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6.17 pm

Mr. Michael Foster (Worcester): An opportunity to discuss the health economy in Worcestershire is always welcome and I congratulate the hon. Member for West Worcestershire (Sir Michael Spicer) on securing a debate on Pershore and Malvern hospitals. Although those hospitals do not serve Worcester directly, they have an impact on the south Worcestershire health economy, and I view Worcester as the capital of south Worcestershire, if I may put it that way.

The hon. Gentleman made a very important point about the role of community hospitals in providing care to support our acute hospital system in Worcestershire. Patients may go to the community hospital for observation before being admitted to the acute hospital, or not admitted, as the case may be. The community hospital also allows people to be discharged from the acute hospital into an area where an appropriate level of care can be given. As he said, that care is in a less intensive and therefore less costly form. The role of community hospitals, be they in Pershore, Malvern or Evesham in south Worcestershire, is very important to the Worcestershire health economy.

Delayed discharges from the acute trust are a problem. We have debated that issue in the Chamber previously and it is to be hoped that we made some progress on it earlier today. The issue flags up the question of Worcestershire's capacity to deal with the health needs of the county and south Worcestershire in particular.

That is why I welcome the opportunity to debate the future of Pershore and Malvern hospitals. These hospitals have a lower bed occupancy rate than the

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acute trust, which gives the health economy a little bit more flexibility to operate creatively in seeing people move from acute hospitals to more appropriate forms of care. Bearing that in mind, however, I discovered earlier this year what I believe to be a form of discrimination against my constituents in Worcester and against people living in the northern part of the south Worcestershire area, in terms of how the relationship between community hospitals and the acute trust works. I shall give an example. If two patients—one from Pershore, the other from Worcester—were in an acute hospital but no longer needed acute care and were awaiting discharge, and two beds became available at the Pershore community hospital, the Pershore resident would pretty much automatically go to that hospital. The patient from Worcester, however, would not, even though it would be more appropriate to transfer that person to the Pershore environment. That is because the community hospitals serve the smaller towns and villages in south Worcestershire.

When I raised this issue with GPs from the local medical committee, they confirmed that that was indeed the case. My constituents are being discriminated against in terms of how the hospitals at Pershore, Malvern and Evesham currently work. Will the Minister look into this form of discrimination?

Mr. Luff: The hon. Gentleman is making an important point. I know, however, that, in the case of Evesham—on which I can speak with authority—the South Worcestershire primary care trust regards the hospital as the property, as it were, of the whole south Worcestershire health economy. It is certainly the trust's intention that people from all over south Worcestershire should be able to use it when they are discharged from an acute hospital. To be fair to the trust, it is taking this issue on board and dealing with it.

Mr. Foster: I can confirm that the South Worcestershire primary care trust is indeed taking this matter up. It has confirmed that the form of discrimination that I have just outlined can occur, and it is endeavouring to ensure that it is cut out, so that we can view south Worcestershire as a single health economy, rather than as distinct geographical locations. That is why I would like to ask the Minister to look into this matter.

This debate flags up the issue of whether Worcester as a city, and perhaps the northern part of the south Worcestershire area, should have some form of community hospital capacity. I put it on record that we in Worcester may have to campaign for a community hospital, so that we can get the type of care from which residents in the more rural parts of the county benefit, and from which those in the heart of Worcester currently do not.

Sir Michael Spicer: Surely that is the answer to the conundrum that the hon. Gentleman described at the beginning of his speech. He seemed to be implying that people were being prevented from going into hospitals in areas close to their families. Patients having their families close by is one of the advantages of such

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hospitals; that is why they are called community hospitals. The answer to the hon. Gentleman's conundrum is surely to have one for Worcester as well.

Mr. Foster: I am most grateful to the hon. Gentleman for that intervention, because I was about to ask the Minister to support such a campaign for a community hospital in Worcester and to ask my colleagues from Worcestershire to do so as well, as there would be benefits not just for the residents of Worcester. There would also be knock-on effects for the more rural areas of the county.

I would also like to ask the Minister what I think are some pertinent questions, given the contribution made by the hon. Member for West Worcestershire. If the Minister does not have the answers to hand, perhaps he could write to me to put them on the record. There has been an increase in the rate of national insurance contributions, and the money raised by the Exchequer is to pay for improvements in the national health service. How much of that increase will go into the Worcestershire health economy? In particular, how much will the South Worcestershire primary care trust get as a result of the increase?

Will the Minister also make an estimate of the impact that there would have been on south Worcestershire—particularly on Pershore and Malvern hospitals—if national insurance contributions had not been increased? That is a relevant question to ask. Will the Minister also confirm which Members of Parliament from Worcestershire voted in favour of the increase in national insurance contributions—

Mr. Deputy Speaker (Sir Michael Lord): Order. I must remind the hon. Gentleman that this is not his debate. It was initiated by another Member and its context is quite specific. He has not yet strayed too far from the future of Pershore and Malvern hospitals, which is the subject of the debate, and I should be grateful if he would stick to that.

