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§ Mr. Deputy Speaker (Mr. Nicholas Winterton)Two hon. Members have sought my permission, and that of the proposer of the debate and the Minister, to participate in the debate very briefly, so that the Minister may reply in full.
§ Mr. Laurence Robertson (Tewkesbury)I am pleased to have secured this debate and to see the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), in her seat. I thank her for coming to reply. I am also grateful to my hon. Friend the Member for Cotswold (Mr. Clifton-Brown) and the hon. Member for Stroud (Mr. Drew) for being present. They both have an interest in the debate as they represent constituencies in Gloucestershire.
I have been applying for this debate for some time but have been unlucky in the selection procedure. My desire to have the debate began on Christmas day, when I made my usual round of hospital visits, as I am sure all hon. Members do. My visit to my local hospital was unhappy: when I arrived, I discovered that a ward was closed due to a shortage of staff. Not even agency staff could be found on that occasion. I also found a great many patients who should not have been in hospital but were waiting for nursing home places. One poor chap had been waiting for six months for a place at a specialist spinal unit.
All hon. Members receive letters telling us of problems with the health service, but when we go to hospitals and meet such people, the problems become very real. When we see the problems at first hand, they have a great effect on us. For example, I am concerned about the oncology ward in Cheltenham general hospital, at which people who are in a very sickly state sometimes arrive first thing in the morning and have to wait all day for treatment. As all hon. Members will have done, I have spoken to doctors, nurses, scientists, therapists and carers in my area, who feel not only short-staffed but extremely stretched in their work. I do not want to paint too black a picture, but I have become aware of those problems over the past year, especially in the Christmas period.
I do not blame the doctors, nurses or other staff, or the health authority in that area. The health service has national problems, to which I do not want to refer too generally, given that the debate focuses on Gloucestershire. However, there are national problems with funding, despite the Government's claims that they are increasing funding and despite the previous, Conservative Government's increased spending. Without taking into account the private sector contributions, Government spending on the health service puts this country ahead of Luxembourg, Ireland, Finland, Spain, Portugal, Greece and Italy. However, we fall way behind Germany, Denmark, France, Belgium, Sweden, the Netherlands and Austria in that respect.
There are also problems with what is known as the postcode lottery, whereby drugs such as beta interferon, for the treatment of relapsing and remitting multiple sclerosis, are prescribed in some areas and not in others. People understandably find that unacceptable, given that the NHS is supposed to be a national service.
123WH One reason why problems have been made worse for the health service is that it has been the victim of its own success. It has kept people relatively well and allowed them to live longer. Only 50 years ago, there were 4 million pensioners in the country, whereas now there are 11 million. Although I do not want it to appear as though I am blaming pensioners for the problems, hon. Members will recognise that their greater calling on health services presents the NHS with another problem. The fact that there are also new drugs, new treatments and new operations has created greater demand. There is also a greater public awareness, and a greater expectation of public servants. All those factors add to the problems of the health service. I fully recognise that the Gloucestershire health authority and the staff there are doing the best that they can in a difficult situation.
When I visited Tewkesbury hospital on Christmas day, I found that delayed discharges, which are unkindly known as bed blocking, are a big problem. I raised the matter with the Prime Minister and the Secretary of State for Health, The picture in Gloucestershire is bleak. There was a time when Gloucestershire had many nursing home places. I do not want to be party political, but in 1997 the county had 4,047 nursing home places; now it has only 3,064. Those figures were kindly provided by the Minister in a written answer, so I can only assume that the figure of 983 for the home care places that the county has lost is accurate. That is a significant fall.
What are the reasons for that fall? Again, I do not want to be party political, but people have told me that they have to work to the national standards, and say that other factors such as employment regulations and a shortage of staff have all added to the problem. We are all aware that the situation is unfair to those waiting to be discharged from hospital, their families, the hospital staff, and to those waiting for operations and for the beds that are unnecessarily occupied. It may be a bigger problem in Gloucestershire because the county has a slightly older population than some other counties. I draw that to the Minister's attention, although I am sure that she is aware of it. Unfortunately, over the past few weeks there has been another flurry of nursing home closures in the county, which will add to the problem.
As I say, I do not want to paint too bleak a picture, because many people are trying their best to make something of the situation. For instance, there is a sheltered housing scheme and a hospital home care discharge scheme, and the new trust will bid for development funds to provide further beds to be commissioned as and when they are wanted. Some initiatives are being taken, but the picture is not good.
