– in Westminster Hall at 2:30 pm on 24th May 2006.
I shall judge the debate by the Annunciator, the clock on which is accurate, unlike the one ahead of me.
Thank you,Mr. Bercow, for this opportunity to raise the issue of community hospitals. First, I would like to pay tribute to workers in the national health service, especially those who are involved in patient care. I am sure that anyone who has been directly involved personally or through a family member will wish to join in that tribute to NHS workers.
A local journalist asked me on the telephone, "Will this be your usual Haslar speech, Peter?" I said that it would not be my usual Haslar speech, but I would of course be referring to Haslar, specifically the Royal hospital Haslar, which I would claim has become one of the best known hospitals in Parliament.
The background is that the Royal Naval hospital Haslar, which had become the only hospital within the armed forces, became the Royal hospital Haslar. It was, in effect, operating as a second district general hospital in the Gosport area when in 1998, to everyone's astonishment, it was announced that it would close not earlier than 2000. That caused serious problems in the armed forces. They studied various sites where they might locate a hospital and eventually settled, not with great enthusiasm, on the Selly Oak site in Birmingham. They were cheered by the fact that £200 million would be spent on an all new, all-singing and dancing centre that would provide them with messing, sports and other facilities in Birmingham. Unfortunately, however, that project was cancelled. Within the armed forces now, there are serious shortages in most of the important faculties. I shall return to the issue of armed services medicine later in my speech.
The reaction in the south Hampshire area to the closure was one of anger and disbelief. I shall not recount all the facts, as they are very much on the parliamentary record, but there was an unprecedented march of some 22,000 people demonstrating against the closure of the hospital. We demonstrated in every way we could think of to catch the public eye. Wehad "Save Haslar" in lights photographed from a helicopter, we had a relay taking a petition to Downing street, we had demonstrations outside Downing street, and we had many debates in Parliament. After much pressure was applied, a deal was cobbled together with the health authorities whereby Haslar would indeed be saved and would continue to be used for local medical facilities and for the armed forces as well.
Unfortunately, in what I regard as a shameful chapter in the history of health care in south Hampshire, the primary care trust went back on the agreement. It "consulted". Whenever one uses that word in connection with the NHS, one has to put it in inverted commas, because the result of a consultation is usually well known before the consultation takes place. There was local discussion, aided by the consultation, of whether Haslar or Gosport War Memorial hospital should continue as the local community hospital. The votes for Haslar were overwhelming, but at a meeting in a church in Fareham, the PCT unanimously voted against popular wishes and decided to close Haslar and continue the Gosport War Memorial hospital, on the basis of what I have to say was some very unreliable information on matters such as costings, car parking and so on.
Later, I chaired a packed meeting in St. Mary's church, Alverstoke, in Gosport. I believe that 800 people were present, with many standing at the back of the church. We took a vote on whether we wished Haslar or Gosport War Memorial hospital to continue. To my disbelief, every single hand went up in favour of Haslar. I remember asking, "Is there no one here who wishes to say anything in favour of the primary care trust's proposals?" but not a single soul supportedthe PCT.
We went through the statutory procedure. Hampshire county council's overview and scrutiny committee referred the matter to the Minister for reference to the Independent Reconfiguration Panel. I went to see the Minister, who turned down reference to the IRP. The Minister's veto means that Gosport is the only place in the whole of the United Kingdom that the IRP cannot investigate. It has widened its brief, but the only place in which it cannot take an interest is Gosport.
So there we stand. The Royal hospital Haslar is to have its Ministry of Defence support withdrawn with effect from
I turn now to the general picture in the national health service as it relates to hospitals. Spending has increased—it has almost doubled—from £40 billion to £76 billion, but most of that increase has gone on salaries, drugs and compensation, and there has been a 66 per cent. increase in the number of managers. There have been various problems: we all know, for example, that it is much easier to admit someone to a district general hospital than to transfer them out of one, particularly because the Government, in their wisdom, have changed the standards for nursing homes and required them to widen their doors, raise their ceilings, put in en-suite bathrooms and so on. As a result many nursing homes have closed, and the loss of nursing home places has made it difficult to get people out of district general hospitals and into nursing homes. The Government have therefore resorted to the rather shabby process of fining councils that do not have enough nursing home places. Hampshire county council, to give one example, has had to build places in nursing homes.
Although I do not agree with all the hon. Gentleman's preliminary comments, does he agree that one of the problems is that the market has, in a sense, been created the wrong way round? It does not give PCTs sufficient powers or resources and does not allow them to be big enough to be comparable in power to acute hospitals. Where acute hospital trusts have had problems, they have, in their enfeebled position, transferred financial pressures into areas over which they have more control, such as community hospitals. Perhaps the Government have now addressed that by allowing larger PCTs to emerge, similar to the one that has always been present in North-West Leicestershire, which is more comparable to the acute hospitals in the area. Does the hon. Gentleman agree?
I do agree. PCTs have been required to pay so much of their budget to hospital trusts that it has been difficult for them to develop the community facilities that are needed.
I would describe some of the difficulties in the national health service as tactical problems, which derive from the Government's obsession with micro-management. Let me give three examples of that micro-management in the setting of targets. A cancer specialist was sitting in her consultation room, when a manager burst in and said, "You must see the woman in the waiting room immediately." The cancer specialist said, "I cannot possibly see her. She hasn't been referred to me by a GP. I haven't got her notes. She has not been given any tests. It would be absolutely pointless for me to see her." The manager said, "You must see her immediately. She's been booked in. Every minute that she sits there runs against our averages. You must see her now." I can vouch for the truth of that story because I am married to the doctor in question.
I can also vouch for the truth of my second example, although I will spare the blushes of the person involved. I went to see a hospital manager, who told me, "I know, Mr. Viggers, that you have not received the service that you need from this hospital group, but I can assure you that the situation will change. We have doubled the size of our complaints department and put three new people in the public relations department, so I am sure that you will get a much better service in future." People simply do not understand.
I can vouch for the truth of the third example, as well. An accident and emergency unit had to meet its targets and set a period in which to do so. For weeks in advance and for weeks afterwards, there was distortion and difficulty and the unit was all over the place, but it met its targets during the relevant period. The important thing, however, is not meeting the target, but giving a good service.
Let me also give an example of the manner in which the Government have messed around with primary care trusts. In my area, we had Gosport primary care trust, Fareham primary care trust and East Hampshire primary care trust. Then Fareham and Gosport were merged. Then, in an incredible move, it was decided that the two primary care trusts should share management facilities with another primary care trust. Then both were merged with East Hampshire. Now there is to be a merger for the whole of Hampshire. That is very bad management.
I also have serious reservations about the PFI process. I was in the Treasury as a Parliamentary Private Secretary many years ago when the PFI process was first thought up. The point then was to bring private sector skills into the public sector. Now, however, the Government use the PFI process to get borrowing off balance sheet. It is a notable fact that about £2 of borrowing is off balance sheet compared with every £1 on balance sheet. That is very worrying.
Another point is that the contractor who takes the risk under a PFI scheme is in the private sector—he is there to make money, not to lose money. Therefore, in assessing the risk over the 30 years or whatever the period is, he has to assume the worst from his point of view. Almost by definition, that means that the price will be at the higher rather than the lower end of the range. It would take a great deal of skill to make up for that higher price.
