, that resource will be moved to Oxford and we will also, effectively, lose The Elms. Any hope of a new-build successor to The Elms is forever lost, and, increasingly, any medicine that is vaguely specialist will be centralised in Oxford as a cost-saving measure.

It is also disturbing that we have been told that, as a consolation for not getting a community hospital in Bicester, we will have a minor injuries unit there. Having heard my hon. Friend the Member for Witney describing what is happening to the minor injuries unit at Witney, I wonder what benefit a minor injuries unit at Bicester will bring, and whether it will function as promised. There is a substantial attempt to shift the blame, both by the NHS centrally and by the strategic health authority, which seeks to blame any problem on the primary care trusts. That is one of the reasons for my concern about a treatment centre in Banbury. Of course one wishes to see greater activity in the national health service, but my concern is whether there will be increased money to match the increased activity.

Whenever I question the strategic health authority about that, I am told by the chief executive that: decisions on the commission of services are taken within the PCT's current commissioning budgets", and that PCTs are in control of how and where their commissioning funding is used. In other words, the funding for a new treatment centre in Banbury will have to come largely from Cherwell Vale primary care trust's existing budget. The PCT is in danger of being put in the invidious position of feeling obliged to support the treatment centre initiative, even though it might have to do so at the expense of funding that would otherwise have gone to the Oxford Radcliffe Hospitals NHS trust. If that turns out to be the case, it will be a curious state of affairs. Local people—GPs and others—would rather see services delivered coherently at the local NHS hospital than have to worry about the fact that delivery of services at that hospital is being undermined to satisfy ministerial press releases saying that additional activity is being introduced into the NHS.

Our other challenge in the Thames valley is the EU working time directive. Obviously, the directive's impact will be felt throughout the NHS, but potentially it will be greatest on smaller general hospitals. The geography of England is not convenient; the population does not always divide neatly for the purposes of the large general hospitals, and Oxfordshire is a case in point.

Oxford is pretty much in the centre of what is now the county of Oxfordshire, and, conveniently, the John Radcliffe hospital is able to serve much of that county's population. Looking at a map, one sees that the north of Oxfordshire tapers into a triangle surrounded by Warwickshire and Northamptonshire. At the apex is Banbury, the second largest town in the county, which is at the centre of what historians have frequently referred to as "Banburyshire"—the traditional area of surrounding towns and villages, from Brackley in Northamptonshire to Chipping Norton, and across to the Cotswolds in Oxfordshire and Shipston-on-Stour in Warwickshire.

Such places have always looked to Banbury, which was historically a day's cart ride away, as the local market town. To many people, Banbury is still the local town. The Horton hospital in Banbury has a catchment area with some 140,000 people, with many more at the margins. For decades, it has been the chosen general hospital of a very large population in north Oxfordshire, south Warwickshire and south Northamptonshire. There is no way that the John Radcliffe hospital could cope with all the extra work from the Horton.

However, there is no doubt that the Horton is a smaller general hospital. A number of years ago it started to have difficulties with some of the royal colleges, which asked whether medical training for junior doctors at the Horton alone was sufficient for them to qualify. Horton General Hospital NHS trust merged with the John Radcliffe NHS trust to form the Oxford Radcliffe Hospitals NHS trust, largely for that reason. The main intention was that junior doctors should be recruited by the trust as a whole and required to work both in Oxford and Banbury. By suitable rotation, one could then ensure good junior doctor coverage at the Horton and the junior doctors would achieve the necessary specialist training to satisfy the royal colleges. That system has been working well for some time.

However, the threatened impact of the EU working time directive is about to cause considerable difficulties at the Horton hospital. The Oxford Radcliffe Hospitals NHS trust is already reviewing whether it can continue to deliver 24-hour-a-day in-patient paediatric care at the Horton. That is a good service, which has existed in Banbury for at least 30 years. If the in-patient paediatric care goes, there will be a potential knock-on effect for the 24-hour-a-day accident and emergency cover and for the maternity unit.

If the Government were willing to make money available to smaller general hospitals to enable them to recruit additional junior doctors, that would be one way through the problem caused by the EU directive. I would imagine that the number of general hospitals would not be huge; they would be mostly in rural areas such as Cornwall or Lincolnshire. However, there would be a number in semi-urban mixed rural areas such as Banbury.

Presumably, the Government do not want to see existing general hospitals such as the Horton getting into difficulties with what services they can provide. Indeed, that would be all the more ironic, given that the Government are intent on setting up a treatment centre in Banbury. Presentationally, it would look perverse for the Government to set up a new treatment centre there while the general hospital, which has been in existence for decades, ran down its services.

This coming Monday, a petition signed by 40,000 people local to Banbury will be presented at Downing street. That is probably north Oxfordshire's biggest ever local petition; 40,000 signatures mean that at least one person in every household in Banbury and the surrounding area will have signed, because they wish to see children's services at the Horton saved. We have taken our campaign to Ministers at the Department of Health, to the president of the Royal College of Paediatrics and Child Health, to the board of the NHS trust, and now to Downing street.

