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Hospital Services (Somerset)

1.29 pm

Mr. Ian Liddell-Grainger (Bridgwater): I am delighted to have secured this debate with only 24 hours to go until the recess. I want to be a little parochial; rather than discuss hospitals in Somerset, I should like to talk about the Minehead, Williton and Bridgwater hospitals in my constituency. I shall focus on the Minehead and Bridgwater hospitals, as the Williton hospital is quite new, and has had an exemplary record for many years. I want to consider the problems of a constituency that is more than 52 miles long, and covers some of the most sparsely populated areas of England. The problems of west Somerset are probably quite well known to many people. The area contains the biggest Butlins in Britain, where 9,000 people a week can enjoy the delights of the riviera of north Somerset. Last week, 280 people went down with a virus, and hon. Members can imagine the strain that was put on the local health service to deal with that problem. I could say that that happens only once in a while, but it tends to happen each year, when that number of people are in such close proximity to each other.

My constituency is a tourist area, including Exmoor, the Quantocks and the Levels. The last battle in Britain was fought in my constituency—some say that it still goes on. People come through it at an enormous cyclical rate to enjoy the delights of a very large area. The town of Bridgwater is the opposite extreme. It is an industrial town that makes cellophane, Sunny Delight, ammunition, plastics, extruded plastics and many other things. The hospitals cover a very sparse and dense area, but they have one thing in common: they cover a vast area.

I should like to pass on the apologies of my hon. Friend the Member for Taunton (Mr. Flook) and my right hon. Friend the Member for Wells (Mr. Heathcoat-Amory), from whose areas the hospitals draw people and who cannot be here owing to other duties. They have exactly the same problems with those two hospitals, and would say what I am saying. To put it crudely, we need two new hospitals: one in Minehead and one in Bridgwater. That is because the present hospitals were built by subscription, as most in this country were within living memory. The hospitals have a finite capacity. Minehead hospital is on three floors, with the operating theatre on the third floor. As hon. Members can well imagine, with today's health and safety concerns, doctors cannot operate on the third floor due to the constraints of fire regulations and other modern problems that were not taken account of quite so readily some years ago.

I want to cite some statistics to show why we need a new hospital: it is a case of the devil and the damned. West Somerset covers 218 square miles—London would fit into it easily. Bridgwater is a slightly smaller area, but it covers Mendip, Taunton Deane and a surrounding area that has the sea on only one side. The rest is almost the same size. There are on average 50 beds in Bridgwater hospital, slightly fewer in Minehead and about 30 in Williton. An enormous number of people need health care and they cannot always get it.

The local major hospital, Musgrove Park, is just outside the constituency of the hon. Member for Somerton and Frome (Mr. Heath). That hospital has its

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own problems because its general surgery unit needs about £40 million to bring it up to a standard that is acceptable today. It was built so that US Army jeeps could drive down the corridors during the last war. That is how wide the corridors are, although I am not sure jeeps would get down them nowadays. Musgrove Park is going down the private finance initiative route already, but I do not want to concern the Minister with that. However, we have infrastructure problems that we need to address. The hospital in Minehead is in the middle of the town, and it is physically impossible to expand it any further. The one in Bridgwater has exactly the same problem. It cannot be expanded because it is faced by a river, and a main road lies behind it.

We also have other problems. We have an enormous problem in housing nurses. There are not enough houses. The Minister may respond that that is the responsibility of another Department. It is incredibly expensive to live in Exmoor or the Levels. One would think that it would be comparatively cheap because it is a rural area, but in fact houses in Exmoor are more expensive by far than anywhere locally, because of the area and its outstanding beauty.

We also cannot recruit GPs. The whole of Somerset is short of GPs, but especially in my constituency. We cannot get them to come down and settle there. One would think that GPs would love to come to such a beautiful area and be part of a thriving rural community. It is a lovely place in which to bring up their families. However, they do not come and we are short of them. We are also short of dentists throughout the county, and we are trying to encourage them to come to the area. We have a problem getting them to settle in the area, although we had no problem in doing so until recently.

We have a problem with all levels of care. Until recently we were fighting tenaciously for equipment to keep our X-ray system in Minehead going. We managed to do so, but it cost £150,000, nearly half of which was raised by the League of Friends and others. We could not rely on our primary care trust to raise the money, although it is doing its best to provide money across the spectrum. The trust got the money and now has a digital X-ray machine, but thanks only to enormous support from the local community in the Minehead area.

