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Mr. Kirkwood: I appreciate the thoughtful way in which the Minister is replying to the debate, but I am still very nervous and sceptical about the position of part-time workers and the low-paid under the plans. Will he take a moment or two of the time left to address that?
Mr. Heald: The whole purpose of having the basic pension guarantee is to be able to reflect the sort of
national insurance credits that we have at the moment to help people who are out of work, disabled or are carers. The system of home responsibilities protection will also be replicated in the new scheme. Turning from the basic pension element of the package, the 5 per cent. of earnings-related contributions will also remain while people work and will build as a fund with a yield over the years. I would argue that that protects all the interests of the groups that the hon. Gentleman mentioned. Nobody would be disadvantaged in any way. Indeed, many people in those groups may be considerably better off.
I will end with three points about Labour's plans. First, Labour will not guarantee to uprate the basic state pension in line with prices. Whatever the hon. Member for Peckham says, the shadow Chancellor has made it clear that it cannot be assumed that totals will be automatically adjusted upwards in line with inflation. Secondly, Labour would cut the basic pension by £20 a week. Its plan is to equalise the state pension at 60 with a reduced pension. The hon. Lady cannot get away with it. She used the words:
Those ideas may have come from Australia, because the hon. Member for Islington, South and Finsbury (Mr. Smith) visited that country to get some ideas. It is
wrong to say that stakeholder pensions are no threat. What is a stakeholder? It is Labour code for a trade union. John Monks said so in The Times on 17 January 1996. He answered a criticism that stakeholding was about the unions, because it will help them to rebuild their positions, by saying yes. He went on:
We have had a good debate. The Government's policies will continue to mean that pensioners in the future will have a better income in retirement and a better life.
Mr. Roger Knapman (Lord Commissioner to the Treasury
): I beg to ask leave to withdraw the motion.
Motion, by leave, withdrawn.
Ordered,
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Knapman.]
Mr. James Pawsey (Rugby and Kenilworth):
Rugby's St. Cross hospital has a catchment area of around 110,000 people. I wish to reassure immediately all those of my constituents who are watching and listening to this debate that St. Cross hospital will not close. Recently, however, serious concerns have surfaced about the quality of some of the clinical services. That has resulted in the board of the Rugby NHS trust, at its meeting on 3 February, recording that it
The West Midlands NHS executive was asked to chair a project team to review the provision of services. Given growing fears about clinical safety, some of the royal medical colleges were invited to visit St. Cross and some of their recommendations were highly critical and far reaching and had serious implications for certain services. For example, the Royal College of Surgeons said in its report:
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Knapman.]
Mr. Pawsey:
I am able to confirm, following a meeting between my hon. Friend the Minister of State and the chairman of the West Midlands NHS trust, that a casualty and minor injuries unit will operate 24 hours a day.
It was interesting that the Royal College of Anaesthetists' report stated:
The Royal College of Paediatrics and Child Health commented:
Clearly, certain of the clinical--that is to say, surgical--services are unsafe. My hon. Friend the Minister will no doubt agree that it is the clear duty of the health service to provide treatment that is both safe and effective. Increasingly, it would seem that there is a move in the NHS towards increasing specialisation, and it would appear that treatments are being concentrated at a smaller number of sites. This is necessary to ensure that surgeons maintain clinical skills and that they see sufficient patients to prevent their skills from becoming outdated or rusty through limited use. In addition, those surgeons require effective support and back-up from junior doctors, skilled technicians and the high-tech equipment that is increasingly demanded by those in the medical world. It would appear that the day of the old general surgeon--the Sir Lancelot Spratt of mythology--is now coming towards an end. It would also seem that the day of the smaller--and local--hospital is fast changing. It is my view that what is currently taking place at St. Cross will, over the next few years, be repeated up and down the land, perhaps even, Mr. Deputy Speaker, in your constituency or one similar to it.
One has to ask how many smaller hospitals are even now in a similar position to St. Cross with services coming under scrutiny and with services likely to move to larger hospitals. That is an issue which should have a much greater public debate than has so far occurred.
An article in the Coventry Evening Telegraph quotes a leading expert on health care organisation as saying that Rugby could become a role model for other small trusts facing similar difficult decisions. It continues by quoting Brian Edwards, professor of health care development at Sheffield university, as saying that Rugby could become a very interesting role model for the rest of the country in developing really imaginative first-class local services.
I am certain that you, Mr. Deputy Speaker, would agree with me that it is desirable to maintain services as close to the host community as possible. But at the end of the day, the paramount consideration must be the provision of a safe and effective service. We must provide patients with the greatest opportunity for recovery and extended life.
One of the areas which causes me particular concern and real anger is the threatened closure of the maternity unit. Five of my grandchildren were born there, so I know it well. But unfortunately that unit sees fewer than 1,000 births each year. It is argued that the minimum number for a consultant-led service is about 2,500.
However, I must say to my hon. Friend the Minister, who is listening, as I can see, intently to the debate, that we still undertake births at home where there is no consultant and where conditions will clearly be much worse than, or certainly not as good as, those in a maternity unit. In the maternity unit there will be other midwives able to provide help and advice. That is all obviously lacking with a home birth. If it is considered safe to deliver some women at home, why is it considered unsafe to deliver the same women in a purpose-built maternity unit when other staff are on call and able positively to assist?
I recognise that there may be some difficulties with legal liability should mistakes occur. But women are seen by consultants before the birth. The consultants should, therefore, clearly know which births are likely to be difficult and should be handled by a consultant-led team, so enabling ordinary births to take place in the surroundings with which women have become reasonably familiar.