Hearing "PFI" triggers in me a sort of Pavlovian response. Does the hon. Gentleman agree that, despite all the wonderful things that the present Government have done in the NHS in the last nine years—I mean that seriously—the PFI is a blemish on that record? It is prohibitive in cost, flawed in concept and intolerable in consequence for taxpayers and the patients and staff in the NHS. More traditional and conventional forms of financing would have avoided some of the difficulties that the hon. Gentleman is illustrating so effectively.
Although I am spiritually in tune with some of the criticism made by the hon. Gentleman, I have to say that the PFI inevitably has some disadvantages. I remember attending a meeting addressed by Sir John Bourn, the head of the National Audit Office. He pointed out that contractors who had undertaken PFI arrangements over the past 30 years had done so before the invention and use of the MRI scanner, which blew all the estimates sideways. None of us knows how medical technology will evolve in the next 30 years, so it is impossible to take a clear and firm view about the next 30 years. There is much to be said for PFI schemes if they are properly administered, but they need to be reviewed every five years or so.
Does my hon. Friend agree that if cottage hospitals such as Swaffham and Thetford in my constituency are to continue their excellent work, Government funding must take into account their position in relation to county hospitals? In Norfolk, the Queen Elizabeth hospital in King's Lynn, the Norfolk and Norwich hospital and others used by constituents in my area face a shortfall in funding. That has a profound effect on the services that they deliver and in turn puts more pressure on the cottage hospitals that serve the same community.
My hon. Friend is an assiduous campaigner on behalf of his local hospitals and he makes a fair point on behalf of his constituents, for which I thank him.
On a strategic basis, because there will always be unlimited demand for medical care, a mechanism is needed to govern its use. The present Government will never be able to get that right: their commitment is to central control, including central control of spending, which will always hamper them. The Government ranks are notably short of business skills and experience and notably full of those who have only spent rather than ever earned money. Conservative principles will be to seek harmonious arrangements with the national health service and an integration of the private sector. We need to choose good managers and then to trust them.
As it is, we have a cash crisis. The health services in Hampshire overspent by £80 million in the year before the election, and we are told by Sir Ian Carruthers that after adjustments they will need to recover some £160 million, preferably during the current year. That leads to intolerable pressures and the closure of hospitals. At present, there are about 350 community hospitals and 80 or 90 are under threat.
That brings me to January 2006 and the document "Our health, our care, our say: a new direction for community services". I am sure that I and my hon. Friends would support many of the principles that are articulated in it. To quote a statement from that document:
"Some community hospitals are currently under threat of closure... we are clear that community facilities should not be lost in response to short-term budgetary pressures".
It goes on:
"We will...invite interested PCTs...to bid for capital support"—
To continue my quotation from "Our health, our care, our say":
"We will further invite interested PCTs...to bid for capital support... This will provide the opportunity to create many new community hospitals".
I very much welcome that, and I would like to fold in another reference to the armed forces, which I mentioned earlier.
In 1998, the Government decided to sever the link between armed forces personnel and the armed forces medical services, so that instead of persons in the Army, Navy and Air force automatically being treated by Army, Navy and Air Force doctors, nurses and paramedicals, they are now given initial primary care at the front by their own personnel and then shipped back, after which they are reliant on the national health service. There is therefore no necessary link between armed forces personnel and those who are injured, which can have some extremely disadvantageous effects.
To cite an example from a newspaper on Sunday, a reservist who had severe spinal injuries was given a walking stick and told to find his way to his own general practitioner. He has had nine operations on his back, which is still causing him extreme difficulty. That has happened because although personnel in the regular armed forces have priority in the national health service, reservists do not.
I was pointing out that armed service personnel are no longer treated within the armed forces but are treated within the national health service, where they are supposed to receive priority. There are two problems with that. First, reservists, when they are dismissed from active service, do not get priority. Secondly, there is no point in having priority if there is no service to have priority within. I specifically cite mental health services. A significant number of service personnel, particularly reservists who have served in Iraq, are suffering from post-traumatic stress disorder but there are no facilities within the national health service to treat them and the only residential unit has closed. Within the Hampshire Partnerships NHS Trust, which treats mental health patients in the south of Hampshire, there were no new consultations at all for many months last year. For both those reasons, I maintain that the present arrangement is not satisfactory. I know that service chiefs are seriously worried about the medical provision for armed services personnel.
There is such a difference between the Americans' attitude and ours. In America, the attitude is, "If we put our boys and girls in harm's way, we will do anything to put them right if they are injured." The attitude in the British armed forces is that if someone is injured, facilities are available in the national health service and one must go and seek them. It is not satisfactory and service chiefs are worried.
There is a model that we could develop. The Aldershot centre for health is a partnership between the Army and Blackwater Valley and Hart primary care trust. It provides excellent facilities, including GP practices and nursing teams, health promotion, diagnostics, counselling services, and drug and alcohol teams. It also has an Army medical reception ward, general practice and psychiatric services, and a standing medical ward. That is the kind of facility that I believe should be used as a model for the constituency hospital of Haslar in Gosport.
I tabled a question last week asking the Secretary of State
"whether his Department has assessed the Aldershot Centre for Health as a model which could be followed at The Royal Hospital Haslar."
Rather encouragingly, the Ministry of Defence states that it
"will be assessing options for innovative partnerships...particularly in the light of NHS developments and future military basing. However, it would be premature"— not wrong, but premature—
"to model another facility on the Aldershot Centre for Health until the functional success of the project has been evaluatedand any lessons have been identified."—[Hansard,17 May 2006; Vol. 446, c. 958W.]
I hope that the Ministry of Defence and the Department of Health will work together and, even now, find a way ahead for the Royal hospital Haslar.
Order. If there are no further Divisions, the debate will conclude at 4.30 pm. It might help hon. Members if I explain that I intend to call the first of the Front-Bench speakers at or close to 4 o'clock. Right hon. and hon. Members will be ableto do the arithmetic for themselves, and if they tailortheir contributions accordingly it will be possible to maximise the number of Back-Bench contributors.
I take careful note of what you say, Mr. Bercow. I will keep my remarks as brief as possible.
I congratulate Peter Viggers. I, like him, want to talk about local problems. That is the best way to approach the difficult debate on how we can save our community hospitals and enhance our community services. I have a series of questions for my hon. Friend the Minister that relates largely to how "Our health, our care, our say" is to be implemented, about which the hon. Gentleman spoke.
I am the fortunate possessor of a document that was sent to all strategic health authority chief executives and directors of performance. It is a public document, so I am in no way leaking information, and it is entitled "Moving care closer to home". It takes up two sides of paper, which is wonderful, because the issue does not need to be spelled out any more clearly, and it highlights community hospitals. I shall read two paragraphs from it:
"In many parts of the country, community hospitals are an important part of the strategy of moving care closer to home. This vision for the future of community hospitals was set out in chapter 6 of the White Paper and the new generation of community hospitals could be either new or refurbished existing facilities. Further guidance will be available in the summer."
