I am grateful to you, Mr Streeter, for chairing the debate. I believe that your constituency is also devoid of minor injuries units, so you might pay particular attention to the debate. I am also grateful to colleagues, including my hon. Friend Justin Tomlinson, for taking time out of their hectic schedules to attend. I am grateful to my hon. Friend Guy Opperman, who, as many will know, worked selflessly on the judicial review that resulted from the shutdown of services at Savernake hospital. If I had a pound for every time I was told during my selection campaign, "If Guy Opperman was standing, you would not stand a chance," I would be a very rich woman today. Thankfully, we have both made it to this place and can campaign together on this and other important topics.
I am also especially grateful to the Minister for attending, as I know that the launch of his team's momentous proposals yesterday means that he must have an extremely long "to do" list. I would also like to mention briefly my local paper, the Gazette and Herald, which is a tireless campaigner against the loss of our local health services, as well as the hundreds of other individuals in the constituency who have protested, petitioned, written letters, held meetings and tried their best to roll back the tide of closure and service erosion.
I want to mention briefly the DASH2 group-Devizes Action to Save Our Hospital-and the new Devizes health matters forum, which was set up only this month to try to resolve the impasse we have reached. I will also mention the CASH group-Community Action for Savernake Hospital-which fought long and hard to keep open the day hospital and the minor injuries unit at Savernake hospital in Marlborough. That hospital was completely rebuilt in 2005 under a PFI contract that will cost taxpayers almost £70 million over 25 years, but the services at its core-the day hospital and the minor injuries unit-closed less than a year after it reopened. The hospital now hosts a multitude of services completely unrelated to local health care, such as the eating disorders clinic for patients of the Oxfordshire and Buckinghamshire mental health partnership, while Wiltshire primary care trust scrambles to pay its unitary charges.
For my constituency, which is the 25th largest in England by land area and home to more than 91,000 people, the past 13 years of NHS management has meant multiple top-down initiatives, a continual reshuffling of priorities and the management of local health services by quangos. The result is clear: a slow and steady erosion of our local health services, despite the protests of clinicians, patients and politicians. Let me refresh people's memories of what we have lost. In the Devizes hospital, the UNICEF award-winning maternity unit, the in-patients' facilities, the minor injuries services and now the X-ray department have all gone. In Marlborough, the day hospital, the maternity unit, the minor injuries facilities and now 50% of in-patient beds have also gone. That pattern has been replicated throughout the rest of Wiltshire as services have been farmed out to neighbourhood or community teams-they can deliver good outcomes in some cases, but not all-or concentrated in larger hospitals in Swindon, Bath and Salisbury.
In January 2007, Wiltshire PCT set out its vision for services in the now infamous document "Reforming community services in Wiltshire", which announced the closure of minor injuries units in Devizes and Marlborough and the axing of a host of other services, which was driven in large part by the burgeoning financial deficit that the PCT had inherited after the merger of three other organisations. In my view, the loss of reliable local minor injuries services was the most keenly felt of all the changes. My constituents literally have nowhere to go locally if they suffer a fall, cut, wound or some type of minor trauma. Nurse practitioner-led minor injuries units had served the constituency well for years. They were well used, cost-effective in comparison with sending patients to far more high-spec accident and emergency departments, and extremely popular. Indeed, with the exception of the head of the PCT, I could find no one-literally not one person-who though that it was a good decision to close those minor injuries units and ask people to travel instead to Trowbridge, Chippenham, the Great Western hospital or a walk-in centre in Swindon, the Royal United hospital in Bath or Salisbury district hospital.
My constituency ranks among the 20 lowest by population density in England, with only 20 people per hectare. Members who have visited Devizes-I hope that many will-will know that there are almost no dual carriageways, no railway connections between our major towns and few direct bus services. As a result, there are extended journey times, which is particularly problematic for families or individuals without full-time access to private transport, who account for 25% of the people in Devizes.
I thank my hon. Friend for giving way in this crucial debate that she has secured for Wiltshire residents. I want to highlight a concern that supports her specific point about public transport. When the Great Western hospital in Swindon was set up in my constituency, there was an emphasis on green travel, so there was a limit on parking provision. The residents of Devizes who are sent to Swindon almost invariable come by car, and there simply is not adequate parking provision.
I thank my hon. Friend for that important point. We have built hospitals following the sound principle of encouraging local travel and walk-ins, but the major service review forgot that most bus services do not run to the existing services from the places where minor injuries services used to be provided. In fact, it is impossible to take a bus from Marlborough to any of the six suggested units for minor injuries services.