The Prime Minister is ultimately responsible for funding the NHS, and he—and, through the Department of Health, the taskforce—should listen to the deep local concern. If paediatric services are downgraded at the Horton, children's lives will quite possibly be put at risk, as was said at the public inquiry that set them up 30 years ago. We come back to the conundrum with which my hon. Friend opened this debate. Ministers will tell us that more and more money is being put into the NHS, but the practical effect on the ground in our general and community hospital services in Oxfordshire is cuts and reduced services, bringing short-term crisis and long-term uncertainty.

10.5 am

Dr. Evan Harris (Oxford, West and Abingdon) (LD)

We should all be grateful to the hon. Member for Witney (Mr. Cameron) for securing this debate, which has given us an opportunity to talk about the problems affecting health services in the Thames valley—and, as we can see from the MPs who are present, Oxfordshire. I am in no doubt about the hon. Gentleman's commitment to improving services in his area. The same applies to the hon. Member for Banbury (Tony Baldry), who has a long history of seeking to secure the maximum possible effectiveness of the services in his area, and has raised some of the issues in various Adjournment debates and in questions to the Prime Minister.

I shall deal with a number of points, but I shall try not to duplicate what has been said by the hon. Member for Witney, much of which I agreed with. I agree that the problem is one of the health economy. When we discuss the NHS in Oxfordshire, we need to ensure that we do not "silo off" parts of the NHS, and that we recognise that it is all interrelated: we are talking about acute trusts, primary care trusts, community services and social services. If one or more of those service providers is constrained, it will have significant implications for the rest of the system. If we sort out constraints at the cheaper end of the service, where care costs less per night stay, for example, we can deliver savings in the rest of the system, and avoid false economies.

As the hon. Member for Witney said, that has not happened in Oxfordshire, because of the ongoing problems facing social services both with its budget—the services that it provides already have very tight eligibility criteria, although it spends above standard spending assessment, and is under Government pressure to reduce that spend for fear of council tax capping—and because of the difficulty, in an area of housing shortage, in recruiting relatively low-paid staff into jobs that are difficult. challenging and not well rewarded.

If the concept of joined-up government and joined-up provision of services is going to mean anything, it is time the Government demonstrated how they can be provided at a local level. There are partnerships, and service providers are working together, but a lot of that working together simply shows that none of them has any spare funding.

At the acute end, where most of the targets apply, there is enormous pressure to invest in acute services—"Hospitals first," in the words of the Prime Minister—but that means that we often do not get the funding for the more community-based services that would reduce demand for and spend on acute services. I am in no doubt that the money available could be better spent on simply sorting out the order of treatment. The Cinderella services—community and social services—should get a fairer share of the funding. The Government are at fault, because they have invested so much political capital in meeting targets that predominantly relate to the secondary care sector, which is far more expensive.

I did not wholly agree with the comments of the hon. Member for Witney about the unfair allocation system. I have always supported a system of funding allocations weighted according to the York formula, and I supported from the Front Bench the amendments that the Government made in the early years to ensure that it responded to need even more accurately. I cannot say that it is wrong and unfair simply because an area such as Oxfordshire gets less per head of population than inner-city areas, or areas in the north of the country with greater health needs and more deprivation. I have always been clear about that. It is easy to claim that the system is wrong if one is not prepared to look for more money globally.

However, the Government can be criticised on two grounds. First, generally speaking—I believe that this has been confirmed by independent inspectors—although there have been significant real-terms increases in funding, which have given the opportunity for underfunded primary care trusts, and health authorities before them, to move more quickly to target, the Government have not moved quickly enough to tackle areas whose funding is significantly below target. However, that criticism does not apply to Oxfordshire and the Thames valley as a whole. The figures show that if anything, Oxford city, which covers part of my constituency, has benefited in a sense from the slowness of the movement towards target, and I recognise that.

That is a general point, and we should look beyond our own areas. I hope that the Government take on board the fact that as there are significant real-terms increases—for which I voted on every occasion—if they set out a target allocation based on need, they have a duty to move those who are below target more quickly to it.

The point that the hon. Member for Witney made about Oxfordshire and other parts of the Thames valley receiving proper recognition of the cost of living—effectively, the cost of hiring staff—needs to be stressed. It is clear that the arrangement is inadequate when the comparison is made with the London living allowance. Something must be done, because the inability to attract staff because of the high cost of living, and particularly of housing, is the major constraint at all levels of health and social care provision in Oxfordshire.

The Government have chosen to try to tackle the housing issue by providing mortgage help for what they call key workers—although I do not think that their definition of key workers is wide enough. That is not a holistic approach to the problem. Merely increasing the demand side through mortgage subsidies does not solve the problem; if anything, it puts house prices up. I want the Minister to say which NHS land has been identified as useable for affordable housing for key workers.

