The Secretary of State was asked—
Waiting Times
At the end of November 2006, seven Leicester patients had been waiting for more than six months for in-patient treatment following the decision to admit. That compares with 3,437 in March 1997.
It is interesting to note that on 16 November, the Secretary of State said:
“We have cut the waiting time for elective operations, hip replacements and so on… from GP referral to the operating theatre”.—[Official Report, 16 November 2006; Vol. 666, c. 147.]
Will she look into the case of Mr. Ferriman, who lives in Braunstone town, about 100 yards from her constituency? His GP referred him for a hip replacement in April last year, and he has been given an appointment for an operation in April this year. Does the Secretary of State think that that counts as less than six months?
If the hon. Gentleman sends me the details, I will of course examine the case and write to him, but I am surprised and disappointed that he did not take the opportunity to congratulate the NHS on bringing waiting times down to their lowest level since records began. I am really not prepared to take lectures on waiting times from the hon. Gentleman, who voted against the increased investment that we are making in the NHS.
I welcome the reductions in waiting times, and if there are cases in which individuals have struggled I am sure that my right hon. Friend will look into them; but will she also acknowledge that one of the consequences of increased throughput is the potential for superbugs? Is she aware of the campaign launched by the Loughborough Echo, aimed particularly at clostridium difficile and its consequences for my constituents? Will she try to ensure that it appears on death certificates in future, to make not just patients but hospital staff more aware of the problem?
We all share my hon. Friend’s concern about the increase in clostridium difficile—which is a particularly problematic hospital-acquired infection—in some hospitals, including hospitals in Leicester. That makes it all the more important for us not just to continue to shorten waiting times for operations but to ensure that patients are treated in the community, closer to their homes, when that is appropriate and clinically safe.
I join the Secretary of State in welcoming the reduction in six-month waiting times in Leicestershire, but may I remind her of information given by the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), in a written answer on 8 November 2006? He reported that in the NHS as a whole, 87 per cent. of patients had been treated within six months in the year to last April. May I also remind the Secretary of State that in 1990, 17 years ago, the equivalent figure was 86 per cent.? Does she think that an increase of one percentage point over 17 years is a good return for the huge increase in investment that she mentioned earlier?
I am glad that the right hon. Gentleman began by congratulating the NHS, and I welcome his recognition that waiting times for elderly people needing hip replacements, for instance, were longer than 18 months when he was Secretary of State for Health. But of course we need to do more, which is exactly why we have promised that by the end of 2008 the maximum wait from GP referral to operating theatre will be just 18 weeks, but that for most people the wait will be much shorter. I hope that the Conservative party will support the NHS in making the further changes needed to achieve that dramatic improvement in care, and will congratulate the NHS as it achieves them.
I thank my right hon. Friend for increasing the budget of the primary care trust over the past 10 years. It doubled to £173 million last year. Does she, however, share my concern and that of my constituents, who, when they try to obtain appointments with GPs for referral purposes, are met with administrative delays and difficulties? Is she planning any guidance for local GPs on the way in which their front-line staff should deal with the public, so that when people ring to ask for an appointment they are given one and are therefore referred as quickly as possible?
My right hon. Friend is right. Because some general practices—although, I think, only a minority—do not have proper appointment systems, it can be very difficult for people to obtain appointments when they need them, whether on the same day or in advance if that is what they require. However, I hope that my right hon. Friend welcomes the fact that thanks to the target we have set, people no longer wait for weeks on end to obtain appointments. I believe that the patient survey which will begin this month, and which will be linked to GPs’ pay, will ensure that the minority of GPs who are not yet offering convenient appointments will do so in future.
Mental Health
We are introducing supervised community treatment for patients who have been detained in hospital under the Mental Health Act 1983. That is an important change, which brings legislation into line with modern service delivery and follows the example of modern practice in other countries around the world.
I am sure my right hon. Friend is aware of the fear expressed by some in the mental health world that people could continue to be given supervised community treatment for lengthy periods without the introduction of adequate safeguards. Can she assure me that that will not happen?
My hon. Friend is right that such concerns have been expressed, but I hope that I can reassure her that patients receiving supervised community treatment will be entitled to a comprehensive package of safeguards that are just the same as those for patients detained in hospital. The need for SCT will be subject to regular review in exactly the same way, and patients will have the right to apply for discharge to a tribunal and the hospital managers of their responsible hospital.
The Minister mentioned countries around the world, so presumably the Department of Health has access to information that proves that supervised community treatments are successful around the world. When will that information be released for general consumption?
