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Health Trusts Merger (Lincolnshire)

10. Mr. Edward Leigh (Gainsborough): If he will make a statement on the proposed merger of health trusts in Lincolnshire. [85006]

The Minister of State, Department of Health (Mr. John Denham): Ministers are currently considering a proposal from NHS Executive Trent to carry out a public consultation on a possible merger of the three Lincolnshire acute trusts: Grantham and District Hospital NHS trust, Lincoln and Louth NHS trust and Pilgrim Health NHS trust.

Mr. Leigh: As he sits in London, does the Minister understand the real fear and concern of rural people that, as these mergers continue, it is the rural hinterlands that will suffer? People from those areas may lose their places

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on the boards, and small hospitals, such as Gainsborough, will not receive the same level of commitment and energy that they enjoyed when they had their own health trusts.

Mr. Denham: We would never proceed with a merger of trusts unless we were convinced that patient care would benefit as a result. In addition to that overall criterion, we have set down some important tests, one of which is that mergers between NHS trusts would be expected to realise a minimum of £500,000 in bureaucracy savings within the first two years of going ahead. That money would be available for investment in front-line services. Trusts will not be forced to merge; the test is whether they would improve patient care. Clearly, that test must apply for all the patients whom they serve--not merely for some of them.

Private Finance Initiative

12. Mr. Derek Wyatt (Sittingbourne and Sheppey): How many private finance initiative community hospital schemes are awaiting decision by his Department. [85009]

The Secretary of State for Health (Mr. Frank Dobson): The private finance initiative scheme for a new community hospital in Sheppey, being taken forward by the Thameslink Gateway NHS trust, is one of a package of PFI schemes being negotiated with one consortium. Difficulties in resolving some of the outstanding issues on the most advanced of those schemes--that for Chichester--has held up progress on all the schemes. I expect the Chichester scheme to reach financial close shortly. I am sure that my hon. Friend will be pleased with that, because it should mean that, within the next two months, the trust in his area will know whether it has a viable scheme to build the much-needed community hospital in Sheppey.

Mr. Wyatt: I thank my right hon. Friend for that reply--although he has stolen some of my thunder. That particular PFI scheme on the Isle of Sheppey has been going for three and a half years and £1 million has been spent so far on legal fees for a scheme costing only £10 million. What my constituents are most concerned about is that, if the scheme does not go ahead, we will not have a hospital. Will my right hon. Friend comment on that matter?

Mr. Dobson: That was one of the innumerable shambles that we inherited from the Conservatives. [Hon. Members: "Come on."] It is no good moaning--it was. It is as simple as that. We have gone a long way towards sorting things out; that is why 12 major PFI hospitals are being built already and there are dozens of smaller schemes. Provided that the Chichester scheme is okay, I expect the Sheppey scheme to go ahead. What is crucial is that, if the scheme cannot be undertaken through the PFI, we shall have to use other methods. The people of Sheppey are entitled to a decent community hospital, and that is what we are determined to provide--one way or another.

Mr. Stephen Dorrell (Charnwood): I am pleased to welcome the fact that the Government are continuing to develop the private finance initiative for hospital

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building. May we be precisely clear about the Government's position? Would it be accurate to say that, in relation to the ancillary services of the national health service, the present Government are more effective privatisers of those services than their predecessors? Is that the Secretary of State's position?

Mr. Dobson: No, it is not. Given that, for countless decades, the average cost overrun for major hospital developments was 20 per cent.--so that the NHS got five hospitals for the price of six--the main thing that we are privatising is the cost overruns. Under the PFI, if there are any cost overruns, the private sector will have to meet them--not the taxpayer.

Mrs. Eileen Gordon (Romford): Is my right hon. Friend aware that the delay in the PFI decision on Oldchurch hospital in Romford is causing great anxiety within the community and having an impact on the modernisation of other health service facilities--for example, the overdue reprovision of Warley hospital, which should have been closed years ago? The delay is even having an impact on the local authority's review of leisure facilities in Havering. Are we likely to have a decision soon?

Mr. Dobson: I certainly hope that we shall have a decision soon. However, it has to be said that, until the Labour Government entered office, no decision was taken, even in principle, to go ahead with the new hospital at Oldchurch, so it is no good any of the local Tories moaning--their Government did nothing about the matter for 18 years.

Audit Commission NHS Management Letter

13. Mr. David Heath (Somerton and Frome): If he will make it his policy to publish the annual Audit Commission NHS management letter. [85010]

The Minister of State, Department of Health (Mr. John Denham): The Audit Commission does not produce an NHS management letter. However, it does prepare a summary of the findings of its appointed auditors, and the decision on whether to publish that summary is for the Audit Commission. The view of the Department is that publication would duplicate the statutory work of the National Audit Office, which covers similar ground in its annual report to Parliament on the NHS accounts. The NAO report is, of course, published.

Mr. Heath: That is extraordinary. Is the Minister aware that, year after year, members of the Audit Commission asked the previous Secretary of State to allow publication, but that their request was always refused? The current Secretary of State has continued the practice of refusing to allow publication. Is the Minister aware that, at the end of next month, the Audit Commission will produce a package containing the annual report and the management letter--as it is usually described--for local authorities in England, for local authorities in Wales and for the police authorities, but that the one package it cannot publish is the one for the health service, because the Secretary of State will not allow it? Is that freedom of information?

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Mr. Denham: I repeat: the decision on whether to publish is for the Audit Commission. However, I do not want to mislead the hon. Gentleman: the Department's view is that the summary is valuable, and one of the reasons for that is that the informal status of the document allows for a degree of subjectivity which is quite helpful. To be frank, if the document were to be published, we would expect to agree the text, and the process of doing that would result in the document losing much of its value and many of the messages being lost.

The hon. Gentleman, who was an Audit Commissioner, will be aware that the NAO audits health accounts and the Audit Commission audits the accounts of local government. That is why it is quite appropriate for the Audit Commission to publish its local government management letter and for the NAO to fulfil the same function in respect of the NHS.

Sir Nicholas Lyell (North-East Bedfordshire): Before either the Audit Commission or the NAO produces its next letter or report, will the Secretary of State ask them to investigate the matter of young doctors' hours, and to take special note of the most serious aspect of the problem, which is young doctors who are on call but working continuously, with the result that they work continuously from 9 am one day to up to 5 pm the next? That is contrary to the Secretary of State's own health circular, so will he ask for a report to ensure that the practice is stopped?

Mr. Denham: As I said earlier, last December we agreed and introduced more stringent criteria for rest periods as part of the new deal. That is evidence of our commitment to work to improve the working conditions of junior doctors, not only because it is in the interest of junior doctors, but because it is in the interest of patients. I shall meet junior doctors to discuss that and other matters later this week.

Midwives (Grading)

14. Mr. John Randall (Uxbridge): What plans he has to review the grading of midwives. [85011]

The Secretary of State for Health (Mr. Frank Dobson): In February, we published proposals on modernising the national health service pay system to provide midwives and nurses with a modern career structure to replace the current rigid grading system. The proposals have been generally welcomed and are now the subject of talks with representatives of the staff involved.

Mr. Randall: Is the Secretary of State able to give comfort to those in the profession who are seriously worried that continued recruitment at grade D will only bring further problems with recruitment?

Mr. Dobson: I can try to reassure members of the profession. As I said, our proposals for modernising health service pay are intended to give midwives and nurses a new, modern career structure, with three tiers to replace the current clinical grades, including grade D, and to enable progression within each tier for any individual midwife who takes on particular responsibilities or undertakes courses in professional development.

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