As Members of this House, when we get lobbied against development, we must remember how acute that problem is in the public services. Oxfordshire needs housing, and I am acutely aware of that. My instinct is not to oppose every new development, even those on greenfield sites. I recognise that there is a balance between environmental and housing issues. The Government must play their part, alongside the local health services, and release land in health service sites for housing—and they must do so quickly. I would argue that we are already seven years too late.

The other problems in Oxfordshire are too numerous to mention in this debate, although I will touch on a few. The GP contract is running into problems. I met GPs in Abingdon the other day and they pointed out that they were promised money this year for enhanced services, but that it has not been made available; legally it did not have to be, but they were at a presentation where it was promised. Therefore, there has not, for example, been fair recompense for sexual health services, because the money has been used by the PCT to prop up the family planning clinics, which were threatened with closure, and saved by central diktat at the cost of a transfer of money from other services to which it had previously been allocated.

The John Radcliffe's financial problems mean that there will be job cuts. Rumours abound that the hospital has accepted that there will be such cuts, and it has not said that they will involve only civil servants or bureaucrats—the sort of jobs that, trendily, it seems that we do not have to worry about these days. Front-line jobs will be cut for some of those savings—otherwise known as cuts—to be made. I do not see how that fits with a growing service.

Social services are still having difficulty recruiting. That situation is not getting better quickly enough, judging by a meeting that I recently had with the director of social services. I fear that in the health economy, matters will get worse before they get better.

I support the comments made by the hon. Member for Witney about recognising fairness in the new system of financial flows. I have had representations not only from the Nuffield orthopaedic centre but from other hospitals in Oxford to say that the tariffs still do not recognise the extra costs of delivering specialised care and ultra-specialised care. Research funding under the tariff—and, indeed, under the current system—is inadequate. It is clear that the London teaching hospitals and medical schools get the lion's share compared with everywhere else; there is clearly an imbalance. I hope that the Minister recognises that, and will explain how it will be dealt with.

There are other developments in Oxfordshire in relation to the provision of care that are effectively cuts. For example, South West Oxfordshire PCT has ruled that people who have previously received respite care in a community hospital cannot receive it any longer, unless they are being rehabilitated.

Mr. Cameron

I am glad that the hon. Gentleman said that. As I was preparing for this debate I opened a constituent's e-mail, which arrived at 5 o'clock this morning. It said: Up to last March my wife was given 7 days respite in Witney community hospital every 8 weeks and we were not charged for it. Now we have to pay the full cost of any respite. Can anyone tell me why we have to pay when Tony Blair tries to lead us into believing that the NHS is free for all? An important change has taken place. That e-mail is yet another example of people saying to me, "We've had all this extra money spent on the health service, yet I'm now having to pay. What's happened?"

Dr. Harris

I have several constituents with the same problem. I am glad that the hon. Gentleman took the opportunity to raise that case in his own debate. This is a stealth tax. People who were getting respite care in community hospitals are now being means-tested for it and are having to pay. South West Oxfordshire PCT said that the reason was not that patients did not require nursing care—although that might be a basis for saying, "Let's ensure that the respite care is provided elsewhere, as we don't need NHS nurses to provide it"; the question was whether the patient could be rehabilitated.

Most patients with chronic care needs could not benefit from rehabilitation, but their carers require the support that respite care gives. The decision to deny people ongoing respite care that was provided for only a few days a year, and which was probably inadequate already, has upset several people. I question whether there was adequate consultation on that decision, and therefore whether it was lawful. Will the Minister look into whether that decision, whatever its merits, was conducted in a lawful manner in terms of process, with adequate consultation? I hope that he will agree to do that; I do not expect him to have a reply ready now.

I recognise that we do not have an opportunity in this debate to discuss the likely cuts in the mental health sector, which are often overlooked. We hear that there are proposals to reduce health services in the mental health trusts in Oxfordshire so that they can break even.

Finally, I shall talk about the treatment centre, and the serious allegations of bullying in Oxfordshire. I know that the hon. Member for Witney is aware of this matter, as he has been working closely with the people who have raised concerns. There was a proposal to transfer a contract for cataract surgery from the Radcliffe infirmary to a new independent provider, Netcare. Expressions of interest were invited in 2003, and both Cherwell Vale primary care trust and South West Oxfordshire primary care trust expressed interest.

It later emerged that part of the Oxford Radcliffe infirmary—the eye hospital—was going to meet the three-month waiting time limit on schedule, without the need to resort to expensive Saturday morning lists paid at private practice rates, and was delivering those operations cheaply, significantly below the NHS average—the so-called tariff. Yet when the PCTs realised that they did not need that service, and that it would not be cost-effective to purchase it, they were not allowed to pull out.

In an interview in The Guardian, and on "File on 4", the South West Oxfordshire PCT claimed that it was given the full business case only one hour before the meeting at which it was due to decide. We also learn that prior to that, its members had been verbally threatened with being personally surcharged if it failed to vote the scheme through. However, the primary care trust had a legal responsibility for the scheme, and it was not a national scheme, so it is outrageous that someone should have threatened people with bankruptcy and surcharge if they failed to vote it through. That was never followed up. That is the worst kind of bullying, because the threat was unfounded. We have never heard that idea retracted, unless the Minister can say that the allegation was a falsehood—but I believe that it has been confirmed by more than one person.

