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10.26 pm
The Minister of State, Department of Health (Mr. Alan Milburn): I am pleased to have the opportunity to respond to the debate. I congratulate the hon. Member for Torridge and West Devon (Mr. Burnett) on securing the debate and the terms in which he addressed the important issues. I also congratulate his hon. Friend the Member for North Devon (Mr. Harvey). I know that they met my right hon. Friend the Secretary of State for Health recently and expressed to him some of their concerns. I am also aware of correspondence between them and my right hon. Friend subsequent to that meeting.
At the outset, I acknowledge the hon. Members' concern about rural hospitals and the important role they play in their communities and in the wider health service. It is important, however, that all hon. Members should get the position straight.
We have an extremely challenging legacy as a consequence of the situation that the Government and, more importantly, the NHS and local communities now face. In particular, we have a challenging financial legacy. The hon. Members will be well aware that the local health authority is on the front line in terms of meeting some of those challenges. It is fair to say that those problems are more deep-seated than we and, I suspect, the health authorities had anticipated.
We know that the NHS is under considerable pressure this year. As Liberal Democrat Members will appreciate, we have taken decisive action to agree with the health service that the immediate pressing priority, particularly as we approach the winter months, is to respond effectively and efficiently to emergency pressures. We must also secure a more stable financial environment in the future. Hon Members will be aware that my right hon. Friend the Chancellor has announced a substantial level of investment in the NHS for the next financial year.
All health authorities and trusts have been asked by the NHS executive to balance their budgets this year. I freely acknowledge that that will require considerable effort, but there is a straightforward choice facing the House and the national health service: either we take difficult decisions now, or we defer difficult decisions, but difficult decisions there will be. They will not go away, and no amount of wishful thinking and magic-wand waving will make them go away. They are here, and we have to tackle them.
Mr. Burnett:
The point I tried to make was that, on a cold, calculating analysis of this year's figures, we do not believe that there will be anything like the savings that the Secretary of State is being misled into believing there could be. We invite him to scrutinise those figures again, because we believe that they are at best misleading, and at worst fallacious.
Mr. Milburn:
I am willing to accept the hon. Gentleman's concerns at face value, and I am happy to receive representations from either him or his hon. Friend the Member for North Devon disputing the jointly agreed health authority and trust figures. If he wants to make further representations in the light of information sent to my right hon. Friend the Secretary of State, I shall gladly examine those representations.
As I said, a considerable effort will be required to balance budgets this year. As the hon. Gentleman is aware, North and East Devon health authority faces a difficult financial situation in that it has a recurrent deficit of £2.2 million, which is clearly an untenable and unviable position to take into the next financial year.
The authority is now engaged on a three-phase review of services. The range of proposals announced on 4 June, which includes the temporary closure of Lynton and Winsford hospitals, is designed to save some £6 million by the turn of the century. At the same time, I have been assured that a full range of services to patients will continue to be available locally, although the means of their delivery may inevitably change.
I am aware of concerns about that, and, in particular, of the substantial concerns expressed here this evening and in the community about the way in which decisions regarding the temporary closure have been taken, so, in preparation for this debate, I inquired closely into the background of this rather unusual decision.
Wherever possible, decisions that pre-empt a full- blown health authority consultation on reconfiguration plans should be avoided. I am informed, however, that the health authority felt obliged to close temporarily both Winsford and Lynton hospitals in order to meet its statutory obligation to remain within its financial allocations. Clearly that is a decision and a set of circumstances that everyone involved--including the health authority and the trust--would have preferred to avoid. As I said earlier, the health authority and the trust are at the sharp end of the legacy I described.
The health authority and the trust are not alone--the situation is not unique and very difficult decisions have to be made--but, for the benefit of Opposition Members, I repeat that decisions have to be taken sooner or later. I do not want health authorities, trusts and the national health service to enter the next financial year with the sort of deficit problems with which they entered this financial year.
Opposition Members may smirk, as they are doing, but every pound that health authorities are in debt at the beginning of a financial year is a pound less to invest in front-line patient services. I want public money to go into front-line patient services so that patients in all parts of the country get the services they need and deserve.