A number of studies have been carried out into SCT. As I have said, it is available in countries around the world—including Scotland, now—to bring them in line with modern service provision. One of the published studies is from New Zealand; it shows that SCT not only worked for carers and patients’ families, but that patients also liked it because it meant that they could return home instead of having to be detained in hospital. The Department is also carrying out some research; it is currently being peer-reviewed, and it will be published fairly shortly.
Hackney, South and Shoreditch has a higher than average incidence of mental health issues, and I have received a lot of correspondence from people about community treatment orders; psychiatrists have raised the issue of holding people against their will in the community. Although I think that community treatment can be better than hospital treatment, how can my right hon. Friend reassure those with concerns that people will not be held against their will but will receive the treatment that they need and that their lives and their community will be made better?
First, it is important to emphasise that clinicians will decide whether supervised community treatment is appropriate for individual patients. We all know that there are instances of patients being released from hospital who then go into the community and who, perhaps, do not take their medication or stay in touch with health services, and whose condition deteriorates to such an extent that they become a danger to themselves or to other people. That is an example of where SCT could apply. It is important to remember that that often puts patients back into the care of their families, instead of their having to remain in hospital. That will be good for patients and for public safety.
The Minister acknowledges that community treatment orders are a contentious provision in the Mental Health Bill, so will she now confirm that her Department commissioned a report entitled “International experiences of using community treatment orders”, which was delivered to her last autumn, and which concluded, from a survey of 50 countries, that CTOs have been found to have no clear effect on patient outcomes or risk reduction, and that these psychiatric ASBOs have been described as discriminatory by many patient groups, not least those representing BME—black and minority ethnic—patients who have suffered disproportionately? Why has she failed to publish this report, after my parliamentary questions and my freedom of information request, given its relevance to the Mental Health Bill which is currently under scrutiny in Parliament?
As I have said, the report is being peer-reviewed, and it will be published. Frankly, the Opposition must decide whether they will support a Bill that will introduce supervised community treatment so that high-risk patients get the treatment that they need to keep them well after they are discharged from hospital, and that will lead to people who have potentially serious and dangerous personality disorders getting the treatment that they need. That is the issue.
The hon. Gentleman has called these measures the Government’s latest attack on civil liberties. He needs to think very carefully about the civil liberties of people who go in and out of hospital three or four times a year because we cannot get treatment to them, and the civil liberties of patients, victims and their families who have suffered because we do not have the powers to treat people in the community.
Health Inequalities
Recent figures show that Plymouth is reducing inequalities in coronary heart disease and cancer, although there is more to do on life expectancy and infant mortality. There is active co-operation between the primary care trust, the local authority and other partners to tackle health inequalities in Plymouth.
I thank the Minister for her recognition of the good work done by people in public health in Plymouth, but does she recognise that in order to continue to deliver in that way, they need confidence to plan ahead? What guidance can she offer primary care trusts to continue to prioritise spending to address health inequalities?
I am very pleased to inform the House that in this financial year Plymouth PCT replaced previous health action zone funding with a recurrent allocation of £933,000. In addition, Plymouth secured £966,000 of neighbourhood renewal fund money to tackle health inequalities. That is a total of £1.899 million of funding—twice the amount originally allocated in the choosing health fund. Stretch targets have also been set for the number of healthy schools within the area and also for the reduction of smoking and pregnancy in Plymouth. I congratulate those involved in all those endeavours.
Does my hon. Friend agree that tackling obesity—commonly found, as in Plymouth, in areas of the greatest health inequality—is also helping to deal with the alarming growth in diabetes? That being the case, does she acknowledge the importance of the research being carried out across the country, but particularly in Plymouth by the Early Bird project? It is looking—uniquely—in the long term at obesity and diabetes across social backgrounds, and it needs further funding.
We are acutely aware of the link between obesity and the development of type 2 diabetes. That explains our work in healthy start, which I am pleased to say was trailed to good effect in the south-west and went national last November. It is a way of encouraging better eating habits from the cradle onwards. There is also the healthy schools initiative. Of course we support research, but there is a point at which we know what the reality is and we have to get on with dealing with it.
HIV/AIDS
The Department is continuing to target HIV health promotion towards the most “at risk” groups in England—namely, gay men and people from African communities. In 2006-07, we made an extra £1 million available to strengthen our HIV work for those groups.
Does my hon. Friend agree that work needs to be more targeted at younger gay men? It is important to emphasise that contracting HIV does not mean simply taking a pill a day, when everything is okay. Drug treatment for HIV is very unpleasant and is not 100 per cent. effective, so we need to get that message through to younger gay men.
My hon. Friend makes an important point. There has been a large drop in diagnoses of AIDS and a 70 per cent. drop in AIDS deaths, but it would be ridiculous to suggest anything other than that HIV is something that has to be dealt with every day of a person’s life in respect of the mix of drugs and treatments necessary. My hon. Friend makes an interesting point about the younger age group, many of whom are too young to remember the 1980s campaign and may have a false sense of safety about their future health. I would welcome my hon. Friend, along with the Terrence Higgins Trust, coming to the Department to discuss those issues.