It would be nice to hear from the Minister when that further guidance will come. The letter goes on:
"Where reconfiguration proposals of existing community hospitals relate to facilities that are clinically not viable, or which local people do not want to use, or which cannot economically be raised to modern standards, then local reconfiguration is right but we need to ensure that all such proposals are consistent with the long term strategy of the White Paper to move care closer to patients' homes. This is why the White Paper makes a commitment that"— this is the important bit—
"'PCTs taking current decisions about the future of community hospitals will be required to demonstrate to their SHA that they have consulted locally and have considered options such as developing new pathways, new partnerships and new ownership possibilities. SHAs will then test PCT community hospital proposals against the principles of this White Paper.' (para 6.43)"
That is an important mechanism for primary care trusts, and in Gloucestershire all the trusts are facing cuts as a result of problems that I would argue are not of our making. [Interruption.] Well, that is not entirely true of my own primary care trust; I shall be very careful. However, I have always argued that it was wrong to create three primary care trusts in Gloucestershire; there should have been two, and we are now moving to one. Cotswold and Vale primary care trust—my local PCT, which I share with Mr. Clifton-Brown—was created with a deficit. That deficit has not got any worse; the problem is that we are in the strategic health authority from hell, and I look at Steve Webb as I say that. It is continually overspent, and I could share some of my problems with Dr. Murrison as well.
It is because of those problems that Gloucestershire, which has largely kept in balance, is being penalised. It is being asked to make good some of the problems of the strategic health authority and to come into balance very quickly. There is an argument going on—and I shall advance it with the Secretary of State—about how quickly we are expected to get into balance. That is a key debate, but I shall not say much more about that now. In my area, there is a proposal to shut Berkeley hospital. That proposal has been round the circuit before, but it is being eagerly progressed now.
I have been following the story closely in the Stroud News and Journal and read the hon. Gentleman's remarks assiduously. I am sure that he is as confused as I am about whether his trust is required to balance the books in-year or over three years, because there appears to be conflicting advice coming from his hon. Friends on the Front Bench. Has he considered that, particularly in the context of Stroud maternity hospital?
Absolutely; I shall come to Stroud maternity hospital in a minute, because I want that clarified. I have certainly made it clear to my right hon. Friend the Secretary of State that there is confusion about the difference between being brought into balance this year, and being brought into balance while dealing with historical problems, of which there are some in Gloucestershire, although they are nothing compared with those elsewhere in the strategic health authority. That is part of the debate.
Shutting Berkeley in the south of my constituency and trying to relocate those facilities would be a highly dangerous path to take. I can see Berkeley being shut but there still being no money available to create new facilities in the Cam and Dursley area. I want to maintain Berkeley hospital. I am willing to look at the argument for a community hospital with a changed series of objectives. Berkeley hospital has done that well over the past decade and more but, for a population of 50,000 people, we cannot shut a facility until we open something else. I accept that Berkeley serves a smaller proportion of the population in the southern part of my constituency, but it can still fulfil a number of key objectives. If Berkeley were to close tomorrow, that would cause dramatic pressure elsewhere, on Stroud general hospital and, again, the acute facilities.
The cuts are being driven forward at a relentless rate—we are talking signed, sealed and delivered in five weeks, which is abhorrent. People cannot consult and come up with alternatives in that time. I intend to bring forward alternatives and we will test the model.
It is good that the hon. Member for Westbury has gone to Stroud maternity hospital. I am glad he reads my local paper regularly—it usually quotes me correctly, so that is all well and good. The maternity unit is also being sacrificed, so my simple question for my hon. Friend the Minister is this: do the same criteria—which basically say that a better way forward has to be proven—apply to maternity units or are they purely to do with community hospitals? I am trying to elicit a reply because I have tabled a parliamentary question to that effect. I hope that the same criteria do apply and that we go through the same process, because there is a huge amount to do in Stroud already.
We must know by which criteria we are to judge whether it is right to close and what the alternatives are. I state categorically that the proposals are wrong. We have defeated them before and I think that we will defeat them this time. Now things are more difficult, because of the backcloth of huge cuts, but I want clarification on whether those cuts are real and necessary, and have to be met within the time scale that some are suggesting. That is the basis of the case.
"Moving care closer to home" is a useful document. It expresses in very precise terms what I think the Government want to happen. They want more facilities devolved to more local areas. However, the problem is that if facilities do not exist in a local area, it is difficult for services to be devolved to them. That is why I want some clarification about what we are doing and why. I want clarification about the funding streams and the alternatives if we lose the facilities. I would argue that funding and provision in Stroud are imbalanced, yetwe are still being asked to lose vital facilities. Consideration is even being actively given—although this is not part of the formal cuts—to hiving off Stroud hospital to a private enterprise.
As someone who has worked through a health mutual, which I did for the Standish hospital site, I know a bit about the issue. I am not against looking at alternative models; what I am against is salami-slicing the NHS and saying, "That's all well and good", when in fact we are losing facilities and nothing is being put in their place. I would want to test out the model and the notion that the surgical work at Stroud hospital can be removed and replaced with medical beds. They might be needed, because people have to go somewhere, but that would have a huge knock-on effect on what the Gloucestershire royal hospital and Cheltenham general hospital can cope with. More particularly, if we are talking about choice, there is not much of it when the choice is between the acute hospital and nothing, because that is what most people face.
Those are my questions. I have written to my right hon. Friend the Secretary of State, but have not had an answer, although I have managed to talk to her privately about some of the issues. I shall continue to do so. We are lucky; Mr. Harper has secured an Adjournment debate for Thursday on health services. If business works as it might, some of us will say more about this issue then.
Community hospitals really matter. Stroud in particular has a wonderful league of friends, which is offering hundreds of thousands of pounds to rebuild the maternity unit, or parts thereof, and to work on other parts of the Stroud hospital estate. It seems contradictory—on the one hand, we say that we want partnership with the community; on the other, when the community brings forward such a partnership, the facilities in which it is prepared to invest are cut.
The Government have to get a grip. They must be clear that such cuts are not necessary. There has to be some balancing of the books, but I want the Government's case to be proved to me. We should not be losing community hospitals, because they are the very things that we should enhance. I hope that my hon. Friend the Minister has good things to say, at least about how the arguments on the health service in my area and the area around it should be taken forward. People should not just relentlessly drive the cuts forward over a short period. That is unacceptable.
I congratulate my hon. Friend Peter Viggers on securing this debate; it is the second in which I have participated that emphasises the importance of our community hospitals.
In January, I joined the trustee group of community hospitals acting nationally together, which is chaired by my hon. Friend Mr. Stuart; a number of other hon. Members have also joined. The group identified that of 322 hospitals in England, 80 were at risk of service cuts or closure at the point when it did that work. Three of those hospitals were in my constituency, and I want to draw the Minister's attention to what has happened in them so that he gets a picture of what is going on in some of the more remote parts of the country, where the issues are particularly relevant.
As we have heard, the Government publishedtheir White Paper in February. It gave considerable comfort to those of us who are concerned aboutour community hospitals, as it suggested thatthe Government were listening to the concerns of the people who used those hospitals. Many of the arguments that we had put forward in the months leading up to the White Paper's publication coincided with those of the Government, so we had some sense that our message was getting through. It was disappointing, to say the least, that very little of the Government's message seemed to filter down to the bureaucrats who run strategic health authorities and primary care trusts that are responsible for running our community hospitals.
I endorse the hon. Gentleman's remarks about the initiative taken by Mr. Stuart, on which I congratulate him, to ensure that fragmented voices were turned into an organised chant.