I was interested to learn what the current PCT guidance recommends, so last night I phoned NHS Direct and asked what I was to do if I had a bad cut and lived in Pewsey, which, as many will know, is in the centre of my constituency and, as home to around 4,000 people, one of the largest villages in the area. I was advised to go to Swindon hospital's A and E unit, which is considered to be a journey of only 16 miles. However, as we know, the concept of "as the crow flies" does not give a good indication of distance in rural constituencies. In fact, a simple search on Google maps reveals that that journey takes between 38 and 46 minutes by private car, which is far too long for a mother of a child with a bleeding head wound, or the carer of an older person with a fracture that needs immediate attention.
Let us consider the journey that the residents of Honeystreet, a lovely village in the heart of my constituency, would be advised to take to get to the nearest service. By private car, it would take them 37 minutes to get to Chippenham hospital, or 40 minutes to Trowbridge hospital. In fact, there is only one other constituency with a lower population density and no minor injuries provision: South West Norfolk. Most of the other spread-out rural constituencies are blessed with more than one such unit. Indeed, they trumpet their facilities as being appropriate for populations in a rural area. North Devon has four units, Rutland and Melton has three, and the nearby constituency of The Cotswolds also has three units. Those constituencies all have population densities that are similar to or slightly lower than that of Devizes.
We might all be asking how the situation has arisen. I submit that it is because decisions about our local health care have been taken by decision makers who were unelected and unaccountable, and often uninterested in the local consequences of their actions. It was not because they were bad, malicious or unintelligent-there are many good and dedicated health care professionals in the PCT-but because the whole system rewarded top-down compliance with central Government diktat and ignored the needs and wishes of the population. Indeed, when I went to see the head of Wiltshire PCT only last week about the proposals in the White Paper that we have heard about, he said that he had no intention of reopening the minor injuries units that we have lost and that there was no case for doing so. I would like the Minister's opinion of whether a case can be made for those services.
I would like to cite four facts to frame the debate. The population in my constituency, as is the case across much of rural Britain, continues to grow. There is a population flow from the cities to the villages and hamlets of the UK. The population in my constituency has increased by 5% since the turn of the decade. Indeed, part of the support for the redevelopment of Savernake hospital resulted from the prediction of 20% population growth in the Swindon area.
The Alberti report "Emergency Access", which was published by the NHS in 2006, suggested that it was better clinically and more cost-effective to send patients out of A and E departments and into local urgent care centres where more nurses, paramedics and nurse-led emergency care practitioners could be used to treat them. I am grateful to the PCT for providing data showing that, in the past year, there have been 17,086 attendances by patients registered in my constituency at the minor injuries units in Trowbridge and Chippenham, and the A and E departments in Salisbury and Bath. As I have already stated, the journeys that people have to take to access those facilities are unacceptable. The cost of providing the services at the current tariff is £1.352 million.
With our new localism agenda, and given the cost that the PCT is paying for minor injury services for my constituents, surely a business case could be made for restarting a minor injury service in the constituency, as long as the total cost was below the current tariff. Some doctors in Devizes and Marlborough have expressed an interest in restarting the service and having it delivered by nurse practitioners located in their practices. Premises are certainly available in which the service could be located, including the half-empty and shuttered Savernake hospital.
Will the Minister tell us how, in the light of our NHS reforms, we can move the process forward? The current PCT, which will be in existence for at least another two and a half years, has no interest in recommissioning the service, so can we go around it in the interim period and use sustainable communities legislation, for example, to get back those services that we so desperately need?
I commend the hon. Lady on securing the debate. Some years ago, when the closures first happened, we petitioned Wiltshire county council's health overview and scrutiny committee to intervene on our behalf. I will be grateful if the Minister indicates whether it had a role to play in standing up for the residents, constituents and patients who have written to the hon. Lady and me. Melksham in my constituency has lost its minor injury unit, and it was far closer to her constituents than the one in Chippenham.
I thank the hon. Gentleman for that excellent point. It is interesting that a subtopic of the debate is the PCT's failure to deliver a new primary care centre in Devizes, which was promised as part of the quid pro quo when the closure announcements were made. When I suggested last week that perhaps the time had come to rip up the original plans that seem to be stymieing progress, return to the drawing board and ask whether we can deliver a hospital in Devizes under the current constraints, I was referred back to the council's overview and scrutiny committee, which clearly has an important role to play in defining the services that we need for our local community. Will the Minister say whether, instead of waiting until 2013, we can submit pilot proposals to the national commissioning body when it is up and running and start to make progress, for example by looking for voluntary sector partners to begin a pilot programme?