Domiciliary care is another problem. We cannot get people to come down and settle because we have a problem with training our nurses. If a nurse settles in my area and needs to train to get up to the next level or grade, they have to go to Plymouth, Bristol or in some cases Truro. Truro is in Cornwall and is about 120 miles away. Plymouth is 80 miles away and Bristol is between 50 and 60 miles away. Those places are not easy to get to, so if a nurse intends to take time out and wants to get up to the next grade at a cost of £350, she has to do it in her own time. Getting cover in an area such as my constituency is almost impossible, so many nurses who want to get on and better themselves are not in a position to do so. We do not have enough people to take up all the slack in the system. I am sure that that is true throughout the United Kingdom, but I am describing the particular problems of a rural area.

Nurses' pay is another problem. I am delighted that the Government intend to build more houses in London for nurses, and are doing whatever else they can to encourage nurses, doctors and police, but that does not

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help us in our area. Will the Minister consider some form of inducement for nurses to settle in rural areas, to encourage them and enable them to retrain? In Minehead especially we depend almost entirely on people who retire to the area or who are considering settling in the area because their husbands or wives have moved there.

I wonder whether, in the longer term, we should consider establishing a mechanism to encourage nurses and other specialists to settle in areas such as my constituency. They should not be offered a bribe—that would be cheap—but some form of incentive so that they could set up their family and themselves in an area where they know they can stay for a long time.

The health service is considering how to improve training in our area, and the university of Plymouth, with Somerset College of Arts and Technology in Taunton and Bridgwater college, is actively considering whether something can be done. However, as the Minister knows, the cost of doing anything like that is enormous, and it will be difficult for the university of Plymouth to improve matters without help from the Learning and Skills Council, the medical sector or the Department of Health. If that were forthcoming, a lot of people would be willing to come and settle in the area in the certainty that they would receive training and be able to stay on. That goes for GPs and for everybody else.

About a third of the beds in our three hospitals are blocked. We have a major problem in Somerset with care homes. We have lost many beds during the past few years, in an area with a large number of retired people, and the hospitals have had to take much of the strain. I had a meeting with all the health care providers in my constituency at Bridgwater hospital last Friday. They said that the situation was getting worse. I am not saying that there is an easy fix to the problem—there is not—but I hope that the Minister will try to deal with the problems caused by the fact that up to a third of the beds in those hospitals, which are almost always full, are taken up by people who need to be properly looked after either in the community or in care homes.

Somerset county council pays one of the lowest rates of income to nursing home operators in the United Kingdom. I see Somerset as the forgotten county. People go through it to get to Devon and Cornwall or elsewhere, and we seem to be forgotten. We have more old people than the areas that surround us. As a result of that, and the loss of homes, we cannot afford to keep those people, so homes are shutting down at an alarming rate. In Minehead, we have lost four homes in the past year. We cannot continue that level in any sustainable future. People have to go to Musgrove on the one ambulance that we have or stay in the hospital in Minehead, but the capacity there is such that acute patients have to go to Musgrove to be looked after.

People in hospitals tell us that they want to be in a care home but cannot get into one, which is a shame. That is not because they do not have the money. Some have the money, but beds are not available for them. A lady from one of the homes in my constituency told me a couple of weeks ago that she had a waiting list of five people for every bed. As the Minister knows, people usually get

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into nursing homes usually as a result of the death of a client, to put it crudely. We have a structural problem now that things have reached that level.

Another problem in Bridgwater—it applies to the whole of Somerset—is that the mental health department in the county wants to lay off between 45 and 50 people this year because of a funding crisis. I received an e-mail from a constituent, who stated:

That sums up the problem. The area can ill afford to lose so many mental health professionals. I hope that the Minister will take that on board. It is not a criticism, but it may make him consider the future of a county that has encompassed mental health provision. We bring many people into Bridgwater from elsewhere and ably look after them. Is there any way in which we can bring that to the forefront of people's minds? Unfortunately, it tends to be disastrous when people's mental health is not as good as it should be. All the health care professionals involved suffer, as well as the person who is ill. I do not want blame to be apportioned; I merely want the problem to be sorted out. The Minister could address that.

I want to praise the Somerset Coast primary care trust, which has done a phenomenal job. Its work extends into the constituencies represented by my hon. Friend the Member for Taunton and my right hon. Friend the Member for Wells, and it has tried to bring health care to the forefront of people's minds in the area. Donald Hinds and Alan Carpenter, the two people at the top, have worked incredibly hard with the general practitioners and all the health care professionals in my constituency and in the other two constituencies to ensure that the trust works. So far, so good, I can safely say. It is marvellous that the trust is creating a system in which GPs and nurses feel that they are part of the team and that people are talking to each other. Last Friday, I was delighted to see the executives of the trust and the health care professionals talking openly about the future.

