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2.47 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I congratulate the hon. Member for Aylesbury (Mr. Lidington) on securing the debate. It is a matter of considerable importance to him, to other Members and, most importantly, to the people of Buckinghamshire. I also thank the hon. Gentleman for giving me notice of the issues that he would be raising. That always makes it easier to have a more focused debate. I hope that it will provide his constituents with reassurance, hope and optimism, and confirm to them the original comments of my right hon. Friend the Member for Darlington (Mr. Milburn) that Stoke Mandeville hospital has a bright future.

The hon. Gentleman has a keen interest in the hospital. He is, quite rightly, eager to ensure that the highest possible standards of health care services are secured for his constituents. I assure him that the Government are committed to providing high-quality services for everyone, no matter where they live.

More than 35,000 patients were admitted to Stoke Mandeville hospital last year, 11,000 of whom were emergency cases. Some 39,000 patients attended the accident and emergency department and 76 per cent. of those were seen in less than four hours. More than 200,000 patients were seen in out-patient appointments last year, with 93 per cent. seen in less than 30 minutes. Those figures reflect the nature of Stoke Mandeville as a typically busy and hard-working hospital.

The future of the hospital has been the subject of extensive debate. as the hon. Gentleman said. I am delighted to put on record the Government's plans for the future, not just of Stoke Mandeville but of acute services across the sub-regional area.

On the private finance initiative scheme, I can reassure the hon. Gentleman that contracts will be signed later this year and that building works will commence either late this year or very early next year. I understand that the building works will take some two years to complete, so the new facilities for local people should operate from 2005 if everything goes smoothly and according to plan. That perhaps offers a firmer timetable than it has been possible to give before. I am also delighted to say that the advent of the new strategic health authority will not take us back to square one. Planning is well under way, and the scheme is much wanted by local people.

Plans for services are still subject to consultation, and I want to ensure that no comments that I make can be taken to pre-judge that consultation, on which a decision will be taken shortly. Buckinghamshire health authority and the Stoke Mandeville and South Buckinghamshire NHS trusts have proposed that the two trusts should merge. Those who support the merger have advanced good reasons for it. First, they refer to the need to protect and develop clinical services at the two trusts. Hospitals, such as Stoke Mandeville, that serve relatively small populations may find it increasingly difficult to meet

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standards set by the royal colleges, as the hon. Gentleman said. It is felt that a merger would give the successor organisation more scope to meet and maintain those standards so that local people may be assured that they will receive excellent services.

Secondly, there can be no doubt that maintaining and developing high standards depends crucially on the recruitment and retention of staff with the right skills. As the hon. Gentleman is no doubt aware, skilled NHS staff are a scarce resource, particularly in the south of England. There is evidence that more people are likely to be attracted to organisations that offer personal opportunities for professional development. The feeling that they are participating in the development of excellent clinical services is a real draw for staff. New staff need enough variety and experience to allow them to develop their potential to play a key part in providing good services in future. Larger organisations sometimes find it easier to recruit and develop staff than small organisations that may find it difficult to offer the same development opportunities. That is not the case in every organisation; some excellent smaller organisations take the trouble to develop their staff, but it is usually true that if there is more going on, there are more opportunities for staff.

Technology is developing at an incredible rate. New drugs, therapies and equipment are being used, and that means more training and specialisation for the staff involved. Increasing specialisation can create problems for smaller hospitals that work in isolation. Specialist units need a regular stream of patients to keep staff skills at a high level.

It has been suggested that a merger could maximise the efficient use of resources. I understand the parties involved to mean that having two trusts ties up significant resources in running parallel management structures and processes. A merger could offer the opportunity to reduce those costs, and any consequent saving could be reinvested in direct patient care, which is a matter of concern to us all.

