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§ Mrs. Linda Gilroy (Plymouth, Sutton)Plymouth Derriford hospital is the largest provider of tertiary health services for the Devon and Cornwall peninsula, which has a population of 1.6 million. It also provides the full range of district general hospital services for its local population, some 430,000 people in Plymouth, South Hams and west Devon and east Cornwall. The south and west region has two principal tertiary centres at Bristol and Plymouth. The Bristol trusts are a long way from the peninsula, particularly Cornwall and Plymouth. In the past four years, Plymouth Derriford hospital has received extra investment in areas that desperately needed it after 18 years of Conservative underinvestment in our health services. It received nearly £2.5 million of extra capital and revenue funding for breast cancer treatment. A further £3.5 million has been invested in a new unit for other cancer services, and we have now been designated a regional cancer centre. An extra £12 million of revenue and capital funding has been made available to cardiac care. To modernise the accident and emergency department, Derriford has been allocated £750,000. Plymouth is to receive a substantial amount of extra money, as well as money to train many of the 1,000 extra doctors that are required nationwide. We are excited that many of those doctors will be trained in Plymouth, following the founding of the new peninsula medical school.
In the lead-up to the publication of the NHS 10-year plan, I carried out a local survey in my constituency to find out how my constituents felt that the extra investment could best be used to restore and build the NHS. It will not surprise the Minister that Plymouth people recognise that the urgent need to recruit new staff is basic to improving the quality and efficiency of the service. Last summer, I spent an afternoon on the medical assessment unit in Derriford. I shadowed Sister Louise, who was in charge. In taking an interest in some aspect of admissions, I only had to blink to find myself running to keep up with her as she attended to the next pressing priority competing for her attention. At the end of the afternoon I had a good idea of just how hard-pressed health staff can be.
I also visited the pathology laboratories, and was impressed by the dedication of the staff dealing with things that are immensely important to hospital patients and the community. I was shocked by how little some of them were paid, and was not surprised to learn that there was 100 per cent. turnover in the lower grades in some sections. Last April, I presented a petition to the House calling on the Government to recognise the problems of the pathology service across Devon, especially in terms of recruitment and retention. I am delighted with the announcement made 12 days ago that all support staff not covered by the pay review bodies are to receive an above-inflation settlement of 3.7 per cent., with the laboratory staff receiving between 3 and 13 per cent. on top of that.
A further finding of my survey was that two out of three people did not know of the Conservatives' plans to introduce insurance or charges for many operations, including hip and knee replacements and cataract operations. We know that that could result in swingeing payments for the over-50s, who could be forced to take 126WH out insurance equivalent to paying £70 or more a week on their tax, or pay the cost of the operations—which ranges from £1,000 to £5,000—themselves. The Minister will not be surprised to know that, on finding out this information, the sensible people of Plymouth were opposed to those measures.
We are delighted to have received nearly £33 million more this year from the Government for the South and West Devon health authority, and another £33.5 million for 2001. The two of her health authorities that look to Derriford to provide their tertiary and most of their secondary care services have received similarly significant increases. That money will help us to build on the significant extra sums that we have received since 1997. The 30 per cent. real-terms increase—50 per cent. in cash—announced by the Chancellor last year, to be released over the next few years, is hugely welcome.
Before I talk about the outstanding challenges that we face at Derriford, I place on the record my thanks and those of my constituents for the extra investment coming through the health action zone, which is doing good work to tackle health inequalities in the city. Much of the pressure on Derriford's services results from the gap between rich and poor areas of our city. I am sure that the Minister will recollect that the legacy of my Conservative predecessor was the poorest ward in England. She is aware of the devastating health problems that poverty brings. The inner-city ward of St. Peter in my constituency has a premature mortality rate three times that of the leafy suburbs of Plymstock Dunstone. Cancer mortality is more than twice as high for those under 75 in the St. Peter ward as it is in the Plymstock ward; emergency admissions to hospital are two thirds greater.
