NHS Reorganisation

After listening to the two opening Opposition Back-Bench speeches—that of the right hon. Member for Suffolk, Coastal (Mr. Gummer) and the moving contribution of the hon. Member for Lichfield (Michael Fabricant)—I hope that the Minister will not groan at a similar refrain in the latest instalment from Staffordshire. From previous plain-speaking encounters, the Minister and the Secretary of State will be well aware of what a prickly subject ambulances and PCTs are in my constituency and the whole of our county. However, like my hon. Friend the Member for Carlisle (Mr. Martlew), before I come to the thorny issues I will accentuate the positive. I shall not reel off reams of statistics, but spending on the NHS in North Staffordshire has almost doubled since 1997. Like for like, it has increased from £267 million in 1997 to £521 million today—a 95 per cent. increase. There is not a single MP who has not seen the benefits of such investment through their constituency casework—shorter waiting lists, fewer complaints about delays in treatment and even the odd thank-you once in a while. In North Staffordshire, we also have a new medical school in partnership with Keele university. New health centres are bringing better NHS care right to people’s doorsteps in Newcastle, as elsewhere in the country. Of course, not everything in the garden is rosy. Like any company, a huge organisation such as the NHS always faces challenges in managing that investment, not least in the face of constant organisational change. The PCTs in my area and the university hospital of North Staffordshire face varying degrees of deficit, despite the increase in spending. That is a pressing management issue but it is important to keep the scale of the problems in perspective. There should be no short-term panic measures conflicting with investment to meet long-term need. In our area, we were happy to hear from the new management at the hospital last week that plans for our brand-new hospital remain on track—and rightly so, if I may be partisan for a moment as we approach the 100th anniversary of the parliamentary Labour party. The hospital is the single most important investment ever promised by a Labour Government to an area that has stuck with Labour through lean and fallow, through thick and thin. Aside from painful decisions about costs and deficits, there is little more disruptive and demoralising than constant, continual reorganisation, not least when the benefits are unproven, the perception is of change for change’s sake, and the end result may be a reduction in standards, a loss of responsiveness and a more impersonal service in our much-envied NHS. That is where we stand in Staffordshire in respect of proposals to merge the county ambulance service into one super-organisation in the west midlands covering over 5 million people and over 6,000 square miles in all. My hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins), as well as the hon. Member for Lichfield, referred to the ambulance service. My hon. Friend and neighbour has done sterling work in leading the call for the Staffordshire ambulance service to remain just as it is. She is representing the concerns of her constituents in the border towns and villages of the most northerly part of the west midlands region about a reorganisation that will see yet another HQ based in Birmingham. Those concerns about local responsiveness are shared by people in my border villages—I will be in hot water if I do not name them all—Audley, Bignall End, Wood Lane, Halmer End, Alsagers Bank, Scot Hay, Miles Green, Betley, Balterley and Wrinehill in the constituency of Newcastle-under-Lyme. Over 3,000 residents from the villages signed a petition that I presented to the Secretary of State before Christmas. Many of them turned out last night, too, at a packed public consultation meeting in Newcastle about the changes, to support the continued operational independence at the very least of the Staffordshire ambulance service. That is a political translation of, ““Hands off our ambulances.”” I shall not repeat all the arguments made so well by my hon. Friend and neighbour, but I shall give one short anecdotal example, not necessarily to compete with the hon. Member for Lichfield, but to exemplify the common-sense concerns that people have. Fortunately, I have had the need to call an ambulance only twice in my life. The first time was at a funeral in Newcastle about two years ago, when the emotion was too much for one elderly person. He collapsed with a heart attack. I and other people called 999 and got straight through. The ambulance, stationed on a street corner, arrived within four minutes and the paramedics undoubtedly saved his life. The second occasion was for an emergency with my family here in London before Christmas. In the early hours of the morning, I called the London ambulance brigade not once, not twice, but three times. Each time, I was held up at the call centre with the same pre-recorded message: ““We apologise. We are experiencing unprecedented demand for our services.”” When I got through the third time, the operator told me that they had no record of the first two calls—““Probably because we get so many hoaxes,”” she said. The