Yesterday I took part in a debate about NHS staffing. I spoke mainly about health care in Suffolk….
Mr. Richard Spring (West Suffolk) (Con): On behalf of everybody present, and indeed on your behalf, Madam Deputy Speaker, and the behalf of every Member, may I pay tribute to the wonderful work done by doctors, consultants and nurses, and the ancillary workers who are often the unsung heroes of the NHS? As the hon. Member for Leeds, North-West (Greg Mulholland) says, there are tensions within the NHS. It is therefore simply beyond belief that not one Labour Member of Parliament intends to speak in this debate on NHS staffing. I hope that when the Minister makes her final comments, she will apologise for that, as it sends out a curious message to all those in the NHS who are under considerable stress.
In recent years, the NHS has faced a number of problems, not least in Suffolk. The county has been hit by cash crises, service cuts, closures and redundancies. Our hospitals are continually on black alert. In the past 10 years, the number of available beds has been cut from 1,501 in 1996-07 to 1,194 in 2006-07. What is really sad is that community nurses and doctors have told me that the local hospital, the West Suffolk hospital, is being forced to discharge patients prematurely. Of course, the hospital is doing everything in its power to mitigate those unfortunate circumstances, but the situation has arisen because of very tight finances. The problem is that there are insufficient numbers of intermediate care beds, ever-increasing pressures on staff, and a top-down, centralised, target-driven culture that continues to drive front-line clinicians in our NHS to despair. That is well known.
Chris Bryant (Rhondda) (Lab): I often hear the argument that there is too centralised a system in the health service, and many of us would sympathise with it, but there is a corollary: everybody also complains about the postcode lottery. There is a contradiction in many people’s arguments. How does the hon. Gentleman resolve that contradiction?
Mr. Spring: Of course the hon. Gentleman is right to say that there are difficulties. Naturally, the problem of the fact that it is possible to obtain a certain form of treatment in one part of the country but not another has to be resolved, but I am not really talking about that. I am talking about a culture that has caused people to be pushed out of beds prematurely—that is the view of community nurses and doctors—simply
because of the pressures of centralised targets and control. That is quite different from the dilemma that he rightly mentions. There is a great sense of despair among many of those who work in the NHS. The result is that our GPs are forced to pick up the pieces, which is difficult. I was talking to a GP in my constituency about that only yesterday.
Having targets for capacity in our hospitals raises the risk of superbugs such as clostridium difficile and MRSA. There have already been worrying increases in the number of superbug cases in some of the hospitals in the eastern region. Both West Suffolk and Ipswich hospitals have experienced increases in C. diff infections among patients over 65; in contrast, nationally there is improvement to the problem. Vomiting and diarrhoea bugs are commonplace. It is truly horrific that some elderly constituents of mine are now scared to go into hospital because of those bugs. I reiterate that our doctors, nurses and ancillary workers do a wonderful job, but they are struggling to cope. Job cuts have simply not helped the situation. I acknowledge that, as the Minister said, since 1997 the number of staff employed in the NHS has grown, but since September 2005, some 38,000 jobs have been cut from the NHS. Last year, almost 7,000 nursing jobs were lost. The total number of qualified nursing, midwifery and health visiting staff employed by West Suffolk Hospital NHS Trust has decreased by 9 per cent. since 2004. The number of professionally qualified clinical staff has decreased by 8 per cent. since 2003.
Ann Keen: The vacancy rate for nurses is 0.5 per cent., which is the lowest level for six years. The nursing work force are to be congratulated on that.
Anne Milton (Guildford) (Con): It’s the number of nurses.
Ann Keen: The hon. Lady mentions nurses; they are an important part of the work force. In fact, they are the largest part of it. It is important that we get our facts right.
Mr. Spring: I note that the Minister does not contradict the fact that I mentioned about the diminution in numbers. It is based on information that is beyond dispute; the figures are official statistics.
Sir Nicholas Winterton (Macclesfield) (Con): I am sure that the Minister knows what I am about to ask my hon. Friend. There is a shortage of midwives in the national health service—a fact that is widely publicised by the Royal College of Midwives itself. There is also a shortage of student midwives. If the Government are to meet the guarantees in the midwifery matters strategy, the midwifery profession in the health service must be provided with more money, so that it can ensure safety in birth and the delivery of post-natal work.