Some months ago, we were reassured about the apparent new direction for community hospitals; effectively, 5 per cent. of general hospital expenditure was to be transferred over 10 years. However, there is, was and will be a risk that the finances of those acute hospitals will be destabilised by the proposal. Perhaps the funds should not be top-sliced from their expenditure. Does the hon. Gentleman agree?
Actually, the experience in Shropshire has been the reverse: the primary care trusts are helping to fund the acute hospital deficits. In Shropshire, the deficits have been created in the acute trusts. To repair their budgets, they are looking to extract money from the primary care trusts.
In March, the primary care trust in my area eventually announced that it would not close any of the three hospitals in my constituency. That was a great relief to the community. The primary care trust then produced a document at the beginning of May. As I said directly to the trust when it presented the document to the overview and scrutiny committee, the service plan for Shropshire County primary care trust is a thin, weak document. It fails both to give the context in which the savings are supposed to be made and to provide any clear guidance about whether the proposed savings will be sufficient to meet the deficits that it seeks to identify.
Bridgnorth community hospital has had a great deal of investment by the NHS over the previous 12 months and is currently in the process of being rebuilt, which is welcome. The document said that it would be saved and that it would face no job or bed cuts. That is a great tribute to the people of Bridgnorth, who campaigned actively to save it. The leader of Bridgnorth district council is listening to this debate, and I pay tribute to Councillor Elizabeth Yeomans for the work that she and many others did to save their hospital. That is the good news.
The bad news relates to the other two hospitals. Ludlow community hospital is threatened with the closure of two of its wards, with the loss of more than 30 beds and many jobs—as yet, the detail has not been enunciated by the PCT. The hospital is faced with the closure of the final mental health ward in the Shropshire community, with the exception of a small number of beds in Whitchurch in north Shropshire. Bishop's Castle community hospital—the third hospital—will close; at least, there are plans for that to happen. The site will be handed over to a nursing home operator who currently operates on part of the site. The number of NHS-funded beds will be reduced from 24 this time last year to 12.
The mental health aspect particularly worries me and many of my constituents in Ludlow. The primary argument is that this is a value-for-money exercise, as the mental health ward has not been operated in Ludlow at full capacity and should therefore be closed. The director of mental health in Shropshire County PCT has admitted in public meetings that it is not his preference to have to close the ward and that the decision is entirely driven by efficiency savings required by the PCT to help shore up the financial deficits in the remainder of the Shropshire health economy.
One of the reasons why the mental health divisionin the PCT has operated so successfully within budget in recent years is that its primary provision is at the Shelton hospital. I understand that it is the second to last Victorian mental health asylum still operating in the UK, and it will be the last remaining one, because there are no plans to redevelop it for some time. While its staff do the best that they can, the provision is acknowledged to be substandard. The impact on patients who require acute care of going to that facility is likely to be significant and the impact on the carers who look after them is likely to be even more so, because the geography involved in travelling from the Ludlow catchment area to Shrewsbury is significant.
I shall briefly illustrate that point. Yesterday, a group of concerned residents led by John Nash undertook a journey from Ludlow to Shelton for a theoretical one-hour visit by public transport. The six of them caught the 435 bus from Ludlow to Shrewsbury at 11.50 am. They had to change in Shrewsbury to catch the bus to take them to the hospital at Shelton. One of the group is a frail lady in her 80s who is a former physiotherapist, and she got home to Ludlow at5.40 pm, which represents a journey of almost six hours for a one-hour visit. She would currently be able to walk around the corner to her local community hospital. The ability for the carers of our most vulnerable mental health patients to continue to provide such family contact, as it were, will be severely reduced.
I should like to dwell briefly on the impact of the closure of the other rehabilitation wards. The NHS has argued that it should justify the closures on the basis of an equity audit. The equity profile of primary care and community services for Shropshire County PCT, published in May 2005, argues that
"NHS improvement, expansion and reform should narrow the health gap by ensuring that service planning is performed by an equity audit."
The equity audit that has supposedly been carried out to justify the reduction of rehabilitation beds has not been made public. It has been argued that attempts are being made to provide a fairer allocation of beds across the county, which is why beds are being cut in Ludlow and Bishop's Castle. Yet the document also covers the question of need, which was not addressed in the PCT's latest analysis, among the 18 catchment areas in Shropshire. Four of them serve the Ludlow community hospital area, and they all have a higher need for the 65 to 74-year-olds, as identified in the summary, and all bar one are in the higher category for the 75-plus group. Three of the four catchment areas have the highest dependency ratio per catchment area in Shropshire. Three of the four have the lowest ratio of GPs per head of population in Shropshire, and two of the four have the lowest number of patients per practice nurse.
There is a clear need for beds to be available in Ludlow, and for long-term beds in Bishop's Castle. I have been pressing the PCT to commit itself to a 10-year contract for NHS-funded beds. Experience elsewhere in Shropshire shows that it will commit to much shorter contracts, but that once they end, the number of beds is cut. That salami slicing cannot continue, or our community hospitals will all be closed within a short time.
Order. Time is running out, and I appeal for short contributions.
Thank you,Mr. Bercow. I will try to be brief.
The NHS in Oxfordshire is in freefall. Today, the Oxford Radcliffe NHS Trust is telling its staff that between 650 and 700 posts will be lost—the exact number will be known tomorrow. By my calculation, that is equivalent to about 8 per cent. of the work force. The loss is occurring as a consequence of £33 million of savings imposed on the trust, in addition to the£17 million of savings that Oxfordshire PCTs have been obliged to make. As a result, the new and enlarged Bicester community hospital promised by Mr. Milburn when he was at the Department of Health has now become a complete fantasy.
The White Paper was another fantasy. "Our health, our care, our say" repeated the promise made at the previous general election about having a new generation of community hospitals. Can the Minister tell the House where that new generation of community hospitals is? It is figment of the Minister's and the Department's imagination. There are no community hospitals. Then we are told that community hospitals no longer need beds and that the Government's new concept of primary care centres—better, larger GP practice centres—are somehow new community hospitals. It will not wash.
Last week, I met the acting chief executive of the PCT, who said that because of the enormous squeeze on its budget it is concerned only about acute care. Anything that can be moved off into social care—anything that can be means-tested by the county council—will be moved. An article in one of the Sunday newspapers referred to a new kind of nursing home in Hampshire, in which people are moved from NHS beds simply to die under the responsibility of social care.
We will see an increasing number of people who would have expected in the past to be treated at community hospitals shunted off to somewhere else in means-tested social care, because the NHS no longer has the funds to manage such cases. The PCTs say that they no longer wish to look after such patients. Somehow, they will become lost in the community. It is a disgrace. We are not going to see a new community hospital in Bicester. If we were to have a new generation of community hospitals of the sort that was promised at the Dispatch Box by the Secretary of State in the mid-1990s, one would have expected it to have been delivered. It is a fantasy.
I want to know this from the Minister: what from this White Paper has ever been delivered? It is a public policy disgrace that Ministers come along and waste taxpayers' money with a fake consultation. No public meetings were ever organised in Oxfordshire on "Our health, our care, our say"; what the Government had was a fake meeting in Birmingham with a hand-picked audience. People are becoming increasingly cynical about what the Government are delivering, and I say to Mr. Drew that the part of the Stroud newspaper that he ought to start reading is the appointments page, because given the way the Government are cutting—he used terms such as cuts and sacrifices—come the next election I fear he will be looking for another job. Clearly, as is evidenced in our debate, across the country, county by county, this Government are waging war on community hospitals and community medical services.