air, I am afraid to say, by this time was blue. That is one of the reasons that I have not complained. I would be very embarrassed to listen to the tape recordings. We got to the hospital eventually by minicab. I know that that night, the London ambulance service did not return calls to my mobile and no ambulance ever arrived at my house. I cannot draw conclusions from one experience, but I can well understand from that experience the plain, everyday concerns of local people in Staffordshire. Those concerns are heightened by the fact that, despite the widespread campaign in the west midlands by our strategic health authority, there is only one option on the table in this consultation, and we are all politicians enough to know what a shortlist of one really means. We need guarantees about the operational independence of Staffordshire ambulance service. Primary care trusts are the bodies that we set up just over three years ago to make the NHS more local, more responsive and therefore, in everyday terms, more efficient in meeting local needs. Here, I am glad to say that we have had more success, with the Department’s help, in making the consultation more meaningful. Instead of just one option, we have two: one for the whole of Staffordshire bar Stoke-on-Trent and one, bringing me even closer in my tryst with my hon. Friend the Member for Staffordshire, Moorlands, for a merger of our two local PCTs. That was not arrived at without a struggle—a bare-knuckle fight would be a better description. I must acknowledge the help of Ministers in the Department, who had to remind the SHA of its duty to be fair and balanced in consultation. Nevertheless, as appeared to be the case in Waveney and Great Yarmouth, it had to be dragged kicking and screaming. It was not good enough to sing the praises of option 1—the super-sized approach—while adding a grudging PS in the first draft of the document: ““By the way, here’s option 2, which all the local people, voluntary groups, professionals and medics in north Staffordshire support, but we think is rubbish.”” I hope that that is not the end of it. Colleagues in the south and east of the county are also balking at being thrown into one super-PCT, and we will support them as they develop their proposals. One of the non-sequiturs used by the proponents of a super-sized PCT for the whole of Staffordshire is that outside the northern sub-region, which is identifiable in its need, there is no coherent health community. That is clearly designed to set one part of the county against another. It is, of course, patent nonsense to suggest that it is better to have one super-sized PCT covering 782,000 people—by far the biggest in the west midlands—that would then have even less in common as regards health needs. When the consultation is finished, I urge Ministers to reject that sort of reasoning and likewise to reject redrawing the NHS simply for the administrative convenience of the officials concerned. Much has been made, without any evidence, of the benefits of coterminosity on our patch—that is, the alignment of the PCT and county social service boundaries. My hon. Friend the Member for Carlisle mentioned the local government White Paper due this summer, which may mean that coterminosity is a transient concept. From my experience, I wish that Staffordshire social services was shaken up to be just as responsive as my local PCT. That is what the county now says that it is going to do by restructuring it to follow our district boundaries. That remains to be done. The county still has to prove that it can get it right. To use that to justify shuffling the NHS furniture into one super-sized option at the same time defies common sense, particularly given that the PCTs in Newcastle and Moorlands already work well together, and with Stoke. They are getting things right, yet follow two discrete district boundaries. Other claims have been made for a single PCT, but again without evidence. First, it is said that, by being bigger, it will assist the new practice-based commissioning. There are smaller PCTs in the region and that argument of convenience simply does not hold water. Secondly, it is said that a super-sized option will save on the costs of bureaucracy. That is unproven. The SHA, unable to produce the costings, has recently admitted that the two options would be financially neutral. That brings me to my concluding observation about the driving force behind the reorganisation—cost savings. Of course we must direct more resources to the front line—we made a manifesto commitment to save £250 million through ““further streamlining””—but we must do it intelligently. It is not good enough simply to shake up SHAs, PCTs and ambulance services and say to each of them, ““This is your £X million share of the cost savings to bear.”” It is not good enough for our regional health authority to say from on high, ““This is the only option.”” Like other Members, my target has been the approach adopted by the SHA. I am grateful for the help that has been given by the Department in the consultation on PCTs. On that basis, I will support the Government tonight, but they must continue to listen and learn from the profound concerns that have been expressed throughout this debate.