I am glad of the opportunity to contribute to the debate, not least because I, like many others here, have received a positive snowstorm of letters about the health service in past months. There is a sense of bewilderment about the changes. It is a pleasure to follow Charlotte Atkins, who started her speech by saying that there had been far too much change in the NHS, something on which all Conservative Members would agree.
People in Hampshire cannot understand why the huge increase in resources provided by the Government has not led to an improvement in services. Even worse, despite those increased resources, some services are being cut in some areas: dentistry and hearing aids are two examples in Hampshire. The series of events has contributed to the feeling that the NHS is once again in crisis. I want to examine some of the reasons why, and to relate them to the problems that my constituents are experiencing in Hampshire.
First, there is a conflict between payment by results and the desire to retain and promote community hospitals. It is clear that payment by results should not have been introduced until a formula had been devised for protecting community services. Payment by results inevitably leads to larger hospitals, where there are economies of scale, having the opportunity to increase their patient throughput and therefore their income from primary care trusts, while the smaller community hospitals find that they cannot compete on the same basis. The Government said in their White Paper, "Our health, our care, our say: a new direction for community services", that they wish to deliver more health services in the community. If that is the case, the Government needed to find a mechanism to ensure that payment by results did not undermine community services, but they failed to do so. It is no wonder that about 100 community hospitals are now under threat.
My constituents have experienced the vulnerability of community hospitals twice in the past few years. In Alton, the community hospital faced partial closure in the summer of 2005; 24 of the 48 in-patient beds were closed because of staff shortages and a financial crisis. Eventually, those beds were partially restored, largely as a result of pressure from local GPs and the community, which caused managers to look again at their priorities. The Grange maternity unit at Petersfield was also closed in 2005, at three weeks' notice, because of alleged staff shortages. It took another vigorous campaign—of longer than a year—to get it reopened.
The new chief executive of the NHS, Mr. David Nicholson, seems to suggest that midwife-led maternity units, such as the one that we have in Petersfield, should be closed and that only consultant-led maternity units should operate in future. That is a reversal of the move away from the highly managed, rigid and clinical approach to childbirth that was common in the 1970s. Some Labour Members seem to have forgotten that it was women themselves who rebelled against the birth factory concept and their campaigning helped to bring about the sort of local maternity services that we now have.