After the primary care trust rejected the deal—which, under "Shifting the Balance of Power", it had the right to do—the then chairman of South West Oxfordshire PCT, Martin Avis, said that he contacted Jane Betts, the strategic health authority chair, to communicate the decision. She said, "The tumbrels are ready." If that is not a threatening expression, I do not know what is. Martin Avis said that he took it to mean that his job was on the line, and that she was aware that hers was, too. He went on to say that Jane Betts said: Our jobs were at risk if there was not a note on the secretary of state's desk by the beginning of the following week saying that the decision would be reversed. We have never heard the Government explain the role of the Secretary of State in pressurising the primary care trust to reverse its decision. Indeed, a fortnight later that decision was reversed by a full turnout of executive members, who are effectively employees of the Secretary of State.

The chairman of the primary care trust, who was well regarded by people on all sides of the debate, was the only primary care trust chairman not automatically reappointed when his job fell due for reappointment. He was told that he would have to apply again for his own job solely because of the decision that had been made. He had taken a casting vote to side with all the non-executive members of the primary care trust, whose job it is to defend the interest of the patient and the community when such decisions are made. At best, it is a murky business. We have never received full clarification of the matter from the Government. I do not understand why the Minister does not request an independent inquiry. When Sir Nigel Crisp, the head of the NHS, was questioned on Radio 4 about what had happened, he ended the interview and walked out of the room. What sort of response was that? What sort of open government or accountability was that?

If the head of the NHS will not take responsibility for such matters, politicians must. Will the Minister ensure that the issue is examined independently so that we know what is happening? We will not find people to work as non-executive directors in Oxfordshire or Thames Valley because of the bullying, let alone the financial problems facing the NHS that we have heard about today.

10.23 am
Mrs. Patsy Calton (Cheadle) (LD)

I offer my congratulations to the hon. Member for Witney (Mr. Cameron) on introducing the debate, and to the hon. Member for Banbury (Tony Baldry) and my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris), who have also made important points. The hon. Member for Witney made it clear that despite the huge increases in spending, the news on the ground is bad. The bad messages tend to overwhelm the good news that the hon. Gentleman acknowledged when he said that there were decreases in some waiting times, that no one was now waiting for more than 12 hours—although that still seems a long time—and that his son had received superb care. He also acknowledged that when one is inside the system, it is brilliant. It is getting in, and sometimes getting out, that can be difficult. In the light of my experience, I echo that.

The good news is being somewhat overwhelmed by the bad news. However, it would have been fair for the hon. Member for Witney to acknowledge that although the situation is bad, it would have been considerably worse if the decisions had been up to the Conservatives, who voted against the extra funds that have recently been put into the health service.

After listening to the problems that have been aired and reading the necessary information to familiarise myself with the issues involved, I believe that there is a real problem centring around the role and functions of the John Radcliffe hospital. We have had a national sickness service, focused on hospitals rather than on primary care and care outside hospitals. We must acknowledge that the model we have now, whereby gradually everything gets sucked closer to hospitals, needs to change. I suspect that no one in the Chamber would say that no change is necessary, but change can sometimes be painful and difficult, and the process of change could be a lot better managed.

The hon. Member for Witney is concerned about staff shortages, and about the fact that many of the potential closures do not allow for travel by public transport. Although the target-driven culture is undoubtedly producing some change for the areas that are covered, they are hospital-focused, which can mean that anything that is not a target gets neglected. My hon. friend the Member for Oxford, West and Abingdon made it clear that those targets are distorting clinical needs. The Government would do well to consider that.

The responsibility for local services, and the role of the PCT and its autonomy, is reflected throughout the country, not just in the Thames valley. Although the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Rosie Winterton), has said in a written answer that the responsibility for local services now rests with PCTs, the truth is that, as we can see from South West Oxfordshire, local PCTs are autonomous only as long as they do as they are told. In my area, the Greater Manchester strategic health authority will allow plans to go forward only if it is satisfied with them. If it is not entirely satisfied, the PCT has to go back to the drawing board—and that will continue until it comes up with something that the Greater Manchester strategic health authority is happy with.

There is overt bullying. An article in The Guardian on 2 June 2004 said: the recently-retired chairman of the areas primary care trust … explained how his board was bullied by Thames Valley strategic health authority … to sign a contract with a South African company for a treatment centre that it did not need. The chairwoman of the SHA, who has also retired, admitted that she had engaged in bullying tactics, but claimed her authority was merely 'the jam in the sandwich', and she was simply carrying out what she had been asked to do: It behaved as it did, she said, because it was under heavy pressure from the Department of Health to deliver a deal that the Prime Minister had set his heart on. The Government cannot have it both ways; they have to make their mind up. Do they want PCTs to take responsibility, or are they intent on ensuring that everything happens from the centre and there is total central control?

