HC Deb 13 July 2004 vol 423 cc419-26WH

4 pm

Norman Baker (Lewes) (LD)

I am pleased to be able to raise a significant matter for Lewes, namely the delivery, funding and organisation of health services as they affect my constituents.

Let me say first that I recognise that the Government have put significant extra resources into the health service, particularly in the past couple of years. That investment is welcome, and if that allows the Minister to tear up 10 minutes of her speech telling me how much the Government have allocated, so be it. This is not a plea for the overall amount of money allocated to the health service to be increased.

There are particular local factors that make NHS delivery complicated in my area and currently detrimental to my constituents. The Minister will be aware that my constituency has a significant number of elderly people, so the demands on the health service are greater than elsewhere. That is particularly true in towns such as Seaford and Polegate.

It is also true that East Sussex is not part of the rich south-east. We are sometimes wrapped up with Surrey and West Sussex and regarded as having a lot of money, but, according to all the Government's indicators, East Sussex is a poor county. Dependence on the health service is greater there, and the possibility of going private, which might be an option elsewhere, is not available to as many people. In any case, we all want to reach the stage at which the NHS is delivering so fantastically that there is no wish to opt out in that way. The Minister and I probably agree on that objective.

Let me say as a preface that nothing in this speech is a criticism of the excellent staff who work in our health service and hospitals and who look after my constituents to the best of their ability. However, there are particular problems that specifically affect my constituents.

The first is health service inflation. The Minister will know that the inflation rate for the health service runs ahead of that for the economy as a whole. That is partly to do with the ever-increasing drug budget. Will she comment on how those issues are considered by the Government? What steps can they take to ensure that drug companies do not abuse the extra money that is being made available to the health service? We all want to see the money going to the patients, rather than the companies simply cornering it for themselves.

Secondly, the Government have rightly been trying to reduce waiting lists, and they have been largely successful. However, the price of reducing waiting lists has been extra pressure, albeit perhaps only in the short term, on the acute trusts in particular. Given the historic absence of doctors and nurses, the trusts have responded by recruiting large numbers of agency staff. That has produced a gigantic bill for the local trusts, which has meant that some of the money that should be directly allocated to front-line services has been allocated to agencies that supply staff. That has been a short-term reaction to the work of reducing waiting times. The Government's ultimate objective is desirable but there is a short-term problem, and I would welcome the Minister's comments on it. I am concerned about the amount of money spent on agency staff by my local NHS trusts—the Brighton and Sussex University Hospitals NHS Trust, which covers the western part of my constituency, and the East Sussex Hospitals NHS Trust, which covers the eastern part.

The third issue that worries me, and which is particular to my constituency and those of other East Sussex Members, is the relationship and co-ordination between the various parts of the health service and those who are delivering health care. I refer in particular to the three trusts—the two acute trusts and the non-acute trust, the East Sussex County Healthcare NHS Trust, which delivers mental health and other such services—the primary care trusts that serve my constituents, and East Sussex county council, which is responsible for dealing with the care of those who are discharged from hospital, or not as the case may be.

Let me start with that last point. If the Minister has seen the figures for bed blocking in East Sussex, she will be concerned, as the incidence of bed blocking is unacceptably high. Indeed, her colleague, the Under-Secretary of State for Health, the hon. Member for South Thanet (Dr. Ladyman), stated in an Adjournment debate on 22 June that last week 10 per cent. of the acute hospital beds in East Sussex were occupied by patients who no longer required hospital treatment. That is not good enough."—[Official Report, 22 June 2004; Vol. 422, c. 1319.] I entirely concur that that is not good enough. The figures from the East Sussex Hospitals NHS Trust for 1 July tell me that 99 people who should not be in hospital are occupying beds. More than 10 per cent. of the beds are occupied by bed blockers, and well over half of those result from the county council's failing to take responsibility for people who ought to have been discharged into county council care.

What steps will the Minister take to ensure that the county council takes its responsibility seriously and discharges people from hospital in a timely fashion, not simply leaving them in hospital beds, thereby preventing other people from occupying them? That has an impact on waiting lists, creates unnecessary costs for the NHS and, sadly, because the patients are not in a suitable environment, causes their condition to deteriorate.

The Minister may say that the Government have introduced an Act of Parliament that subjects county councils and others to a fines regime if they fail to take their responsibilities seriously. I personally do not have a problem with such a regime, but I wonder—perhaps I am being rather cynical—what the position is if a county council or similar authority decides that it is financially more advantageous to pay the fines that are racked up than to take responsibility for those who ought to be in its care? It seems that the financial arrangements are not on an even keel. I suspect that the county council is not taking its responsibilities seriously and discharging people into its care as readily as it might. I hope that the Minister will address that point.