In the past month, we have had two yellow alerts in Musgrove. There have been 12 medical outlays in July as well. We are a tourist area, and we cannot always cope with problems when we have an influx of tourists. The information about the yellow alerts came from a doctor, as I had wondered about them. Two in one month is not good. We cannot cope, and it does not help when people are in corridors on beds or when they cannot be admitted to hospital because there are no beds. The situation in Musgrove is extremely difficult.

We should consider new hospitals in such areas. They could be built with small accident and emergency departments, out-patient departments and so on. At the moment, in neither of my hospitals are such departments manned all the time. They do not have the capacity or the people, and that point must be considered. Resolving that problem would help the situation dramatically.

The only downside or fear that we have about the strategic health authority is that we have been thrown in with Dorset, and if people in my area need acute care they must go to Dorchester, Poole or Bournemouth. It is a long way to travel from my area to Dorset, through

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the constituency of the hon. Member for Somerton and Frome. I wonder whether the decision is right; if it works, it will be marvellous, but if it does not it will be difficult for people in Somerset—certainly for those in my constituency. That is why we need those hospitals, because it takes the whole day to go down to Dorset.

1.45 pm

The Parliamentary Under-Secretary of State for Health (Mr. David Lammy) : I congratulate the hon. Member for Bridgwater (Mr. Liddell-Grainger) on securing this important debate. His passion for his constituency and for health issues in the area is evident. I know Somerset a little, having had occasion to visit Glastonbury in the past. One of the first media events in which I participated on becoming Member of Parliament was to visit Frome's Women's Institute for "Any Questions", so I know how friendly people are in that part of the country. The national health service is vital for people in his constituency and for everyone in the country. I am pleased to take on board much that has been said and to speak on the issue.

The hon. Gentleman referred to two community hospitals in his constituency, at Bridgwater and Minehead, which provide a valuable role and, at least to some extent, enjoy good local support. I join him in expressing my appreciation and thanks to those who work in them for the care and support that they provide to their patients. The hon. Gentleman raised the need for investment and to improve the environment of the two hospitals, which are managed by the Somerset Coast PCT.

I am pleased to be able to inform the hon. Gentleman that as part of the clean hospitals programme, the Government last year provided that PCT with £75,000 to improve cleanliness and decor at hospitals. Extensive refurbishment of community hospitals in Minehead, Williton, Bridgwater and Burnham has now been completed. It included the painting of hospital corridors and foyers, the provision of new signs to give patients clear directions around the hospitals, refurbished toilets and new tables and chairs.

The refurbishment is part of the Government's £60 million investment to improve the environment for patients across the country and comes with the requirement for NHS trusts to carry out monthly cleanliness inspections and quarterly building maintenance audits, to be monitored by strategic health authorities and NHS Estates.

The hon. Gentleman raised concerns about the changes to the two hospitals. One would expect a constituency MP to raise such concerns, and I take them on board. It is important to emphasise that the NHS has a new framework; we have been serious about shifting the balance of power from Richmond house to local PCTs in liaison with their strategic health authorities. The debate will be on record, but I encourage the hon. Member to take his views and those of his constituents to the local PCTs, which liaise with the strategic health authority to make those important local decisions.

The hon. Gentleman expressed concerns about mental health care. Those decisions may need to come back to Richmond house. Essentially, investment is shifting the balance of power. We are serious about that and committed to it in the NHS plan. That means that it is for local areas to make any decision.

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I also hear what the hon. Gentleman says about the configuration of the strategic health authority. Again, that involves local decisions, and there are discussions about reconfiguration and other issues elsewhere in the country. That is an issue for the hon. Gentleman and his colleagues in the health community in the Somerset and Dorset area.

The hon. Gentleman highlighted the problems faced by the local health community in recruiting suitably qualified staff. He will know that the main problem facing the health service is not necessarily the provision of extra money; indeed, people throughout the country will say that they see the resources coming through. The NHS is growing faster than any other health service in Europe and it has undergone the longest sustained period of growth that we have ever known. However, the hon. Gentleman rightly mentioned staffing constraints, including the number of trained and qualified staff across a range of specialties. Increasing the work force is therefore a top priority for him and, indeed, the Government. We have said that, by 2004, there will be 7,500 more consultants, 2,000 more GPs, 20,000 extra nurses, 6,500 extra therapists and 1,000 more medical school places, on top of the extra 1,100 already announced. That huge programme of growth is intended to deal with capacity issues that affect some of our larger counties, and particularly those whose population profiles include a large elderly community.

