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7.4 pm

Mr. Jon Trickett (Hemsworth): I wish to associate myself with the remarks that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) made about you, Mr. Deputy Speaker, and about the high quality of the staff--clinicians and managers--employed in the health service in the Wakefield area.

Until recently, I was a publicly elected representative in a major city--Leeds. I was closely involved with the Leeds health service for a considerable time. We had two relatively robust general hospitals, albeit within a flawed health care structure. Since being elected to represent Hemsworth, I have been dismayed to discover the fragile state of the health service in our district.

My constituents come within the catchment areas of Pontefract and Pinderfields hospitals. I can therefore express an overall view of the services provided right across the district. The NHS provision in the area suffers from a series of structural problems, which, taken together, produce a service in serious crisis. In no particular order, I shall identify seven structural problems.

First, the continued underfunding of the service in our area has been compounded by the recent changes to the funding formula. That means that our district is to lose several millions of pounds a year, and is certainly the worst loser in the region. Secondly, there is a lack of recognition in the funding formula of the problems that arise from trying to apply a uniform health service across such a heterogeneous set of communities as there is in our district.

The third structural problem is the acute fragmentation--almost a disintegration--of the health institutions in our district. There is clear evidence of a breakdown of confidence between the health providers: the two acute trusts and the community health trust. As Members of Parliament for the district, my hon. Friends and I have been informed of the extraordinary allegations that have been made by people in one or other of those organisations against their colleagues.

Fourthly, that fragmentation has been seriously exacerbated by the effects of the internal market. There is evidence of what can only be regarded as irresponsible

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poaching by each of the trusts from the others, and by trusts outside the district. More serious still is the impact of the extension of GP fundholding in the Wakefield district, to a point where every practice is part of the fundholding system, thereby achieving twice the national average level of GP fundholding. The impact of that extension of fundholding is not yet fully understood, but it is already having a serious effect on the acute trusts.

In my constituency, at least two practices have constructed, without proper planning, what can only be described as mini-hospitals, which are taking services away from the existing acute trusts. It is widely believed that services are being purchased by GP fundholders in our district from hospitals as far away as Manchester and Glasgow. I have been informed of patients being sent by taxi to hospitals in Manchester for minor ophthalmic operations. I have been told of one patient who was taken by taxi to Manchester airport and flown to Glasgow for a relatively minor operation that was paid for by a local GP fundholder.

The fifth problem is that the health service in the area suffers to a degree from regional imbalances. The presence of big neighbours, such as Leeds, inevitably causes problems for smaller hospital trusts. The sixth problem is the general morale in the district, which, as in the rest of the country, is now poor. Hospital trusts are suffering from major problems of recruitment and retention of key staff.

The seventh problem is the lack of leadership among those who have been appointed to give directions to the health service in our area. In Pinderfields, both the chief executive and, now, the chair of the trust appear to have been removed without adequate public explanation, and with no private explanation to any of us who represent the area. I am led to believe by a senior individual in the Pontefract region that the chair of the trust there is likely to be reappointed only for a single year. Can anyone--such as the Minister--explain why such action is being taken? Why was the Pinderfields chair removed recently, and why was the chief executive removed? We have been given no explanations about that, or about why the unusual procedure of establishing a single-year appointment has apparently been adopted.

My exposition of those seven structural problems may not constitute a comprehensive description of all the difficulties facing our area's health service, and not everyone may share my analysis; but it is clear that nearly everyone who is interested in the health service in our area believes that the service faces serious difficulties. Anyone who doubts that should read this week's edition of The Independent on Sunday, which draws attention to the extraordinary fact that a whole ward of nurses has been privatised. It is understood that this is the first time that nursing for a whole ward has been put out to tender. That must be regarded as a step towards privatisation of the health service, either by stealth or, possibly, by incompetence.

The answer from those responsible for the health service in the area has been wholly inadequate. They have been unequal to the task, tackling only one symptom of the problem rather than the multiple causes. To suggest that we can solve all the problems to which I have alluded, and others as well, simply by merging two acute trusts is a grotesquely inadequate response that fails to recognise the scale of the crisis. Indeed, such a response does not address one of the structural problems that I have

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described. It disappoints by its lack of ambition; it was also badly bungled, and the manner in which it was executed was arguably illegal, or at least outside the law. If it was not illegal, it was certainly unethical.

How could anyone seriously believe that the public consultation could be conducted properly and transparently by individuals who not only were the authors of the merger proposals but were actively advocating the cause of the merger during that consultation--and, moreover, appeared likely to benefit from the merger? No one could have confidence in a public consultation exercise undertaken in such a way.

