§ 12.27pm
§ Mr. Derek Wyatt (Sittingbourne and Sheppey)Part of my constituency is an island and it is known as the Isle of Sheppey. Islanders throughout the world feel that they are unique, and even if they are not, that is their perception of themselves. Of course, that does not apply to my islanders, because they are unique.
The Isle of Sheppey has never been permanently linked to the mainland of Britain, but that is due to end soon. As part of the Labour Government's commitment to the community that I represent, they are to build a new bridge, which I hope will be called the Queensferry bridge, and which was part of our 1998 roads review scheme. It is due to start in 2003, for completion in 2005. The Highways Agency is not known for its transparency, so I urge it to confirm that timetable as soon as possible—this afternoon would do.
The way in which the previous Tory Government went about the island's planning issues and the way in which they understood difficult words such as "infrastructure" and "funding" has been a joy to behold. It is like a bad dream—housing and more housing. There is housing everywhere. But every time that the building of a new school is in the plan, Tory-controlled Kent county council always reneges on its promises to build one.
In my short life I have found that housing tends to be occupied by people, and that they need professional back-up if the quality of their life is to be maintained. They immediately need roads to travel on, as well as a bus service. They need water companies that do not have failed pumping stations, or perpetual sewage flooding their brand new gardens or sidewalks, especially in the summer. They need doctors' surgeries to be included in these plans at the micro level, and they need to know that at the macro level the Government have planned for an adequate number of new general practitioner recruits to enter the system. They need a local community hospital.
Minister, you need to come and minister to Minster, on the Isle of Sheppey, because at Minster we have a building that doubles as a hospital. It is in a dreadful state of repair. The staff do a marvellous job, almost despite the system. I hope that they will get their due rewards in heaven. They are our public servants and public heroes. They are not the fancy, unaccountable consultants who, one by one, have found excuses not to continue their clinics there, or the myriad faceless administrators who have to fight our corner.
Those nurses, cleaners, cooks, ambulance drivers and doctors are the glue that keep the national health service working—in some cases, barely working—on an island not yet connected to the mainland, where the nearest accident and emergency department is 20 miles away. When the trains are running and the buses turn up, it takes about two hours on public transport to travel from Warden bay or Leysdown on the east of Sheppey to Medway Maritime hospital and two hours to get back. It is tiring, expensive and often frustrating, especially when one arrives to find that one's notes are missing or that the appointment has been cancelled by mistake. One would be forgiven for thinking that we were talking about a third world country.
300WH For those reasons, my island has not had a healthy respect for past Tory Governments. It would be fair to say that it is also running out of patience with the current Labour Government.
When I was on the hustings in April and May 1997, my Tory predecessor was fond of telling us that a new £10 million private finance initiative-funded spanking new community hospital, albeit smaller than was originally planned, was almost signed off. Four years on, it is not signed off and we have no idea when it will be.
My community is very angry, and it is justified in being so, for many reasons. Although I have toiled away trying to make Sir William Wells take some decisive action over the sheer incompetence of the administration of which he is the chief executive officer, I have failed. There is little public respect left for the administrators of the NHS in my patch.
All that we want is a small community hospital. The funding is minuscule. It is about £11 million: a snip. In the two years when we said that we would abide by the Tory spending plans—1997–98 and 1998–1999—the total spending for West Kent health authority was £479.9 million in the first year and £501.4 million in the second. We have done better than that. We increased the budget by 11.6 per cent. in 1999–2000 and by a further 13 per cent. in 2000–01. Next year the initial allocation, which at this time does not include further sums that are still to be debated and agreed, has increased by at least 8 per cent. My constituents understand that expenditure tends to increase year on year anyway, because wages and salary costs must be taken into consideration, but the figures that I have quoted, whose source was the acting finance director at West Kent health authority, are in real terms. Therefore, £11 million is still a snip.