Both the Conservatives and the Liberal Democrats have made it clear that they would like control to be much closer to home, and that it should be in the hands of local people. The difference between the Conservatives and the Liberal Democrats is that they would give the control to local hospitals, whereas we would like to see proper democratic control, both locally and regionally.

The hon. Member for Banbury asked the Minister to give a proper explanation of funding, and particularly wanted him to consider the finance and funding of the John Radcliffe hospital and Oxfordshire social services. He wanted greater flexibility on pay, with which we agree, and freedoms for all hospitals to manage themselves. The Liberal Democrats also want to see a considerable advance on that front.

My experience of consultation in my area is that plans for future provision are often nebulous. With regard to provision for care outside hospital, people have been asked to agree to locations, but when they look at the map it says, "Location still to be determined." That is not real consultation. It is the type of consultation in which it is hoped that those being consulted have not read the document, and when they read it, they find that they cannot possibly agree with it because it does not give them enough information. Rather than people going through the motions of consultation, there should be true consultation. There should be true engagement with local people. That sort of consultation is not taking place, either with patients or with local people.

That must start to happen. I doubt whether anyone in Oxfordshire or the Thames valley thinks that there should be no changes to hospital services or other services in their area. However, if there is not proper consultation about what needs to happen, people will feel that things are being done to them, rather than that they are being properly involved in the future of the health service in the Thames valley.

10.31 am
Mr. John Baron (Billericay) (Con)

I, too, congratulate my hon. Friend the Member for Witney (Mr. Cameron) on powerfully raising his concerns about the state of the NHS in the Thames valley. I hope that the Minister will address those concerns, and some of my hon. Friend's suggestions. I also congratulate other Members on their contributions, including my hon. Friend the Member for Banbury (Tony Baldry), who has done a lot over many years to raise these issues; among the concerns that he has raised in this debate is the impact of the working time directive.

My hon. Friend the Member for Witney was right to say that the extra resources being pumped into the NHS are not achieving the results that we expect and hope for. Nowhere is that clearer than in the Thames valley. My hon. Friend touched on the financial health of the NHS in the Thames valley. That is a major concern. The 2003–04 report of the chief executive of the Thames Valley strategic health authority stated: Overall, the NHS in Thames Valley achieved financial balance but had to rely on one-off measures to achieve this.

The one-off measures needed to meet the Government's target of achieving financial balance last year included the sale of the Radcliffe infirmary. In addition, the Oxford Radcliffe Hospitals NHS Trust had to take out a £25 million loan. Across Thames Valley strategic health authority, the debts run up by the health service were so serious that PricewaterhouseCoopers was called in to help. Last Wednesday's financial performance report of the Thames Valley SHA board suggests that in order to meet the Government's target, and despite the increases in health service expenditure, funding of the NHS in Thames Valley may have to be reduced by 7 per cent. That is quite a cut, all things considered.

The effect on, for example, Milton Keynes, with its rapid population growth, is likely to be far worse even than that. On July 8 the chairman of the Milton Keynes primary care trust said that it had to provide for 235,000 patients but that funding was available for only 212,000.

The Government must shoulder some of the blame for the deterioration in the finances of the NHS in Thames Valley. The PCTs in the Thames Valley area will receive £170 per head less than the English average for next year. That has contributed to the appalling financial situation there. In addition, we have heard that there is no local cost of living allowance. I want the Minister to explain why Thames Valley is being discriminated against compared with other areas. The facts speak for themselves, and they suggest that there is a major issue here.

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman)

Will the hon. Gentleman share with us which areas of the country he thinks should get less so that Thames Valley can get more?

Mr. Baron

The Minister is missing the point. I am suggesting that no area should be discriminated against. It is clear from the funding formula that has been devised for Thames Valley that it receives far less than other areas, which is wrong. I simply ask the Minister to explain why that is the case.

The Government will doubtless point to increasing staff numbers, and to a long line of statistics that suggest that the NHS is improving. There is no doubt that it is improving in certain areas, but our central point—to return to the conundrum presented by my hon. Friend the Member for Witney—is that there has been a massive increase in money, but not as much improvement as we had all hoped. As I said, no doubt the Minister will point to an increase in the head-count number of people working in the various departments of the NHS, but the three-month vacancy rate for posts in the Thames Valley area is worse than the English average. For example, the average three-month vacancy rate for all qualified nursing and midwifery staff in the strategic health authority area is 4 per cent., and that rate rises to about 7.5 per cent. in Milton Keynes general hospital. The English average of about 2.9 per cent. is well under half that.

In addition, the lack of permanent staff surely exacerbates the already grave finances of the NHS in Thames Valley as the rising cost of the agency staff needed to fill temporary staffing posts kicks in. That does not help the situation at all. There is also a particular shortage of radiographers in Thames Valley, and breast cancer patients are forced to wait up to four times longer than specialists recommend they should have to wait for potentially life-saving radiotherapy.