The Minister will also be aware from earlier discussions in the House and elsewhere that there are plans to close wards in the Eastbourne district general hospital, which serves my constituents in Seaford, Polegate and elsewhere. She may have seen the front page of the Eastbourne Herald, which is one of the papers circulating in my constituency. It states: Wards to be shut at DGH: This is a scandal! That is what my local paper is saying.

I raised the matter with the relevant PCT and also with the acute trust. They tell me that the closures are partly the result of the bed blocking to which I referred, but that they would close wards behind those who left the hospital even if the bed blocking problem were solved. In other words, the wards will shut in any case as soon as the bed blockers are discharged. Part of the reason for that is that the hospital has been set a savings target for this year of £10.8 million—more than 5 per cent. of the budget—despite the fact that its management costs have decreased by 0.5 per cent. in the past year. The difficult financial situation and the ongoing clinical review are leading them to consider options that are not regarded as acceptable or palatable by my constituents and others.

Despite the initial denial, the options include discontinuation of in-patient children's services at Eastbourne, which will be transferred to Hastings. The trust has been rather mealy-mouthed about that. It has said in public that that will not happen—indeed, the Under-Secretary of State for Health, the hon. Member for South Thanet, quoted the trust in good faith on 22 June—but I have subsequently had discussions with the trust and learned that that service is secure for only a year and that financial and recruitment pressures may force it to be discontinued thereafter. Front-line services are being affected in a way that is unacceptable and contrary to the Government's clear intentions to provide better health care services for the population at large. They have provided the money, but services are still being cut.

The Minister ought to ensure that Government money is being spent properly and that Government targets are being met. I do not believe that that is the case. It appears that the trust's deficit will rise to about £5 million by the end of the year. That means that several improvements are on hold and treatments that have been approved by the National Institute for Clinical Excellence will not be implemented or begun in my trust area because it cannot afford it. So we return to the post-code lottery of health services, which the Government tried to avoid by creating NICE, because trusts suffer from a shortage of money.

The problem also affects the other acute trust, the Brighton and Sussex University Hospitals NHS trust, which serves the Lewes and Newhaven end of my constituency. In 2003–04, the trust failed to meet its primary duty to break even, having a retained deficit of £7.9 million on total income. It has a financial recovery plan, but the reasons that it gave for the deficit are, first, the high cost of temporary staff to cover vacancies—the point about agency staff that I mentioned a moment ago; secondly, the use of the private sector to maintain levels of patient care and achieve its waiting-list targets—because it is striving hard, as it should, to meet the Government's determination to get waiting lists down, but that has a high, short-term cost; and, thirdly, the increased costs of development in medicines and supplies, which ran ahead of anticipated levels by 12 per cent. last year, and the cost of drugs. The Government need to grasp those things if they are to deliver want they want to deliver.

Management costs, have been kept at 3.3 per cent. of turnover. The trust is not run by the bureaucrats the Chancellor wants to get rid of; there is a pretty tight management team in Brighton. It says that the 2004–05 budget will be every bit as challenging as 2003–04, particularly given the brought-forward deficit of £7.9 million that needs to be repaid and the underlying cost pressures that must be controlled.

The East Sussex County Healthcare NHS Trust has a horrendous problem, mainly because of spending on locum doctors and agency nurses, various private sector placements and the rising costs of drugs—the same reasons given by the other two trusts to which I spoke. The trust took up the matter with the strategic health authority, but it offered no financial support and merely said that any deficit at the end of 2003–04 would have to be repaid in full as a first call on this year's resources. It considered some serious options, including a full vacancy freeze, avoiding all private sector placements and said: Clearly, services, clients/patients and staff will be affected. The trust has made desperate efforts to improve matters since then, but in its most recent statement to me it presented a pretty bleak picture of how things are. Ironically, that letter sent to me on 17 May by the chief executive Stephanie Parkes-Crick stated: I am pleased to be able to advise that as at the end of March, so the end of the last financial year, the Trust was £1 million overspent. The chief executive was "pleased to advise" that she was £1 million overspent—that shows the depth that the trust had reached. There is a further £2.8 million to be realised this year, which will be provided by avoiding private bed usage, and the PCTs have said that they want a further £1 million in the course of the year from that already tight budget to contribute to the East Sussex health economy's financial gap. A trust that is absolutely strapped for cash is being asked to make a further contribution of £1 million.

The trusts say that the PCTs require too much money from them, and that they should consider savings first. I am not able to judge who is right, but I can tell the Minister that serious cuts are being made in front-line services despite the Government's extra cash to the health service. There is a dispute between the PCTs and the trusts, which the strategic health authority will not sort out, and also between the acute trusts and the county council about who is responsible for bed blocking and where the buck should stop in that respect.