In 1996, there were 2,629 consultant anaesthetists. Five years later, there were 3,549—an extra 900. However, that is simply not enough, and we estimate that we will need another 2,500 consultant anaesthetists over the next nine or 10 years. We expect 1,850, so it looks as if there will be a shortfall. We therefore need a massive recruitment campaign to step up the numbers right across the board.

Trusts in Somerset have been active not only in recruiting the necessary additional staff but in retaining those who currently work in the area. The PCT has attended several career fairs around the country to showcase the facilities that are now available, and that is starting to have positive results. In addition, it offers a range of flexible working conditions, including flexible working patterns, team-based self-rostering, annual hours and flexitime. I understand that it is also looking to develop a child care strategy centre to provide staff with good, accessible and affordable child care. There will also be particular local needs and local ways of recruiting, which the PCT will be well placed to take on board, and I listened with interest to some of the hon. Gentleman's suggestions in that regard.

Several new developments are under way in Somerset. They are the result of the hard work and commitment of staff and of new moneys invested by the Government. They are helping the trust to attract new members of staff from across the country, and I want to mention some of the exciting new services in the Somerset area. A £17 million oncology centre is due to open in 2005. It will significantly improve services for the people of Taunton and Somerset, while reducing the need for patients to travel to Bristol for treatment. The Dene Barton House medical step-down unit has been developed at a cost of £700,000. That vital unit provides on-going care for patients once they have left the acute wards of Taunton and Somerset hospital, but before they are ready to go home, and it enables the trust to

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reduce the length of time that people stay in hospital unnecessarily following treatment. It also helps to free beds in the district general hospital that are taken by patients who are waiting for nursing home places and who would be better placed outside the hospital environment.

A new cardiac catheter lab and angioplasty service have been developed at a cost of £420,000. The new service will increase the range of services available to the people of Taunton and Somerset, while reducing the need for patients to travel to Bristol. Those significant new investments will lead to an improved service for patients and show the commitment of the local NHS to providing specialist services closer to home, so that patients need not travel long distances for treatment.

I take on board many of the suggestions that have been made. I hope that the investment, alongside the ideas and good practice that have arisen as a result of the PCT's work with the hon. Gentleman and others, is the beginning of a health journey for people in the Somerset area. We are starting to see the benefits of investment and reform, both nationally and locally. Waiting time figures have improved significantly. The trust met its 2001 NHS plan targets of no patients waiting in excess of 15 months for in-patient treatment, or 26 weeks for out-patient treatment, by March 2002. It also achieved a maximum in-patient wait of 14 months and reduced the number waiting in excess of 13 weeks for an out-patient appointment to 971.

The trust will achieve the NHS plan target of a maximum 2l-week out-patient wait by March 2003 and will move towards a 13-week maximum during 2003–04. Waiting list figures should continue to improve following the redevelopment of existing theatres and ward areas, the establishment of additional beds and the development of a diagnostic and treatment centre.

The hon. Gentleman raised concerns about delayed discharges, and linked the problem to the geography and population profile of his constituency, which

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includes a large elderly population because people retire there. A few weeks ago, I was in Devon, where there are similar issues because of the nature of the county. He is right that there are too many delayed discharges, not only in Somerset but across the country. However, we are investing record amounts of money in social services. The Chancellor's Budget commitment to double annual increases in social services funding for the next three years will give social services departments the money that they need to build care capacity in the future.

We have already taken action to maintain capacity in the care home sector, to ensure that older people get the choice of a care home place when they need it. An extra £300 million has been allocated to local authorities to build capacity locally. From this, Somerset county council received £2.25 million. Our monitoring shows that at least half of that money has gone to support care homes with fee increases of between 3 and 10 per cent. since last September. The rest is enabling older people to stay in their own homes or to avoid having to go into hospital in the first place.

The number of delayed discharges is also falling as a result of the investment, which has ensured that people get the care that they need in the right place. In March 2001 there were 5,938 beds blocked but there were only 4,691 in March 2002.

We have already taken action to ensure that the care standards do not lead to the closure of good quality care homes. We will continue to monitor the situation and will take further action if necessary. The hon. Gentleman will be aware of the on going discussions between the local council and independent care home providers to address local concerns.

In conclusion, I would like to praise the staff working in the Somerset Coast PCT. I am pleased to support the hon. Gentleman's view that their dedication and commitment is highly commendable.

Question put and agreed to.

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