I want to mention health service staffing in Gloucestershire. I mentioned the closed ward in Tewkesbury hospital; it was certainly needed. Staff could not be found, not even agency staff, to run the wards. When I spoke to nurses in other hospitals in Cheltenham and Gloucester, I was told how stretched the staff were and how short-staffed the service was. I was told that nurses are leaving the NHS to work for agencies, only to be employed by the NHS at a huge extra cost. No one can blame those who take advantage of that, but it benefits neither patients nor the NHS budget.
124WH Scientific staff carry out a vital job behind the scenes. Most people never come across them, but they do important work. They, too, are stretched, as is the ambulance service. The rurality of Gloucestershire makes it difficult to provide an effective ambulance service, and it is a great tribute to those who work for it that they manage to provide such a good service. Therapists, too, are stretched, and we have far too few carers.
A great deal more is expected of public servants today, not only in the health service. However, it applies particularly to the health service, and we must consider the rewards that health service staff receive compared with what they could earn elsewhere. We must also consider their conditions of work. On a recent visit to the ambulance service in Gloucestershire, I was reminded that those who train as paramedics get very little more than those who do not. I am sure that the Minister will want to address that, as it is a big problem. If we want to provide the kind of immediate service that people want, we must ensure that we have the staff to do it.
I also want to talk about waiting times. I have been a little concerned by some letters that I have received—I am sure that my hon. Friend the Member for Cotswold and the hon. Member for Stroud share my concern—about people having to wait a long time for treatment. The national figures for people who wait 12 months or more are not impressive, and have increased during the past four years. That is reflected locally. I am worried about people who have to wait for heart bypass operations. They suffer from an extremely serious condition, and we all know of people who have waited far too long for such operations.
Several drugs have been developed to treat serious illnesses, and it is a tragedy when they are not prescribed. Gloucestershire was certainly not helped by the uncertainty created when the National Institute for Clinical Excellence seemed to point in different directions on beta interferon. To its credit, the health authority did its best to provide funding for some patients, but it was by no means enough. When a serious illness could be, but is not, treated by a drug, we have to ask what is going on and whether we have a national health service at all.
Another example that concerned me recently was brachytherapy, a treatment with which I am not familiar. I am sure that the Minister will correct me if I pronounced it wrongly. It is a treatment for prostate cancer that is considered to be far less traumatic and to have fewer side effects than others. Cheltenham has a machine for it, but I am told by the Gloucestershire prostate cancer brachytherapy unit trust that it needs to raise £50,000 a year itself during the next two years to pay for the machine to run. That concerns us, given that we are supposed to have a national health service. The service seems rather patchy, and I hope that the Minister will mention that in her reply.
Some arrangements are being introduced that I hope will improve the delivery of health services. I want to draw attention to two problems. One is the joint emergency services unit, which will be effective in Gloucestershire from next year when the three 125WH emergency teams will work together. The ambulance service has told me that it wants comparative pay levels introduced if the emergency services are to work together. The Minister might consider that with her colleagues.
New strategic health authorities and primary care trusts will also be developed. Tewkesbury and Cheltenham will form one of the smallest in the new strategic region. I am a little concerned about that and hope that the Minister will say a word or two on the subject. We are trying to be as positive as we can be about the changes, but we are concerned about the merging of hospital trusts. We hope that it will benefit patients, but we shall have to see how it works.
Gloucestershire is seen as an idyllic place to live—a wonderful place with beautiful countryside. It is a lovely place, and I am sure that all those who live there are proud to do so. However, it has pockets of deprivation and problems caused by rurality and poor health in some areas. That needs recognition. All too often, Gloucestershire is not given the funding or the treatment by Ministers that it deserves. The same may apply to other shire counties as well. I hope that, in future, simply because a county sounds beautiful to live in, it will not suffer through shortage of funding.
I thank the Minister for listening so intently, and look forward to hearing what my colleagues have to say before she replies to my points.
§ Mr. Deputy SpeakerOrder. Before I call the hon. Member for Stroud (Mr. Drew), I should tell him and the hon. Member for Cotswold (Mr. Clifton-Brown) that the Minister wants a full 10 minutes to reply. I hope that they will show self-discipline.
§ Mr. David Drew (Stroud)I hope that I shall take somewhat less than two minutes, and no more than my fair share.