Can I come as well? [Interruption.] Why not? The Minister will know that the incidence of HIV/AIDS has quadrupled since 2000 and part of the problem is the Government’s complacency about it. They announced a substantial advertising campaign last year, but it was many months late and in the end it was pegged back to a £4 million campaign. Would it not be far better if the Government now embarked on a substantial advertising campaign to prevent needless thousands of people contracting HIV/AIDS in the future?
I believe that the last Conservative Government had a review in 1995-96. It looked into the value of mass campaigns in respect of HIV/AIDS. After that review, it was argued that the approach should be targeted more at the particularly vulnerable groups most at risk of contracting HIV. That is the position that we adopted and we carry out that targeted work with the Terrence Higgins Trust and the African HIV policy network. Our recent campaign was about getting across a strong message that is appropriate for tackling chlamydia, gonorrhoea and other sexually transmitted infections as well as HIV. The message is: if you are having sex, always make sure that you use a condom.
Is it not also the case that of the 7,450 new cases of HIV/AIDS in the UK only—of course, it is still far too many—2,356 arose through homosexual sex? Do not many of the cases of AIDS in the UK come from legal and illegal immigrants who enter the country already infected with AIDS? What steps is the Minister taking to liaise with the Home Office to ensure that infection from that source does not spread throughout the UK?
We want to work with all communities that are vulnerable to HIV/AIDS, and that is why we support the Terrence Higgins Trust and the African HIV Policy Network. HIV diagnoses have been increasing since 1999 for several reasons. First, test uptake has increased. For example, among gay men it has risen from 45 per cent. in 1997 to 80 per cent. in 2005, and among heterosexuals it has risen from 25 per cent. to 82 per cent. over the same period. More testing is important, and among those tested are people who may have been living with HIV for some time but in whom it is being diagnosed for the first time.
We are not complacent about any of those areas. We have taken other action, including, for example, the testing of pregnant women. Some 95 per cent. of pregnant women with HIV are diagnosed and that has been enormously successful in preventing mother to child transmission.
We are in discussion with the Home Office on several issues, but it is important not to stigmatise people and to do the best we can. We should also remember that we are a very low prevalence country, with lower rates than places such as Spain, France and Portugal, and we should be proud of our record in that area.
NHS Finances
The NHS as a whole is on course to deliver net financial balance by the end of this financial year, It continues to cut waiting times and perform well against key service targets. Our quarter three financial report will be published next month.
In 2006 and with much fanfare a shiny new hospital was opened in Gravesend. Given the projected year-end deficit for the south-east, what assurance can the Secretary of State give that the hospital is safe and that services will not continue to go elsewhere from it?
The new hospital to which the hon. Gentleman refers is just one of 70 new or rebuilt hospitals already under way, with many others to come. I hope that he will recognise that the enormous investment that we are making, including in the new heart centre that has just opened at Darent Valley hospital, illustrates the fact that we are investing record sums of money in the NHS—investment that his party opposed. We are not cutting services: we are improving them.
I recently conducted a survey of all local authority chief executives in the UK about the impact of NHS budgets on their local authorities, 25 per cent. of whom said that NHS budgets were hurting them. For instance, Buckinghamshire county council estimated a cost shunt of £670,000 from the health service on to the local authority. Camden is seeing an increase in the number of hours of home care as a result of faster hospital discharges. What discussions has the Minister had with the Department for Communities and Local Government about the impact of NHS finances on local authorities and what action is she taking—
Order. This is a supplementary question, not an Adjournment debate.
The hon. Gentleman reflects well the need for social services authorities and the local NHS to work closely together to provide even better care for the people whom they look after from both the local government budget and the NHS budget. We have increased both those budgets and my Department works closely with the Department for Communities and Local Government on that score. I hope that the hon. Gentleman will encourage Liberal councillors to ensure that they do not cut social services for vulnerable elderly people.
Notwithstanding the Secretary of State’s earlier replies, I still cannot see how the undoubted deficits in this year’s budget can be made up other than by cutting services. Mine is a predominantly rural constituency, and is she aware that my constituents will not take kindly to any cuts in services at hospitals in Macclesfield, Leighton or north Staffordshire, or at the Congleton War Memorial hospital? In addition, they will not accept cuts in the mental health services, which remain the Cinderella of NHS provision in this country.
In that case, I hope that the hon. Lady will welcome the recent opening of a new day-case unit and a new medical admissions unit at Macclesfield district general hospital where, in addition, a new MRI scanner has been brought into commission. Moreover, we have invested more in mental health services in every part of the country than any previous Government.