Instead, we have had a series of dreadful decisions. The first was the Tory love affair with private finance initiatives. Although the Tories introduced PFIs in 1992, not one PFI hospital was signed off by 1997—and that from a party that was supposed to be close to the City and business. Thankfully, under the Labour Government 38 major hospitals across the United Kingdom, worth £4.1 billion, have been given approval to proceed under the PFI since 1 May 1997. That is the biggest hospital-building programme since 1945. Alas, for some reason we have not been able to find a mere £11 million for Sheppey: a snip.
There we were in May 1997, months away from that snip of a hospital. Of course, as with the new bridge, which was one of 500 road schemes with no Treasury bills attached, we took most of our first year setting down some rules and regulations about how PFIs should work, and not just in the NHS. That was good and sensible government. What none of us can understand—perhaps the Minister will enlighten us—is who took the decision in her Department to move the goalposts so that our snip of a PFI suddenly had to embrace four other small community hospitals. I have given the Minister some notice of that question, and I look forward to her response.
That decision was wrong. It was seriously flawed. Five health authorities were obliged to pay out five sets of legal and consultancy bills. Surely that was not in the rules that we laid down in 1997 and 1998. Thames Gateway NHS trust has spent nearly £1 million in costs 301WH to sustain a £11 million snip of a community hospital. Which chief executive officer gave approval for that amount of money to be spent when we still do not have a decision on a hospital?
Thus our snip of a community hospital became a larger snip, and we waited and waited for a decision about the future of Sheppey community hospital. I even had a visitation from the chief executives of West Kent health authority and Thames Gateway NHS trust in my office in the House of Commons. They told me that all was well. I was told that it would happen in 1998, then 1999, then 2000—and now we do not have a clue.
Throughout all this time, the old hospital at Minster has deteriorated further. The clinics have decreased. The beds have been reduced. The service that the islanders receive is well below the level of the service provided to those of my constituents who live in Sittingbourne, who have the wonderful services of Sittingbourne memorial hospital. I thought that we were supposed to want an end to postcode health care. I also thought that we were supposed to favour our poorer communities. We just want the community hospital to he given the go-ahead.
The Treasury rightly turned down the PFI. Why, if it was that obvious, was a marginal business case made for it in the first place? At what stage did the Minister become aware in her Department that there was a case for trying to justify the unjustifiable?
Enough. My community wants its community hospital. We have been waiting for over a decade. We want the Government to release the money. As my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), then Secretary of State, said to me in the House of Commons at Question Time:
The people of Sheppey are entitled to a decent community hospital, and that is what we are determined to provide—one way or another.—[Official Report, 8 June lo99; Vol. 332, c.456].As the Minister knows, on 4 April 2000 I wrote to the Prime Minister, pleading for the hospital. Will the Minister please announce, in her response, the funding solution and the day that we can expect the first brick to be laid?
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Mr. Wyatt) on securing this debate on the Sheppey community hospital and I pay tribute to his vociferous and unceasing commitment to placing his constituents' case on the record. Every Health Minister, and even the Prime Minister, must be aware of his concerns. I fully understand and endorse the commitment of my hon. Friend the Member for Sittingbourne and Sheppey to ensuring that all his constituents receive the best possible health care services. He kindly gave notice of some of his major concerns, and I hope to be able to address his very specific questions. Should I inadvertently leave anything out, we will write to him.
I shall respond very specifically to one comment. My hon. Friend refers to "faceless administrators", but he pays tribute to the people who work in the national health service locally, and to the nurses and doctors whom he encounters. Although I fully accept that he may not often see the administrators, I assure him that they care just as much about the NHS as the more visible 302WH people. Moreover, I can reassure him that that commitment to a better NHS is not just on the front line. However, I support him in saying thank you to all those in his constituency who work to make the NHS better for the patients.
I am also aware that the decision not to proceed with the proposed private finance initiative scheme for Sheppey has caused considerable uncertainty to the local community. The cancellation of the various projects has further compounded that uncertainty, not least because this is not the first Adjournment debate that I have been part of in relation to that issue, and I am probably more familiar with the details than I would always like to be.