I rise to make one point. There is a third acute hospital in the wonderful county of Gloucestershire: besides the Gloucestershire royal hospital and the Cheltenham general hospital, there is also Standish hospital. For some years, we have been waiting for the relocation of facilities to the main site at Gloucestershire royal hospital, but will the Minister reconfirm—if not today, perhaps later in writing—that before services are relocated, the medical uses of the Standish hospital site will be considered? That is only fair and reasonable, and it links up directly with what the hon. Member for Tewkesbury (Mr. Robertson) said. That site could be used to help with the provision of facilities and to overcome the problem of delayed discharge, and we might consider to what other uses the site could be put. Will the Minister consider that and ensure that the commitment given to me by the chief executive of the health authority is fulfilled? Obviously, such matters are not so easy in these days of changing structures. On the day when we saw the launch of Care and Repair England's document, "On the mend", which considers how housing can be combined with health and social services to ensure better care for older people, it is appropriate to consider how the facilities at Standish could be used to play a part in that process.
§ Mr. Geoffrey Clifton-Brown (Cotswold)Thank you, Mr. Deputy Speaker, for allowing me to catch your eye. I congratulate my hon. Friend the Member for Tewkesbury (Mr. Robertson) on securing this important debate. As he said, Gloucestershire is a highly rural county. I have one of the top half dozen most rural constituencies, which also contains the third highest number of over-85-year-olds of any constituency in the country. I have made those points before in this Chamber, but the capitation formula for distributing money to the various health authorities does not adequately take into account either rurality or care of the elderly. The elderly and the very young are the most expensive categories to care for, and that should be taken into account.
I want to make one narrow point. Following a debate in this Chamber before Christmas about the future of Cirencester hospital, I went to see the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), and we discussed the need for openness from the health authority and from the new Cotswold and Vale primary care trust. Having dragged out some information from that care trust this morning, I was disturbed to discover that what I understood at that meeting would take place will not now take place. The understanding at that meeting was that on 1 February junior doctor status would be withdrawn and locums would be put in place pending Cirencester doctors being trained to house officer status.
I now discover—I was not told this as Member of Parliament for the constituency, which is disgraceful—that that was not possible and that senior house officers will have to be seconded from Cheltenham general hospital. That hospital is already overstretched. If it has surplus capacity of senior house officers, what was it doing before? That arrangement is tenuous and bodes badly for the future of Cirencester hospital, but above all, it is not in keeping with the spirit of openness that formed part of my discussion with the Minister, who was only too keen that a discussion forum should be launched, and an inaugural meeting will take place on Friday. However, for the local Member of Parliament to have to find out about proposed changes at Cirencester hospital from the local press is unacceptable, and I ask the Minister to speak to her officials in Gloucestershire to ensure that I am kept fully in the picture in future.
§ The Parliamentary Under-Secretary of State for Health (Yvette Cooper)I welcome the decision of the hon. Member for Tewkesbury (Mr. Robertson) to hold a debate on the national health service in Gloucestershire, and congratulate him on his success in securing the debate. Clearly, the NHS is vital to his constituents and to people throughout the country.
I shall start by briefly addressing the points made by other hon. Members. My hon. Friend the Member for Stroud (Mr. Drew) raised the question of Standish hospital, and I shall look into his remarks on the site's future medical role.
I was not aware of the issues raised by the hon. Member for Cotswold (Mr. Clifton-Brown) about Cirencester hospital. I shall discuss them with my hon. Friend the Member for Salford (Ms Blears), the Under- 127WH Secretary of State who has responsibility for the region, and we shall get back to him. We have discussed the capitation formula before, and although he pointed out the importance of considering the elderly in that context—I completely agree with him—he will be aware that other parts of the country make equally strong representations that they are penalised by a focus on the elderly. In areas where life expectancy is much lower, there is a lower elderly population, so people feel that health inequalities in their areas need to be addressed in the capitation formula. The hon. Gentleman will be aware that the capitation formula is under review, and that all those points are being taken into account.
The hon. Member for Tewkesbury raised a series of issues concerning the NHS in Gloucestershire, and I shall try to address some of them. Many of them were broad issues that apply both to Gloucestershire and to other areas across the country. We should be clear that there are pressures in Gloucestershire and elsewhere. Patients in many parts of the country wait too long for treatment, too many operations are cancelled at the last minute and too many patients who could be discharged are waiting in hospitals. Those problems result from years of underfunding and under-investment, which have reduced the NHS's capacity to respond. The Labour Government inherited a situation in which there were too few doctors and too few beds across the NHS.
We must also recognise the improvements that have already been made and that are being made. Such improvements are often a result of the hard work of health professionals both in Gloucestershire and across the country. The extra investment needs to be sustained into the future; we are working to provide improved care for patients in the NHS in Gloucestershire and elsewhere, but we need to go further.