Is my right hon. Friend aware that we in Coventry have received enormous benefits from the great investment made by this Government? We have a brand new hospital, and there has also been tremendous investment in mental health services. That continuing success derives in part from the city’s MPs’ ongoing close consultative relationship with the Department, which I hope will continue with her blessing.
I can assure my hon. Friend that that will indeed be the case.
During the Christmas recess, did my right hon. Friend have the opportunity to read the Institute for Public Policy Research’s recent report entitled “The Future Hospital”? One element of the analysis stated that, on average, patients stay in hospital a day longer if they are admitted on a Thursday than if they are admitted on a Sunday. What is her estimate of the savings that NHS trusts could make if they corrected that inefficiency, without jeopardising patient care?
I did have the opportunity to see that report. It confirms that the NHS would save nearly £1 billion every year if all hospitals ensured that patients went home as soon as they were clinically ready. That is what the best hospitals do already, and the report provides further confirmation that there can be no trade-off between better care for patients and better value for money. The two things go together, and that is what our reforms are designed to achieve.
What incentives are there for primary care trusts to try and balance their books? My Barnsley PCT has been funded under target for years, but it would have achieved financial balance by the end of this financial year had it not been required to pay £7 million to fund the deficits in Sheffield, Doncaster and Rotherham. How long is that money likely to be held by the strategic health authority?
My hon. Friend makes an extremely important point, which reflects the fact that only a small minority of hospitals and PCTs are overspending. Indeed, 50 per cent. of the NHS’ deficit is concentrated in just 6 per cent. of its organisations, and it is unfair for that minority to overspend at the expense of the majority. That is why we are so determined to ensure that the NHS as a whole returns to financial balance, and that the minority of overspenders put their houses in order by making themselves more effective. They must deliver better care for patients and better value for money, and they must also repay the money that they have borrowed, as in the example that my hon. Friend gave.
What steps is the Secretary of State taking to promote more widely the valuable information contained in the NHS’ quarterly “Better Care, Better Value” indicators? In particular, is she promoting that information to hon. Members, so that they can point out to their PCTs the benefits of prescribing generic statins? Is she aware that, in the league table of prescribing generic statins, the PCTs of two of her colleagues on the Front Bench are ranked 291 and 298 out of a total of 303? If they improve—
Order. I have counted three supplementary questions already, and I think that the hon. Gentleman is about to ask a fourth.
The hon. Gentleman is right; the quality and value indicators that we published last year repay close study. That is why we have made them available on a website so that each PCT and hospital can see where they need to make their services more effective, and how they can improve patient care and free up money for new drugs and new treatments. I certainly commend the quality and value indicators to every Member, because they show, once again, how better care for patients can go hand in hand with better value for the record sums of money that the Government have invested in our NHS.
In tackling the difficulties that some areas of the NHS have experienced with their finances, innovative programmes —such as the one in our accident and emergency department to help older people—are often the first to go, rather than traditional programmes. What can my right hon. Friend do from the centre to encourage innovative programmes, which tackle health inequalities and provide improved access to services, and to ensure that they are not the first out under the last-in, first-out programmes that sometimes seem to happen when dealing with health budgets?
My hon. Friend makes an important point. Sometimes, under the pressure of financial difficulties, local organisations understandably make short-term decisions that may undermine innovative programmes that give patients better care and prevent falls, injuries and disease in the future. They thus help to deliver better care with better value for money. We do not try to micro-manage every hospital and PCT from the centre, but we give guidance—[Interruption.] We do indeed give guidance to ensure that such innovation is supported.
Can the Secretary of State tell us what proportion of the additional money going into the NHS is being absorbed by large pay increases, not for categories of staff in short supply—for whom, as she knows, I have long advocated increases—but for groups of highly paid staff, including consultants and general practitioners who have received increases of between £14,000 and £25,000 a year? Before the increases the General Medical Council was sending out notices headed “Important information for medical graduates”, which pointed out:
“There are an average of 210 applicants for each advertisement for junior hospital posts. Many posts attract over 1,000 applicants.”
In the light of that fact, why were the pay increases necessary?
I am sure that the British Medical Association and its membership will note with great interest the right hon. Gentleman’s desire to cut the pay of both hospital doctors and GPs. I am proud of the fact that about half the additional record investment that we have made in the NHS has gone on additional staff and better-paid staff. In the case of GPs in particular, the reason they are earning so much more with a Labour Government than they were under the right hon. Gentleman’s Government is that they are doing so much more work, preventing so much more illness and caring for patients so much better.