I know that my hon. Friend has been in close contact with Ministers and that he has met the Minister of State, my right hon. Friend the Member for Southampton, Itchen (Mr. Denham), to set out his concerns in more detail. Today, I should like clarify the current position and say what the next steps will be. I hope that this will end any uncertainty and reassure my hon. Friend the Member for Sittingbourne and Sheppey that his constituents' needs will be addressed. Moreover, I hope that, after the debate, my hon. Friend will be left in no doubt that the Government are dedicated to ensuring that his constituents receive first-class health services in a new community hospital.
With my hon. Friend's permission, I should like to begin by reiterating the Government's support for PFI and take the opportunity to remind him of the key principles behind PFI and the key factors that need to be taken into account when approving any PFI case. It is important to do so, to make it clear why we decided that the PFI scheme proposed for Sheppey was not the right way forward. I know that my hon. Friend has been involved in business and knows that the path of good decision making is sometimes to say, "On this particular occasion, we do not proceed". That does not undermine the whole process or the whole case.
When the Government came to power in 1997, the NHS was crying out for the biggest building programme in its history. There had been chronic underinvestment for far too long and the private finance initiative is key, because it will provide extra resources for the NHS building programme. The initiative transfers many capital investment risks to the private sector and ultimately results in better care for patients and best value for money for the taxpayer. The process is designed to allow the NHS and the private sector to work together effectively, to build new hospitals or provide information technology services.
I know that my hon. Friend is extremely keen on using new technology and would not argue with me for a moment that the private sector is a very useful source to complement Government action, not only with capital but also with ideas. However, PFI also deals with support services or the supply and maintenance of equipment, and it provides an opportunity for the NHS and the private sector to liaise and provide fruitful results that are beneficial to both parties. Within our commitment to expansion of the NHS, there is increasing support from the PFI initiative, leading to improved facilities nationwide.
303WH My hon. Friend mentioned the postcode lottery. We are aware that one of the biggest problems that we still face in the NHS is huge differences in performance between both institutions and areas, but also sometimes within institutions. We strongly feel that the way to deal with the situation is in terms of capacity. In a sense, money is no longer the real problem, as the money is there, but we must ensure that the money comes with the right price tag. The right price tag is that we change the way in which we deliver the service, but also use it with best value.
I return to the PFI projects. Thirty-four major hospital developments, worth over £3.7 billion, have been given approval to proceed on the PFI since 1 May 1997. My hon. Friend is right when he draws attention to the fact that although the previous Government showed in their rhetoric that they were determined to use PFI, they did not make it work. Not a single new hospital was built under the PFI scheme. We have already completed some of these hospitals, and have seen that it works.
The NHS plan that we published in July 2000 included a number of PFI commitments: to set up 18 more schemes in 2001 and 2002, to provide at least 40 more medium-sized hospitals by 2010, to provide 20 new diagnostic and treatment centres by 2004 and to invest up to £1 billion in primary care facilities. PFI does work and we have seen it work. We are committed to developing new forms of public-private partnership that work better and protect the interests of the NHS. The bottom line is that it works better for the NHS.
PFI does have a future, but that does not mean that it is always the best solution, and in the case of Sheppey it was not the best solution. My hon. Friend has referred several times to £11 million as a snip. I can see why he may think that it is a snip in terms of the entire NHS budget, but we still have to be very careful that £11 million is used in a right and proper way.
Factors that need careful consideration before PFI schemes can be approved include the following: overall value for money, the need for proposals to represent best value, and whether a scheme would be better value for the NHS and the taxpayer under PFI than it would be under the equivalent NHS alternative. Proposals must also be affordable, and local health authorities and those that commission services must be able to afford the overall cost of a proposed scheme.