I congratulate Peter Viggers on securing the debate. Many useful points have already been made. The hon. Gentleman said that the Royal hospital Haslar is one of the best known in Parliament. That is true; it comes a close second after West Cornwall hospital.
I wish to raise a single issue, which I hope the Minister will respond to. It is to do with the thesis—or, as I would argue, mantra—that has been coming from the NHS Confederation, which is, as I understand it, the provisional wing of the NHS; it certainly puts out a lot of the arguments that Ministers might not be prepared to argue. Its argument is that the acute sector requires fewer hospital beds. It is a thesis that has become a mantra in the style of the management consultant culture that seems to have pervadedthe NHS.
What worries me is the way in which that approach relates to the future of community hospitals, which is a very pertinent question. When I have debated this matter with GPs nationally and locally and with the trusts that argue that we should push for such an approach, I can understand the frustration of those running the acute sector about large numbers of patients going into acute hospitals who, they argue, should not even be going through their front doors. In other words, they are saying that there are unnecessary admissions to acute hospitals. That may well be the case, and there is also another argument that has been made today and which is repeated regularly with regard to the difficulty of discharging patients once they have come into acute hospitals.
The approach taken by the NHS Confederation—and supported by Ministers, I would argue—is causing a great deal of difficulty for acute hospitals and nursing staff, who have to cope with other Government targets on communicable diseases. In many acute hospitals, bed pressures mean that there is a lot of hot-bedding. Severely and acutely ill patients are being moved around hospitals or discharged from them, and other patients are moved in. One of the best ways of getting on top of infection control issues is to manage beds so there are surplus beds in acute hospitals, not too few.
In order to achieve the outcome of fewer acute hospitals, which may be desirable in the longer run, the Government need to address such issues, many of which they have in fact contributed to. The way in which the primary care GP out-of-hours service is currently managed means that many patients are not seen by their GPs out of hours. Given an environment in which there is an increasingly litigious public, ambulance-chasing lawyers and so forth, on the precautionary principle many patients are admitted to acute hospitals when they do not need to be. That trend will inevitably continue, and it may get worse.
As my hon. Friend will be aware, the out-of-hours service in our county of Cornwall has recently changed from a locally based service to a service provided by a much larger company. Does he agree that there are concerns in communities that the provisions under the new contract perhaps do not deliver as local people expect them to?
I agree with my hon. Friend, although in view of the time available I shall not elaborate. There is a scenario in which clinicians appear to be overruled by bed managers, while chronic conditions are still not well managed in the community and many patients who could be managed in the community therefore go into acute hospitals. Crucially, in the light of social services and primary care funding, it is not possible to discharge patients from acute hospitals to social services care or community hospitals, because beds have been cut. In my constituency and in many parts of the country it is becoming impossible to discharge such patients.
To achieve the desired outcome I urge the Minister to recognise those factors and reflect on the need to front-load the argument by ensuring that investment is made in primary care and community hospitals and that there are sufficient social services resources to enable patients to be discharged safely to community hospitals or the community, away from acute hospitals.
I am grateful for the opportunity to contribute to the debate and to my hon. Friend Peter Viggers for ensuring that it was called. As my hon. Friend Tony Baldry has said, the survival of community hospitals in Oxfordshire is a huge issue—probably the most important in my constituency.
There are three community hospitals in my constituency: one in Wallingford, one in Didcot and one in Wantage. My constituents are also served by a fourth, in Abingdon. As the people of Oxfordshire are now well aware, we are suffering an acute financial crisis. Oxfordshire is part of the Thames Valley strategic health authority, which has the lowest funding per head in the country. By contrast, I understand that the strategic health authority that covers the Prime Minister's constituency is among those with the highest funding per head. I wonder whether that is a coincidence.
The Oxford Radcliffe Hospitals NHS Trust is the most efficient large hospital trust in the country, yet it is being asked to make £33 million-worth of cuts. My hon. Friend the Member for Banbury alluded to job losses. I understand that it may tomorrow also announce up to 150 bed closures. What will the result be? The answer is obvious: more pressure on our community hospitals.
The reason why those hospitals are called community hospitals is that they were built by the people who used them. They were built 70 or 80 years ago, by their communities, to serve their communities. Now they serve as an overspill for the John Radcliffe hospital, and just as they are under threat they are being asked to take on yet greater burdens.
Every hon. Member who has spoken in the debate and has alluded to a sham consultation process is right. People who have made their feelings known and want community provision and a community hospital are completely fed up with the fact that every year a consultation is held to try to persuade them to want something that they do not want. The debate that goes on between the high-ups—the professionals who claim to know what they are talking about—and the people is about whether community care should be closer to home or in the home. It is put about that care in the home will be superior and better. I do not buy that. Most people in community hospitals are grateful for ready access to medical care and grateful to be with other patients.
The vital thing, to which my hon. Friend Mr. Dunne alluded, is that those hospitals remain in their communities. Particularly in predominantly rural counties, the idea that elderly relatives can easily visit relatives in a hospital that is 10, 12 or 15 miles away is ludicrous. The mayors in Wantage, Wallingford and Didcot did the same exercise as that in Shropshire, and they spent six hours getting from A to B and back again. Such easy visits are simply not possible. Two weeks ago, the A34, the main trunk road in my constituency, was closed after an accident. The scene was like something from a disaster movie. People took four hours to travel from Wantage to Didcot. We need community hospitals in our communities.
It all comes down to money, I am afraid, and nothing angers people more than when the Government put out a White Paper saying that they will not close hospitals for financial reasons and that the money is there if the clinical case can be made. It is quite clear that these hospitals are being closed for financial reasons—there is no other reason. What particularly sticks in the craw of the people of Wantage is that they have just bought the land from the PCT to build a nursing home for £800,000. It is being built and paid for by the community. The money has gone to the PCT, which is now going to use it for what? The PCT will try to close down their community hospital.
The idea that a county such as Oxfordshire can be served by one huge hospital and nothing else is laughable, and I have told my PCT again and again that it could have a far more reasonable debate with the people of Wantage, Wallingford and Didcot if it accepted the principle that people want a community service. Instead of saying, "We are closing your hospital—let's consult about it", it should give some clear, credible, alternative proposals that people can sign up to.
There have been a number of interesting contributions to the debate and I hope that the new Minister will take on board the strength of feeling of Members from all parties. As Members have mentioned, I am the chairman of CHANT—Community Hospitals Acting Nationally Together—which is an umbrella group for Members of all parties in the House of Commons, and those in the House of Lords, who are concerned about the future of community hospitals. They are concerned because they share precisely the aspirations of Government policy.
Many hon. Members have already referred to "Our health, our care, our say", but we do not just need to consider that document. The new Minister may have seen the previous primary policy instrument for this Government on health, the 2003 document, which was called—believe it or not—"Keeping the NHS local". Before that, in 2000, we had the NHS plan, in which there was a commitment to bringing care closer to home. For six years, the Government have espoused views that Labour Back Benchers, Liberal Democrats, independents and Conservatives all agree make up precisely the vision that we need.