Particularly extraordinary is the fact that, when the views of local residents and health care users were supposedly being obtained at public meetings, members of the project team did not merely attend those meetings to provide information but advocated the proposals--and then commented on and participated in a debate that was taking place, supposedly, among health care users. Even more extraordinary, they then proceeded to vote.

At a meeting in Upton, in my constituency, an extraordinary event took place. Every member of the public who was present voted against the merger; every one of the seven votes in favour came from one of those who had been brought along by, or were apparently connected in some way with, the project team who had been charged with consulting the public. It is bizarre, surely, that one of the principal architects of the proposal for a merger, a senior executive on one of the trusts and a member of the board, was actually found to be voting in favour of a merger about which he was supposedly consulting the public.

Will the Minister now tell the House why the public consultation exercise was aborted--why it was handed over to the district health authority, and removed from the project team? I have received no explanation; indeed, I have received no information that such a change has taken place. I understand that no other local Member of Parliament has been told that a new round of public consultation has been taking place. I consider that a fundamental error. Perhaps it will be explored in other places.

Public consultation about the merger has produced overwhelming hostility from the people of the area. Other than those with vested interests in the outcome of the proposal, no significant represented body or elected individual throughout the Wakefield district--as far as I am aware--has been found to favour it. The proposal was cooked up behind closed doors, and no one has yet made an admission to Members of Parliament representing the district about who first came up with the idea.

What we do know about the mystery is that primary care providers were certainly not consulted at the time. Surely it is outrageous that the community health trust in particular--on which the merger will have a direct bearing--was not consulted when the proposal was being drafted. It is also apparent from first-hand accounts given to me--and others--by local general practitioners that they were not consulted, either. Moreover, we know that the district health authority was not directly involved in the drafting of the proposal. Finally, it appears that the consultants were not involved in the conceptual stages, either individually or as a body.

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Who sponsored the original suggestion, if it was not the clinicians and those responsible for the direct provision of care? It seems that the whole train of events was concocted by Department of Health officials, whose primary motivations were financial and administrative rather than clinical. There is also evidence that those same administrators had been conducting discussions with developers about a private finance initiative in relation to the district hospitals, concurrently with preparations to seek the trust merger. Indeed, one of the chairs of the hospital trusts let the cat out of the bag to local Members of Parliament when he informed us that a named private sector developer--we know the name--had requested that the discussions about the PFI in the Wakefield area in relation to the hospitals be put on ice until the proposal had been agreed.

The Secretary of State had suggested to the district Members of Parliament that he would judge any merger proposal on the basis of improvement in clinical care; yet we know that the basis of the merger document about which we are now being consulted was financial and administrative rather than clinical. Indeed, the whole thrust of the document is based on non-clinical considerations. It could not be otherwise, given the way in which the merger proposal itself originated.

Hon. Members will search the document in vain for any detailed proposal about clinical changes. A reading of the document, taken together with discussions with practising hospital clinicians, leads to the conclusion that the reconfiguration of clinical services that is implied--but not made explicit--in the merger document will be revealed only subsequent to any decision to merge. That is clearly putting the cart before the horse. Changes in the structure of the NHS should follow clinical change, not vice versa.

A reconfiguration of the services is inevitable if a merger takes place, as we all know; yet the public have no idea what the new configuration will look like. Notwithstanding that, they are still being required to express their views during the current flawed public consultation exercise.

Although those who manage the health service in the district have not been prepared to come clean about the new configuration, I think that it is possible to guess its likely shape. In the absence of evidence to the contrary, here is my own educated guess about the likely shape of the health service in the district within a few years, given that the merger proceeds and assuming the continuation of the financing regime of the current Conservative Government.

I guess that a single privately owned acute hospital--possibly on neither of the two existing sites, and clearly geographically and clinically remote from the communities that I represent--will have emerged. Statutory ratios will have changed, and the terms and conditions of staff employment contracts will have been renegotiated. Indeed, secret discussions with the trade unions are already taking place on those matters.

The clinical services will have been transferred--sometimes out of the district entirely--and frequently devolved to fundholding practices. Already existing tensions with other health providers will be exacerbated and the community health trust's future will be placed in jeopardy. Heaven knows what will happen in the case of statutory duties of care that are owed to certain vulnerable

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groups. I understand that, in some cases, those duties have already been transferred out of the district to other providers.

That is not the right outcome for our district. I do not accept that the current modus operandi in relation to the consultations is valid in determining the district's needs. What is required is a halt to the merger proposal until such time as a major review, of the type described by my hon. Friend, takes into account both health needs and the district's institutional structures, dealing with, among other points, the seven problems that I outlined.

I hope that the Minister will deal with our request for an overall review and, even at this late stage, put on ice the merger discussions until we can identify the long-term future of health care, which all our citizens would dearly love to be of the best.

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