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Mr. Giles Radice (North Durham): I congratulate my hon. Friend on obtaining this Adjournment debate--she is using the opportunity to debate this issue with her customary skill. I want to add my voice to her assertion that there is a crisis of confidence in hospital provision in north Durham. We want to hear from the Minister some reassurance that there will be the leadership necessary to get us out of this crisis. It is a crisis of confidence, not only for those who work in the hospitals, but for patients and for our constituents.

Ms Armstrong: I could not agree more. Indeed, I was about to say that someone has to get hold of this sorry affair and make sure that the people of north Durham get some reassurance. Those people are covered by my constituency, by my hon. Friend's constituency and by the constituency of my hon. Friend the Member for City of Durham (Mr. Steinberg), who is unfortunately unable to be here this evening, but who has been supportive of efforts to ensure that something is done.

Reassurance will not come merely with warm words. The Minister must demonstrate today, first, that the Government recognise the crisis facing the people of north Durham in terms of hospital care and, secondly, that he is prepared to take action. The future of the new district general hospital does not feel secure. I want a commitment from the Minister tonight that the Government still intend to ensure that the PFI for the new district general hospital will go ahead.

Reading the Red Book for last week's Budget, I was concerned to learn that it allows for only half the projects currently being pursued in the health service to proceed over the next three years. That suggests that the Government will allow some to fall by the wayside and that a proposal that is not picked up by the market may not become reality.

That will not do. A new district general hospital for north Durham must not be left to the vagaries of the market. Surely the Government must have projects that they are not prepared to allow to fail. We seek from the Minister an assurance that they are not prepared to see a new district general hospital on the Dryburn site fall by the wayside because the contract is not right or because they cannot reach a private finance initiative agreement at this stage.

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What will the Government do to ensure that the necessary developments outlined in the letter from Dr. Robson take place? Before more services are moved from Shotley Bridge to Dryburn, we need to be sure that Dryburn is capable of receiving those services, delivering them effectively and caring properly for patients who will go there.

What will the Government do to ensure that there is an opportunity for the development of the community hospitals at Chester-le-Street and at Shotley Bridge? Dr. Levick, general practitioner in Consett, has done some excellent work for Shotley Bridge. Following wide consultation, he put together an excellent proposal for a community hospital which, if it is able to proceed, will become a model of its kind for the next 20 years. I seek reassurances that the Government understand the need for that facility and are determined to ensure that it will come into being.

We raise the issues in the House because of the real anxieties of our constituents. Recrimination does not take us forward, and we need to go forward. I cannot impress on the Minister too strongly the need for urgency. People in our area should have a health service that they can rely on and have confidence in. I am sorry to say that that confidence is ebbing away. It is our responsibility, in the positions that we hold as representatives of the people, to be the guardians of the health service.

I believe that the Government have let down the people of north Durham. Our constituents deserve better and I hope to hear from the Minister tonight that they will get better.

8.21 pm

The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I acknowledge the persistence of the hon. Member for North-West Durham (Ms Armstrong) on this issue, and her grave concern about the provision of hospital facilities in her part of Durham. I also acknowledge the concern of the hon. Member for North Durham (Mr. Radice), who intervened in her speech.

May I first say something about the accident and emergency service and relate some of the history of this matter? In March 1995, Ministers approved the closure of the accident and emergency department of Shotley Bridge hospital, where about seven of every 10 patients were treated for purely minor injuries, and approved its replacement by a nurse-led minor injuries unit.

That followed more general public consultation on the proposed reconfiguration of services between Shotley Bridge and Durham. The A and E department dealt with 18,000 attendances each year, well below the threshold recommended by the British Association for Accident and Emergency Medicine. That agreement followed more general public consultation covering proposed reconfiguration of services between the two hospitals.

All serious cases are now redirected to North Durham trust's main A and E facility at Dryburn hospital. However, in conjunction with the changes, North Durham trust did the following things. It appointed an additional consultant to the A and E department at Dryburn; upgraded the A and E department at Dryburn at a cost of £1.25 million, to provide increased facilities such as resuscitation bays; and installed a high-technology communications system--telematics--to link the two hospitals at Shotley Bridge and Dryburn.

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The hon. Member for North-West Durham will concede that ambulance services have responded well. There are now paramedics on every emergency ambulance in the Consett area, and a high-dependency paramedic unit is stationed in Consett. It is equipped to allow paramedics to fax ahead vital information to Dryburn hospital.

The trust also issued leaflets explaining those changes, to help people understand them and to help the Shotley Bridge minor injuries unit to receive cases that it would be appropriate to treat there.

Ms Armstrong: I did not want to intervene, but it would be exaggerating to say that Members of Parliament feel that the ambulance service is doing everything well. There have been several hiccups. Although we want to demonstrate our confidence that the Durham ambulance service will in the long run get it right, we have not been altogether satisfied. We have had to deal with some very difficult issues in the past few months.

Mr. Horam: I take the point that some cases may have been less than satisfactory, but I am describing the new arrangements that have been made, and I believe that, in general, the performance of the ambulance service has been very good.

I recognise also that recently there has been concern in Durham because, as the hon. Lady said, some non-urgent patients have had to wait longer than usual for treatment at the A and E department. The North Durham acute trust has recognised that, as she said, and has acted speedily. In any case, it had always planned to review the A and E changes after six months.

The trust set up an internal review of its A and E department, and it will act quickly on many of the recommendations from the action plan produced by the review team. These proposals include: improvements in staffing of the A and E reception, so that nurses can use their time more productively; the appointment of a senior nurse to act as a nursing leader for the A and E department; and improved nurse staffing levels.

Contrary to what the hon. Member for North-West Durham said, the trust has allocated extra funding to cover the cost of those improvements until the end of March. It is also implementing a wide range of measures to improve communications with patients and prevent delays for patients awaiting admission.

The trust's chief executive recently emphasised that those improvements were being made. Last week he said:

"Despite the fact that the A and E department is treating an increasing number of patients, the overall quality of medical care provided is extremely high. It is important to remember that all emergency cases have always been dealt with immediately and this will continue to happen".

So we should keep in mind the fact that patients do receive high-quality care in the A and E department of Dryburn hospital. The minor injuries unit at Shotley Bridge hospital is still capable of treating the vast majority of cases that previously went to the former A and E department there. Moreover, the new enhanced service represents a safer alternative for some seriously ill patients.

The hon. Member for North-West Durham mentioned the future role of Shotley Bridge hospital. I understand her worry about that. I understand the anxiety of local

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residents. As she knows, the Shotley Bridge working party was set up in 1995 partly in response to local concerns about the proposed new role for Shotley Bridge hospital. She is familiar with the history of the development of Shotley Bridge hospital, and I believe that the way in which it is developing has been perceived as very progressive by local opinion.

I am pleased to note that the leader of Derwentside district council, Alex Watson, is a non-executive director of Community Health Care: North Durham NHS trust--the trust that is playing a leading role in the development of Shotley Bridge hospital. His concern and knowledge will be valuable in that context.

I shall now discuss the matters of concern.

Mr. Radice: I understand why the Minister would not want to mention it tonight, but will he ask his Department to inquire how the plans for a new community hospital in Chester-le-Street are developing? Perhaps the Minister would write and give me a progress report.

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