There are also problems in dentistry. The Thames Valley area has the lowest percentage of people registered with an NHS dentist. For example, only about 32 per cent. of adults in Oxfordshire are registered. That is an appalling record of the Government's making. They have now been in power for seven years, but they have done very little to reverse the decline in the general dental service. As a result, only 11 of the 113 dental practices in Oxfordshire are taking on new NHS patients.

The Government will no doubt hail the new contract as a solution to those problems, but we are not so optimistic. They will know that the British Dental Association has warned that 60 per cent. of dentists will reduce their NHS commitments, or will opt out of them altogether, when the new contract comes into force. That, surely, does not bode well for the future. Little attempt seems to have been made to increase the dental work force above 1997 levels. In 1997 there were about 576 graduates of UK dental schools. Last year there were about 549—a clear drop.

People with Alzheimer's disease are also suffering needlessly in the Thames Valley area. Recent research has discovered that many people with the disease are being denied access to drugs that could slow the advance of their condition. The drugs in question were recommended in guidance issued by the National Institute for Clinical Excellence back in January 2001, but a recent report has shown that there is significant geographical variation in their uptake. West Yorkshire has a population of 312,000 over the age of 65, and about £880,000 was spent on the drugs last year. Thames Valley has the same size of population over the age of 65, but not much more than half that amount—about £485,000—was spent on the drugs. That postcode lottery in the prescription of drugs is all the more tragic, because, as we all realise, without medication to slow the onset of the disease, sufferers will be forced into residential care.

What is happening in Thames Valley illustrates what is happening throughout the NHS, and returns us to the conundrum presented by my hon. Friend. There is no disputing the Government's best intentions, given the extra money that has gone into the NHS, but improvements have not been what they should have been. In some cases things have got worse, as we have heard from Members' contributions today.

One of our key concerns is the demotivating effect of targets. Despite the best efforts of NHS staff, to whom we are all thankful for their hard work and achievements, the NHS suffers from too many Government targets and too much red tape, which clogs up the NHS, prevent; many people from reaching front-line services, distorts clinical priorities and demoralises staff. That is one of he main reasons why there are so many recruitment and retention problems in the NHS, and why, after such a massive increase in spending, there has been only a modest increase in activity, and patients are suffering because they have to wait longer than necessary to be treated. It is also one reason why staff turnover in the NHS runs at something like 22 per cent., whereas the national average is 16 per cent. In financial terms, the cost to the NHS of about 270,000 people leaving and having to be replaced is approximately £1.5 billion—the cost of something like 10 new hospitals.

There is no shortage of evidence that the Government's targets are distorting clinical priorities and demotivating staff. Last year, BMA News asked its readers whether then were too many specific targets set in the NHS. Nine out of 10 replied that there were, and more than 60 per cent. suggested that they had personal experience of clinical priorities being distorted to meet targets. What will the Government do to try to reduce the incidence of clinical priorities being distorted by their targets? Such targets can and do demotivate staff who are already working under tremendous pressure. As Dr. Ian Bogle, outgoing chairman of the British Medical Association, put it last year: The one memory that will linger long … is the creeping, morale-sapping erosion of doctors' clinical autonomy brought about by micro-management from Whitehall which has turned the NHS I hold so dear into the most centralised public service in the free world.

No wonder morale among medical professionals is so low and frustration so high. A recent Royal College of Nursing survey, "Stepping Stones", consulted 10,000 nurses. One third said that they would quit the profession if they could, and more than 11 per cent. said that they planned to quit in the very short term. No wonder the number of nurses leaving for the US doubled last year. Morale has not been helped by the delay in the roll-out of "Agenda for Change". What measures are the Government going to take to reduce staff turnover and raise staff morale? That is so important to the efficient running of the NHS.

It is no surprise that, with morale so low and staff turnover so high, the NHS has not made the progress that it should have, bearing in mind the extra money being spent. We know the figures: expenditure has increased by more than 40 per cent. in real terms since 1997, and yet hospitals treatments have increased by only 5 per cent. According to the Organisation for Economic Co-operation and Development, the NHS increase in output lags far behind increases in input. It points out that in the health sector there are few indicators showing unambiguous improvements in outcomes over and above trend improvements that were already apparent before the surge in spending".

We have seen a massive increase in bureaucracy: the number of managers has increased at approximately three times the rate for doctors and nurses. There has been a £2 billion increase in the amount spent on administrative and other non-clinical staff. Meanwhile, the Department's own figures suggest that average waiting times have increased—a fact admitted by Sir Nigel Crisp, the chief executive of the NHS. In addition to addressing the specific concerns with regard to Thames Valley, will the Minister address the central conundrum of why money is not reaching front-line services so that patients can benefit? something is clearly going wrong.

I hope that the Minister will address the specific concerns raised by me, and by other Members, about the state of the NHS in the Thames Valley. but I put it to him that what is happening there reflects the fact that, although it cannot be denied that there have been some improvements in the NHS, progress it not what it should be, bearing in mind the money invested. Why else does the NHS have such a high turnover? The situation is not the fault of the professionals who work in the NHS, but that of the Government, who still cannot see that they have got their approach fundamentally wrong. Politicians must stop interfering and the Government must stop bombarding staff with targets and micro-managing the NHS. The NHS has been a political football for far too long. Politicians must learn to trust medical professionals and allow them to get on with their job. Targets simply ensure that the NHS responds to the Government and not to patients' need for care.

