Daniel Rogerson (North Cornwall, Liberal Democrat)

May I apologise to you, Madam Deputy Speaker, to my hon. Friend Andrew George and to the House for not being in the Chamber at the beginning of his speech? I was involved in the debate on the Business Rate Supplements Bill and took the opportunity to leave the Chamber for a short while, anticipating that the next debate might continue for longer than it did. I am pleased that you found time to call me to speak, however, Madam Deputy Speaker, and I thank you for that.

I congratulate my hon. Friend on securing the debate, and it is fortuitous for Cornwall that he did so as we have the opportunity to debate matters in more detail than we might have anticipated. He addressed clearly the underlying funding issues in Cornwall and focused on some of the problems that have occurred, sadly, in the management of the Royal Cornwall hospital in Treliske. Of course, in turn that has caused problems for the acute trust, but it is important to note that the deal that has been worked out to allow the PCT to support the acute trust as it gets its finances back on track has longer term implications for resources across Cornwall.

Many of my constituents in the western part of north Cornwall use the Royal Cornwall hospital at Treliske and are very pleased with the service there, but people in the east of my constituency tend to go to Derriford hospital in Plymouth, the Royal Devon and Exeter hospital or the North Devon district hospital at Barnstaple. The question is whether the necessary support for the provision of acute services in Truro is drawing resources away from the more accessible services over the border in Devon.

If we were starting with a blank sheet of paper to plan for health investment in Cornwall, we would probably not begin by placing a major district general hospital in the middle of the county. We might put one in both the west and the east, but that is not how things are. Many patients in the east of Cornwall cross the border into Devon for their health services; not only does that pose transport problems, as I shall explain, but it causes peak-time car parking difficulties at Derriford. The fact that services are concentrated there—it is one of the largest hospitals in western Europe—may need to be examined in future.

My hon. Friend the Member for St. Ives mentioned the problems encountered by people living some distance away from major health care centres such as the Royal Cornwall hospital. A while ago, I came across a case involving an older lady in Camelford in my constituency. Having been prescribed a course of therapy in Truro, she turned to the hospital transport system to get herself there, but the cost became so prohibitive that she decided to abandon the therapy. Although her illness was not life threatening, it was enough to affect her quality of life. The therapy had been recommended by health professionals: they said that it would benefit her, and it was something to which she was entitled on the NHS. The only thing that prevented her from taking advantage of the therapy was the fact of where she lived.

A truly national health service must reach into every community in the country. Those of us who live in rural areas know that, unlike those who live in urban areas, we cannot have all services right on our doorstep. There are other compensations about living in a rural environment that people come to Cornwall—or stay there—to enjoy. However, there is a baseline of provision in all public services that people ought to be able to expect, and health is no exception to that. For that reason, I would welcome anything that the Minister is able to say about hospital transport.

Hospital transport services come under threat when fuel costs rise. Drivers get some money to provide those services, but in effect they end up subsidising them when mileage allowances do not properly reflect the costs that they incur. That problem eased when fuel prices fell recently, but it could return as they creep back up again.

In the past, Health Ministers have said that the problem relating to car parking provision needs to be addressed, as the NHS cannot be in the business of providing subsidised car parking. They have added that people need to accept that there is a cost to visiting hospitals, but that is all very well where there is a public transport alternative. In many areas, however, there is no such alternative to car use.

The problem is most acute for older people. So many young people have left Cornwall that the county has an ageing population, and that problem is predicted to get worse. Many older people would prefer not to be forced to use their car to travel the large distances involved in accessing health services, but that is what they have to do.

At the meetings that I have had with PCT representatives, they have said that they are keen to work with the acute trust and consider providing more community hospitals. That, of course, is something to be welcomed. There are many clinics, and there has been wider provision in some areas, but a lot more remains to be done on that. If the NHS were able to concentrate, in rural areas, on trying to widen the range of services available in our excellent community hospitals, that would make a great contribution to overcoming the problem of access; transport seems to be proving a barrier.

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