Mr. Harvey:
The Chancellor in his Budget, and Ministers since, have made much of the additional funding that is going into the NHS next year. Would it not get us out of the position that these two hospitals and many others must find themselves in, if just a small amount of debt were allowed to be carried forward into next year, which we are told will be so much more benignly funded than previous years have been? As my hon. Friend the Member for Torridge and West Devon (Mr. Burnett) said, the sums involved are tiny. If it were allowed to carry just that much forward into next year when the bounty arrives, we need not suffer the pain and anguish of this temporary closure now.
Mr. Milburn:
I know that Liberal Democrat Members are always tempted to try to defer decisions, but the present Government believe in taking decisions--that is what government is all about.
I return to the substantive issue that the hon. Members for Torridge and West Devon and for North Devon addressed. Decisions on the long-term future of services in Winsford and Lynton will be taken by the health authority in consultation with the local community later this financial year, following completion of a review of the health and social care needs. I should like to reassure both hon. Members that any proposals for permanent service changes will be subject to full public consultation.
I give both hon. Members a further assurance: that I will ask the south-west regional office of the national health service executive to monitor that consultation exercise very carefully indeed, and especially to ensure that it embraces and engages with all of the key stakeholders in the community, to ensure that the right decision is ultimately reached.
That is important because small cottage hospitals inspire a great deal of affection and attachment in the community. As hon. Members are aware, traditionally the role of the rural cottage hospital has been to provide basic cost-effective care, generally for an elderly population, in an environment that is close to their homes and where there is easy access for relatives and friends to visit.
However, as I am sure all hon. Members are aware, the pattern of health service demand has altered radically during the past few years. Change is endemic in the national health service, and change will continue.I believe that, overwhelmingly, most changes in the NHS will be positive changes that will benefit patients.
That is not to say that local community hospitals closely linked to primary care services will not have an important role to play in future; they will. However, decisions must be taken in the context of the resources available to the local health service.
The hon. Member for Torridge and West Devon made some important points about the resource allocation system. As he knows, health authorities are responsible for the expenditure of significant amounts of public money. I do not know whether I am one of the dead or the insane, being in the Chamber at this time of night, but the national formula for the allocation of resources to health authorities distributes resources on the basis of the relative needs of local populations, and takes account of several key factors. Those include the age structure of the local population, the additional health needs of that population and the unavoidable local variations in cost that occur in the delivery of local health services.
I can tell the hon. Member for Torridge and West Devon--and in so doing respond to the concerns and promptings of the hon. Member for North Devon--that the weighted capitation formula is being kept under review, and we shall continue to look at the way in which resources are distributed throughout secondary and primary care, to ensure that their allocation fully reflects the needs of local people and operates as fairly as possible.
The hon. Member for Torridge and West Devon will be interested to know that work has been commissioned to investigate the possible extra costs associated with the provision of accident and emergency and ambulance
services in rural areas. A report is expected in the autumn, and the results will be carefully considered. I hope that that helps to provide some reassurance to hon. Members who represent important rural communities.
The review of how resources are allocated notwithstanding, priorities in the NHS have to be established. Whereas clinicians will always have the lead role in deciding the care and treatment of patients, it is health authorities that must decide on the right investments for differing population groups in different areas. In doing so, they will seek and pay heed to any advice that clinicians and other stakeholders can give.
Health authorities assess the health care needs of their resident populations, draw up strategies and purchasing plans in collaboration with local people and other interested organisations, and secure a range of primary, acute and community health services which will best satisfy those needs.
The challenge facing health authorities in Devon is how best to get the right mixture: how to provide as comprehensive a range of services as possible for their local populations within the resources at their disposal.I hope that the hon. Member for Torridge and West Devon will agree with me that rural hospitals are an important
element in the NHS, but that they are also just one element of a comprehensive range of services available throughout the country.
I hope that the hon. Gentleman will further agree that the staff of small hospitals and other hospitals in rural areas, in collaboration with family doctors, community and district nurses, and the larger, more specialised hospitals, together provide and integrated service which offers the community a continuing excellent standard of care.
Unfortunately, when closure plans are in operation, attention inevitably centres on the many difficult decisions that the NHS is having to take. It is always important, therefore, to remind ourselves that most patients and staff take the view that the NHS is something of which to be proud. It is the envy of the world; I want to make sure that it continues to be the envy of the world. To that end, NHS care must be available on the basis of clinical need to all patients who need it. Above all, every part of the country must have access to one standard of NHS services of the highest possible achievable quality.
Question put and agreed to.
22 Jul 1997 : Column 867Adjourned accordingly at nineteen minutes to Eleven o'clock.
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