It is not a happy situation. I am not particularly interested in where the blame lies; I just want my constituents to have the best possible health care. I welcome the fact that the Government have made more money available through the NHS but it is not reaching the people on the ground. That is not necessarily the Government's fault, but now that I have drawn it to their attention, it is up to them to sort it out. People are suffering; they are denied treatment that is available elsewhere in the country and that requires the Minister's help.

I will give the Minister an example. A constituent of mine, a Liberal Democrat councillor called Peter Harper, who lives in Newhaven, was in hospital for a serious operation in M arch. He has been told that he will have at least a 14-week wait for the pain clinic; he will have to endure three months of agony before he can be seen by someone at Brighton. That is simply not good enough. I know that the Minister and her colleagues want to deal with the problem. I hope that the information that I have given will enable her to consider the issues that I have raised and to try to ensure that the Government's objectives, which by and large I share, result in action on the ground to make life better for my constituents, particularly those in Seaford and Polegate. They are seeing services disappear from those big towns into Eastbourne, rather than having more services on the ground.

4.15 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I congratulate the hon. Member for Lewes (Norman Baker) on securing the debate. I very much appreciate the interest that he takes in his local health services, and these matters are obviously of considerable interest to him and his constituents. I join him in paying tribute to all the NHS and social care staff who work in the local health economy. Their commitment is obviously to the continual improvement of the local NHS and social care services, which is to be commended, because they make the difference.

I will deal first with the question of national investment. I am glad that the hon. Gentleman welcomed the investment we have put in and accepted that a lot of extra money is being invested. There is 7 per cent. real growth year on year in terms of what goes into the NHS, which is considerable real-terms growth. The NHS plan, which was launched in July 2002 and drawn up with the help of staff, patients and other stakeholders, set out a programme of sustained investment to turn the NHS round, and it has delivered real progress.

Let me turn briefly to progress that has been made in East Sussex. No patient in East Sussex now waits longer than nine months for in-patient treatment or longer than 17 weeks for an out-patient appointment. I accept the hon. Gentleman's point that 14 weeks is still a long wait for a pain clinic, but we are making progress. Indeed, we have made considerable progress and we hope to make more.

Yesterday's announcement highlighted the fact that we are working towards a maximum 18 weeks from referral to treatment for every patient across the NHS by 2008. Considering we inherited IA waits of more than 18 months from out-patient clinics to treatment, that shows what a huge turnaround has been achieved and our ambitions for the service. Ninety-seven per cent. of patients in the Eastbourne Downs primary care trust area can access a general practitioner within 48 hours, and 100 per cent. of patients in that area can access a primary care professional within 24 hours.

The indications show that all primary care trusts in East Sussex are making good progress against the target for reducing the number of patients waiting six months for an in-patient appointment. The PCTs are also making good progress against the target for reducing the number of patients waiting 13 weeks for an outpatient appointment. The situation is very positive.

The new MRI scanner equipment at the Conquest hospital in Hastings is faster and 50 per cent. more powerful than the previous scanner. That hospital also has a new investigation suite for urology and gynaecology investigations. There is a new consultant in care of the elderly at Eastbourne district general hospital, which may be relevant to other issues that the hon. Gentleman raised.

In counter-balancing some of the hon. Gentleman's remarks, which suggested that everything is dire, I emphasise that big improvements are going on in the NHS. I am not saying that everything is all right; lots of things still need to be done. We accept that although we are making a lot of progress in the NHS, including in East Sussex, more is needed. That is why the continuing investment and reform are necessary. We continue to increase our investment—our spending on buildings and equipment—which has gone up from £1.1 billion to £3.4 billion. Without those things and without the help of NHS staff, we will not improve services and access to care and treatment.

As the hon. Gentleman knows, the funding system has changed. I will not spend too long on this point. Primary care trusts are those with the specific local knowledge and expertise that are responsible for improving health, securing the provision of the relevant local health services and integrating health and social care. I will return to the point about the relationship between health and social care in a moment.

PCTs are the cornerstone of the modernised NHS and they are best placed to reflect the needs of local communities. I am sure that the hon. Gentleman, as a Liberal Democrat, supports devolution and local decision making, because they are in common with his party's general philosophy. PCTs control 75 per cent. of the budget at local level.

The funding allocated to East Sussex PCTs comes on the basis of the relative needs of the population. A weighted capitation formula is used to determine it. I know that the hon. Gentleman started by saying that he is not concerned about the funding and that he recognises that we have put a lot more money in, but at times he was tempted to blame money for the problems he outlined, which still need to be resolved.

I am sure that the hon. Gentleman is happy that the PCTs in the constituency will receive considerably increased allocations. Eastbourne Downs PCT gets £47 million, or a 29 per cent. increase, during the years 2003–06. I am sorry that I do not have the updated figures. Sussex Downs and Weald PCT will receive a cash increase of £33.8 million, or 30 per cent. That is close to the England average of 30.8 per cent. So, they are receiving funding on a par with the rest of the country.