The action zone is working with the new deal for communities project, "Devonport People's Dreams". On Monday, I joined 100 people working on that project to hear them finalise their dream of investing £30 million in their community. Doing something about those health problems at source is high on their agenda.
Against that background of poverty and pressures, I shall describe in more detail the special circumstances and unique challenges faced by Plymouth Derriford hospital trust, which are well documented. It has the same problems that hospitals face throughout the country. Waiting list targets, winter pressures, recruitment and retention of staff and the cleanliness of wards and theatres have all been the subject of local and national press attention. As a result of those problems, there have been distressing cases of inadequate patient care and attention. Some have hit the press; some have not.
Last year, the chief executive resigned in circumstances that placed serious question marks over waiting list management and the accuracy of statistical records. Derriford's management costs are among the lowest in the country. That could be something to be proud of, but in the context of the challenges that I am outlining, I think that we have probably paid a high price for some of the consequences of those low costs.
Constituents have raised concerns about all those issues, as they no doubt do with the Minister and Members the length and breadth of the country. I am pleased that, with fresh management, we are seeing new approaches. We have some extremely good news stories 127WH to tell about staff at Derriford providing high-quality and some exceptional health care. It would be invidious to single out only one or two staff for praise, which is all that this short debate would permit. Perhaps the best way of reflecting the situation is to refer back to my survey, in which 75 per cent. of people said that they were satisfied or very satisfied with the health service.
I have listed the challenges at greater length than the achievements, because they are an important backdrop to the case that I want to put before the Minister. Plymouth's Derriford hospital is the largest non-teaching hospital in Europe, so it does not receive the extra resources allocated to teaching hospitals. I mentioned the successful bid for the new peninsula medical school. It will bring some £30 million a year to the local economy and improve the chances of local young people to become doctors. In Plymouth, Devon and Cornwall we have one of the lowest rates of young people entering the profession. We also have great hopes that the school will improve equity of access to a range of specialist services. People in the peninsula have the poorest rates of access to life-saving tertiary procedures in the region and substantially lower rates than the national average.
The school alone, however, will not solve the problems. It may even create extra pressures in some respects. There is simply insufficient capacity to provide, let alone improve, services across primary, secondary and tertiary care to meet the expectations of the national health service plan. The successful implementation of the plan and our modernisation agenda will require extra capacity in the form of extra beds, theatres and other facilities.
Since January 2000, bed occupancy at Derriford has been running at an average of 94 per cent., compared with an average of 84 per cent. nationally. It is running well over capacity, which is one reason why it is having great difficulty limiting waiting times. There is no prospect of ensuring that the people of Plymouth, Devon and Cornwall receive the same treatment and are subject to the same waiting times—let alone having equity of access to tertiary services—as people in other parts of England, unless that problem is addressed. It is only because of the exceptional dedication of medical and support staff that we have been able to hold the line on meeting winter pressures.
As the Minister knows, we have problems meeting the waiting list targets. That was recognized by the winter and emergency services team when it visited toward the end of last year. I know that my hon. Friend observed those problems when she visited Plymouth a few months ago. In particular, WEST praised the excellent approach of Derriford's bed management team, the flexibility of surgeons in achieving waiting list targets, and developments in primary care. The trust has worked hard with local primary care groups and social services to ensure that patients can return home with adequate support as soon as they are fit enough.
It was a huge blow to the hospital's morale to be named among the seven hospitals in the country that were failing on waiting lists. Nevertheless, the national patient access team, which was tasked to support Derriford in addressing such issues, has been welcomed. A supportive relationship soon developed with the hospital, in order to meet the challenges faced. The team 128WH probably recognised that an average of 94 per cent. bed occupancy, to which I referred earlier, was a challenging background.
People living in the South and West Devon health authority area have more than 15 per cent. worse access to vital procedures such as cardiac valve operations, coronary bypasses, burns services, kidney transplants and bone marrow grafts. My hon. Friend will have noticed that I mentioned kidney transplants. Despite the fact that the people of Plymouth gave huge support to Derriford's kidney unit when it was threatened with closure last year, access to kidney transplants is comparatively poor. I am pleased that we managed to retain the kidney unit, and that I and my hon. Friends the Members for Plymouth, Devonport (Mr. Jamieson) and for Falmouth and Camborne (Ms Atherton), as well as my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), were able to lend our not inconsiderable weight to that successful campaign. However, I am concerned that access to renal transplants remains poorer than elsewhere.
