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Mr. Kevin McNamara (Hull, North): Is my right hon. Friend aware that many of us who have, through our cities, particular relations with Sierra Leone--as my city of Hull does with Freetown--were grateful and glad when democracy was restored to that country? The harrowing tales that we heard from that unhappy country during the period of despotic tyranny caused great concern, and the non-governmental organisations and other organisations involved were grateful that democratic government was restored to Sierra Leone.

Has my right hon. Friend noticed that four words have not been used at all in the cross-examination of him today, which I think merit some consideration? Those words are "public interest immunity certificates". What on earth has happened to them?

Mr. Cook: I must admit that I am rather enjoying the cross-examination, because, the more it goes on, the more empty the Opposition's case becomes. My hon. Friend draws attention to one reason why Opposition Members cannot get off the back foot: it is because their back foot is so mired in the mud of the last Government. As I said to the House last week, one of my first reactions when I heard of the lawyers' letter was to make it plain that I was not prepared to sign any public interest immunity certificate in this matter. I want the full facts to be out, and I want any court case to be fair.

Mr. Howard: The Foreign Secretary has today been dancing to his master's voice. What was "very seriousand grave" last week is now apparently "receiving disproportionate attention". He failed to answer the questions of which I had given him notice earlier today. Will he now tell the House who was on the distribution list of the document received on 6 February, to which he referred in answer to my right hon. Friend the Member for

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Bromley and Chislehurst (Mr. Forth), and will he finally answer the question that he has scrupulously avoided: will the inquiry that he has promised be carried out by a High Court judge and in public, following the precedent set by his own Government with the Phillips inquiry?

Mr. Cook: The documents of 6 February were telegrams, and those telegrams would be widely circulated. [Interruption.] Of course they would be. Telegrams are always widely circulated. They detailed the intervention in Sierra Leone by the military observers group of the Economic Community of West African States--ECOMOG--and the overthrow of the military junta there. As President Kabbah has pointed out, that was a military intervention by the west African forces; it was not a military intervention by any mercenary force.

I have some sympathy with the right hon. and learned Gentleman. He has been looking forward to this event throughout the past two days. Every radio broadcast today promised that there would be an hour on the rack for me here this afternoon. I must say that this has been quite a pleasant interlude from the work that I have to do at the Foreign Office. If the right hon. and learned Gentleman wants to do it again, I shall be happy to come back and repeat it.

Hon. Members: On a point of order, Madam Speaker.

Madam Speaker: Order. I seem to be getting points of order from hon. Members who are rather frustrated, so I hope that they are genuine points of order. I shall start with Mr. Winnick's.

Mr. Winnick: We have freedom of expression in the House, which is fortunate for all of us, but you, Madam Speaker, like your predecessors, have always said that we should be careful how we exercise that freedom of speech. The hon. Member for Reigate (Mr. Blunt) implied the gravest form of misconduct by the Foreign Secretary. My right hon. Friend responded by saying that, if those accusations had been made outside the House, he would sue. Is there not an obligation on the hon. Member for Reigate to reflect on what he said, and, if he considers that it was inappropriate, to apologise?

Hon. Members: Hear, hear.

Madam Speaker: Order. As I feared, these are not matters for me. The point of order seems to be an extension of the statement and questions on it. I see that the hon. Member for Reigate (Mr. Blunt) is rising. He may wish to say something.

Mr. Blunt: I will be happy to put the question in a detailed form outside the House, if that is what the Foreign Secretary wishes.

Mr. Bayley: On a related point of order, Madam Speaker.

Madam Speaker: I have dealt with the matter.

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Points of Order

4.22 pm

Mr. Jonathan Sayeed (Mid-Bedfordshire): On a point of order arising out of Foreign Office questions, Madam Speaker. I suggested during questions to the Minister of State, Foreign and Commonwealth Office, the hon. Member for Leeds, Central (Mr. Fatchett), that General Motors had considered withdrawing its support for Vauxhall in Luton, and that one reason given was the high value of the pound. The Minister said that my question was based on a false hypothesis, and he therefore would not answer it.

As many Labour Members know, what I said to the Minister about the withdrawal of support by General Motors was correct. I have the briefing paper from Vauxhall, which states that one of the reasons is the high value of the pound. I suggest that inadvertently the Minister misled the House.

Madam Speaker: That is an interesting situation and one that concerns the hon. Member's constituency. He might like to apply to me for an Adjournment debate, in which he can develop that theme and get a full response from the Minister concerned.

Sir Peter Emery (East Devon): It has always been the tradition in procedure that interventions after a statement are put in the interrogative, as a question. We seem to be sliding away from that, with statements being made, not put in the interrogative, and often not even with a question at the end. Will you, Madam Speaker, reinforce the fact that hon. Members have been here long enough to learn that, according to the tradition of the House, questions must be questions, not just statements?

Madam Speaker: The right hon. Gentleman is absolutely correct. He will know, as do many other hon. Members, that I often call Members to order because of the comments they make. It happens too in the case of hon. Members who are leading on an issue for their party. May I suggest--I think that it is a good suggestion--that the party Whips should give seminars to some of their Back Benchers and take them through some of our procedures? If I had the time, there is nothing that I should like more than to put on my mortarboard and give hon. Members lessons in how to proceed in the Chamber.

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Rural and Community Hospitals

4.24 pm

Mr. David Prior (North Norfolk): I beg to move,


I represent a rural constituency with many elderly, retired people. Public transport is not readily available, and the general hospital is a good 40 miles away for many people. There are five community hospitals in north Norfolk, a pattern reflected across the United Kingdom.