I put it to the Minister that the time has now come to scrap targets and the star-rating system, and give all hospitals true freedom so that they are accountable to patients, not bureaucrats. Such an approach would usher in an environment in which doctors and nurses would choose to stay because they enjoyed the freedom to deliver to patients a standard of care of which they could be proud. In that environment, the NHS, for the first time in a long time, would realise its full potential and become a patient-centred health service. That would benefit the patients in Thames Valley, and throughout the country.

10.45 am
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman)

I, too, congratulate the hon. Member for Witney (Mr. Cameron) on securing the debate and on the interest that he takes in the national health service in his area and in general, although in other Adjournment debates that I have shared with him, he took a slightly less political and more constructive view than he has today. Before I deal with the hon. Gentleman's substantive points, let me dispose of the two contributions from the Opposition Front Benches.

The hon. Member for Billericay (Mr. Baron) asked what we could do to reduce staff turnover. One thing that we can do to reduce turnover and increase morale is to stop running down the NHS. Several times during his contribution, the hon. Gentleman said that things were getting worse. They are not. His comments contained numerous inaccuracies, one of which was the ludicrous productivity figure that the Conservatives continually trot out, which takes account only of operations done in hospitals. It ignores the huge increase in services now being provided in primary care, and does not look holistically at the total output of the NHS. That demoralises the people who are providing valuable services in primary care, which the Conservative party completely ignores.

If we want to increase staff morale, we can also stop talking about a huge growth in bureaucracy, red tape and the recruitment of managers. The fact is that when the hon. Gentleman cites statistics for the total management overhead of the NHS, he is including people such as cleaners, cooks and technicians—everyone who is not a doctor or a nurse—to arrive at his ridiculous figures. If we compare the management overhead of the national health service with that of any blue-chip company in the private sector, the NHS appears rather lean and mean. It would be nice if the Conservatives started to recognise the contribution that management makes to the improvements in the NHS.

Mr. Baron

Will the Minister give way?

Dr. Ladyman

No I will not, because the hon. Gentleman took too long, and I need to get on to the points made by the hon. Member for Witney.

I wonder whether the hon. Member for Cheadle (Mrs. Calton) recognises some of the contradictions in her comments. At one point she talked about the need to democratise the national health service, but she contradicted that when she voted against foundation hospitals, which are a small step in the direction of democratisation. However, I note that although she voted against them in the House of Commons, she then shot back to her constituency and issued press releases to say that she supported the creation of a foundation hospital there.

Mrs. Calton

Will the Minister give way?

Dr. Ladyman

I will not, because I have very little time.

Mrs. Calton

This is on a matter of fact, so I again ask the hon. Gentleman to give way.

Dr. Ladyman

Very well.

Mrs. Calton

The Minister will know that that hospital was seeking foundation hospital status before the Bill was published or debated, and that there were various flaws in the Bill that were not put right by the time it became an Act. It was therefore not difficult to vote against it.

Dr. Ladyman

So the hon. Lady is now telling me that she does not support her local hospital becoming a foundation trust, which I do not think is the case. It believes that she is supporting its bid to become a foundation trust under the existing Bill, which she voted against.

That was not the only contradiction in the debate. The hon. Lady referred to her local Greater Manchester strategic health authority and its strategic overview. That is why strategic health authorities exist—to take such an overview and to ensure that PCTs are working together. I do not accept the allegation that central influence has been used, which emerged several times in the debate in connection with the treatment centres in Thames Valley. The other allegation, which was put to us by the hon. Member for Banbury (Tony Baldry), was that we are not using central control on issues such as community hospitals. On the one hand, we have the cynical view that "Shifting the Balance of Power" is actually shifting the blame, and that we should be more dogmatic and centrally controlling from Whitehall in establishing community hospitals. On the other hand, we hear from the Front Bench that all targets should be swept away and all power given to the front line.

The Conservative party cannot have it both ways. Either we shift the balance of power to the front line, which is what we are trying to do, or we keep it at the centre and I decide from my office whether the hon. Gentleman gets a community hospital in his constituency. I suspect that he would not want me to make that decision, as I do not know his constituency as well as local people do. That is why we are shifting the balance of power—to allow such conflicts to be resolved locally. They are conflicts and challenges, and as the hon. Member for Cheadle said, for consultation to work, people have to understand the challenges that are being faced.

Several hon. Members mentioned the affection that local people have for community hospitals. That is true, but equally, when we speak to people about what they believe can happen in a small community hospital, we discover that they have completely unrealistic service expectations, which it would be clinically unsafe to try to fulfil through community hospitals. Clinical safety and patient outcomes must be put first, and part of any consultation process is ensuring that people start to face and address the challenges.

