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Access to NHS Services

I welcome the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), to his new responsibilities and I look forward to our exchanges at the Dispatch Box. I am sure that he will soon realise that nothing is more important to our constituents than their security and their health, so, conscious of the values of the doctors’ pledge—the Hippocratic oath—it is poignant that we are meeting as we learn of the doctor arrested in Brisbane, Australia, who had worked in a hospital in my home and constituency county, treating my constituents and those in neighbouring constituencies. We have had a good, wide-ranging debate, throughout which Conservative Members have defended the NHS from the ravages and ramifications of the Government’s poor planning and the even worse implementation of their top-down targets. The Secretary of State, who has just returned to the Chamber, had a prize opportunity to steal our clothes, but instead he dug in and defended everything done by his predecessor, who of course paid the ultimate political price for just that. As we have said before, we remain concerned that the Government’s basis for their NHS policy decisions is a desperate scrabble for cash rather than a focus on the health outcomes for the people of our country. The hard-working staff of the NHS, to whom we all pay tribute, deserve far greater support than they are receiving from the Government, so we have presented the new Prime Minister’s team with a copy of our NHS autonomy and accountability white paper. Although the Prime Minister seemed to distance himself from the idea of taking politics out of the NHS in the closing days of his non-campaign, at the weekend he told the News of the World that he would be pursuing our policy. Clearly, he has found ““all the talents”” for NHS policy in the Conservative white paper. Ultimately, whatever the specific issues we have debated today, the future of fair access to our NHS services lies in the autonomy of the NHS to make decisions based on clinical, not political, criteria and its accountability to the House and to the public and patients who use it every day. The case was made fairly and forcefully by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), supported by an excellent and powerful speech from my hon. Friend the Member for Wellingborough (Mr. Bone). In addition, I pray in aid the following quotation:"““The NHS was the creation of all three parties. Its fundamental principles have never been under greater threat.””" Those words appeared recently on the website of none other than the hon. Member for Grantham and Stamford (Mr. Davies). My right hon. Friend the Leader of the Opposition has constantly confirmed our commitment that the NHS is our No. 1 priority, and that under an incoming Conservative Government it will continue to be a public service free at the point of need, with access based on need, not on ability to pay. I hope that even at this late hour the Government will support that part of our motion—interestingly, their amendment would delete that crucial overriding principle and value without repeating it or replacing it with words of their own. What do they mean by that? Last December, the new Chief Secretary to the Treasury undertook the Government’s consultation on the core principles of the NHS, which we have committed to enshrining in legislation. In that consultation, the Government omitted the principle that"““public funds for healthcare will be devoted solely to NHS patients””." What do they mean by that? Perhaps the new Minister will tell us whether he still wants to get rid of that central pillar of the NHS. Amidst the various disasters that befell the NHS on the watch of the right hon. Member for Leicester, West (Ms Hewitt), the negotiation of the new GP contract will be remembered as one of her biggest political tombstones. The cost was over £250 million more than the Government had originally intended for a service that had been slated by the National Audit Office—[Interruption.] I am happy to take all bids for admission of failure. What does the Minister intend to do about those costs? As the motion makes clear, our recommendation is that practice-based commissioning be developed to provide greater incentives for the integration of GP services with out-of-hours care. I hope that the Minister will not be tempted to repeat the point that 96 per cent. of practices have taken up practice-based commissioning. As I have discovered through parliamentary questions, his Department counts only GP practices that take up component 1 of the PBC incentive payment, which is, in effect, free money: 95p per registered patient if the practice submits a plan on how it intends to deliver direct enhanced services. The practice receives that money whether or not it delivers on the plan. Component 2 of the payment is made available when it actually delivers, so it is no wonder that I was not surprised to discover that information about the take-up of PBC is collected only at primary care trust level. Will the Minister tell us what percentage of GP practices have taken up component 2? We also recommend the use of PBC to integrate urgent care. Will the Minister give us the timetable for publication of the urgent care strategy? The White Paper, ““Our health, our care, our say”” promised:"““During 2006 we will develop an urgent care strategy for the NHS.””" However, we are halfway through 2007 and all we have from Ministers is a commitment to publish ““in due course””. We also await the review of walk-in centres and the patient access survey results. As regards the former, a year ago last month, according to the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis)—who has not returned to the Chamber:"““The matters are still under consideration.””