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12.18 am
The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I am glad to have the opportunity to respond to the hon. Member for Normanton (Mr. O'Brien) and to congratulate him on securing time to debate a subject that is linked to health services in Wakefield--Pinderfields hospital. This is the fifth time since January 1995 that we have had an opportunity to debate health services in Wakefield. Opposition Members certainly deserve full marks for persistence. I acknowledge that you also have an interest in this area, Mr. Deputy Speaker. I, too, have an interest, because, as the hon. Gentleman will be aware, I went to school in Wakefield. I have known Pinderfields over many years, particularly when I was a teenager.
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I have listened to the hon Member's concerns and the case that he has outlined against the proposed merger of the trusts at Pinderfields and in Pontefract. I am aware of the strong local feelings on the proposal. However, as I said in the Adjournment debate in November on the proposed merger of the two trusts, it seems that some hon. Members might be trying to link two separate issues--the management of the acute trusts at Pontefract and Pinderfields, and the delivery of services.
The consultation, which, as the hon. Gentleman knows, ended last week, was on a proposal to merge two trusts, not on a proposal to change the health services in the Wakefield area.
The proposal that is under discussion in Wakefield, and in Pontefract, is a proposal to merge two trusts--or, to be more exact, to dissolve two trusts and create one new one. It is a proposal to change the management structure of NHS trusts in Wakefield, and it is not a proposal to change the services.
The responses to consultation on the merger proposal are now being considered by the NHS executive. It is likely to be referred to Ministers for consideration shortly. I must and will keep an open mind until the appropriate time. As I have said, I am aware of the strong local opposition to the proposal, including from local hon. Members and from the local community health councils. On the other hand, I am told that there is strong clinical support for a merger from local consultants and from general practitioners.
As I said in November, Wakefield health authority has announced that it will look again at its health strategy, and will hold a separate public consultation on that later this year.
The Secretary of State for Health is required to consult on proposals to establish new health trusts. There has now been a long consultation, lasting from July 1996 until the middle of this month, on the proposed merger of Pinderfields and Pontefract trusts. As soon as it was realised that more was needed to be done to fulfil the statutory requirements, Wakefield health authority was asked to consult on behalf of Secretary of State, and the consultation period was extended. That has meant that consultation has taken longer than might have otherwise been the case.
However, the extra consultation period will certainly not be wasted. All the views expressed during both periods of consultation have been passed to the NHS executive, and will ultimately be seen by Ministers. The extension has allowed local people almost double the usual time to express their views. There can be no doubt that the consultation period has been thorough.
Many factors need to be taken into account when considering a proposal such as this. We will carefully consider the adequacy of the consultation process and the views of local people, including those who took the time to sign a petition organised by Normanton town council and presented by the hon. Member for Hemsworth (Mr. Trickett) recently. We will also look at the likely impact on effectiveness, efficiency, and accessibility of the potential creation of a new trust. Any potential economies of scale will have to be balanced against any possible loss of patient choice.
I can assure hon. Members that this is most certainly not a fait accompli. We had a statutory responsibility to consult publicly, and we will weigh the results both fairly
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The hon. Gentleman and his hon. Friend the Member for Wakefield (Mr. Hinchliffe) have previously expressed concern about the results of past consultations. I understand their feelings on this subject. In particular, they have cited the investment in rehabilitation which the former Yorkshire regional health authority had planned to place in Wakefield, following agreement that neurosurgery should be concentrated in Leeds. There were good reasons for concentrating neurosurgery in Leeds, but I understand the way in which the hon. Member for Normanton expressed his feelings this evening.
We cannot turn the clock back to 1994, because the regional health authority was abolished in March of that year, almost three years ago. We live in a changing world, but it is also a fact that the NHS executive northern regional office has offered support in the form of research and development support worth around £50,000 for an academic development in rehabilitation medicine. So at least something will come to Wakefield out of that situation, which is now past and gone.
