Commons Hansard
7 Feb 2006

NHS Reorganisation

Mr. Eric Martlew (Carlisle): I did not really take seriously what the right hon. Member for Suffolk, Coastal (Mr. Gummer) said. I remember when he was Minister of Agriculture, Fisheries and Food and his Department was a shambles. I was surprised that he said that there had been no improvement. Anyone who has been a Member of the House for any period of time - new Members can be forgiven - will remember the letters that we got about waits for hip replacements of two, three or four years. That does not happen anymore. Although we have a problem with dentists, there have been massive improvements. When people ask where the money has gone and why productivity has not increased, the answer is simple: a lot of money had to be used to pay the staff a decent salary because they were underpaid under the Conservative Government - I sometimes wish that the staff would remember that, too. The reality is that we now have a lot more nurses and consultants.

I welcome the opportunity for the debate that the Conservatives have given us, although they cannot be taken seriously because when we debated extra money for the NHS - the penny on national insurance - they voted against it. Conservative Members may say that their PCTs are in trouble, but they really would have been in trouble if the Conservatives had won that vote.

Mr. Paul Truswell (Pudsey) (Lab): Does my hon. Friend agree that Conservative Members have a brass neck when it comes to talking about changing the NHS? He has been a Member for longer than me. Does he remember the hugely expensive chaos that was caused by so-called general management, when our area got the manager of a biscuit company to run the NHS? The family practitioner committee became the family health services authority, and that authority amalgamated with the district health authority. The district health authority was then split between three provider trusts and a commissioning health authority, but the commissioning function was then divided between a health authority and a family health services authority. Are we not hearing absolute doublespeak from Conservative Members?

Mr. Martlew: I remember that well. My only caveat is that the biggest employer in my constituency is a biscuit factory and its manager is very good.

I would like to talk about the situation in the north-west and Cumbria. I must say from the outset that we have had too many reorganisations, so I hope that we get this one right. I was a young member of a city council back in 1972 when the ambulance service was part of the local authority, but I do not know whether Conservative Members advocate going back to that situation. Of course, the service was then taken into the health authority, but we must have had eight or nine serious reorganisations since then. I agree that reform is needed because last time it happened in our area, it was not done very well.

Bob Spink (Castle Point) (Con): While the hon. Gentleman is talking about massive changes due to reform, is he aware that Essex strategic health authority is trying to remove the excellent cancer centre from Southend hospital? Does he agree that there can be too much change to, and meddling with, NHS structures without any clear purpose or evidence that it will improve service levels and outcomes, which should be our aim?

Mr. Martlew: The hon. Gentleman wanted to get that in. I have got to know him well over the years and suggest that one reason why he lost his seat at one election was the way in which the Conservatives ran the NHS.

Let me come back to the serious problems caused by reorganisation in Cumbria. In 2002, I wrote a letter to the chief executive of the North Cumbria health authority, who has now retired. I said that the proposals being put forward for my area - the hon. Member for Falmouth and Camborne (Julia Goldsworthy) used this term - were a "dog's dinner".

Keith Vaz (Leicester, East) (Lab): The hon. Lady said, "Dog's breakfast."

Mr. Martlew: My hon. Friend is right.

I said at the time that it was nonsense to create three PCTs in the area of north Cumbria, which used to be Cumberland, for its population of 350,000, but that was what happened. One of the PCTs covered fewer than 70,000 people. All the other north Cumbria Members disagreed with me, as did all the district councils and the county council, but in 18 months, instead of having three management teams, it was decided that there would be one management team and three trusts. We thus have the nonsense at the moment of having three chairs of trusts - one for west Cumbria, one for Carlisle and one for Eden - and those trusts' non-executive members, but one management team. It cost millions of pounds to make the change, but it caused tremendous confusion about which PCT was responsible for which service because, for example, Carlisle and District PCT could end up being responsible for services in west Cumbria. That is why I support the reorganisation.

Cumbria and Lancashire strategic health authority has come up with a solution, but unfortunately it is not the easy one, which would be to keep Morecambe Bay PCT, which is working well and covers the south of the county and part of Lancashire, and create one PCT for north Cumbria. Instead, it has decided to use the county boundaries and go for a county-wide PCT. I accept from Conservative Members that that is basically what the Government want, rather than a reasonable rationale.

Anyone who knows Cumbria will realise that it is vast. Its two centres of population are my constituency of Carlisle and Barrow-in-Furness. Those places are 90 miles apart and have little to do with each other, yet it is suggested that we create one PCT for the area. However, everyone knows that two-tier local government is to be reformed, so we could end up in three years - this is a 50:50 bet - having created a PCT for Cumbria that is not conterminous with the new local government boundaries, which would not make any sense.

The Home Secretary announced yesterday that Cumbria is not really that important because its police service will be in with that of Lancashire - I do not have major worries about that. The ambulance service will be merged, too. I have been to see the chair of my local ambulance trust and the chair of the control. They are not concerned because they believe that being part of a big consortium will create greater buying power, so the service will be able to get the equipment that it has been lacking under the present scheme and thus be brought up to the standard that exists in the rest of the north-west. I do not buy the idea that there is an issue about mergers. If it was left to some hon. Members, we would still have the old county borough of Carlisle ambulance station. We have to think about saving money.

We need a PCT in the north of Cumbria and the one at Morecambe bay. We also need - this was mentioned by my hon. Friend the Member for North Swindon (Mr. Wills), who is no longer in his place - to take that process further. The acute trust should manage the community services and, eventually, the social services. We should have a care trust in the north of the county. That works well, as a pilot scheme in Northumberland has shown.

We will end up with another unsatisfactory situation, and we will reorganise again. We do not want any more reorganisation. It is not necessary; it costs money and on many an occasion it has cost us talented people.

The right hon. Member for Suffolk, Coastal mentioned the problem of rural areas. In north Cumbria, the population determines that we have one district general hospital, but because of the geography, that population is split between Carlisle and the west coast, so we need two. We find it very difficult to manage with the moneys that are available. Governments of both parties have ignored that. There used to be a thing called the RAWP, or resource allocation working party, formula - only two people understood it, and one of them was mad - and that never gave us adequate money. We welcome the extra resources from the Government, but I feel, and I may be alone among north Cumbria's MPs, that they have got it wrong. I felt that last time, and I was right then.

8.30 p.m.

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On behalf of Eric Martlew, 3 Chatsworth Square Carlisle Cumbria CA1 1HB