My hon. Friend will recall that at the last meeting that I had with him I specifically asked whether the maternity unit could remain open for at least a period of consultation, and that was readily agreed by the chairman of the West Midlands NHS executive. That was a helpful gesture. However, I should be grateful to hear my hon. Friend's comments on the substantive point that I have raised regarding the maternity unit itself.
Another area that causes me concern is the accident and emergency department mentioned by the Royal College of Surgeons. It is proposed that the A and E be closed and replaced by a minor injuries and casualty department supervised by a staff grade doctor. I am happy to confirm to the House and to my constituents that that department will remain open for 24 hours a day. However, to pursue one of the points made by the Royal College of Surgeons, I believe that we need the additional high-tech equipment that would facilitate the treatment of those who are brought to the casualty department.
I welcome the assurance that the chief executive of the combined trusts, Mr. David Loughton, has given that 90 per cent. to 95 per cent. of services will remain at St. Cross, and that certain services may be enhanced. I am advised that some elective surgery that is currently undertaken at Walsgrave may be transferred to St. Cross. That is welcome news. It confirms that the hospital will not close, and will continue to serve my constituents. I also welcome the statement by Mr. Loughton that there will be no redundancies at St. Cross--a fact that will reassure both staff and public alike.
I am grateful to my hon. Friend the Minister, who will respond to the debate, for the five meetings that we have had so far about the hospital. That is a clear indication that he understands my anger and that of my constituents about events at my local hospital. I have also met members of the St. Cross board, the chairman of Warwickshire health authority, and many others involved in this matter. In addition, I shall lead a delegation, comprising the leaders of the Conservative and Labour groups on Rugby borough council, to see the Minister next Wednesday.
However, something has gone wrong at St. Cross, and it would be helpful to know precisely what has gone wrong and why--if only to prevent other hospitals from
making the same mistakes, as mistakes have clearly occurred. I want to know what might be done now to sort out matters. I want assurances that St. Cross will continue to provide high-quality care for my constituents. I want assurances that that high-quality care will be available for the foreseeable future, and not simply for two years. I want assurances that there will be no further downgrading of our hospital. I want an assurance that resources are not a problem and that adequate funding for St. Cross will continue.
"we anticipate . . . a lower level of basic state pension."
She said that she would consult the Government Actuary about how much the cut would be. We did so, and it would be £20 a week. Thirdly, Labour's plans for pension entitlement would mean a means test for everybody before they received the state pension entitlement. Its plans would be a disincentive for saving, because the more people saved, the less state pension they would receive.
"Independent unions are the means for individuals to . . . realise their stakes".
The right hon. Member for Sedgefield (Mr. Blair) went to Singapore to examine its scheme, and the hon. Member for Islington, South and Finsbury went to Australia. The schemes they praised were industrywide and operated by trade unions and employers. The investments were influenced by trade unions. Most people in this country would prefer British pensions to be run by the private sector providers, who have put £650 billion of assets aside, than by sticky-fingered trade union barons.
That the Speaker shall put the Questions necessary to dispose of proceedings on the Motion in the name of Mr. Tony Newton relating to Northern Ireland Business not later than one and a half hours after their commencement, such Questions including those on any amendments to the Motion which she may have selected which may then be moved; and the said Motion may be proceeded with, though opposed, after Ten o'clock.--[Mr. Knapman.]
13 Mar 1997 : Column 599
9.57 pm
"agreed in principle to merge with Walsgrave Hospitals NHS Trust and the North Warwickshire NHS Trust."
Since then, the chairman and the chief executive of the Rugby NHS trust have resigned.
"To provide comprehensive 24 hour cover, and develop site specialisation, a minimum of 4 consultant posts are necessary.
It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.
Rugby's catchment area is not large enough to provide either adequate clinical depth or sufficient opportunities for practice to enable clinicians to maintain skills.
College approval would not be forthcoming for four consultant general surgeon posts given the low work load and the lack of variety of work. By combining with Walsgrave, it would be possible to increase sub-specialities and to offer an improved service to both populations. A 5 day elective surgical service should be possible if merged with Walsgrave, providing an on-site resuscitation team and appropriate levels of post-registration junior doctors working in Rugby on an agreed rotational basis. A full accident and emergency service cannot continue without adequate support services particularly in intensive care and advanced imaging. Consideration could however be given to a casualty or minor injuries unit possibly on a GP-led basis."
"Rugby NHS trust lost recognition for training in March 1995. There are currently no trainees in anaesthesia in Rugby. Since the time of derecognition, there has been a change in training patterns which requires modular anaesthetic experience in various surgical sub-specialities. These would not be available at Rugby.
13 Mar 1997 : Column 600
The consultants service 19 out of 27 operating lists on the weekly schedule. The remainder, and cover for absences, are serviced by the 4 non-consultant career grade staff. There are, therefore, insufficient consultants for the routine operating and this situation will worsen due to retirements."
The report added that anaesthetists in Rugby are not core members of the cardiac arrest team, although they attend if they are not in theatre.
"Children should not stay as in-patients overnight. Children requiring admission should be directed to Walsgrave and bypass Rugby. There should be a fully comprehensive children's daytime service to offer acute assessment and both general and specialist clinics. All consultants would work out of the Coventry and Warwickshire paediatric consortium on a rotational basis. There would need to be a back up consultant on call to cover out of hours calls in order to stabilise cases before transfer."
In addition to the visits made by the royal colleges, the regional postgraduate dean, Professor John Temple, visited the hospital on 20 February. He endorsed the comments made in the reports. That is a clear indication of the critical and developing position at the hospital of St. Cross.
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