The hon. Gentleman also reported on the winter pressures that he has experienced in the local hospitals in the Wakefield area, particularly in Pinderfields hospital. Although the position is undoubtedly difficult at this time of year--it usually is--the trust is coping and has coped well. Indeed, I hear that some general practitioners have complimented it on its performance.
Some non-urgent elective admissions have had to be cancelled, but the Pinderfields hospitals trust chief executive has emphasised that the percentage is small--about 33 out of around 1,000 planned operations. Hospitals cancel operations occasionally, but they try to keep cancellations to as few as possible because a cancellation is undoubtedly extremely unfortunate for the patient concerned--it is very disappointing indeed. It is only right that emergency and urgent cases should have priority.
As the hon. Gentleman said, the trust has made six new beds available at its Clayton hospital to ease the pressure on Pinderfields. A similar thing has been happening throughout the country. Admissions units have been opened and additional beds made available where possible. I am glad that Pinderfields was able to make that effort to ease the pressure. I am sure that that sort of sensible management move has helped during this winter.
Once the proposal for a merger is decided, we can look at the management arrangements. Meanwhile, Pinderfields hospitals trust has an able acting chairman and an experienced acting chief executive, in a trust that has also recruited 25 new consultants since 1993--a considerable investment in the appropriate skilled health care for the area.
I also recognise that the Pinderfields hospitals trust is facing a complex set of interdependent issues. As I have said before, the ultimate goal is to ensure that sustainable, high-quality and cost-effective clinical services are provided with modern facilities. Although the consultation on the proposed merger and, separately, the configuration of health services will take time, those
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The hon. Gentleman also, very fairly, raised the question of the finances of the health authority, the trust and the GP fundholding practices, which, as he knows, are extensive in the Wakefield area. I must point out that, in November, we announced that an additional £1.6 billion would be available to the health service next year to safeguard and improve patient care.
Hon. Members have criticised the funding for Wakefield, but the health authority is above its weighted capitation target. Despite that, it will receive an integrated revenue cash increase of £5.3 million next year, which is a real-terms increase of £2.3 million, or 1.6 per cent. Surely that is not a cause for complaint. Wakefield has done rather better than the average, despite the fact that it is over its capitation target.
The hon. Gentleman was also concerned about how that capitation target is made up, and was worried that the needs of Wakefield people were not taken into account. I acknowledge his interest in the problems of asthmatics and in the National Asthma Campaign. I was glad to hear about the activities of the Wakefield and Pontefract asthma group. I am sure that that is very relevant. I can well imagine the sort of respiratory diseases that are common in that area.
I assure the hon. Gentleman that the formula, particularly next year, when it has been adjusted to take account of community health needs, including mental health, is more focused on need than it has ever been in its history. If anything, the sort of area in which Wakefield is situated will have gained from the reformulation of the formula for the cash handed out next year.
I also want to stress that the work on the formula is undertaken as a result of the effort and research by York university. It is independent, and considers objectively the population needs of areas such as Wakefield. It is as objective a measure as we can possibly make it. That is the basis on which the Wakefield health authority gets its money.
The hon. Gentleman was also concerned about the trust's finances. Certainly, I would not deny that there have been some problems over the finances--that has been the case for some time--but I am assured that the situation is not deteriorating but is, on the contrary, improving, and that a firm three-year plan is in place to resolve the problems. That will be affected by the merger, but it is none the less in hand to put things on a sound footing. There is no reason to believe that that sensible approach will not be successful.
The hon. Gentleman further expressed concern about the amount of money in the GP fundholding system and asked in effect whether it could in some way be transferred to help with the problems in the acute hospitals. My point about that is that it would essentially destroy the whole point of the GP fundholding system, which is that, where fundholders generate surpluses, they can put them back into improving primary care. They must be allowed to do that.
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The health authority may hold those surplus funds for the moment, but they are in effect held in trust on behalf of the GP fundholders who generated them, and it is right that they should go back into primary care. We are, after all, talking about a primary care-led service.
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