Norman Baker

I accept the Minister's figures on the PCTs' money, but my queries, which are twofold, are not about the overall sum. First, are the PCTs passing on the money properly or are they taking too much for themselves in management costs? What is the mechanism to deal with that? Secondly, what about the short-term pressures in the health service to get the Government's waiting lists down, which are leading to excessive short-term spending on agency staff? Those are the issues that I referred to, not the amount allocated.

Miss Johnson

I understand the hon. Gentleman's point, but I am making the point that money is going in, and going in based on, and in recognition of, need. The East Sussex trust has also got additional money—from £161 million in 2003 to £167 million in 2003–04—and it will get £7 million more in 2004–05. So, the picture is of additional resources going in.

As the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman), pointed out in a debate on 22 June, which the hon. Gentleman referred to, the NHS in East Sussex has achieved and continues to achieve the national standards. That is good news, but we want to go further and build on it.

To do that, the NHS must consider how it uses the resources it receives and the health care and social care organisations in East Sussex need to consider carefully how they work. That is, in fact, what they are doing. I am glad to receive confirmation from officials that the Surrey and Sussex strategic health authority and the PCTs in East Sussex have agreed funding positions for the delivery of the local delivery targets for 2004–05. The local delivery plan describes how the NHS and social care community will deliver during the next three years. It has been agreed by all the NHS organisations in the area.

The hon. Gentleman referred to the county council. The East Sussex county council cabinet has endorsed the overall direction of travel. That envisages a reduction in the number of avoidable admissions to hospital, which is a key area and often one in which a much better performance can be secured; shorter stays in hospital, which relates to the question of people who are unnecessarily still in hospital; reduced hospital capacity; and a reinvestment in community facilities, in particular intermediate care. That also relates to issues that the hon. Gentleman raised.

In the short term, the NHS and its partner organisations need to work together to make the most of their resources. I do not know the details of the working relationships between, for example, the county council, the strategic health authority and the PCTs locally. If there are particular problems with them, I would be grateful for more detail from the hon. Gentleman about what he considers the problems to be. As far as I am aware, all the mechanisms are in place. The NHS and its partner organisations have agreed a common strategy and they are working along the same lines to achieve the progress envisaged with the issues that they face.

I would be disconcerted to hear that any county council was more interested in receiving a fine under the revised community care arrangements than making progress with the provision of better services and on the issue of delayed transfer. I understand that there are challenges associated with the delayed transfer of care, but the strategic health authority and the Commission for Social Care Inspection are working with the East Sussex PCTs and social services in the county to bring down the number of delayed transfers of care. They have recently improved systems to streamline the transfer of patients. I am not sure whether the hon. Gentleman's remarks take account of that or whether the arrangements have been in place long enough to be reflected in the changing figures. Improved arrangements obviously take some time to be delivered and seen in improved figures.

Mr. Nigel Waterson (Eastbourne) (Con)

Will the Minister give way?

Miss Johnson

No I am afraid that I will not.

The hon. Member for Lewes raised concerns about agency staffing. Due to our concerns about agency staffing nationally and its costs, we announced the establishment of a special health authority to tackle the problems involved. It will be responsible for the strategic oversight of the NHS temporary labour market. Obviously the NHS needs a temporary, short-term and part-time labour market because of the nature of the work that it does, but it is important for NHS trusts to try to cut back as much as they can on the use of, in particular, expensive agency staffing.

The management of the agency framework contracts, the setting of standards and the policy framework for the NHS rest with NHS Professionals, the NHS in-house agency arrangement for staffing. NHS Professionals has already had considerable success in some parts of the country in reducing the expenditure on temporary staffing, and in due course I would expect that to be reflected across the country.

I do not how much engagement with NHS Professionals the hon. Gentleman's own trusts and PCTs have had in their discussions on what can be done locally, but a local problem can easily be exacerbated by spending a lot of money on solving it. I realise that, in the short term, they need to do that, but it can lead only to further problems. That may be the downward spiral in which they have found themselves.

There are ways out of this, however, and other health economies are not in that position. On the relationship with NHS inflation, which the hon. Gentleman mentioned, there is a substantial increase in funding in any case. Although I recognise that he is highlighting problems in several trusts and PCTs in his area, if we consider medicines and supplies, there should he a wider problem across the NHS but we do not see that.

The resources are with the local health service. It is in a position to deliver and there is a recovery plan in place for three years, which amounts to some £26 million. The partners are working together; there are mechanisms for dealing with many issues that the hon. Gentleman has raised. I trust that people will work together—I agree with him here—to focus on the needs of patients and to deliver for them in the most cost-effective way possible. I am sure that national agencies and the Department are happy to help the strategic health authority and the local trusts if they need more examples of how that has been done elsewhere to deal with the issues that face us.

It being half-past Four o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.