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Mr. Chris Pond (Gravesham): The hon. Member for Woodspring (Dr. Fox) should return to the Chamber and apologise.
Dr. Stoate: My hon. Friend makes an important point. Perhaps the hon. Gentleman should apologise to the House for misleading it, and to my constituents and my hon. Friend's constituents. My hon. Friend and I have been working hard to make sure that we get the truth, and not scare stories.
Mrs. Caroline Spelman (Meriden): In the absence of my hon. Friend the Member for Woodspring (Dr. Fox), does the hon. Gentleman accept that the example was drawn from a body of evidence put together by the community health councils, entitled "Casualty Watch", with which I am sure he is familiar? The document is produced monthly, and contained many other examples of unacceptable waits, often in accident and emergency departments. Is the hon. Gentleman saying that the validity of such a document is completely undermined by
the one piece of information that he has brought forward? A body of evidence has been brought forward by CHCs and it should not be ignored--but it will be, if they are abolished.
Dr. Stoate: If we are to hear and read such stories in the House and in the newspapers, it is important that the facts are checked. I took the trouble to check, as did my hon. Friend the Member for Gravesham (Mr. Pond), whereas the hon. Member for Woodspring appeared not to want to do that before he went to a national newspaper. That is one example of Opposition Members using NHS stories as scare tactics without bothering to ascertain the reality. I am upset not because they are scoring political points, which is their purpose, but because they are undermining what the NHS, the doctors, the nurses and the other staff and managers of the new acute hospital are doing to try to build confidence in a brand new unit. It is a great shame when we hear such stories.
As I have said, bed numbers at the hospital are tight, and we must make sure that it is properly run. The hon. Member for North Devon (Mr. Harvey) appeared to criticise the PFI, but the hospital in Dartford and Gravesham was built on time and on budget. There is a 30-year contract with the company that built it. What hospital will be knocked down after 30 years? Hospitals have a habit of lasting more than 100 years. The fact that there is a 30-year contract with the company is surely no great cause for alarm.
The hospital has been built in such a way as to ensure that it is flexible. It can be changed, because of the way in which it has been laid out. It has been designed so that if we require changes in service delivery over the next 30 years, which I confidently expect we will, all the internal walls can be moved, removed and remodelled at low cost, and with little disruption. It has been designed for a possible 200-bed extension, as the need arises, without destruction of core services, which are large enough and robust enough to cater for increased capacity. This is an achievement--a tribute to the company that built it and the management that is running it.
Mr. Harvey: No one is suggesting that hospitals will be knocked down within 30 years. That is far-fetched. I am sure that the hon. Gentleman is right when he says that the hospital has been designed so that it can be reconfigured. That is all very good, but even after it has been reconfigured, the public will still be paying for the original design. That is the problem that I have with the PFI. We are mounting one set of debt on another. That is why I think it is preferable to pay for such constructions on a shorter time scale if we are to involve the private sector--or, indeed, if we take the usual public sector routes. There is the problem of mounting debt.
Dr. Stoate: I accept the hon. Gentleman's point. I, too, have certain reservations about the PFI. It is brand new and untested, and we must see how it rolls out over the next few years. However, I have carefully examined the Darent Valley hospital PFI project, and I am satisfied that the hospital has been designed for the future, so as to reflect changing needs.
Effectively, we are buying on a mortgage. At the end of 30 years, the hospital freehold will revert lock, stock and barrel to the NHS. First, however, it must be returned to the NHS in good condition. There cannot be 30 years
of decay and neglect. There must be 30 years of routine regular maintenance to ensure that it is kept in good condition. Secondly, and importantly, the private sector has taken on the risk. If something goes wrong--for example, the operating theatres are out of action, or a major piece of equipment breaks down--the hospital does not have to pay for the equipment or facilities until they are repaired.There is therefore a huge incentive to make sure that the hospital is running at full capacity and maximum efficiency the whole time, otherwise the NHS will not have to pay for the facilities. In previous times, if an X-ray machine broke down, it might not be repaired until the end of the financial year, because of lack of money--but that will no longer be the case in Dartford and Gravesham, where there is a real incentive to ensure that the hospital is working properly.