There are few things that unite all the people in my constituency, but the feeling that we have been short-changed by our PCT and the NHS over the past 13 years is almost universal. I am sure that we are all united in welcoming the exciting proposals that the Secretary of State announced yesterday, and I know that the ideas of equality, excellence and liberating the NHS, and the possibility of getting back some of our minor injury services, make my pulse beat a little faster.
I congratulate my hon. Friend Claire Perry on securing this important debate. I know that local health services are a top priority for her and that she campaigned vigorously before coming to the House, and has done so since, as we have heard today, on behalf of her constituents to ensure that she obtains the best health care provision for the people she so ably represents. I admire her dedication and determination in fighting that battle for her constituents. I pay tribute to the NHS staff in Devizes and throughout Wiltshire for the excellent care and dedication that they provide day in, day out when looking after my hon. Friend's constituents and those of other hon. Members in the county.
My hon. Friend is aware that my right hon. Friend the Secretary of State has launched our White Paper on liberating the national health service. It is our vision for freeing the NHS from the shackles of politicians and bureaucrats in Whitehall, giving power to people locally, and working with clinicians and general practitioners to provide those services that local communities in Devizes, Wiltshire and the country need. It is a vision for making the NHS more accountable to patients, whether my hon. Friend's constituents in Devizes or people elsewhere. We want to free staff from excessive bureaucracy and top-down control. We want patients to be at the heart of everything that the NHS does and we want local people to have more choice and control than they have ever had and a greater say in their treatment, their needs and their health requirements. People in Devizes and the other small towns and villages that my hon. Friend mentioned will be in charge of making decisions about their care and provision of health requirements.
My hon. Friend has outlined the strength of feeling in her constituency for local minor injury services, and the support for the NHS generally. The minor injury units for Devizes and Marlborough at Savernake community hospital closed in September 2007, and my hon. Friend and her constituents were, understandably, disappointed at the decision, and have been frustrated by the difficulties and delays that have resulted from it. I am aware that people living in different parts of her constituency access different minor injury units, including those at the community hospitals at Trowbridge, Chippenham, Andover and Newbury, and that minor injury treatment continues to be available at the A and E departments in the acute hospitals in Salisbury, Bath and Swindon. As my hon. Friend rightly said, transport access causes problems for some of her constituents. I have considerable sympathy with the points she made about that.
I am also aware that my hon. Friend's constituency covers a large rural area. She gave some interesting figures and comparisons with other rural constituencies when making her point so powerfully. I understand her desire for local minor injury units that are accessible as quickly as possible to her constituents. But I must be frank with her. Given where we are at the moment and the processes that have taken place in her county and constituency on reconfiguration of services, I am unable to ask the NHS to open previously conceded processes, or to halt those that have passed the point of no return. I know that that will disappoint my hon. Friend, but I am afraid that at the moment we are where we are because of previous decisions and the degree to which they are in process.
My hon. Friend asked what could be done, and whether pilot schemes could be introduced as a forerunner to the abolition of PCTs in 2013, and she suggested other ways of working with outside interests. I want to give her as clear a steer as possible, and unfortunately, until the PCTs are closed and cease to exist in 2013, due processes and proper procedures must be adopted to move forward. Until they are phased out from 2013, the PCTs will continue to have the same responsibilities that they have now for the provision and commissioning of health care in the areas for which they are responsible, including Wiltshire.
I pay tribute to my hon. Friend Claire Perry for carrying on the work that we have all been doing for a considerable period on hospitals in Wiltshire. I spent three years of my life trying to keep them open. The Minister is saying that in reality, whatever the situation, despite the Health Secretary saying in 2007 that clinical need should justify closure, despite this being fundamentally an accounting measure, and despite decisions apparently not being reviewed before 2013, people are desperate for a hospital to reopen that is pre-existing, prepaid and sitting there-
It is a long question. I apologise, Mr Streeter, but the hospital is still there, and capable of being used. With the greatest respect, I fail to see why it is not being used.
I am grateful for my hon. Friend's intervention and I fully appreciate his frustration at the situation. I also appreciate the greater frustration of my hon. Friend the Member for Devizes, because her constituency is directly affected by the issue that we are discussing. I repeat: we are where we are. We have a vision of a health service that works from the bottom up rather than the top down. However, until the changes occur, we are in a straitjacket because of procedures currently in place that have to be adopted.