I am sure that my right hon. Friend is aware that Gateshead Health NHS trust is one of five in the country that has innovated and now offers physiotherapy services over the telephone. I am sure that she will agree that that helps to reduce admissions by caring for people in the community, and that through such programmes money can be saved and lives transformed.
My hon. Friend is absolutely right and I very much congratulate the NHS in Gateshead on that innovation. There is no doubt that as more orthopaedic patients receive physiotherapy directly in the community, those who need surgery can also be treated much more quickly in hospital.
May I ask the Secretary of State about trusts that have massive historical deficits, often of more than 10 per cent. of their turnover? Nigel Edwards of the NHS Confederation said that for those trusts
“financial recovery would imply such damage to patients that no sensible person would go for it. They would not compromise the survival of the people they serve”.
Is the Secretary of State intent none the less on requiring those trusts to clear their deficits within a specified period, irrespective of their current financial performance and irrespective of the impact on patient care?
I congratulate the hon. Gentleman on his promotion and welcome him to his new place on the Front Bench.
I have made it clear all along that we expect the NHS as a whole to return to financial balance by the end of the financial year. For the very small minority of organisations with very serious and long-standing deficits, it would be quite impossible for them to return to balance within one financial year, so they are being given longer. However, the longer they take to return to financial balance, the longer other organisations—we have heard from one of the primary care trusts today—will have to hold back on some of their growth money to compensate for the continuing overspending elsewhere.
Will my right hon. Friend ensure that the future viability of Chorley and Preston hospitals will not be put at risk through the transfer of work from those hospitals to the private sector? The issue is about capacity within those two hospitals and we do not want to see ward closures. Will she ensure that that work is not transferred?
The new independent sector care assessment and treatment service that is proposed for the north-west will deliver to my hon. Friend’s constituents and many other patients a better and faster service and it will do so by providing capacity additional to the capacity already available within the NHS and by enabling NHS capacity to be used much more effectively.
Does the Secretary of State agree that the financial stability or otherwise of NHS organisations is a fundamental measure of overall financial performance? Halfway through the last financial year, 134 NHS organisations forecast a deficit at the end of the year. Will she tell the House how many NHS organisations this year are forecasting a deficit?
The information, as at the six-month point, was published in that financial report, but we will update that next month when we publish the quarter three financial report. As I say, I remain entirely confident that the NHS will achieve overall financial balance and that more organisations will move towards financial balance this year.
I am surprised that the Secretary of State did not tell us; the answer to the question is 175 NHS organisations this year. What is particularly worrying is that last year the situation deteriorated between month six and the end of the year. An additional 45 organisations went into deficit. Can she explain why she believes that fewer NHS organisations will be in deficit this year and how many she expects to be in deficit? If they remain in deficit, precisely what the hon. Member for Barnsley, Central (Mr. Illsley) described will continue to happen: the money for organisations across the country will be top-sliced and their growth money will disappear in order to fund continuing deficits.
I notice that the hon. Gentleman never has anything constructive to say about the need to get better value for the record investment in the NHS and nor does he ever support NHS organisations in making the difficult decisions that are needed to get better value. We are publishing quarterly financial reports on the NHS—we are the first Government to have done so—precisely so that we and the NHS can track the progress that is being made, see exactly what steps need to be taken and take account of additional factors, such as the further cuts in prescription drug prices that are coming through, to ensure that the NHS gets back on track financially and continues to improve services for patients.
Mental Health
Improving access to psychological therapies formed part of ministerial discussions for the White Paper “Our health, our care, our say”. The two demonstration sites that have been established will provide evidence for a business case on investing in local psychological therapy services across England and will form part of our discussions with the Treasury as part of the comprehensive spending review.
The Government have done a good deal to tackle the Cinderella status of mental health within the NHS, but there remain difficulties with access to psychological therapies such as cognitive behavioural therapy, where waiting times exceed 12 months in 90 per cent. of primary care trusts. Can the Minister please act to ensure that such talking therapies are made available to all who need them and not just to those whose employment prospects will be improved and, in particular, to widen access to marginalised groups such as children, adults in hospital or in prison and black and minority ethnic communities?
My hon. Friend is quite right to say that waiting times are too long at the moment, particularly for CBT. The point of putting the demonstration sites together is to learn from them exactly what is working so that we can make the case to persuade other areas to follow that example. As well as improving the number of clinical psychologists, it is important to look at the part that other health care professionals can play, particularly in the case of the new graduate workers that we are bringing in, and to look at extra training for health care visitors, for example, so that they can reach out to some of the groups that he has outlined to make sure that they get access to these important therapies.