As I said, with 400 beds, numbers are tight, and we do not know how the hospital will bed down over this winter, even with the new community resources. That is why my hon. Friend the Member for Gravesham and I have been working hard to try to set up a step-down facility-- a convalescent unit, effectively--at the North Kent hospital in my hon. Friend's constituency. The idea is to set up 24 beds there, to allow for any possible overstretch from casualty or from the acute hospital at Darent Valley, to make sure that patients are properly looked after and to reduce the risk of delays and hold-ups in casualty.
We have been working hard with all the authorities involved, including Ministers, who have been extremely helpful. The problem that we face is a problem for the NHS because, in a way, the Government are the victim of their own success. The resources are available to fund the unit, we have the unit in place and it could be up and running fairly quickly, but we cannot find enough nurses to run it.
As hon. Members know, nurse recruitment is a problem. Despite the fact that the Government are recruiting and training more nurses than ever before, there is a significant shortage, and we are finding it extremely difficult to recruit the nurses for the hospital. Managers have rightly told us that they cannot open the 24-bed unit over the winter until extra nurses can be recruited.
If there are any nurses out there in Dartford and Gravesham who are following the debate, I should be grateful if they would apply for some of the existing vacancies. I can offer them a good deal and a good job working in the acute hospital or in the new step-down unit that we are trying to establish.
The shortage of nurses is clearly an issue, but, as I said, with changes in the way in which hospital stays are organised and changes in hospital practice, I believe that we can make a success of the hospital. However, it will not be a success if Opposition Members continue to talk it down, drive down morale and frighten patients. We should see it as a brand new facility and a brand new opportunity. Generally, the patients to whom I have spoken--I am sure that my hon. Friend would echo this--have been extremely pleased with the service that they received at the hospital, despite certain teething problems.
We are moving towards new methods of delivering care in the community. Far more community care will be delivered in people's homes or closer to their homes, with shorter hospital stays. That requires much more flexibility in the community, which is sometimes extremely difficult
to manage. My own practice, for example, currently has on its books 19 patients who are terminally ill. That is quite a large number.Our policy in the practice is to try to keep people at home for as long as possible, because that is where they want to be, but that depends on the availability of enough highly trained community nurses and others. It is clearly a matter of capacity, both in hospitals and in the community. I am sure that the Government are doing all they can to address the problem, but I should like them to focus on increasing the resources available for community care, particularly nursing, so that such people can be looked after for as long as possible in their own homes.
Mr. Barron: My hon. Friend raises an important point, especially in view of the exchanges at the beginning of the debate, when the official Opposition were asked whether they would support the increased expenditure on social services that the Government are promoting. There was no answer. Unless they undertake to continue that expenditure, they will precipitate a crisis in the health service, because there will no longer be the community support that my hon. Friend outlines.
Dr. Stoate: That is a good point, because many of the plans rely crucially on the availability of adequately resourced and trained social services staff in the community to deliver them. If there are hold-ups and bottlenecks at social services level, the plans will be difficult to implement and patients will suffer. I am therefore disappointed that the Opposition were unable to give a commitment to the adequate funding of social services care.
I have one final point to make. There are many people in the NHS who could do more, and would like to do more, in terms of their professional development. I refer to a particular group, community pharmacists. The House knows that I am chair of the all-party group on pharmacy, and I work hard with pharmacy groups and individual pharmacists. I get from them the feeling that they are highly trained and motivated, and clearly they can do more than they are currently doing. What is more, they clearly want to do more.
I am pleased that the Government have launched a new plan for the future of pharmacy, which has been well received by pharmacy groups. I hope that when the Minister replies to the debate, he will address the fact that pharmacists want to do more, although I believe that it will probably require primary legislation to allow them to do so. I refer in particular to patient group directions and prescribing under that scheme, whereby pharmacists and others, including nurses, will be able to prescribe more medications to patients direct.
I shall focus on two issues. The first is emergency hormonal contraception. In a number of pilot schemes around the country, pharmacists under patient group directions have been able to supply emergency hormonal contraception directly from the pharmacy's premises, without patients needing to go to a general practitioner first.
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