Mr. Spring: I am most grateful to my hon. Friend for making that point. He is entirely correct; the UK birth rate is increasing appreciably, so not only has there been a shortage of midwives but with the rising pattern of births the situation can only get worse. The statistics I gave are not in dispute, but in various parts of the country accident and emergency attendances put huge pressures on the staffing resources of hospitals. At West Suffolk Hospital NHS Trust, A and E attendances have soared by 34 per cent. since 2001-02, at the very time when there have been staffing cuts at the hospitals and a reduction in the number of beds.There has already been an allusion to the recruitment of doctors. It is a growing problem in Suffolk, so I welcome the Government’s announcement today that they are attempting to preserve health service jobs for British graduates. However, budgetary constraints are another reason why junior doctors struggle to find employment; GP practices are unable to fund extra posts. I have had many conversations about that point with GPs in my constituency.I am constantly told by constituents and people who work in our hospitals that rather than cuts we desperately need more doctors and nurses in the local NHS, reversing the pattern of the past few years, yet instead the number of NHS managers is increasing three times as fast as the number of nurses. Between 2005 and 2006, twice as many nursing jobs were lost as managerial jobs. In the east of England, there has been a 4.9 per cent. increase since 1997 in the number of manager and senior manager positions—from 2,027 to 3,126—yet there has been only a 2.8 per cent. increase in the number of nurses, from 29,424 to 37,377.
Ann Keen: It is important to get the facts right. Our training levels for doctors have never been higher. The recruitment and retention rates for junior doctors, and for GPs in particular, have never been higher. It was right that we looked at their contracts some time ago, which has helped considerably in recruitment and retention, but I do not recognise the claim that there is a shortage. There are areas with inequalities and it may be more difficult to recruit GPs to them, but training in our medical schools, in particular for GPs, has never been at a higher level.
Mr. Spring: I agree that the level of training for doctors is of high quality, but over the last few years, because of the appalling mismatch between the training and production of junior doctors and the lack of opportunities, many of them have been unable to find jobs, so they have emigrated. I am pleased about the Government’s announcement, but I hope the Minister will not resile from the fact that over the last few years the morale of junior doctors has been severely tested by considerable confusion on the part of the Government, the results of which are clear to see. Mr. Bone: My hon. Friend is making a powerful speech. Does he agree that one of the problems is not the number of doctors trained but the number of vacancies available? In some cases, up to 20 qualified doctors apply for one post; on average three times as many people apply as there are posts.
Mr. Spring: My hon. Friend is entirely correct. In close memory, we saw junior doctors walking through the streets of London in protest against what had happened—an unprecedented situation in the history of the NHS.
Management costs in the Suffolk primary care trust increased by 22 per cent. in the last financial year. Amazingly, there are now more people managing and organising the NHS than there are beds. I hope that some justification can be given for the astonishing payments to officials in our strategic health authorities, where massive salaries are paid. My dealings with the East of England SHA have not inspired me with confidence that the organisation is on top of the role it is meant to play.
Mr. Baron: We all accept that there is a role for good management in any organisation, including the NHS. Does my hon. Friend feel that sometimes when we talk about bureaucracy the Government misrepresent the argument to make it seem as though we are attacking management, whereas in effect we are saying that there is room for good management but we must look at the costs of bureaucracy in the NHS for the benefit of all patients and staff?
Mr. Spring: I entirely agree. Of course, good management is important but I do not think my hon. Friend will disagree that the extent and volume of management, especially in our SHAs, has not been particularly productive and is extremely expensive. Considering the ever-greater pressures on the NHS, because of demographic and other factors, there is a mismatch, which is exactly the point he was making.
At West Suffolk hospital, there has been an increase of 184 per cent. over the past six years in the amount spent on salaries and wages for managers and senior managers. There has also been an 82 per cent. increase in the amount spent on salaries and wages for administrative and clerical staff. The figure has nearly doubled, yet there has been only a 73 per cent. increase in the amount spent on salaries and wages for nursing, midwifery and health visiting staff—from £16.6 million to £28.7 million.