Will the Minister look at the effect of the delays in psychological services generally and cognitive behaviour therapy specifically on young people, including students? All the evidence is that young people going into early adulthood, particularly at universities and colleges, are the most likely to commit suicide or to self-harm. There are often long waiting lists and no local services available, even with the best will of the universities. Will she see whether she can either buy in more services or allow people to use other services locally to prevent a crisis or worse?
The hon. Gentleman is quite right: it is important that we look specifically at younger people. There are many instances where different agencies could work more closely together. I am talking about some of the personal advisers through the Connexions services and some of the facilities available in schools. We need to look at how we can bring those more closely together to make sure that, when people need those kinds of services, we are able to provide them more readily than they are provided at the moment.
Will my right hon. Friend look closely at the positive results coming from pathways to work pilots, where cognitive behaviour therapy offered by the NHS, but paid for by the Department for Work and Pensions, is having an enormously beneficial effect in improving people’s mental health and allowing people not only to re-enter the work force, but to be happier as human beings? Clearly, that needs to be available in the rest of the country. Will she also look at the evidence that this therapy can be offered not only by psychologists, but by other health care professionals such as nurses and health visitors?
My hon. Friend is absolutely right. Part of the important work that is being done in the pathways to work pilots is making that connection with employers. There is a lot that employers can do not only to break down some of the stigma and discrimination that there is against people who have mental health problems returning to work and remaining in work, but to support them when they have those difficulties. Again, the demonstration sites, linking with the pathways to work project, show a way in which we can build that into the services that we provide more widely. She is absolutely right that, as I have said, there are other health care professionals who, with a little extra training, can provide some of these services extremely effectively.
Bedford Hospital NHS Trust
There have been three parliamentary questions and the hon. Gentleman has written to the Secretary of State and to me on this matter. The Department has also received correspondence from other hon. Members and from members of the public. In addition, my right hon. Friend the Secretary of State visited the trust on 4 October and discussed these issues with staff.
I have also had a letter from the Minister’s permanent secretary apologising for a misleading written answer that was given to me earlier. Is the Minister aware that, since the new year, Bedford hospital has had to instruct its doctors that no non-emergency case can be operated on in less than the maximum allowed time frame, that outpatient clinics are being restricted and that bed shortages are causing real concerns? All that is happening because of a need to fulfil an arbitrary time scale to combat an arbitrary calculated deficit. When my constituents pay so much for their NHS, why are they and all who work so hard at the hospital being put through such downright misery, and why is it so often the case that Government targets dictate to patients, rather than patients’ needs driving the targets?
I acknowledge that the hospital has had a difficult time and that difficult decisions have been taken to get it back into financial balance. However, I hope that the hon. Gentleman welcomes the fact that the hospital is now in monthly run-rate balance—it is in balance or better on what is coming into the hospital. The hospital is also forecasting a year-end financial position that is close to break-even. I did not hear any mention of that in his question and nor did he acknowledge that no waiting time target will be breached. The waiting times that are being met in his constituency are significantly better than those with which he left us when his party left government.
Does my hon. Friend recognise that an agreement has been reached between Bedford Hospital NHS Trust and Bedfordshire PCT on moving to a 20-week maximum wait? An additional £500,000 has been allocated to the hospital for planning purposes to enable it to do that, which will represent steady progress towards the national target of an 18-week maximum referral time from GP to intervention. Is that not part of the progress that is being made in the NHS in not only Bedfordshire, but throughout the country, which is in sharp contrast to some of the negative stories that we have heard of late?
I pay tribute to my hon. Friend because he has supported and encouraged his NHS to make the kind of progress that he has described. The NHS in his constituency is making progress towards the 18-week target, as is the NHS in other constituencies throughout the country. Instead of celebrating the hard work of managers and staff in his area to make such improvements, Conservative Members simply decry their efforts and demoralise staff by making exaggerated claims of the difficulties. We hear talk of a save Bedford—
It has been reported in the local press that Bedford Hospital NHS Trust will be asking GPs to take over the provision of genito-urinary medicine and sexual health services. We know that reported cases of chlamydia, gonorrhoea and HIV are on the rise, and my GPs say that they have neither the training nor the facilities that would be required. More importantly, patients want to go to a hospital where they can have guaranteed anonymity. Will the Minister send out a letter to Bedford Hospital NHS Trust saying that GUM services must not be closed down at Bedford hospital and devolved to GPs?
I would just ask the hon. Lady and her Conservative colleagues to stop setting their face against any change to the way in which services are delivered in the national health service. They should consider the possibility—this might just be possible—that it might be in the interests of patients for some services to be delivered out of the hospital setting and closer to their homes. I encourage the hon. Lady to open her mind to a thriving future for Bedford hospital and to accept the possibility that some services might be better delivered in the community.