The Plymouth area has 300 fewer beds for its population than the national average, and Derriford has fewer consultants, compared with national averages, in key areas. I am concerned that the triple challenge of managing winter pressures, achieving waiting list targets, and fulfilling the role of a district general hospital as well as a tertiary service regional resource, which gives equitable access to acute services, cannot be met for ever with such a strained infrastructure. Sooner or later, something more will have to give. No scope exists for achieving targets on all fronts when strains and challenges, across almost every area of activity, are so evident. We need a significant and strategic investment in the physical infrastructure of our service, to match the welcome increase in medical staff numbers and pay and conditions.
I do not need to quote more figures to demonstrate to the Minister the specific challenges faced in Plymouth. I know that she shares my real concern about the situation, and a desire to do something about it. Plymouth Hospitals NHS trust, in conjunction with the community services trust, is bidding for one of the major hospital developments announced by the Secretary of State in the NHS plan. The strategic outline case for a new planned care centre envisages allowing acute and specialist care to be totally redesigned around the patient at Derriford. For patients, that would bring reduced lengths of stay away from home, a need for fewer visits, reduced cancellations and shorter waiting times.
I appreciate that the Minister cannot announce further investment of that type in the context of this debate, but I hope that she will recognise the exceptional challenges that the hospital faces. I welcome the amount that has already been done, but there is so much further to go.
Improvement will not happen overnight. The investment made so far and still to come on stream is absolutely vital. I wish that it could have flowed faster, but the Minister and I know that, in 1997, a shocking 43p in every pound of taxpayers' money was spent on the cost of rising debt and unemployment. The comparable figure today is only 17p. We can both look our constituents in the eye and tell them that we can build on what we started year on year—as long as we 129WH avoid returning to the boom-and-bust economy, which resulted in so much underinvestment in our vital public services from the beginning and almost wrecked them in the longer term.
Labour believes in the national health service as a public service in a way that the Conservatives do not. Thanks to the Chancellor's prudent management of the economy, we can put problems right over the medium term through the NHS 10-year plan.
The trust faces significant organisational and clinical challenges. I look forward to hearing the Minister's views on how the Government can help Derriford trust to play its full role in achieving a modern health service for the people of Plymouth, Devon and Cornwall. I am confident that Derriford's board, management and staff will rise to the challenge of providing a service that compares with the best available on a far greater range of its activities than it does, or can, at present. The Minister's recognition of Derriford's special needs and challenges will be appreciated at this crossroads in the history of health care in our city.
§ Mr. Mike Hancock (in the Chair)I thank the hon. Lady for that well-presented case.
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)I congratulate my hon. Friend the Member for Plymouth, Sutton (Mrs. Gilroy) on her success in securing the debate and I acknowledge her continuing support for and active engagement in the health community. I recognise the presence of my hon. Friend the Member for Plymouth, Devonport (Mr. Jamieson) who, as Government Whip, is by convention silent in the Chambers of this House. I can assure his constituents that he is not silent when it comes to representing their needs before Ministers.
Plymouth Hospitals NHS trust provides both secondary and tertiary health services to the constituents of my hon. Friend the Member for Plymouth, Sutton; as such, it plays an extremely important part in their lives. The presence of my hon. Friend the Member for Falmouth and Cambourne (Ms Atherton) demonstrates that the trust is important not just for the city of Plymouth, but much more widely.
The trust has had its problems over the past year, but they must be placed in context. It is important to recognise the steady work being done locally to improve the situation. The trust and its staff have shown tremendous commitment and Government investment has also helped. The context of the development of the Government's vision for the NHS in the NHS plan should be recognised. Many improvements have taken place in many spheres of the trust since Labour came to office. Expenditure, activity, staff numbers and beds have all increased in the past three years and further significant service developments started in that period.