However, when we look around the country, we find that the very community facilities needed to make the change from acute hospital-centred care to care given much closer to home—either in the home, where appropriate, or in the community close to home—are being closed down. Hundreds and hundreds of beds have been closed in community hospitals during the past six years, while the Government are espousing a need for care closer to home.
The NHS Confederation has been mentioned. A few days ago, bizarrely, it issued a slim document called "Why the NHS Needs Fewer Beds". In Hornsea community hospital in my constituency, the number of beds has been cut from 22 to 12 and there have been regular waiting lists. An elderly lady who could see the community hospital from her front room in Hornsea could not be admitted because there was a waiting list. Meanwhile, the chief executive and chairman of the acute trust in Hull told me that the hospital is often running at more than 100 per cent. capacity.
We have a bizarre conflict between stated Government policy and the reality on the ground. The Government should make good their position on health; all hon. Members recognise the near doubling of expenditure on the NHS. I hope that the new Minister might be like the new Home Secretary, coming to the Department with fresh eyes and able to see that it needs serious change. Members throughout the House want the Minister and the Department to defend our community hospitals and support them, because they will deliver the Government's policy for them. Until now, we have questions that have not been answered.
To make a very, very short contribution, I call Dr. Julian Lewis.
It is a privilege to follow my hon. Friend Mr. Stuart, who has done an outstanding job in setting up the national co-ordinating campaign. All those of us who were fighting our individual campaigns knew that that needed to be done, and I take my hat off to him—he has done an excellent job and a service to us all.
Earlier today, Mr. Bercow, you renewed your efforts to save the Nuffield speech and language unit in Ealing. A couple of days ago, I received a delegation of mental health users from the emergency clinic at the Maudsley hospital in south London who were desperate that their specialist centre should not be closed down. Every so often a collective, pseudo-ideological mania seems to take over some of our public services, and it can be seen in the way in which children are taught to read or taught through play; in the wholesale closure of mental hospitals and the decanting into the community of far too many people who are unable to cope; in the closure of special schools, which has been gathering pace; and in the current determination to say that the NHS needs fewer beds.
I have time to make only one point to the Minister, and it is this: when he winds up the debate, will he please not tell us that it is for local decision takers to take responsibility? The Government are at the top of the tree, the community is at the bottom, and the so-called local decision takers, who staff the PCTs' bureaucracies, are in between. Which group is the odd one out? It is the one in the middle—the one that is not elected. It is the Government's responsibility to ensure that the systems that they set up are responsive to the communities that they are supposed to serve.
Finally, the Minister should not tell us how much money he has been putting in. That is like saying that we are pouring more and more water into the bath when there is a great hole in the bottom of it. The bath will never be full, because the water will drain away faster than we can pour it in. We are interested not in the resources that are going in, but in the outcomes that are not coming out.
It is appropriate that the final contribution before the winding-up speeches should highlight the issue that underlay many of the other contributions, but which was not made explicit: accountability. What has run throughout the debate is the notion that local people are clearly expressing their preferences—the term "sham consultation" keeps coming up in these Westminster Hall debates—but that we can do nothing about it when nobody listens.
That causes me to ask the fundamental question of whether we need to look at accountability in the national health service and decide whether we are satisfied with the present arrangement, whereby just one person—obviously, she is not present today—is accountable for the 1.3 million people who work in the NHS, or whether there needs to be closer, more local accountability. We have that in embryo form in local authorities' overview and scrutiny committees, but they are weak, and one of the few things that they can do—this links to the introductory remark made by Peter Viggers—is to refer a decision to the Secretary of State and ask her, in turn, to refer it to the independent reconfiguration panel.
I was interested in the hon. Gentleman's remarks, because his experiences are identical to mine. I had a hospital closure in my area, and the local authority asked the Secretary of State to have it looked at independently, but she refused. There is history in that respect. Although there is an independent panel, it does not, on average, get asked to look at the things that local authorities want it to consider, because the Secretary of State stands in the way. We therefore have no serious local accountability, and the one bit of local accountability that we do have gets overridden by the Secretary of State, who refuses to let someone independent look at things.
We therefore need to look at serious local, democratic accountability in the NHS, and it will be interesting to find out in the Conservative winding-up speech whether there is anything in the Conservatives' plans, to the extent that they exist, to deal with local democratic accountability and to determine whether the people who make the decisions—it is rude to call them faceless, but they are the people whom we cannot get rid of—should be replaced or answerable to elected representatives, because, at the moment, they are not. That is the frustration.
We have heard some important points. The hon. Member for Gosport, who secured the debate—I congratulate him on that—gave some powerful examples of micro-management and of targets distorting the NHS. I met a woman only this morning who had a specific need to see a particular consultant. She said that she was happy to wait to see the right person, but was told that she could not wait because she would go past the target. She was told that she would be sent to someone else and said that that specialist would not know about her. She was told that which did not matter and that she had to see a consultant so that she would be off the list. She went to see the other consultant, who asked, "What are you doing here? I cannot help you." She said that she knew that but that she had been sent so that the box could be ticked. That is the sort of absurdity that arises.
I was interested to hear from my constituency neighbour, Mr. Drew, about the situation in his area. He came up with a criterion with which many of us have sympathy. None of us is emotionally wedded to bricks and mortar. Buildings that were once fit for purpose may no longer be so or may be in the wrong place. No one is saying that nothing must ever change, but we want proper public engagement without a preconceived agenda.
It was good to hear the hon. Gentleman and David Taylor—the Statler and Waldorf of the Labour Back Benches—pointing out that Government health policy rhetoric is fine, but the disjunction between the rhetoric and reality shows that the Department of Health is out of touch with what is really happening. The classic example is the White Paper on community hospitals. The disjunction is that when something goes wrong locally, the decision was made locally, but when 500 new or upgraded community hospitals are planned, they are the Government's responsibility. How can both be true simultaneously? The Government are responsible for good news and new hospitals, but bad news and closed hospitals are due to local decision making and nothing to do with the Government. Both cannot be true, so which is?
In this very Chamber Mr. Dunne properly raised the issue of his local community hospitals and Tony Baldry raised another critical point about the absurd division between health and social care. While we have different budgets and something can be shunted into someone else's budget, the welfare of the individual will come second to the financial pressures. Again, the logic of the argument that we have heard today is that budgets should be merged and pooled with a single stream of health and social care funding and democratic, local accountability. Those are two big steps, but that is what I want and it would deal with many of the points raised. We would then have responsive public consultation and effective social and health care.
My hon. Friend Andrew George properly raised the issue of capacity and the extraordinary situation that when beds are cut, occupancy rates rise well beyond the level at which even experts in infection control believe they can do a good job. There will then be another Government target, initiative and action plan to tackle MRSA or whatever the bug of the day happens to be. There is no joined-up thinking in the whole process.
Mr. Vaizey made an important and incisive point about the difference between care closer to home and care in the home. People often slide between the two. It is assumed that we all want care closer to home, but many of us need specialist and local NHS facilities close to where we live which we can get to even when the A34 is blocked. The Government increasingly do not mean beds close to home; they mean people going from their homes to a super-GP clinic or something like that. There is no intermediate step.
What is it about community hospitals that we favour? It is localness. Being treated close to home has a medical benefit, because loved ones can pop in and friends and family are nearby. It is the human scale of such hospitals. People do not want one dirty great hospital for the whole county. They want local hospitals where they know the names of the staff and can build a relationship. Caring for people locally is evidence-based medicine on a human scale and takes pressure off the large acute trusts.