York Hospitals NHS Trust
As my hon. Friend is aware, the PCT is working closely with the trust and the strategic health authority to agree changes that will lead to more cost-effective services. These changes will lead to a better use of resources, with some patients being treated more appropriately closer to home.
The national health service is based on the principle that care is provided on the basis of patients’ clinical needs, not their ability to pay, so will the Minister reassure the House that the rights of patients in north Yorkshire will be protected, despite the PCT’s deficit, and that they will retain access to the same range of NHS treatments, and experience the same waiting times, as NHS patients from other parts of Yorkshire and the Humber?
I agree with my hon. Friend and congratulate him on adopting a constructive approach towards the difficult financial circumstances that his PCT faces. As difficult decisions are made to ensure that we get that organisation back into balance, it is important that patients continue to enjoy access to high-quality services. However, it sometimes might be more appropriate to provide those services in the community, so this might be an opportunity to make some of the changes that frankly should have been made anyway, irrespective of the financial pressures that the organisation faces. Of course, the interests and needs of patients must remain at centre stage, and the trust must maintain the national standards that are set down on the quality of patient care.
Does the Minister think that it is fair that while NHS workers in York are bearing the brunt of the £77 million deficit in north Yorkshire, the nature of the contracts imposed on the PCT by the Government means that the new private Capio hospital in York escapes relatively unscathed?
What is important is the fact that patients in the hon. Gentleman’s area have access to high-quality services and are required to wait for as short a period as possible. If that means allowing constructive engagement between the NHS as a direct provider and the independent sector, leading to better treatment for patients in his community, I would have thought that he would welcome it.
I am delighted that Capio is enabling us to reduce waiting times for certain operations, but will the Minister respond to the question asked by the hon. Member for City of York (Hugh Bayley), with whom I entirely concur? The issue is not about having services delivered by other providers in the hospital trust, but about unacceptable delays and clinical need being put on the back foot. Will the Minister please respond to that question?
The waiting time targets apply in the same way in the hon. Lady’s constituency as in the rest of the country. Indeed, if we look at the facts, we see that no patient is waiting longer than 26 weeks for in-patient treatment, compared with 1,317 patients who did so when we came into Government in 1997. I hope that she will acknowledge the two new CT scanners that have been delivered to the hospital, the replacement MRI scanner, the fully modernised accident and emergency department, the additional cardiac catheter laboratory, and the new day unit, which was opened only in December last year, not to mention the £6.1 million integrated breast unit on the York hospital site. These are difficult times, and there are difficult decisions to be made, but there have been massively increased levels of investment and performance since 1997.
Health Care (East Cheshire)
Central and Eastern Cheshire primary care trust is developing new health services that will enable patients to receive treatment closer to home.
I am surprised that my namesake did not refer to maternity services, because they are the subject of my question. Is the Minister aware that birth rates in east Cheshire, which is served by the Macclesfield district general hospital, have increased for three years in a row? Women are opting to come to Macclesfield, in increasing numbers, to have their babies. Does she not agree that if women show that preference, it is essential to keep in-patient paediatrics, maternity, obstetrics and other children’s services in the Macclesfield district general hospital, in accordance with that decision? Will she ensure that those services in the hospital, which serves a predominantly rural area, are fully, properly and fairly funded?
I was not aware of the massive increase in the birth rate that has taken place, but I am now. I also know that the PCT is exploring the possibility of linking some of the maternity and paediatric services in the Cheshire area. Obviously, in doing so, the PCT will have to satisfy the strategic health authority that it is meeting clinical standards, such as those set by the Royal College of Midwives, and can still provide a full range of local services. I understand that the hon. Gentleman is meeting Mike Farrar, the chief executive of the North West strategic health authority, on 12 January, and I am sure that he will make his views clear at that meeting.
Is my right hon. Friend aware that in my constituency, which is part of the Central and Eastern Cheshire primary care trust, for the first time in 30 years, we shall have a totally new health centre in the middle of Crewe, an entirely new health centre in the middle of Nantwich, and a new centre in the middle of Sharington? That is a remarkable feat, and I hope that she will give credit to the remarkable negotiating skills of Professor Dr. Ong, who has managed the normally unachievable feat of getting vast numbers of general practitioners to work together.
My hon. Friend is right to highlight some of the results of the Government’s increased investment in the national health service, and the real benefits that it can bring to patients. I am glad to hear her praise the work of NHS professionals, too; perhaps the Opposition would like to take her lead.
Further to the comments of my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton), the fact remains that maternity services in Macclesfield, like those in Salford and Bury, have not been selected to become centres of excellence in the “Making it Better” reconfiguration across the north-west. It has not escaped public notice that some Ministers are trying to have it both ways by pushing for service redesign at a national level while opposing closures that affect their constituencies. Is not the reason for that embarrassing inconsistency the fact that those reconfigurations take place in the absence of an evidence-based model of safe and accessible maternity care? Will the Minister respond to our call for the Government to engage in a national debate about such a model, so that much loved local services do not face closure without good reason?
