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Health and Education

The hon. Gentleman is right to say that what has happened was predictable, not least because the primary care trusts, which are now responsible for putting in place alternative provision, do not have the budget necessary to pay for the most expensive part of the provision, which is the bit that nobody wants to do—call-outs in the middle of the night and at weekends. That was foreseeable, and I am concerned that so far nothing is being done rapidly enough to address the matter. Lives are at risk as long as the problem is not addressed. When things go wrong with out-of-hours GP cover, there is a knock-on effect on our accident and emergency departments. Again, I draw on my own constituency experience. Our accident and emergency departments are overstretched, partly because people often cannot get a GP out of hours, so they head down to the A and E department, which was never meant to provide many of the services that out-of-hours GP cover should provide. There are knock-on effects through the system when one part is not working properly. I want to raise with the Secretary of State the issue of accountability in the NHS. For me, that is one of the biggest gaps. Trying to establish who is responsible in the NHS is like trying to grab hold of a greasy stick. To cite another constituency example, Frenchay hospital is set to be downgraded—to use the jargon—from being a major international hospital with more than 700 beds to being a community hospital with 50 beds. I have raised the matter in debates in the House on more than one occasion. Each time the relevant Minister of State has said, ““Nothing to do with me, guv. This is a matter for the locals.”” That sounds great, but when one finds out locally who made the decision, it is the unelected chairmen and chief executives of the trusts and the executives of the strategic health authority, none of whom we can vote out if we think they made the wrong decision. As far as I am aware, the overview and scrutiny committees are not in the business of sacking chief executives when they make the wrong decision. When my constituents and thousands like them are confronted with a decision that they do not like about a hospital trust or an accident and emergency department, whom do they hold accountable? The money for any reform will ultimately come from the Secretary of State, yet her Ministers tell me she is not accountable for what is going on. I should like to have a discussion with her about that. There are other important issues that we should flag up. There is a huge problem of capacity in our health service. Very often, when reform and modernisation take place, new hospitals are built with fewer beds than those that they replace. I am not convinced that, with a growing ageing population, we can get away with cutting bed numbers. Recently GPs in my constituency were written to and asked not to send people to hospital. The hospital had eight or nine wards closed because of infection, which is clearly germane to our debate, and therefore could not cope. The accident and emergency department was overwhelmed. Against that backdrop, telling my constituents that there should be fewer beds, not more, is a hard message to sell. The NHS will try to be more efficient by driving people through more quickly, with higher bed occupancy and shorter stays, but we all know the problems with that. Linking that with the MRSA debate, there is clear evidence that driving up bed usage beyond certain critical thresholds is damaging for infection control. If beds are essentially never empty, how can standards be maintained? I am pleased that the Secretary of State appears to recognise that. When the Government came to power, bed occupancy was around 80 per cent., by last year it was 87 per cent., and there are plenty who feel that that is too high. Professor Barry Cookson of the Health Protection Agency has said that that high bed occupancy is related to the rise in hospital-acquired infections. He says:"““We have got to get down to 85% . . . Patients should realise that there is a certain safety level above which we start having problems.””" Without going on at length about the targets culture, the danger is that one bit of the Department will say that waiting lists must be brought down and we must achieve this and that goal, and another bit will say that if bed occupancy is driven up beyond 85 per cent., 87 per cent. or 88 per cent., quality health care, another goal, will be sabotaged. I hope that the Secretary of State will oversee—dare I use the phrase?—a joined-up Department whereby a target in one area does not have a counterproductive effect elsewhere, as a plethora of targets are wont to do. Clearly we need to monitor and know what is going on, but a plethora of centrally driven targets can be counterproductive, and MRSA is a classic example of that.