Expenditure since Labour came to office has increased by a third from just over £123 million in 1996–97 to nearly £165 million last year. That must be set against an extraordinary increase in the trust's activity—by 1999–2000 an increase of 8.2 per cent. since 1996–97, which amounts to almost 108,000 finished 130WH consultant episodes. The number of nurses employed at the trust since 1996–97 has increased by 386—a rise of nearly 23 per cent. This year alone has seen an extra 165 nurses and, over the past three years, more than 40 consultants—new posts, not replacements for clinicians who had left—have joined the trust.
Despite those impressive increases in medical and nursing staff, there are difficulties in Plymouth, as in other parts of the country. The major constraint on the NHS is no longer a shortage of money, but of staff. Investment in medical and nursing education and training during the 18 years of Conservative power was insufficient to meet the current needs of the modern NHS and to deliver the changes necessary in the NHS plan. The trust has a current nursing vacancy rate of 5.7 per cent., which compares favourably with that of other trusts. The success of the trust in recruiting and retaining staff is due to a number of factors: long-term recruitment initiatives, including the hiring of 91 nurses from the Philippines; the introduction of annualised hours and other flexible working arrangements and, importantly, help with child care through vouchers or the hospital nursery, which the trust is currently seeking to expand; and greatly enhanced training and development opportunities to facilitate retention.
I take the opportunity to thank everyone working in the NHS in Plymouth for their tremendous work, day in, day out. The doctors, nurses, ambulance workers, scientists, clerical and maintenance workers, laboratory staff and others who work in Plymouth have been pushed to the limit, as I saw on my visit there. It is difficult to judge a hospital only on the information received, but I saw on my visit there that the trust's staff were completely committed. We do not want them to be pushed to the limits in the long term; it is to their credit that they are so committed, but long-term developments must ease the situation.
There have been major service developments in recent years; the NHS plan recognises that merely doing more of what has always been done is not a long-term solution. The most significant of those service developments was the opening in November 1997 of the new three-theatre cardiac surgery unit to provide heart surgery in the peninsula for the first time. Patients no longer have to travel to London, Oxford or Bristol for treatment. Since its opening the unit has already expanded, with the recruitment of two additional cardiothoracic surgeons. In March this year, the trust intends to open a second cardiac catheterisation laboratory, to provide additional diagnostic procedures and interventions. That is a real benefit to all who live in and around Plymouth.
In October 1999, the trust opened a new 15-bed unit to fast track the assessment of emergency surgical admissions. In May last year, we announced a £150 million extra investment specifically for critical care—the biggest ever investment in critical care in the history of the NHS. South and West Devon health authority received more than £1.7 million, leading to an increase of 20 per cent. in the number of critical care beds at the trust.
We have already invested £115 million to modernise every accident and emergency department in England that needs it. From the funding provided by the Government, the people of Plymouth will have the benefit of a newly refurbished A & E department; at a 131WH cost of nearly £800,000, it will double the number of bays in the resuscitation room and provide a 12-bed observation unit. The Government are committed to ending waiting times for cancer surgery, thereby helping thousands of women waiting for breast cancer treatment, for example. As part of that commitment, in March the trust will open a new £1.46 million outpatient breast care unit and a 15-bed surgical ward for female patients.
A development that is less obvious to the patient is the substantial investment of £1 million a year for seven years to develop the trust's new patient information management system. That initiative, with the other significant investment in IT, will mean that when patients receive care the professionals treating them will be working on the best quality knowledge about their condition and available treatments. They should expect to be given up-to-date information from professionals about their condition, the treatment they are receiving and other sources of advice.
When test results are returned to the referring doctor, patients should expect to hear the results quickly. That is a step change for NHS patients from which people in Plymouth and the surrounding areas will benefit.
There have been comments in the press recently about problems in the orthopaedic and gastroenterology specialties. This year, the trust intends to appoint an additional two orthopaedic consultants and to install a laminar air flow in the orthopaedic operating theatre. In gastroenterology, the trust intends to appoint an additional consultant and nurse endoscopist to reduce waiting times for diagnostic investigation and treatment.