I am sure that my hon. Friend recognises that hospitals are complex buildings and take considerable effort to design. That is why all PFI schemes in the NHS are subject to review before they are approved. The results of the national beds inquiry have led us to look at a number of larger projects to ensure that those big designs fit the requirements of the community. It is a complex jigsaw.
I know that there is considerable frustration about the time that the process can take, and I do acknowledge the concerns that my hon. Friend has raised about that today. The process is lengthy and detailed, even if the PFI scheme succeeds. When there is a situation like the one in Sheppey, there comes a point when it is clearly recognised that the PFI is not the way forward. That causes a further delay, and I fully acknowledge that, but 304WH I hope that it is understood that we are taking the constituents' best interests to heart and will ensure that we can deliver. However, it is vital that all critical factors have been accounted for and are properly tested. Reviews must ensure that schemes represent a good deal for the public, and that can take time. If schemes fail to meet these criteria, they do not proceed. Sadly, the Sheppey PFI proposal failed on the two criteria: value for money and affordability.
My hon. Friend has raised a number of detailed issues concerning the responsibilities for procurement decision making. I would like to confirm that for all the schemes referred to, the trusts received NHS Executive approval for their outline business cases prior to commencing procurement.
No decision was taken to procure the schemes as one PFI scheme. However, a decision was taken to try to expedite the development process by agreeing a framework contract on one scheme, Sheppey, that could then be used as a template for the others. In a sense, although a number of schemes were going on that appeared to be going forward as one package, it was an umbrella package. It was not the case that suddenly Sheppey, with its snippet demand for £11 million, was thrown into a much bigger pot. That decision was reached by the trusts in liaison with their legal advisers and the NHS Executive. The decision did not require Treasury or ministerial approval.
The trusts pursued negotiations with the Investors in Health consortium to develop a value-for-money solution, in accordance with NHS Executive guidance. When it became clear that, despite the intensive efforts of the trusts and the NHS Executive, a value-for-money solution could not be agreed, the Minister of State, my right hon. Friend the Member for Itchen, was informed and agreed that further work should be terminated. However unfortunate it may be when such decisions have to be taken, if that is the right decision, we have to take it.
I can confirm that all the trusts involved followed established practice and Treasury and NHS Executive guidance throughout the procurement process. I recognise that money has been spent during the development of these schemes. However, that money was invested to ensure that the schemes would be approved only if they provided value for money. That investment is more cost-effective in the long run than proceeding with a scheme that is not economically sound. It is one of those paradoxes that we have to face. If we have to invest, sometimes in schemes that will not be proceeded with, the important issue is to ensure that we learn what made each scheme inappropriate. We are continuously fine-tuning that process.
What matters now is how we are moving forward and what we are doing to ensure that the health care needs of the people of Sheppey are met. I am sure that at some stage my hon. Friend the Member for Sittingbourne and Sheppey will be back on the stump in his election hustings. I would be extremely surprised if his constituents were to ask him which funding groups were used for the provision of the health care. They will want to know whether they will get the health care that they need on the island.
Once it was decided, in November, not to proceed with the PFI option, Ministers stressed how important it was for all parties concerned to move forward as quickly 305WH as possible with alternative arrangements to ensure that the health care needs of the local people were met. A review process was immediately initiated to appraise alternative options for provision of the new hospital, and concurrently to reaffirm the service model and functional requirements of the new facility. A priority has been to consider the proposal put forward by the Isle of Sheppey healthcare charity for funding and provision of the new hospital, which my hon. Friend mentioned today. Should that option prove not to be viable, the review will also consider the potential for public funding of the scheme.
The review has been fully supported by the south-east regional office of the NHS Executive. The views and opinions of the local stakeholders have been taken into account, as have those that my hon. Friend raised in correspondence and conversations with the Minister of State, my right hon. Friend the Member for Itchen. The review is close to completion and I am sure that my hon. Friend the Member for Sittingbourne and Sheppey appreciates that it would be inappropriate for me to speculate on its outcome now. An announcement will be made in early February and I will ensure that my hon. Friend is informed of the decision personally.