Through the NHS plan, we have increased the number of doctors, nurses and other health professionals in training, we have reversed the decline in bed numbers for the first time in 30 years and we are increasing the amount of money invested in the NHS by record amounts. In Gloucestershire, as in the rest of England, that is starting to deliver changes to the services that people receive. Extra investment and extra capacity are extremely important. The hon. Member for Tewkesbury made many points concerning additional staffing, capacity and equipment, and about facilities for staff to use. I agree with him, but it is all about putting in extra investment.
The health authority has received a 5.7 per cent. real-terms increase in its budget in 2000–01 and this year. Next year, the health community's allocation will increase by 6.7 per cent. in real terms. Compared with a historical average across the country of some 3 per cent. in real terms, that is substantial additional investment in the health service. We need to look into the long-term needs of the NHS, which is what the Wanless report was about. That requires decisions about how we shall fund continued investment in the health service.
Although Westminster Hall is not a party political forum and I respect the tone in which the hon. Gentleman made his comments, he needs to debate the matter within his party, and not simply raise it with Ministers. I agree that the NHS needs greater capacity, 128WH and that we should find additional capacity. However, he may want to raise that issue with colleagues in his party.
More than £1 million has already been allocated from the modernisation fund to improve accident and emergency services at Cheltenham general hospital, where £413,000 was used to create a new surgical admissions lounge and improve security, and at the Gloucestershire royal hospital, where the accident and emergency department was refurbished. Additional investment has enabled the number of beds in the Gloucestershire health community to increase for the first time in more than 30 years of reductions. From 1999–2000 to 2000–01, the number of beds increased by 126, or 6.6 per cent.
From 1997 to 2001, the number of doctors employed in the hospital and community health service in Gloucestershire increased by 28 per cent. Additional investment has been targeted at critical care facilities—intensive care and high-dependence beds at Gloucestershire royal and Cheltenham general hospitals. Further investment will be made during the next few years. Gloucestershire royal hospital is developing a major £32 million capital scheme under the private finance initiative.
Extra investment has enabled the health community to tackle long waits. In the two years to September 2001, the number of outpatients waiting more than 13 weeks for a first outpatient appointment fell by 31.5 per cent. and the number waiting more than 26 weeks fell by more than 46 per cent. Plans are in place to ensure that no patients wait more than 26 weeks for a first outpatient appointment after the end of March this year.
Clearly, waits must be much shorter for cancer and other urgent referrals. The target for a GP referring someone with suspected cancer to a consultant is two weeks. The Gloucestershire health community has achieved that target for all patients covered by it since last July. In the three years to last September, the number of in-patients waiting for treatment fell by 12.6 per cent.
The Gloucestershire health community is making progress and plans to deliver the targets on waiting times set out in the NHS plan, which should make a considerable difference for patients in Gloucestershire and across the country. However, we must not only put in place the extra capacity, but introduce the right reforms and ensure that money is well spent. The hon. Member for Tewkesbury mentioned the postcode lottery. I agree that we need national standards in a national health service. For the first time, in the National Institute for Clinical Excellence, we have an authoritative body able to produce national standards for treatment and drug use that must be followed by health authorities and primary care trusts across the country.
The national service frameworks for coronary heart disease and cancer are providing national standards. New national service frameworks, for example, for children and for long-term conditions, will also come on stream. Many modernisation projects are already under way in Gloucestershire—"action on" and "collaborative" projects are leading the way in the modernisation of services and improved care for patients. They include the booked admissions project 129WH led by the Gloucestershire royal hospital, by which all surgical day cases, physiotherapy and routine radiography appointments are electronically booked.
"Action on" programmes are leading to shorter waiting times for patients. The ear, nose and throat programme at the Gloucestershire royal hospital is developing a GP specialist role to promote direct access for routine tonsillectomy. The action on cataracts programme at Cheltenham general hospital is improving efficiency and patient care so that patients can be treated more quickly. The orthopaedic collaboration, working across the acute hospitals, has reduced the length of hospital stays for routine hip replacements by improving pre-operative care, including physiotherapy to reduce recovery time. Discharge has now been reduced from 14 to seven to eight days.
The hon. Member for Tewkesbury raised concerns about delayed discharges. He is right that there are too many, not only in Gloucestershire but across the country. Gloucestershire social services received an additional £1,463,000 last October to tackle that problem. The average number of patients waiting to be discharged has declined by more than 60 per cent., from 109 in July to 48 in January. Progress must continue, but it is already under way.
Changes to the structures of the health service in Gloucestershire are already in place. Those will allow more decisions to be made locally, provide more resources to front-line clinicians making decisions about care, and provide a better structure and better reforms with which to use the considerable, additional investment already going into the NHS.