Previous SectionIndexHome Page


Mr. Bradshaw: That is the problem--Exeter has expanded to its limits. It is surrounded by lovely green, rolling hills, and further expansion on the periphery would alter the character of the city out of all recognition.

Mr. Raynsford: I entirely accept my hon. Friend's point, which highlights the dilemma of trying to ensure that development pressures are accommodated in such a way as to respect the character of the area and the countryside, and to avoid creating an unnecessary urban sprawl that would damage people's enjoyment of the countryside.

Mrs. Browning: I cannot let the hon. Member for Exeter (Mr. Bradshaw) get away with his comment. Those lovely green, rolling hills on which his constituents look out are all mine.

Mr. Raynsford: I am delighted that there is unanimity across the Chamber on the attractiveness of the countryside in that area, which, as a regular visitor, I entirely endorse.

To meet the identified need, the county believed that a new community offered the only satisfactory and sustainable solution. To accommodate the proposed level of development for the Exeter area, it considered that the new community would need to provide for 3,000 dwellings and land for any associated employment. That provision was considered the minimum at which a new community could achieve some self-sufficiency and support an adequate range of local facilities and services.

The county accepted that new communities represented a major new approach to development in the county. It wanted sustainable development of the highest-quality design; an integrated transport system that would promote the use of modes of transport other than the private car; and development that would minimise not only the need to travel, but waste and pollution.

11 Mar 1998 : Column 518

After the structure plan had been placed on deposit in November 1996, there was a six-week period for objections and representations to be submitted to the county council. A panel was appointed, led by an independent chairman, Professor Graham Shaylor, to conduct the examination in public to which the hon. Lady has referred. The EIP was held between 16 September and 9 October 1997. The panel submitted its report to the county council in January 1998--it was made public shortly afterwards.

A number of key issues were debated at the examination by selected participants with a range of interests--I know that the hon. Lady took a close interest in that process. Relevant discussions included the strategy, the countywide provision for housing and the distribution of development in the Exeter, east Devon and mid-Devon areas. In those discussions, the county council's proposals for the overall level and distribution of housing provision and the proposals for two new communities were debated in considerable depth.

Having heard all the representations to the EIP, the panel concluded that the overall housing provision for the county should be increased, in line with household projections, from 74,500 to 79,000, which was some 4,000 less than the figure that was given in the regional planning guidance for the south-west. The allocation for Exeter city was recommended to be increased by 800 to 6,400.

The panel felt that, in east Devon, there was sufficient scope for new development to be assimilated into the landscape and that the existence of a good road and rail infrastructure would help to ensure that new development was not entirely dependent on the private car. It therefore recommended that housing provision be increased by 1,500 to 11,200.

While the panel supported the concept of a new community east of Exeter, arguments about the specific location were not part of its brief. The panel felt strongly that the strategic importance of this area to the county as a whole, its benefits in locational and economic terms and the high level of unmet need in that part of the county should be considered.

The structure planning authority for Devon currently comprises the county council, along with Dartmoor and Exmoor national park authorities, and, with effect from 1 April, they will be joined by Plymouth and Torbay unitary authorities. Together, they will consider the additional information provided by the examination in public, along with the written objections and representations received, and decide whether a new community is the most sustainable solution to provide for the housing needs--

Mr. Deputy Speaker (Mr. Michael J. Martin): Order. We now come to the next Adjournment debate.

11 Mar 1998 : Column 519

Health Services (Birmingham)

1 pm

Mr. Richard Burden (Birmingham, Northfield): I am grateful for the opportunity to raise with the House and with my hon. Friend the Minister important questions that face health services in England's second city. It is particularly appropriate that the debate takes place today, as Birmingham health authority is in the middle of a major review aimed at developing a strategic framework for health care in the city into the new millennium. In putting behind us the destructive, dog-eat-dog days of the internal market, the Government have urged health authorities to take on a strategic and visionary role. I welcome the fact that Birmingham health authority is attempting to do that and I emphasise the importance of a full partnership with the people of the city.

It is difficult to look to the future of health care in Birmingham when the legacy of the past hangs over us so much. In the last Parliament, I had several Adjournment debates on bungled reorganisations and financial scandals in the then South Birmingham health authority and West Midlands regional health authority. There were Public Accounts Committee reports on those authorities. Myhon. Friend the Member for Birmingham, Selly Oak(Dr. Jones) was also very vocal on the issue. A climate of mistrust remains about any proposals for change and for the future of health care in the city. I understand that. As well as addressing my hon. Friend the Minister today, I address people in Birmingham. The time has come to put that mistrust behind us.

The services offered by health service staff in Birmingham are nationally and, in many cases, internationally renowned. The work of Birmingham Children's hospital and of the burns unit at the University Hospital Birmingham NHS trust, and that hospital's work on cancer and renal disease, are all internationally renowned. The University Hospital Birmingham NHS trust, Birmingham Women's hospital, Birmingham Children's hospital, Birmingham Heartlands hospital, the City hospital, Royal Orthopaedic hospital and Good Hope hospital are internationally and nationally renowned, and that remained the case throughout the scandals. As far as the health authority is concerned, those days of financial scandals and deficits are over. It was painful, but the problems were faced and dealt with.

Now pioneering work is being done in Birmingham on the local commissioning that forms the cornerstone of the Government's policy and is a consistent theme running through the recent White Paper and the Green Paper. Birmingham health authority, in conjunction with the voluntary sector and the city council, has recently made a bid for a health action zone.

We are getting things together in Birmingham, but our needs are still acute. The care provided by staff is second to none, but all too often it takes place in buildings and surroundings barely fit for this century, let alone the next. The last hospital built in Birmingham was Queen Elizabeth hospital. People in Birmingham sometimes think that the name refers to the present Queen, but it does not. The hospital was built in 1938.