§ Ms Candy Atherton (Falmouth and Camborne)Would the Minister be kind enough to publish the numbers of new consultants, doctors and nurses across the entire peninsula? On a recent visit to a hospital trust, I was told that that information was not published as it encouraged people to take up the services provided. It is important for people to know just how many doctors and nurses the Government are providing.
§ Ms StuartI will certainly look at the information that is made publicly available. I am sure that my hon. Friend is aware of the useful device of parliamentary questions.
Developments of the kind I have described can bring their own pressures. Plymouth has in some way been the victim of its own success in opening the new cardiac unit because more patients were referred to the hospital than had been anticipated or planned for, with the result that waiting times rose. There were pressures in other parts of the hospital too, and towards the end of 1999 a number of patients were identified who had waited longer than 18 months for treatment, which breached the patients charter guarantee.
An independent investigation commissioned by the trust found that there had been manipulation of waiting list returns, which was completely unacceptable. The chief executive and deputy chief executive subsequently resigned. However, since then, the trust has been tackling those and other problems and has moved on. We must recognise that good work.
A new chief executive has been appointed and a new management team is being assembled. The number of in-patients waiting on the waiting list, which continued 132WH to increase until July, has been coming down. By the end of November the trust had reduced the total by over 22 per cent. Similar hard work has resulted in improvements in the number of out-patients who had been waiting over 13 weeks to see a consultant.
I recognise that the trust still faces many pressures. There is a need for more investment, more facilities and more staff. The trust has established a recovery and modernisation steering group to tackle the immediate pressures and to oversee the production of a three-year recovery and modernisation plan. That will ensure that the trust achieves financial stability and meets the waiting list and access targets set out in the NHS Plan. It is the responsibility of all those who work at Derriford, whether consultants, nurses or managers, to work in cooperation with the new management team to ensure that the trust can meet the challenges set by the NHS plan.
Let me now turn to the future. In the NHS plan the Government have set out their vision of what the NHS will be like in 10 years time. It will be an NHS focused around the needs of patients offering fast and convenient high quality care; not one that is characterised by waiting for the GP, waiting to see a consultant or waiting for tests results. Waiting times at every stage in a patient's contact with the NHS are a major cause of public discontent with the service. We have therefore set out ambitious targets in the NHS plan to deal with that.
Maximum waits for out-patients will be cut to three months by 2005. Appointment dates will be pre-booked for a date convenient for the patient. Tests and diagnosis will usually be undertaken the same day. If treatment is necessary it will be arranged there and then with a maximum wait of six months by 2005, which we hope to reduce to three months by 2008. Again the date will be pre-booked to suit the patient.
We need the resources to put these plans into action. In the Budget last year my right hon. Friend the Chancellor of the Exchequer announced the largest ever sustained increase in funding of the NHS, which will see spending increase over the next five years by one third in real terms. This year South and West Devon health authority received initial allocations that represent significant real increases. It must also be recognised that the major constraint of staffing shortages must be met with more training places. We had already announced an increase of 1,100 extra training places nationally and a further 1,000 will come on stream.
As my hon. Friend the Member for Plymouth, Sutton recognised, the creation of the peninsula medical school will be a major boost for the health community in Devon and Cornwall, not only because of the extra doctors who will be trained there, but the impetus it will give to clinicians and academics to come and work there and take part in the research. I also hope that it will encourage more local youngsters into medicine. There will be support to continue the development of tertiary services in the peninsula.
The trust has been planning how it will meet the requirements of the NHS plan, and it has submitted a strategic outline case with the support of the wider health community, for which my hon. Friend has argued so persuasively, consistently and persistently. That £100 million scheme to develop a planned care centre and to 133WH reconfigure Derriford hospital is being considered as part of the national prioritisation exercise for the fifth wave of PFI schemes.
I cannot comment now, but I would like to make it clear that we recognise the problems. There has been tremendous investment in the past three years.