The hon. Gentleman will be aware that people who make decisions on the organisation of local NHS services consider what is the best care for patients in the light of the best value for money. We have produced national guidelines and a national plan for maternity services. There is a well established process for service changes, which naturally includes hon. Members expressing views on behalf of their constituents. In the case of maternity services in Greater Manchester, a final decision has not been made, but hon. Members are free to express their views and those of their constituents.
The hon. Member for Macclesfield (Sir Nicholas Winterton) and Members representing Cheshire and Wirral share an excellent mental health trust which, my right hon. Friend knows, has made a bid to become a foundation trust. When will we know the outcome of that bid, and can she assure us that services in east and west Cheshire and Wirral—an area covered by two separate primary care trusts—will be maintained at the same level or, indeed, improved in the new structure if foundation trust status is awarded?
It is obviously a great credit to the mental health trust in my hon. Friend’s constituency that it has been considered for foundation trust status, as that will allow it extra freedom to expand its services. The bids are being examined and a decision will be made as quickly as possible. I am glad that he supports his local mental health trust, which has made genuine improvements for patients in recent years.
Recruitment
Between May and September 2006, about 16,000 graduates qualified. Latest estimates suggest that about 60 per cent. of nurses, midwives and allied health professionals have found jobs, and the situation is improving. About 1,600 physiotherapists completed their training in 2006, and we are working with the Chartered Society of Physiotherapy to address local recruitment problems.
I am pleased that the Minister acknowledged that there are local recruitment problems and difficulties, but he will be aware that in my constituency and elsewhere many physiotherapy graduates have failed to secure jobs, which is a huge worry, both for them and their parents. What else will be done to put that matter right, as it is a great waste of resources?
I appreciate the point made by the right hon. Gentleman. There have been problems in certain parts of the country in the recruitment of physiotherapists who have graduated in the past 12 months. We need to do more to find roles in the community for physiotherapists, but I am confident that there is a need for more physios around the country to help, as we keep saying, to provide care at the local level, to keep people out of hospital and to reduce delayed discharges from hospital. I therefore accept the right hon. Gentleman’s general point, but the most recent returns to the Department of Health for his area show that 71 per cent. of nursing graduates and all midwifery graduates have found employment.
Following the point made by the right hon. Member for Bracknell (Mr. Mackay), is the Minister aware of the predicament of my constituent, Rachel Smith from Shafton in Barnsley, who last year qualified as one of more than 90 physiotherapists at Sheffield Hallam university? The vast majority of those students have still not found gainful employment with the NHS. Nationally, 75 per cent. of last year’s physiotherapy graduates have yet to find employment. Next year, Sheffield Hallam university will train another 120-plus physiotherapists, and my constituent would like to know from the Minister what is the point of continuing to train physiotherapists if the NHS is not going to employ them.
I am aware of the case that my hon. Friend mentions, and I accept his general point, as I did in answer to the right hon. Member for Bracknell (Mr. Mackay). There is pressure and a particular difficulty for people graduating in physiotherapy this year. My hon. Friend’s PCT recently recruited six newly qualified physios, and a further six bank staff to provide on-call services, so there is evidence of investment in physiotherapy in his local area. However, we need to do more to help people find jobs, whether in social care or in health care. In some parts of the country, consideration is being given to a combined job bank of vacancies in social care and health care. Perhaps we can explore that in his region.
Graduate unemployment among physiotherapists stands at 68 per cent.—a waste of nearly £40 million on training. Two thirds of midwifery units are understaffed, yet 40 per cent. are taking on fewer graduates, and 70 per cent. of graduate nurses have not found jobs. Furthermore, we learn that the Secretary of State is planning cuts of 37,000 to NHS staff, dwarfing even our estimates of her staffing cuts, which the Government have, incredibly, tried to refute. Will the Minister tell the House whether graduate unemployment and consequent cuts to patient care are due to shoddy work force planning or short-sighted reaction to the massive cash crisis engendered in the NHS by the Government?
I read the nonsense about staff shortages that the Conservative party put out before the Christmas break—a fantastic piece of Christmas fiction. It claimed that 16,000 graduates could not find work. That is the total number of people who completed training last year. As I said in my answer, 60 per cent. of them say, in reply to the Department of Health, that they have found jobs. The Conservatives should stop scaremongering on these matters. They are trying to frighten graduates and NHS staff by exaggerated talk of NHS job cuts around the country. They are trying to frighten local communities with talk of accident and emergency closures, and maternity—