The Prime Minister’s own independent reviewer of NHS finances, Sir Derek Wanless, said that little benefit has been gained from the huge pay deals that were a consequence of “Agenda for Change”. The Select Committee on Health criticised the Government’s poor financial planning:
“The Government’s estimates of the cost of Agenda for Change and the new GP and consultant contracts proved to be hopelessly unrealistic”.
Last year, while nearly £1.5 million was paid in bonuses to 231 “senior” civil servants in the Department of Health, a county such as Suffolk struggled to cope with an unfair funding allocation and considerable debts.
Like many other parts of the country, Suffolk has an ageing population. The number of people aged 65 or over has increased by 11 per cent. since 1997; 19 per cent. of the population of Suffolk are now aged 65 or over. Furthermore, much of my constituency is rural, which adds to the problems. That lies at the heart of the NHS funding problem.
Our local NHS struggles to match the needs and demographics of the local population. The Minister talked about inequalities, so I shall address that point firmly. For 2007-08, the per capita spend on the NHS was £1,156 in my constituency, well below the national average of £1,388. However, in the Prime Minister’s constituency in Scotland, which does not experience the health crises that people have to put up with in a constituency such as mine, the per capita health spend was £2,019, almost double the amount in Suffolk, so the service cuts and huge debts in Suffolk have not happened in his constituency.
Sir Nicholas Winterton: My hon. Friend is making a most interesting speech. I am most impressed by his statistics. Has he any statistics about the problems relating to mental health, where the shortage of professionally qualified staff is creating problems for GPs?
Mr. Spring: My hon. Friend has always made an enormous contribution in the House on health matters, in which he takes a close interest. His question is about what is commonly described as the poor relation of the health services. I do not have specific statistics about the problem, but I am sure that he agrees that one of the tragedies in how mental health has been handled, from a financial and back-up point of view, is that many individuals who are tragically caught up in the vortex of mental ill health land up in the criminal justice system, where they remain for good. Nothing is more tragic in personal terms; it is also very destructive for society as a whole.
I welcome the 5.5 per cent. increase that all PCTs are receiving in 2008-09, but it does not sufficiently address the problem that I have outlined. I have met officials at the Department of Health on several occasions to discuss the funding given to Suffolk, and have spent a great deal of time examining the funding formula that distributes funding to PCTs. The strategic health authority has accepted that we get a particularly raw deal. Rural areas such as Suffolk—many of my hon. Friends will be in exactly the same position—have been adversely impacted by a funding formula that discriminates against them.
I raised the issue at a meeting with a former Secretary of State for Health, and she agreed that if the NHS structures in Suffolk and elsewhere were in financial balance by last spring, she would re-examine the problem of rurality as part of the NHS funding formula. I hope that the reason why the advisory committee on resource allocation has requested more time to finalise its review of the resource allocation formula is that it is seriously examining the rurality factor. I eagerly await the report, which we hope will finally be published this summer. I hope that the revenue allocation in my area will be considerably greater. The impact of the cuts on staffing is just one manifestation of the negative effect that the skewed funding formula has had in Suffolk and other more rural parts of the country.
At the level at which most people have contact with the NHS, I fear that we are seeing a similar discriminatory effect. Haverhill, which is the largest town in my constituency, is being affected by the operation of the Carr-Hill formula, especially through its effect on the weighted list size of each practice. That has caused considerable distress to my constituents. I touched on the national funding formula and the fact that it has thrown up various anomalies over the years. Now we have an anomalous situation closer to home.
For most people, contact with the NHS is most frequently made through their local GP surgery. A general practitioner is invariably the first port of call for people seeking help and GPs are hugely trusted in the local community. Yet the application of the centrally determined Carr-Hill formula has resulted in the town in my constituency which is the largest and most rapidly expanding in the whole county experiencing cuts of £280,000 for the local GP practices. That has meant that those practices will have to cut back, possibly remove staff, and make additional savings.