Although I cannot speculate on the outcome of the review, I assure my hon. Friend that the people of Sheppey will get their community hospital. The scheme is a high priority for the south-east region and I guarantee that public capital will be made available for the scheme if it is required. It is important for everyone to be confident that effective primary and community services are in place in Sheppey before the new hospital opens, and they do exist. Recent innovations include a nurse-led assessment centre operating from the leisure centres in Sittingbourne and Sheerness, enabling GP referrals for subsidised access for coronary heart disease patients; and recuperative care developments in partnership with social services in Sheerness, initially developing two, then three recuperative beds for short-term rehabilitation for elderly people who are unable to go straight home from hospital. The increase in practice and administrative staff in 25 per cent. of GP practices brings the lowest-staffed practices closer to the West Kent average; GPs are making good use of informal networks, with consultants visiting for out-patient clinics, which, for example, allows them to get specialist advice without making referrals.
In addition, considerable work has taken place over recent months to ensure that the health economy can cope this winter. Many of my hon. Friend's colleagues raised their concerns within the West Kent region about how that would be done, not just within the NHS but in the social services. I have met representatives of the various stakeholders in order to ensure that there is a comprehensive service. Judging by the feedback that we received, there is a tremendous commitment. The planning has paid off. However, that requires money and West Kent health authority received an extra £1 million, some of which was targeted at Sheppey residents, to help with the work. For example, four additional recuperative beds at Sheppey hospital will free up acute beds and there will be additional medical staffing at Sheppey to allow more dependent patients to be cared for in the community hospital. That includes additional staff-grade locum cover for annual and sick leave, increased clinical assistant hours from local GPs 306WH to cover beds under the care of a consultant on a GP ward—including out-of-hours cover—and increased nursing on De Shurland rehabilitation ward to enable more dependent patients to be admitted.
I appreciate my hon. Friend's concerns; it is only right that he and his constituents should question how local health services will be provided in future. The doubts about PFI schemes are legitimate. PFI's history as a solution to problems extends over 10 years, but it did not work under the Tory Administration. There was a reduction in the number of beds, and no work was done on intermediate care. We inherited a model of private and public finance working together but not making things work. We recognise that some of the underlying structural trends in the NHS were wrong, which increased delay. We must get it right.
The Government are clearly committed to a publicly funded NHS, as my hon. Friend will see if he finds a moment to look at the NHS plan. Its interesting chapter on the funding of the NHS restates the Government's commitment that the NHS is a public funded service. We will not go down the route of private medical insurance or charge people for GP visits, but we will work with the private sector on capital investment because that is in the best interests of taxpayers and my hon. Friend's constituents.
I know that my hon. Friend and his constituents are frustrated by the time that the project in Sheppey is taking, but we must get it right because I am sure that that package is right for the NHS. Although the proposed PFI scheme in Sheppey has undoubtedly caused anxiety, we will bring the matter to a swift conclusion. I well understand my hon. Friend's cynicism in saying that he has heard such things before, but I say confidently that if the consultation reveals that PFI or other projects are not the right option, we will find the public money to fund the project.
I hope that my hon. Friend will leave in the knowledge that his constituents will get a new community hospital and will receive high-quality health care and modern facilities, and that public funding will be made available if required. I was struck by the opening of his speech; displaying his usual way with words, he asked the Minister to minister to the people of Minster. He will no doubt be in touch with my private office to find a suitable slot in the diary. One reason why I am happy to accept his invitation is that it will give Ministers an opportunity to thank people in the NHS who have sometimes had to work in conditions that are less than perfect, but who always put patients' interests first. I hope that they agree that we in the Government also do that.
I am delighted that the Department of the Environment, Transport and the Regions seems to be tackling the issue of the bridge so that those people on the island who, as my hon. Friend powerfully illustrated, have not been connected will have easier access. I hope that my hon. Friend is reassured that something is happening in the interests of his constituents, and that the right thing is being done.