We must not allow the myth to continue that community hospitals are inefficient and bad value for money. Putting someone in a small community hospital instead of tying up an expensive acute hospital bed is good value for money and good for the individual.
We need a merger of health and social care budgets to avoid cost shunting and we need serious local accountability. We also need funding—funding is not irrelevant—and I have supported that, but we need more than funding and the Government should listen to what local people are saying because, at the moment, local people have no voice.
We need to be clear about what we are dealing with. We are dealing with closures that have been prompted by deficits, which is the responsibility of Ministers. Steve Webb asked what the Conservatives would do to improve accountability. Accountability rests squarely with the Secretary of State for Health who, ultimately, is responsible for the closures that we have seen. Most Conservative Members would, for reasons to which my hon. Friend Peter Viggers alluded, attribute the deficits to the actions of the present Government, and I would like the Minister to answer for the 80 or so closures that are threatened up and down the country.
I admit a constituency interest. On Friday, I visited the four community hospitals in my constituency, all of which are threatened with the axe. There was a fifth—Bradford-on-Avon—but it has already closed. I also visited an EMI—elderly mentally infirm—unit for 26 in-patients in Trowbridge, which caters for a large part of Wiltshire. That, too, is threatened with closure, together with the maternity unit, so I have some sympathy for Mr. Drew. All those facilities will go.
The hon. Member for Northavon talked about evidence-based medicine. I do not think he really understands what evidence-based medicine is. There is no evidence that the plans that the primary care trust has produced would do anything other than destroy what we have traditionally enjoyed in my part of Wiltshire—good local health care. All the evidence suggests that we would lose a great deal and pick up very little in return. The PCT, in the spirit of the age, will talk about taking health care closer to patients, and of course we would all wish to be treated in our home if that were possible.
I apologise for not being present for the whole debate—it is not possible to do everything in this place. My hon. Friend is aware of the announcement made in Gloucestershire on black Wednesday, as I call it, that 12 institutions would be closed or have their services severely curtailed. That was to involve a loss of 250 beds and more than 200 staff. In Gloucestershire, we will not have many health facilities left other than the two acute hospitals. That is what the present Government have reduced the health service to in Gloucestershire. Does he agree that what needs to be considered is people's welfare, not just bottom-line budgets to rake back last year's and this year's deficits?
I agree. What my hon. Friend describes is what Ministers have told us should happen. It is clear from the White Paper that short-term budgetary fixes should not result in the closure of community hospitals, so he is right. I have visited a couple of his local community hospitals and I am as distraught as he is to hear of their closure. We are told that intermediate care teams will sally forth and look after people in their own homes. Come on, we live in the real world. We all know that people will not receive proper hospital care at home. The best that people can hope for is health care in homely settings in the community. That is what people have at the moment in areas that are blessed with community hospitals. I understood from the White Paper that the community hospital model would be expanded across the rest of the country, but it appears that that will not happen. We hear about new-generation community hospitals, but the reality is that well before they appear, we see hospitals such as Bradford-on-Avon and those in my hon. Friend's area closing. At the very least, we are putting the cart before the horse.
We have to accept that when those institutions close, a whole generation of health care workers will be lost. People who work in community hospitals are very special. They are often seen to be on the margins of health care, and often they are. They usually work in community hospitals for particular reasons. They choose to work in those hospitals, yet there seems to be an assumption that when the hospitals close, the workers will all march off and rebadge themselves as community nurses or district nurses, or perhaps work in acute centres. Clearly, many of them will not do so and many of the particular skills that they have will be lost. I do not think that the Minister has thought that through adequately.
I shall not dwell at length on sham consultations. Suffice it to say that I am as incensed as most other hon. Members who have spoken that a culture of cynicism should be built up around what should be a perfectly reasonable thing for us to do—ask people what they want in terms of health care delivery in their locality. I now have to say to my constituents, "Please respond to the primary care trust's consultation because it will take your silence as assent to the plans." However, most people are reluctant to take part, because they see themselves putting a great deal of time and effort into consultation in good faith and then finding the PCT simply proceeding with an agenda that it created beforehand.
The White Paper makes a number of referencesto community hospitals, and it actually refers to Trowbridge community hospital, which is interesting, because under the primary care trust proposals, that is one of the community hospitals that will close. It says, in bold, that
"PCTs taking current decisions about the future of community hospitals will be required to demonstrate to their SHA that they have consulted locally and have considered options such as developing new pathways, new partnerships and new ownership possibilities."
There is very little room for weasel words there.
There is a delicious irony, because many of the hospitals had what I suppose, in retrospect, were new partnerships, which were created by the communities that they served. They were often the gift of a local benefactor and they have been supported royally over the years through local effort. I am intrigued and, in all candour, I am interested to hear the Minister's take on exactly what those words mean, and to hear how he will encourage new partnerships and new ownership possibilities. What does he have in mind, and how will he make sure that those partnerships happen? I actually think that partnerships are quite an imaginative solution for the future, but they will not happen if the Government do not support them, and they will certainly not happen if PCTs do not support them. His comments on that point would be most welcome.
On Monday, the NHS Confederation produced what is best described as a leaflet. It was much trumpeted but it contains very little apart from anecdote, and it does not mention community hospitals at all, really. The issue of what on earth will be done as the number of acute hospital beds continues to be reduced is left hanging in the air, but people will have to go somewhere.
Interestingly, a couple of months ago, Dr. Foster, a body that is in some level of partnership with the Department of Health, published a paper in the British Medical Journal that compared health care in America with health care in this country. Of course there are differences between the two countries, but it is instructive to note how much more reliance America puts on intermediate care, and how little time people spend in acute hospitals in America compared with people in this country. America also has greater reliance on intermediate care beds, which of course are cheaper.
Health maintenance organisations that manage health care in America are, of course, run by accountants, and they are very exercised by how much health care costs. Primary care trusts are getting it all wrong in trying to save costs by disestablishing the intermediate care level. The Minister looks surprised, but I am surprised that he has not been given the paper by members of Dr. Foster—they came to see the Opposition Front Bench team earlier this week—because it has a partnership arrangement with the Department of Health, and it seems that the research is crucial to what we are discussing today. I can send it to him, but I point out that it is in the BMJ of March this year, so he can look it up for himself. It seems that we have been given a false prospectus by primary care trusts, which hold that we will save money, as we will, of course, in the very short term, in terms of balancing the books in-year, but in the longer term the result will simply be more cost.
We are rusticating cost from one part of the public purse to another. We heard earlier about how social services will bear much of the burden for all this. Likewise, voluntary organisations will pick up the bill for things such as palliative care, and of course carers will pick up a lot of the burden, as well. So when we talk about cost, we must ask: the cost to whom? That is extremely important.
I apologise to the hon. Member for Stroud for intervening on him, but we take a particular interest in what is going on in Stroud. I am pleased that his contribution was so powerful, because it is all very well for my hon. Friends to debate the issue, but the fact that someone on the Labour Benches is doing so will, I hope, have more impact on the Minister than we have had hitherto. In connection with Stroud maternity hospital, it will be particularly interesting to hear which of the following holds: the January 2006 operating framework for 2006-07, which said:
"All NHS organisations should plan to recover deficits for previous years and balance their books for 2006-07 or the Secretary of State's letter dated
"organisations which are overspending will be required to show improvement and by the end of 2006-7 be in monthly balance."