Before the intervention by my hon. Friend Guy Opperman, I was responding to the question from my hon. Friend the Member for Devizes about the way forward. I hope to give her a glimmer of hope and I will give her some advice about how I see the situation, both as a constituency MP and as a Minister. As long as we are in what is effectively an interim period since the publication of yesterday's White Paper, with the PCTs still commissioning services and having the lead role, I advise her to continue her spirited and dedicated campaign to get what she seeks for her constituents. She should continue seeking to persuade the PCT, local clinicians, GPs and the local community to stay onside in the desire to establish a minor injuries unit, and ensure that the other care services she mentioned are instigated for her constituents. At the moment, that route is the only way forward because the PCTs are the commissioning agents.
I urge my hon. Friend to continue her campaign in the hope that during the interim period over the next three years, she will see a change of heart if that is possible. If it is not possible, when the changes come in, she should use the new system to seek to persuade those in charge of reconfigurations and the provision of services to reinstate the services that she so passionately and rightly believes are needed and deserved by her constituents. That is my advice. It may not be as palatable as she would hope, but I know that she will appreciate and understand that under current circumstances, we have not yet changed the system. That vision was announced yesterday and it is a vision for the future.
By 2013, if we get our ducks in a row, get our clinicians onside and our draft contracts drawn up, will we be able to present that business plan-in whatever forum we are in-to the national commissioning body and have some chance of success? Is there hope that within a three-year period before the next election we might get those services back under a new contract commissioned by the central body?
Obviously, I cannot give a commitment that my hon. Friend would be successful. I wish her well in her endeavours, but it is not for me to prejudge what might happen. She is certainly right that if she puts all her ducks in a row-as she put it-with a business plan for what she believes her constituents need, she can present it to the national commissioning board and to GP consortiums in her area. Everybody will then work together, and make an overwhelming case for what my hon. Friend wants to see delivered for the local people of Devizes and her constituency.
As my hon. Friend will accept, "The times they are a-changin'". The Government's approach is different from the top-down approach taken by the previous Government. We believe that local decision making is essential to improve outcomes for patients and drive up quality. We will do more than just talk about pushing power to the local level; as the Secretary of State's White Paper shows, we are going to do it and make the dream a reality. That will be of considerable help to my hon. Friend in her campaign.
Given my hon. Friend's experiences during her ongoing battle, she will agree that we must move away from having Whitehall dictate how care should be delivered in Devizes, Westbury or any other town or village in Wiltshire. We believe that change must be driven from the bottom up, and that the patient must be the heart of health care provision. The patient must be put first; their interests and quality of health care is the No. 1 priority, not the decisions, ramifications and shenanigans of politicians and civil servants.
In future, all service changes must be led by clinicians and patients, not driven by Ministers such as me, or civil servants from the Department of Health. Only then will the NHS achieve the quality improvements that we all want to see.
In his search for local accountability in decision making, it would be helpful if the Minister advised hon. Members where in the process the public's demand for these services will be heard. Is there a role for locally elected politicians to secure influence in determining outcomes through the health overview and scrutiny committees of our local councils?
If the hon. Gentleman refers to current arrangements, he will no doubt be aware that in late May, the Secretary of State announced changes to the criteria that need to be taken into account in any reconfigurations currently under way-providing that those reconfigurations are not so far advanced that it would be impossible to reverse them-and any future reconfigurations. The main priorities include taking into account the views of local people, clinicians and GPs and ensuring that health care is relevant for the local area.
If the hon. Gentleman is asking what will happen after the changes in the White Paper, let me say that once the PCTs are wound down and abolished, there will be a transfer of powers to the national commissioning board and all that flows downwards from that. Provision and responsibility for the commissioning and delivery of health care in a local area will be linked to local authorities, and accountability will be through local authority input with locally elected representatives. Public health is currently dealt with through the input from the primary local authority level in each area. That is where the accountability will be. The predominant point is that because one must have a locally driven health service, the wishes of the patient-not only in their individual care but in the requirements of the local community-must be fundamental to the decision about units or configurations. I hope that the hon. Gentleman and my hon. Friend are reassured by that.
In conclusion, I once again pay tribute to my hon. Friend for her commitment and dedication in fighting so hard for her constituents, not only before the election but afterwards. She has been in the House for about eight weeks, and she has already made her mark fighting for her constituents on the issue that she promised, during those long days in April, to take to Westminster. She is now in Westminster and has brought the issue to the debate today. I have every confidence that she will continue to use the means available to her in the House to pursue her agenda, and that she will mobilise support in her constituency to ensure that the issue does not go away. She will be determined to get what she believes to be the best health care for her community, and I wish her every success.
Sitting adjourned without Question put (