The hon. Member for Witney mentioned a number of issues, including—several times—delayed discharges. I do not know which political party controls Oxfordshire. I suspect that it is not the Labour party, but whoever it is, he might wish to talk to them about the social services that are being provided. It is largely the authority's responsibility to take a strategic view of facilities in the community to enable people to be discharged.

I also note that the hon. Gentleman voted against the reimbursement system. which is having a tremendous impact across the country. It has reduced delayed discharges by 1.5 million bed days since its introduction, which is the equivalent of eight district general hospitals. That was opposed by him, and both the Opposition parties represented here are committed to getting rid of the legislation if they form a Government. If the reimbursement system were removed, how would that alleviate bed blocking at the John Radcliffe?

This is not the only time that I have debated the health economy of Thames Valley in this Chamber. Last time, the debate was largely focused on Buckinghamshire, and I remember one Conservative Member making the bizarre argument that because the wealthy middle classes are more assertive and articulate, they place greater demands on the national health service than poor people from inner-city communities who may have greater health needs. According to that Member, we needed to reflect that in the money given to the Thames valley health economy.

Mr. Cameron


Dr. Ladyman

Let me just finish my point.

I am pleased to say that that bizarre argument was not deployed today, but the hon. Member for Witney did his best to give the impression that the health service in the Thames Valley is somehow fighting against insuperable odds, with falling budgets and crippling financial overheads, and that services are going backwards as a consequence. In reality, the average expenditure per weighted head of population in the area now covered by Thames Valley SHA was £594.29 in 1997. whereas in 2002–03, expenditure was £904.32—a 52 per cent. increase. In case the hon. Gentleman did not catch that, I will repeat it: £594.29 then and £904.32 now. Those figures do not even include dental or pharmaceutical services, and under this Government, plans are in place for that expenditure to continue to grow.

Mr. Cameron

The Minister said, rather unfairly, that I had introduced the debate very politically, but as his reply so far has been pure politics and knocking copy aimed at the two Opposition Front Benches, will he now address the question about the John Radcliffe hospital? He only has five minutes left. My hon. Friend the Member for Banbury (Mr. Baldry) and I have discussed the serious problem there many times, and it seems to us to be causing some of the problems in the Oxfordshire health economy. We came to debate that point seriously, and I wish that the Minister would respond in the same spirit.

Dr. Ladyman

If the hon. Gentleman wanted to debate the issue seriously, he should not have filled his contribution with political knockabout stuff or given the ridiculous impression that services in his area were declining. However, he is right to say that the financial balance at the John Radcliffe hospital is important, and is causing pressures in the local economy. The hospital has managed to achieve balance in the past two years as a result of land sales and funding from the NHS bank, but it has still not managed to address the overspend. In June the trust estimated it at £25 million, although it believes £17 million to be a more realistic figure. It will have to be put right.

Each local health economy must end up with a balanced budget. If it does not, the money must come from another area. Why should an area that has managed its budget properly finance an area that has failed to balance its budget? The hon. Member for Billericay seems not to understand that for every average, there are always some people above the average and others below it. As I told him, shifting money to Thames Valley from another area would mean that that area lost out.

We can argue about whether the funding formula is a good one, but no one who has spoken in the debate has challenged the view that there should be variability in the funding formula to reflect the different costs in different areas. The present funding formula reflects the increased cost of provision in some areas, which is one reason why Thames Valley gets more money. As the hon. Member for Oxford, West and Abingdon very fairly noted, however, it is also important that funding distribution should reflect areas' health needs. Areas with the greatest health needs must have the most funding.

One could argue, as the hon. Members for Witney and for Billericay did, that all that variability has left Thames Valley too far behind and that it is being unfairly treated, but how do we measure whether it is too far behind? Surely, one way would be to look at the performance of the area's health economy to see whether it was moving forward. How has the Thames Valley health economy performed under the existing funding formula? No patients are now waiting more than nine months for planned treatment. Twelve-month waits fell from 1,657 in March 1997 to zero in March 2004, while nine-month waits fell from 3,712 to zero in the same period. The number of people waiting more than 13 weeks for out-patient treatment fell from 4,256 in March 1998 to 992 in March 2004.

Patients are being treated more quickly in the accident and emergency departments. Three acute trusts in the Thames Valley—Buckinghamshire Hospitals NHS trust, Heatherwood and Wexham Park Hospitals NHS trust and Milton Keynes General NHS trust—were among the first to receive financial rewards for overachieving on A and E targets. They saw more than 94 per cent. of patients within four hours in the quarter to December 2003. Overall, 89.5 per cent. of patients were admitted, transferred or discharged within four hours in the quarter to December 2003. Some 99.4 per cent. of people with suspected cancer are now seen by a specialist within two weeks of being referred by their GP. Some 96 per cent. of people can now see a GP within 48 hours, while 97.8 per cent. of people are offered an appointment to see a primary care professional within one working day. There are 1,970 more nurses and midwives than in 1997—

Mr. Bill O'Brien (in the Chair)

Order. We must now move on.

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