That is, monthly expenditure should cancel out or equal monthly income. It will be interesting to know which one of those propositions holds true, because clearly both of them cannot be true. There appears to have been something of a difference, and clearly Gloucestershire is working to the former proposition, not to the latter. That is important in the context of Stroud maternity hospital.
Order. I am sure that the hon. Gentleman will bring his remarks to a close very soon, as the Minister must have an opportunity to reply.
Thank you, Mr. Bercow. I am indeed bringing my remarks to a conclusion. I hope that the Minister will address those points. In particular, I make no apology for underscoring my constituency interest, which informs my more general concern that stems back 25 years.
I congratulate Peter Viggers on securing the debate. He raised a number of interesting and important issues that deserve a proper response. We have heard good contributions to the debate, particularly from Mr. Dunne. Steve Webb, as always, made a good contribution and some important points. The good turnout this afternoon shows the depth of feeling about community hospitals in communities across the country.
I do not doubt the sincerity of the hon. Member for Gosport, but I doubt the quality of some of the analysis he gave us about what is happening in the national health service today and since 1992. I have doubts about some of the statements that have been made in the course of the debate, such as the suggestion that the Government are doing nothing to support community hospitals.
Tony Baldry made something of a rant, which was uncharacteristic—if that helps, as I do not think he is normally associated with such speeches. He talked about the Government "waging war" on community hospitals. That is simply not borne out at all by the facts on the ground. I have a quote for him from the Community Hospitals Association, an organisation with which he will be familiar. On its website, it states:
"Despite common belief there are still, in Great Britain, over 470 Community Hospitals. And for every closure in recent years there has been a new hospital opened."
The hon. Gentleman's views are simply not borne out by the facts.
A number of hon. Members have mentioned the NHS Confederation's analysis that was put before us this week. I refer the Chamber to a table in that report that shows the number of hospital beds lost in the20 years from 1984 to 2004-05. If we consider the figures for 1997-98, we see that there were 148,828 beds in the national health service. In 2004-05, there were 145,218. That is broadly the same figure, with a small reduction. If we look further down the table, we see in the period from 1984 to 1997-98 a reduction of 63,000 beds during those years of Conservative Government. A little more humility tempering the strident comments of Conservative Members might not have gone amiss.
I do not have a great deal of time, so I will press on.
Our manifesto made absolutely clear our commitment to a new generation of community hospitals, rebuilt or refurbished, with state-of-the-art NHS facilities. Our commitment to the future of community hospitals was further highlighted by the recent White Paper, to which many hon. Members have referred. "Our health, our care, our say" firmly placed community hospitals, old and new, at the heart of achieving the shift in care and resources that the White Paper signalled. I say to Conservative Members that during the period when they were in government it was very much the trend that the acute sites began to draw in more and more services. That is what we saw in communities up and down the country, not least in my own, where the accident and emergency department at Leigh infirmary was closed. That was the direction of travel in the '80s and '90s.
I will not. The reduction of 63,000 in the number of beds in our national health service is the evidence of that process. The direction that the White Paper has laid out—
On a point of order, Mr. Bercow. Is it in order for the Minister not to have read the NHS Confederation's pamphlet, produced on Monday, to which I referred? He has completely misled us.
I reject the suggestion that I have misled Members. I was giving figures from the NHS Confederation, issued this week, which show the true state of our national health service. Raising a frivolous point of order when I have been left with little time does not help our debate.
We made our commitment to community hospitals because that was what the public told us strongly in the consultation, "Your health, your care, your say". People want services to be available closer to where they live, and they want health and social care to become more seamless with more personalised and integrated care. That point was fairly made by the hon. Member for Northavon. It is true that people want to be treated in familiar, comfortable surroundings.
England is unusual among developed countries in that a high proportion of care is accessed through large, acute hospitals on-site, particularly for out-patients. That is why the White Paper laid out clearly our intention to move toward more local and community provision. We want the NHS to challenge the status quo that has seen care increasingly centralised in large institutions. If we are serious about shifting care, we need to make sure that the facilities out in the community are fit for purpose, and that they are not simply bricks and mortar that have been there for a long time, but modern, good quality facilities in which the kind of care for our constituents that we all aspire to can be provided.
Picking up on the NHS Confederation theme, there is a challenge for all elected politicians, in this place and locally, to get beyond some of the emotion. Thatis what it is challenging us to do. The NHS Confederation called for a well informed debate on these matters. It is incumbent on every one of us, as leaders within our communities, to lead that debate rather than follow it. We, too, should put informed positions into the public domain about hospital reconfiguration. Let us make no bones about it: from time to time there will need to be reconfiguration of services to reflect modern standards and aspirations. The duty to lead that debate is incumbent on us all.
I will now pick up on a point made by thehon. Member for Gosport. There is an onus on the NHS to listen to local opinion when it is expressed ina moderate and reasonable way, where local representatives have gone out to listen to their communities and taken the trouble to work through the detail of proposals. The NHS needs to be good at hearing that debate and the argument coming back the other way. I accept that it might not have done that well in the past, and that we need to make sure that our consultation within the NHS is true consultation, but that is a two-way street. All hon. Members should reflect on that.
A new generation of facilities is already being put in place. The hon. Member for Banbury asked where they are. Examples include Colchester and Tendring PCTs, which have recently seen a primary care centre and a community hospital open under the NHS LIFT—local improvement finance trust—initiative. There are other examples with a number of other services: Colchester primary care centre is providing a renal dialysis unit that will provide local facilities for patients who currently travel to London or Cambridge three times a week for treatment. Harwich hospital is a new facility constructed on the grounds of an outdated community hospital. It will provide numerous specialist primary care and diagnostic services, as well as an operating theatre, in-patient beds and a maternity unit. They are the evidence of the new generation of facilities that the hon. Gentleman asked for. It is there, on the ground, and it is benefiting patients across the country.
I was asked for evidence of the manifesto commitment. There is capital: a significant sum of money has been set aside to enable communities around the country to come forward with plans for new community provision. More information will be made available and a statement will be made soon as to how that capital can be accessed. It is not possible to build new hospitals within a year of our manifesto commitment, but the commitment will be honoured.
I shall pick up on some of the specific points raised by the hon. Member for Gosport, because he deserves a detailed response to them. I understand the concerns in his communities about the transition in service provision; we all acknowledge that that can be difficult to understand. The hub-and-spoke model that is proposed for his area—given the geography of his constituency—must respect all the communities in it. To be viable, the hub-and-spoke system needs to consider all the communities, not just one in isolation. A new facility is being constructed at Fareham. Seeing the health economy in the round is important, and it is crucial to ensure that one community's aspirations do not cut across the legitimate aspirations of another for modern health care facilities in their area.
I say to my hon. Friend Mr. Drew that we will make an announcement on the White Paper in due course, which will apply to all kinds of services, including maternity units; it will cover the breadth of services. We want PCTs to look carefully at the White Paper; it is not just words, and we want them to see clearly the direction of travel and provide the kind of services that his constituents and mine want on the ground.
The hon. Gentleman—
Order. I am sorry to interrupt the Minister, but we must now move on the next debate.