In the minority of organisations that do have deficits, the targets we have set—for example, on waiting times and faster access to cancer treatment— are being met. The overall quality of services to patients continues to improve, but I do not underestimate the very difficult decisions needed in some organisations to restore financial balance.
Since the Secretary of State’s visit to Milton Keynes in the summer, we have seen the closure of the Fraser day hospital and the surgical assessment unit, cuts to mental health services, cuts to language therapy, cuts to oral health services, cuts to podiatry, cuts in ambulance call-out availability, cuts to counselling services and cuts in payments to the hospital of £2.8 million. Despite all those cuts, the primary care trust still needs to find cuts of another £18 million before March, which the chairman says he has
“not a cat in hell’s chance of achieving”.
As well as promising never to come to Milton Keynes again, will the Secretary of State suggest what the PCT should do to make more cuts in Milton Keynes?
I and my hon. Friends will promise to continue voting for record investment in the NHS—in Milton Keynes and every other part of the country. The PCT in Milton Keynes is getting more money than ever before and there will be more fast growth in its funding next year. Yes, people have to make some difficult decisions to ensure that they give patients the best care within available resources. As spending for those of the hon. Gentleman’s constituents who have cancer is below average, while spending on urgent care is above average, I hope that he will support his local PCT in ensuring that it rebalances that spending, puts more services into the community, and increases investment, for instance, for patients with cancer.
Even at this time of record investment in the NHS, everyone involved in providing its services, including in my right hon. Friend’s Department, has to understand that resources are finite, so local services require careful planning. Does my right hon. Friend agree that introducing independent treatment centres in local health economies needs careful planning, as their effect could be to undermine health care trusts that are trying to recover their budgets and go into balance? Does she agree that where independent treatment centres may have such an impact, they need to be reviewed?
I entirely agree. We have written a big cheque for the NHS, but it is not a blank cheque; it never has been and it never will be. Of course, we need to look at the introduction of independent sector treatment centres and we are doing so with the strategic health authorities and others, in each region, to ensure that the centres are properly integrated in the local NHS and continue to give NHS patients better care, but also faster care.
On Saturday, more than 2,500 people marched in the rain to protest against closures and cuts at St. Helier hospital. What assurance can the Secretary of State give me and my constituents that the decision to close 200 beds and cut 500 staff at the Epsom and St. Helier trust will not result in more mixed wards, more premature discharge of patients who are not well enough to go home and a rise in levels of infection at the hospital?
The decisions at that hospital are taken first and foremost, as I hope the hon. Gentleman would expect, on the basis of patient safety and quality of care. Difficult decisions have to made in his part of London in order to ensure that the local NHS gives patients the best possible care within the available resources and does not ask other parts and services of the NHS to bail out its overspending. As demonstrated by the quality and value indicators recently published by the NHS Institute, there is ample opportunity, for example, for hospitals to do more day case surgery, providing better care for patients, with better value for money as well. Those decisions are difficult for the staff, as we all recognise, but it is all about getting better care for patients within budgets that are bigger than ever before.
I fully accept the need for our PCT to deal with its own deficit and get into balance by the end of the year, but it is hard when the strategic health authority comes along in mid-year, takes the money away and tells it to get into balance—and even harder when, with four months to go, the SHA comes back and takes more. Will my right hon. Friend ask the SHA to give us a bit of leeway and assure me that we will get our money back quite quickly in future?
I know that my hon. Friend recognises the difficult decisions that have to be made in order to be fair to trusts that have not overspent, and to ensure that those who have overspent get enough time to take good decisions to get themselves back on track. The NHS is committed to repaying money that has contributed to regional reserves as quickly as possible, usually within the three-year allocation period, and those with the worst health problems will get their money back first. That, I believe, is fair, but the speed with which it can be done depends on the speed with which difficult decisions by overspending organisations can be made so that they get back on track and do not keep asking other people to bail them out.
Does the Secretary of State share my concern that the present financial crisis in the NHS may be leading hospitals into inequitable ways to balance the books? In Basingstoke, hospital car park charges were raised by 25 per cent. this year and the money was used—and needed—to fund medical services in the hospital. Does the right hon. Lady feel that that is right?
I would have to refer the hon. Lady to what the right hon. Member for Witney (Mr. Cameron) has recently said. He is not prepared to wipe out overspending any more than I am. If the hon. Lady believes, as does her right hon. Friend, that decisions should be in the hands of NHS professionals, I wish that she and other Conservative Members would support local NHS professionals when they make proposals and decisions to give better care to patients, with better value for money. As her party voted against increased investment in the NHS, I am not prepared to take lectures from the hon. Lady on how that money should be spent.
My near parliamentary neighbour the Secretary of State is right to say that record investment has transformed performance at the three acute hospitals in the city of Leicester that serve our constituencies. The award of an excellent rating a few weeks ago, followed by an award for being the joint best teaching trust, was no great surprise. Was my right hon. Friend disappointed that, almost in the next post, the strategic health authority wrote requiring the University Hospitals of Leicester NHS trust, which covers the three hospitals, to make further in-year savings of £15 million, which led to operational delays, frozen posts and a range of other changes, including reduced training? Can she reassure the House, our constituents and the million people in Leicestershire, Leicester and Rutland that this bitter pill to swallow will—
My hon. Friend is right to congratulate those at University Hospitals of Leicester on the excellent quality of care that they give to their patients, as confirmed by the Healthcare Commission, but he may not have noticed that, for instance, on day-care surgery those hospitals are well below the national average. On length of stay, for instance for hip fractures, they are well above the national average. Certainly, when I recently met the chair and chief executive of the hospital trust, they confirmed that there is ample scope for them to become even more effective in their use of resources and to continue to give excellent care to patients as a result.
May I turn the Secretary of State’s attention to deficits in mental health trusts? She knows that in May, Rethink produced the report “A Cut Too Far”, which identified at least £30 million-worth of cuts to mental health services, in response to which the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), who has responsibility for mental health, said:
“There is no evidence to suggest that mental health services were being disproportionately targeted compared to other health trusts.”
Last week, Rethink came up with another £37 million-worth of cuts to mental health services, and the Secretary of State’s mental health tsar had to admit that
“some acute trusts should be ashamed that they have had to be helped out by services that have been historically underfunded”
—that is, mental health services. Who is more in touch with the disproportionate impact of deficits on mental health services—her Minister or her tsar?
Both our tsar and the Minister of State are absolutely right. There is no evidence that mental health trusts are being asked to take any disproportionate burden while the financial problems are sorted out, but the problem that this underlines is that all too often in the past mental health trusts have bailed out acute hospitals. There is a need to make acute hospitals more efficient, and that means more day-case surgery and reduced lengths of stay so that patients do not spend unnecessary days and weeks in hospitals when they would be better cared for at home. It is high time that the hon. Gentleman supported difficult decisions to make acute hospitals more efficient, to give better value for the money contributed by taxpayers and patients, and in that way, we will ensure that we can go on increasing the already unprecedented funding for mental health services as well.