—[Official Report, 13 June 2006; Vol. 447, c. 1161W.]" What is the hold-up? Perhaps the answer is in the new Minister’s in-tray, or walk-in tray, or his kick-it-into-the-long-grass tray. Who knows? My hon. Friend the Member for Beverley and Holderness (Mr. Stuart), who has been a tireless campaigner on behalf of community hospitals, made a justifiably impassioned late contribution on the subject. Since 1999, more than 3,000 community hospital beds have been lost; 27 hospitals have experienced closures and 139 are under threat. Only £50 million of the £750 million community fund budget announced last summer has actually been allocated to community hospitals, with a further £50 million to polyclinics. Moreover, the Government have dropped their 2005 election manifesto pledge to build or refurbish 50 community hospitals. When will the Minister start defending community hospitals, which are the key to delivering care closer to home? We have heard from Members on both sides of the House who face the threat of closure of their local accident and emergency departments. In April, when questioned by my hon. Friend the Member for South Cambridgeshire, the former Secretary of State refused to say whether she endorsed or rejected the Department of Health guidance on the subject. Will the new Minister tell us what he thinks? I caution him that if he accepts the Department’s guidance"““that to be viable, a full A&E Department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people””—" a claim for which we have seen no evidence, but which is being prayed in aid by strategic health authorities hoping to close A and E departments—he will be condemning 92 of England’s 204 A and E departments to closure, as was highlighted in an intervention about Haywards Heath by my hon. Friend the Member for Mid-Sussex (Mr. Soames). Mothers-to-be in England might take heart from the elevation under the new regime of Government campaigners for maternity services. The new Secretary of State for Communities and Local Government is protesting against the closure of maternity services at Hope hospital in Salford. The new Home Secretary is protesting against closures at the Alexandra hospital in Redditch. Mothers-to-be will be pleased to hear that the Under-Secretary of State for Health, who is still not in the Chamber, and who protested against the closure of maternity services at Fairfield hospital in Bury, is the only Health Minister from the previous line-up to keep his job. Unfortunately, what the hon. Gentleman does in his constituency seems to bear no relation to the policies he signs off at Westminster. We have repeatedly asked for clinical evidence for reconfigurations of maternity services. The report failed to provide it and the hon. Gentleman confirmed that the necessary research will not be concluded until 31 August 2009, yet the mad march of threatened closures continues—such as the closure at Horton, as has been repeatedly and ably pointed out by my hon. Friend the Member for Banbury (Tony Baldry). Sixty per cent. of those services are operated by providers that finished the 2005-06 financial year in deficit, and 65 per cent. of them are situated in parliamentary constituencies held by Opposition MPs. It is depressing that yet again the choose-and-book statistics have been run out. As long as a person has made just one phone call, even though it is completely useless, it is counted in the 85 per cent. ““successful use”” figure. In the spirit of consensus building so beloved of the new Prime Minister, we have today taken a constructive approach and offered a positive way forward, but neither in their motion or in the debate have the Government attempted to answer any of our points. Perhaps the Minister, who is fresh from ducking the issues on badgers to control the spread of bovine TB, can set up a new example of Government transparency when he speaks. Spending is not the same as delivering. Surely now that the clunking fist of the ex-Chancellor has grasped power, the Government should recognise that there is a large elephant in the room, which is, as they say in the motion, their suggestion that the staff and the medical profession have worked hard to deliver the Government’s targets. No—they have worked hard to deliver better patient care and they have done so by working not necessarily with and for the Government, but often despite the Government who have set the top-down targets. That is why we need a new freedom of access and free access that is equitable across the country. I ask my hon. Friends on the Opposition Benches and perhaps some good-thinking friends on the Government side to support the motion.