I reassure local people that the proposal relates only to management arrangements, not changes in clinical service provision. The three hospitals—Amersham, Stoke Mandeville and Wycombe—will continue to provide the same range of high-quality services that are now available. I can reassure the hon. Gentleman that there is certainly no question of a secret agenda or conspiracy to take away services. The proposal has to do with building up local services and acknowledging both that there are pressures on capacity and that people in Aylesbury are entitled to a high-quality national health service. The proposal would not affect the configuration of primary care services. Over the next few years, primary care will become increasingly significant in the configuration of health services in every area.

I reassure the hon. Gentleman with regard to bed numbers in the private finance initiative scheme. He mentioned the review of the local authority plan. Originally it was predicted that there would a growth in population of 3 per cent. over the next six years. I understand that the prediction now is that Aylesbury's population will grow by 10 per cent. but that there will be a corresponding 10 per cent. drop in the population of the rest of Buckinghamshire. Therefore, there is an increase in the population not of Buckinghamshire overall but of parts of it.

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The proposals are still under discussion at local authority level, but clearly Stoke Mandeville is considering their impact and remodelling its plans within the context of the whole of Buckinghamshire. The outcome of the remodelling will be reflected in the full business case. If necessary, plans can be adjusted.

Where there are significant changes in capacity, it is sensible and logical to look at that. Perhaps one reason why there is such strain on many NHS organisations is that planning in previous years was not as closely aligned as it should have been. Getting the right beds in the right place at the right time, with the right number of staff to give people appropriate treatment, is the biggest challenge that all of us face.

I am pleased to deal with the investment issues that the hon. Gentleman raised. Investment in Stoke Mandeville has been considerable in the past few years. The trust has had an extra £302,000 to increase capacity, some of which is to provide 15 extra beds in the hospital to help to reduce the number of cancelled operations. A total of £73,000 has been allocated this year for extra nurses in the accident and emergency department, and an extra £300,000 will be made available for extra A and E nurses next year, recognising the pressure there.

There is extra investment to meet waiting times for in-patient treatment. The trust will receive a share of the £713,000 for delayed discharges in Buckinghamshire. Next year that money will be more than doubled. A total of £413,000 has been provided to modernise diagnostic facilities, including X-ray equipment in A and E, and £165,000 has been spent to improve cataract services. Various other sums have been made available to improve the physical environment and to modernise services, particularly in relation to booked admissions, so that patients get an appointment that is convenient to them and that meets their needs.

In relation to investment in Buckinghamshire, I note what the hon. Gentleman says about Buckinghamshire's distance from the capitation formula. That must be set in the context of the vast increase in resources that

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Buckinghamshire, with every other health authority in this country, has received during the past four years. Since 1997, I understand that funding for Buckinghamshire has literally doubled, a massive increase in resources. Although I take the point that he makes about the comparison with others and the formula, investment in Buckinghamshire has resulted in real improvements for local people.

I wish to put on record the improvements at Stoke Mandeville. Obviously the trust has struggled. It received a zero star rating and under-achieved on five of the nine targets, but in the past few months in-patient waiting lists have been down, waits of more than 12 months have been reduced by 58 per cent. and waits of more than 15 months by 71 per cent. Last-minute cancelled operations are down to below the regional average of 2 per cent. Good progress has been made in tackling delayed transfers of care. In the past two months, the hospital has appointed a discharge co-ordinator and the number of blocked beds has been reduced from 28 to 17—quite a dramatic improvement. I thank the staff and managers who have been involved in achieving those improvements.

I hope that I have reassured the hon. Gentleman and his constituents. I can give the final assurance in relation to patient safety, which he raised. That matter has been considered by an independent review. All the evidence has been examined. I understand that agreements have been reached for the future smooth running of the department. I and the interim chief executive do not believe that patient care has been compromised. Current practices are in line with A and E faculty guidance. The service is, I understand, working well.

I hope that what I have said has confirmed that Stoke Mandeville hospital has a bright future, and will serve its constituents by providing high-quality and excellent NHS services. It is right that we all pay tribute to the hard work and dedication of the staff. I hope that the hospital continues to serve patients in such a good way for many years to come.

Question put and agreed to.

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