Over the years, many community hospitals have been chopped and changed, many have closed, others have been threatened with closure and then reprieved, and wards have been closed. The fortunes of those hospitals have yo-yoed with the annual financial settlement. There has been no long-term security or strategic plan.

In funding terms, community hospitals have been the Cinderella of the health service, relying on financial support from countless leagues of friends, appeal committees and supporters. They have been squeezed by the high-profile and expensive march of new technology in acute hospitals. The sword of Damocles has always hovered above them.

That is no way to run such a vital local service; no way to treat dedicated nurses and frail, and sometimes terminally ill, patients. The public have no confidence in the impartiality or correctness of the decision-making process. Matters have reached such a stage that one chairman of a cottage hospital told me that, if the health authority spent money on a hospital, it was a sure sign that it would try to close it in a year or two. Another said that a consultation was a cosmetic exercise--a case of, "We've written the minutes, now let's have the meeting."

There have been many debates in the House about community hospitals, usually prompted by a particular closure. Today is an opportunity to look at community hospitals in a less emotional setting.

The United Kingdom has 457 community hospitals. Many are approaching their centenary, and many of the war memorial hospitals had their origins in the great war. No two hospitals are the same; they have evolved to meet local patient needs. Most commonly, they allow patients to recover from traumatic surgery and to receive medical treatment near their homes. There is clear evidence, anecdotal and otherwise, that people recover more quickly in small, friendly local hospitals.

Perhaps most important, especially in an area such as north Norfolk, local hospitals have developed a special expertise in treating elderly people. That has led to a growing requirement to provide respite and palliative care for the terminally ill. The increasing number of older people, especially those who are frail or who have mental health needs, require a service sensitive to their needs and preferences. Evidence shows that older people are less likely to be disoriented if cared for at home or close to home, particularly by staff with whom they are already familiar and by their local GP.

The fact that community hospitals are so well supported by the community means that literally thousands of volunteers provide help. Taking time to listen and to talk to ill, old and sometimes lonely people can make a huge difference. During the next 10 years, the Government predict an increase of about 100,000 people over the age

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of 85, many of whom will need the services of their local hospitals and their community pharmacists. That massive local support, part of the moral capital of the NHS, will evaporate if the hospitals are closed.

By contrast, the big acute hospitals are organised primarily for major surgery. They employ highly specialised people, and are hugely expensive. It is essential to move patients out as quickly as possible. The community hospital is the logical halfway house between acute hospitals and home. They can also be used to manage winter pressures and the pressures of rising emergency admissions.

To summarise, community hospitals meet essential patient and clinical needs. They have massive public support, and fulfil a vital role between the large district hospitals and care at home. So it was that I welcomed a number of statements in the Government's White Paper called "The New NHS". They commit themselves to real, not synthetic, consultation, and to three, five, even 10-year funding agreements to give greater stability to NHS trusts. They also commit themselves to allowing local doctors and nurses, who best understand patient needs, to shape local services.

The Government specifically commit themselves to community hospitals in the White Paper, which states:


Those are fine words, but, as they say in Norfolk, "Fine words butter no parsnips." Community hospitals from Cornwall to Wales, from the midlands to East Anglia, are under threat. Community hospital associations believe that at least 16 are threatened with closure. To bridge the gap between political rhetoric and platitudes and what is happening on the ground, I bring the Bill before the House. It is not fair to raise expectations without providing the wherewithal to achieve them.

The broad objective of my Bill is to make it much harder to close community hospitals, by introducing safeguards. First, there should be a presumption, albeit rebuttable, in favour of community hospitals remaining open. For the health authority, there must be a clear burden of proof to show that there is no longer patient or clinical need for the hospital. It would not be sufficient justification to suggest a lack of short-term financial resource.

Secondly, the obligation on the health authority to consult openly and seriously should be entrenched. Consultation must include not only community health councils, but everyone directly involved in primary health care, including doctors, nurses, health visitors and the like, as well as the public.

Thirdly, an independent panel should review the decision of the health authority and the assumptions and the reasoning behind the proposed closure. Specifically, it would consider bed utilisation and management objectively, and satisfy the public that the figures had not been cooked and bed occupation artificially lowered to support the case for closure. It would not take into account short-term financial considerations. An independent panel would restore public confidence in the decision-making process.

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A proposed closure would have to have the seal of approval from the Secretary of State. In practice, he would overrule the independent body only if there were an overriding political imperative. However, the decision should have democratic legitimacy.

Those measures would make it more difficult, but not impossible, to close community hospitals. Some will close in response to changing patient needs, demography or technology, but at least those measures would make closure more acceptable to the public, and better understood. The Government would have to make available funds to support the health authority's strategic plan. No hospital should close because of a short-term funding gap.

The Bill puts down a marker to the Government. Community hospitals are a vital part of the health service. They have widespread public support and must be given a long-term future. There must be no more closures until proper safeguards have been put in place.

Question put and agreed to.

Bill ordered to be brought in by Mr. David Prior, Mrs. Gillian Shephard, Mr. John MacGregor, Mr. Keith Simpson, Dr. Ian Gibson, Mr. Christopher Fraser, Mr. Richard Spring, Mr. Damian Green, Mr. James Gray, Mr. Tim Loughton, Mr. John Bercow and Mr. Shaun Woodward.


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