People read the huge headline rates of supposed increases in spending in the NHS and they hear about the increased commitment by the Government, but they cannot marry that up with the fact that they see cuts in the local hospitals, beds being removed, staff given the sack, and the GPs in the biggest town in my constituency up in arms because they are faced with substantial cuts—about £280,000. The community has come together in an unprecedented way. Petitions of more than 10,000 people have been delivered to No. 10 Downing street and to the House.
People cherish the NHS and want it to work. They cannot understand why such situations continuously arise. Having to deal with the consequences is hugely undermining for those who so loyally work in the NHS. I read Lord Darzi’s proposals with great interest. In the report published last autumn, he proposed that each PCT should have a new GP-led health centre. I am delighted that an initiative is under way in Suffolk that may bring one of those new walk-in centres that is open from 8 am to 8 pm to Haverhill in my constituency.
However, that does not offset the fact that one of the consequences of the budget cut in Haverhill, with its impact on staffing, is that some of the satellite surgeries that the GPs were able to operate in the villages surrounding the town will be cut, notably in the village of Kedington. People have got used to having a satellite surgery and they value it because public transport is limited. Because of staff pressures resulting from the cuts, the surgery there will be cut again. That undermines people’s confidence in the NHS. They keep asking where all the money has gone. Such is the outrage in the village, where the GPs are held in high regard, that we are holding a public meeting. I will do everything in my power to encourage the survival of the GP surgeries, because they are held in great esteem.
During the past 10 years the whole of the NHS has suffered badly, but in Suffolk it has been hit particularly hard. As the Minister said, the NHS marks its 60th anniversary this July. It was based on the founding principle of providing health care for all citizens and it is very much cherished, yet if the Minister has listened to what I said—I have tried to cite the statistics as accurately as possible—she will accept that people question whether that principle is still upheld. They do not understand what is happening.
Our hospitals are at bursting point. There is no question but that staff morale in the NHS is very low, we do not have enough beds, patients are being discharged too early—not for clinical reasons, but because of the target-driven culture—and the obsessive bureaucracy is impacting on the lives of our doctors and nurses. When patients go into hospital, there is the danger, as a consequence of superbugs, that they will leave in worse health than when they were admitted. There is the prospect that some of my constituents will be without a local GP surgery. As the elderly population grows, the situation will become worse.
In conclusion, yes, there has been an increase in staffing overall, although recently that has not been the pattern locally. Yes, more money has gone into the NHS and technology has improved. But my constituents share the concerns of doctors, nurses, community nurses and ancillary workers about what is going on in the NHS. Despite all the good intentions that may exist, morale is probably at its lowest point in the history of the NHS. That is a terrible indictment of what the Government have done.
It is believed by some that one of Labour’s achievements of their time in power has been the reduction in NHS waiting times. However, figures obtained yesterday reveal a different story, which really needs proper airing. 
Of course it is desirable for people to be treated at home, and not in hospital; people naturally would prefer not to go into hospital if possible.
Yesterday, I presented a 10,000 signed petition in the Chamber of the House of Commons. This was in a bid to force Suffolk PCT to reconsider the reduction in funding to Haverhill GP practices. Earlier in the day, I joined two of my constituents Ann Sisson and Marion McLaine, both GP practice managers, to hand in another copy of the petition to 10 Downing Street. 
The top-down, centralised, target-driven culture has driven front-line clinicians in our NHS to despair. Labour’s interference and obsessive centralisation has now led to the tenth reorganisation of the NHS since it came to power nine years ago. Yet s
The colossal debts which continue to beset the NHS in the East of England are overseen by a Strategic Health Authority. There is now such an atmosphere of fear and anxiety in the NHS that each and every element of the health service has so-called communications staff who are very costly indeed.
There have always been health fads, but rather like the late David Niven observing that Xmas seems to come every three months, the rapidity of different and often contradictory health fads is breathtaking.
The NHS has been put under the microscope by the Health Select Committee, with many trenchant criticisms.
Only an urban obsessed and centred Government could actually be orchestrating the wholesale closure of A&E units, whilst saying it will enhance patient care. Yes, it is true, that there are too many visits currently to these units, when treatment could be done by GPs or at home.