I crossed swords with the former regional health authority on several occasions over its bungled reorganisations, but one matter about which it was right was Birmingham's major capital investment needs.

11 Mar 1998 : Column 520

It estimated that about £500 million of capital investment was needed in Birmingham's health infrastructure over12 years. We have seen between £120 million and£130 million of that so far. We still have no news about the rest.

Let us take the example of breast cancer services at the University Hospital Birmingham NHS trust. The services are first class and Calman accredited. An integrated approach is taken to breast care. However, if a woman goes for a mammogram in a hut at Selly Oak hospital and there are more patients than chairs in that hut at any one time, there is nowhere for her even to sit down. That is not appropriate in this day and age. If she needs a biopsy, that will be done the same day and she will get the results the same day. That is great, but she will probably have to sit in a corridor at what may be the most stressful and distressing time of her life. If she then needs breast surgery, she will go Queen Elizabeth hospital. She will be treated on a ward where the staff are first class, but there are simply not enough toilets for the patients.

The £200 million that the Government have made available to improve breast care is welcome. It will significantly improve radiotherapy services in the city and at the trust, but there is still a massive job to be done to tackle problems such as those that I outlined. Breast care is just one example. Many other examples could be given.

We need new investment; of that there is no doubt. We need a major programme of building refurbishment and replacement in Birmingham's hospitals. The health authority has some ideas and others have come from many quarters. I ask my hon. Friend the Minister to speak to his right hon. and hon. Friends in the Government and recognise the real needs in Birmingham.

On the framework in which any future investment will take place, I understand that the private finance initiative remains the cornerstone of major capital investments under this Government. Under the previous Government, there was one major problem with the PFI. Whatever else could be said about it, it did not produce any hospitals. At least under the new Government it is working far better.

However, the PFI can be a straitjacket to investment. In meeting investment needs not only in Birmingham but elsewhere, my hon. Friend the Minister must ensure that the needs of the service and of patients are put first and the investment framework is built around it, rather than trying to shoe-horn the needs of patients and services into a given investment framework.

Not only hospital development is important to Birmingham's health services. One of the strengths of the local health authority's review is that it places hospital development in a context and reinforces and embodies the vision in the White Paper. Unless primary care works, the rest of the health service cannot work properly or effectively. Pioneering work has already been done in Birmingham in developing locality commissioning. A multi-fund has been set up. Fundholders got together, even under the previous Government, perhaps to the embarrassment of the Conservatives, to work co-operatively and pool their resources in the interests of patients.

The problems that we face are still huge. In Birmingham, life expectancy is below the national average. We have one of the highest perinatal mortality rates in the country. We have one of the highest proportions of babies of low birth weight. We are in the

11 Mar 1998 : Column 521

worst quartile for coronary heart disease. Birmingham is the seventh most deprived health district in the country. Integrated primary care and anti-poverty strategies are therefore vital. That is why I welcome the White Paper, the Green Paper and the new deal. That is why it is so important that we have a national minimum wage to tackle poverty. However, if those policies are to work, we also need to tackle the problems of the infrastructure of primary care in our city.

In the next 10 years, between 35 and 40 per cent. of general practitioners who serve the most deprived areas of our city will retire. Unless we tackle that problem, we cannot develop the type of primary care that we need in our city. The health authority, GPs and other health professionals are adopting imaginative and innovative approaches to developing primary care, but they need support. They are getting that through the White Paper and the Green Paper, but they need infrastructure support and resources.

I shall deal briefly with the way in which resources are allocated in the health service and the problems that that creates for Birmingham. Sadly, the current resource allocation formula does not meet Birmingham's needs. As I said, the city suffers from multiple deprivation. The great flaw in the resource allocation formula is that age-related need is not related to deprivation in the city.

The formulas are rather complicated, but the effect is real enough. As we know from the days of the Black report onwards, if substantial parts of the population are poor, that means lower life expectancy: people die in greater numbers before they reach old age. The current allocation formula can mean that such a city gets relatively fewer resources, rather than more. The result is that in Birmingham the health service gets about £533 per resident, which is less than many other cities and less than Kensington and Chelsea, and Westminster.

Studies undertaken by Birmingham health authority show that if the age and deprivation measures were taken into account in the same formula, the city would get an extra £17 million in resources to support its health care.

I welcome the Government's approach to the national health service. We are putting the days of the internal market behind us. The Government have shown that we are prepared to put more resources into health care and to give the NHS the priority that it needs, which is especially appropriate this year, the 50th anniversary of the NHS.

In Birmingham there is a climate of mistrust and problems from the past, but we as a city must come to terms with them. We must come to an agreement about the kind of health care that we want and how to develop it. We are making a start and looking towards a primary care-led national health service, with clear pathways to quick diagnostic treatment where that is appropriate, and stays in hospital for the necessary time, without keeping people in hospital if that is not the most suitable place for them to be. The necessary support must be provided, whether through intermediate care or home support. Where medical conditions require specialised treatment, we have the people in Birmingham who can provide that in tertiary centres in our magnificent hospital services, but the buildings are not up to scratch.

We need to develop innovative plans to take those services into the next century. We are prepared to do that, but we need support from Government. I hope that my hon. Friend the Minister will study closely what is

11 Mar 1998 : Column 522

happening to the health service in Birmingham. We welcome the reviews that are taking place, but we recognise that for those reviews to result in agreement among Birmingham people and to overcome the climate of suspicion that has lasted too long, the resources must be made available to ensure that we have the primary care networks that will be vital to health services in the future, and the investment in our hospital services that Birmingham needs.


Next Section

IndexHome Page