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Department of Health

As you and the House know, Mr. Deputy Speaker, I have no party political axe to grind; my aim tonight is simply to get at the truth. It is entirely natural that the Government should minimise the scale of the deficits, saying that only a quarter of trusts are in deficit and that the projected £800 million deficit is only 1 per cent. of the total budget, but I am not at all sure that that is the true figure. This year—2005–06—trusts have been allowed to use brokerage, short-term loans and cost improvement programmes and, at the half-yearly point, the projected deficit was £620 million. At that time, one trust in my locality admitted to a deficit of £3.8 million; it now has to save £20 million to get into balance. Another trust admitted to a £10 million deficit; it now has to save £36 million to get into balance. The hon. Member for Guildford (Anne Milton) said that her trust has to save £16 million, yet according to its six-monthly forecast it was going to be in balance. If those examples mirror the picture across the country, the gross deficit is far greater than the £800 million that is being admitted to. We should also consider reports of the scale of redundancies in trusts such as Cornwall and North Staffordshire. Technically, the Queen Elizabeth hospital, Woolwich, is insolvent. Many Members have mentioned top-slicing at 2 to 3 per cent., but if that is to be the right answer, the figure would have to be even higher. What has happened to the extra money that has been invested, rightly, in the health service? The figures given to the Health Committee by the think-tank Reform were passed to the Department of Health and have not been queried. Some £3.7 billion of the extra £6.6 billion has gone automatically on cost increases. That leaves £2.9 billion, which has been spent on meeting underestimates of the cost of the new contracts, of the cost of recommendations by the National Institute for Health and Clinical Excellence, and of the cost of private finance initiatives and pensions. That leaves very little to pay for employing the extra consultants and nurses being trained, or to meet the 18-week target. If we could get at the truth of the real scale of the deficits, the Government would have to agree to give more time to achieve balance. It is ridiculous to try to achieve balance in precisely 12 months. The Royal College of Nursing, in a letter that I suspect that it sent to many hon. Members, stated:"““All Trusts should have the option to defer deficits for an agreed period of one to three years as agreed with the health economy where achieving in year balance will restrict choice and adversely impact service provision.””" Apart from the delay, what should we do? It is obvious what we should do. First, we need to examine the equality of funding. Some hon. Members have already mentioned work that suggests that funding is not equitable. We do not just condemn management; we examine the quality of management and see where it is good and where it is not. We ask the Department of Health not to make any more mistakes. It was admitted in a letter dated, I think, 22 February, that the Department had got the national tariff wrong. How can one calculate how to spend one’s money if the tariff is wrong? We should allow time for payment by results to happen and for practice-based commissioning. We should put an embargo on further use of private independent sector treatment centres until we really know—when they have been evaluated—if they are value for money. We should put a temporary halt on PFIs. Some 60 trusts have PFIs tying up about 11 per cent. of their income. That is the first call on the income. We have had 28 reorganisations since 1982. As I keep telling the House, for goodness’ sake, do not have any more reorganisations for the moment. The Government must avoid knee-jerk reactions. Top-slicing the primary care trusts is not right and neither is shifting the cost of long-term care. As for the suggestion that asthma and heart disease can be treated more in the community, doctors do not send patients to hospital for fun and patients do not go for fun. Virtually every case of asthma or heart disease that can be treated in the community is being treated in the community. When the people concerned go to hospital, they do so because they need a consultant opinion, consultant investigations, consultant treatment or intensive nursing care. I cannot imagine where the suggestion has come from. What medical advice did the Secretary of State take on that? Did she ask the royal colleges, the chief nursing officer or the chief medical officer? That sort of plan is a knee-jerk reaction. There is a lot that can be done. I held an Adjournment debate just last week on the logical reconfiguration of acute hospitals, because there is scope for that. I want to make it absolutely clear that I am not talking about community hospitals, which are a cost-effective way of saving acute hospitals work, but there are logical reconfigurations of acute hospitals. Let us take the example of Hartlepool, Stockton and Middlesbrough, which are within 8 miles of each other in an equilateral triangle. One cannot keep three all-singing, all-dancing hospitals with everything there, but services can be shared. There should be a logical review of the work force, with joined-up thinking. We should not train 30,000 extra consultants unless we can employ them and at the moment, we certainly cannot. The move to care in the community might mean that we do not need them all. Perhaps the most important thing is to have an open debate on health care rationing and on what people would be prepared to pay and what sort of NHS charges are realistic. Not very long ago, BMA News carried out a survey of its readers and 96 per cent. of doctors who responded said that health care rationing was one of the most important things that should be discussed. I wonder why Ministers are so scared of rationing. Concluding an article with the headline, ““Why rationing looms for the NHS””, the health correspondent of The Independent said that rationing"““is a word, and a prospect, that health ministers dread.””" If one has a child who is afraid of the dark, one takes them up the darkened stairs and shows them that there is nothing to fear. The Government have to be treated like that. They have to be shown that the fear of health care rationing is completely irrational and that people would welcome such rationing. We must consider it because demand will simply outstrip the money available due to increased longevity and more possibilities for treatment. We should allow beleaguered trusts a little more time while debate continues on all these measures, which would be possible to implement. In my heart of hearts, I would like to abolish the market and go back to what I believe were the halcyon years of the NHS in the 1970s and 1980s. Sadly, that is not possible, but the market is not working at the moment. We must find out whether, with sensible changes, we can make it work.