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Health Care in London

I never thought that I would stand up in the House and agree with the right hon. Member for Holborn and St. Pancras (Frank Dobson), particularly on health matters, but he made a very important point in his criticism of the Darzi proposals. Having spent millions of pounds on new hospitals in London, the Government now want to make a radical change in favour of treating a huge proportion of the people who currently go to the accident and emergency departments of those hospitals in polyclinics, which have not yet been built and which they propose to build during a period of financial difficulty. It is mad to behave in that way. It is in the same category as the Government's deciding to pay GPs a lot more to do less, and then having to pay them even more to do the things that they were originally supposed to do. All these financial and medical decisions by the Government seem to come from Alice in Wonderland. I doubt whether one could find a worse example of what is wrong with the NHS in London than in looking at my own corner of the city—south-east London. There, as my hon. Friend the Member for Bromley and Chislehurst (Robert Neill) has pointed out, we have the South London Healthcare NHS Trust, which was a shotgun marriage between three hospital trusts that had severe financial problems. It was set up with an accumulated deficit of £200 million, and was given an operating target for this year of a deficit of £29.7 million. Since we are near the end of the current financial year, that means that the accumulated deficit is now well over £200 million. To be fair to the Government, a new management structure was put in place with the creation of the new trust a year ago. Some members of the Government have accused the Conservatives of scaremongering, but I have not done so about the management of the new trust. Although criticisms by consultants, patients and voluntary organisations, such as the local involvement network, have come my way, I said to myself that I would hold back from criticising the management publicly. One should be a responsible Member of Parliament and recognise that the management of any such huge organisation need time to bed down. However, the fact is that we have now had 12 months and the results are extremely disappointing, as the hon. Member for Eltham (Clive Efford) may well agree. It is worrying, for example, that the operations director has already gone by mutual agreement. I now understand that the financial director is also going by mutual agreement, although I have not been able to check that. A new operations director is being put in directly from the Department of Health. As a former Health Minister, I know that means that the Department is worried about the new trust. There are clearly problems in its management. As I have indicated, this year's target for the operating deficit will almost certainly not be met. That is a problem, because with generous help from the other parts of London, there is a window of opportunity for the South London Healthcare NHS Trust to pay off its deficit, if it meets its operating targets. It seems as though that may not happen, and the crisis that we face in south-east London will therefore be even greater a year from now. As far as I am concerned, there has been no real improvement in the trust's performance for patients since its inception. As Members know, it currently has a norovirus problem that has meant the shutdown of many wards and waiting lists rising. That is a difficulty that many hospitals have had to face, but nevertheless I do not see any improvements in performance. The origins of all that are quite clear. First, the Government have thrown money at the NHS in London, as elsewhere, with no idea of reform. The hon. Member for North Norfolk (Norman Lamb) mentioned PFI, and he gave the overall statistics for London. In my area we have two hospitals, which now form part of the South London Healthcare NHS Trust. The construction cost of the Queen Elizabeth hospital in Woolwich was £96 million, but the taxpayer will have to repay £799 million. The new Princess Royal university hospital in Bromley will cost £118 million to construct, and the taxpayer will repay £780 million—seven times the construction cost. As Lord Warner, a former Minister in the Labour Government, has said, the NHS received more money than it knew what to do with. Another problem has been top-down political management. Civitas, the consultancy, has said that market reforms have not worked as they should have done, because Whitehall is still exercising too much control. We have had endless and changing targets and endless changes in management. For a period of two or three years, the managing director of the Princess Royal university hospital was being changed every six months at considerable cost. Nobody ever gets sacked at the top level of the NHS. It is astonishing how people appear to perform badly and are removed, but then appear somewhere else in the NHS. No one ever suffers the consequences of poor performance. Finally, weak structures are part of the problem. Commissioning has not been valued as much as it should have been, and in many ways, as has already been said, it has been emasculated. Lord Warner—I quote from an article in The Guardian—has said:""We had 300 PCTs to begin with. That was insanity…The first thing I did was to cut them down to 150. But I wanted to go further and cut the number to 50 or 60."" He said, as The Guardian put it,""that he was thwarted by the Labour backbenches, who feared they would lose vital services from their constituencies."" What is the answer? Briefly, the Government must cease micro-managing. Instead, we need to create opportunities for individuals and companies inside and outside the NHS to come up with more effective solutions, and for the Government to act simply as a regulator. We need fewer targets and quangos; we need commissioning to be more professional; we need to encourage a diversity of providers and for groups of professionals, private charities and so forth to be brought into play; and we need more competition. I suspect that efficiency and better patient care will go together. The tragedy is that all those things were under way when the Conservatives were in charge of the health service, when we made the split between provider and purchaser. That was the opportunity for those sorts of reform. The Government, including the right hon. Member for Holborn and St. Pancras (Frank Dobson), with whom I might disagree on this, set back the whole process of reform. It is a tragedy that 13 years have been largely wasted.