Mr. Foster: Thank you, Mr. Deputy Speaker. I am inclined to get a little carried away when I try to protect the national health service in Worcestershire, whether that is Pershore or Malvern hospital.

Will the Minister make an assessment of what would happen to Pershore and Malvern hospitals if there were a 20 per cent. cut in the budget of the South Worcestershire primary care trust? That would have great relevance to my constituents and those of the hon. Member for West Worcestershire. I support the call for clarification on the future of Pershore and Malvern hospitals, and I put on record again my intention to campaign for a community hospital facility for the heart of Worcester.

6.25 pm

Mr. Peter Luff (Mid-Worcestershire): It is a rare privilege to have such time in which to debate the health economy of Worcestershire. These debates are usually dominated by concerns about the north of the county, which are often expressed by the hon. Member for Wyre Forest (Dr. Taylor). It is good that the three hon.

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Members who represent the south Worcestershire health economy—that is rather an ugly phrase—are able to participate in a debate on the important question of the future of Pershore and Malvern hospitals and the implications and lessons of the consultation that is currently being conducted. I am specifically concerned with the consultation on Pershore hospital.

I congratulate my hon. Friend the Member for West Worcestershire (Sir Michael Spicer) on having the good luck to secure a debate on a subject that is important to his constituents. I shall not tread on his toes too much because Pershore hospital is firmly in his constituency, but he was kind enough to say that many of the villages to the north of Pershore look on that hospital as a health service that is valued and appreciated. Wyre Piddle parish council, especially, shares my hon. Friend's concerns about the inadequacy of the consultation. I have advised the parish council on how to contribute to the consultation but it remains deeply concerned.

I am glad, in most respects, that the hon. Member for Worcester (Mr. Foster) made his contribution and that he agrees that Worcester has a capacity problem. That is common ground between us. Ensuring that the Worcestershire health economy—I do not like the phrase but I shall use it—has an adequate capacity is an important challenge for us all. I agree that the solution to the problem is not closing community hospitals. Indeed, the solution might be to create community hospitals in addition to Pershore and Malvern.

I heard what the hon. Gentleman said about Worcester and I shall make a brief case for Droitwich in the north, although it is not strictly a matter for the debate, because that is short-changed by its community health care facilities. I know that the primary care trust, the town council and other bodies are considering how to improve the situation.

I was sorry that the hon. Gentleman adopted more of a party political approach towards the end of his remarks. He made a point that I shall briefly rebut. No one has ever talked about cutting public expenditure on the health services for Worcestershire, Pershore, Malvern or anywhere by 20 per cent. That is an invention of the hon. Gentleman—and other Labour Members—and a product of his febrile imagination. No one is considering that, and no one in their right mind would. I hope that he will stop making such a ridiculous allegation.

I want to address the consultation process on Pershore hospital and the precedent that it might set for the wider consultation on changes to health care provision that is being held throughout south Worcestershire. Consultation will be held on Evesham community hospital later in the year, and it is tremendously important to get those consultation processes right.

The point of my speech is to ask the Minister a central question. Is he satisfied that the consultation on Pershore community hospital is legal under section 11 of the Health and Social Care Act 2001? People in Worcestershire are seriously worried that the consultation could be open to legal challenge and that the primary care trust has not conducted it properly. That is not necessarily a criticism of the PCT, although its chairman is a leading supporter of the Labour party. I thought that he might have been aware of his own

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Government's policy, but my views on his position are well known. However, there is a problem because of the deficit, which my hon. Friend the Member for West Worcestershire rightly mentioned often during his speech.

The South Worcestershire primary care trust had a small, inherited deficit, which has increased this year. The Government say that it must eradicate the deficit. I have asked parliamentary questions about the length of time that the Government will give the primary care trust to eradicate the deficit, and I found the answers a little frustrating. We know that the consultation on Pershore and the wider health care changes in South Worcestershire is driven by anxiety about the deficit.

The consultation on Evesham hospital is unlikely to be driven by the deficit. I believe that, for the reasons that the hon. Member for Worcester gave, the primary care trust genuinely supports Evesham hospital's continuation and wants it to flourish. However, that will doubtless involve a change in the pattern of service provision. Again, the consultation on Pershore will create the climate for that on Evesham hospital. We must therefore be satisfied that the Pershore consultation is being conducted properly.

Two documents apply to the debate. Malvern is not yet the subject of a document. They are entitled "Modernising Health Services in Pershore" and "Proposed changes to healthcare provision in South Worcestershire". Both are rather coy about the genuine reasons for the policies that they propose.

Let us consider the legality of the process. We held an interesting debate on 11 March in Westminster Hall during which the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), outlined the guidance in "Keeping the NHS local—a new direction of travel". I do not want to quote her out of context, and I shall therefore read the relevant paragraph. She said:

"The guidance has three core principles that will in future underpin everything that we do in this field. The first principle is that options for change should be developed with patients not for them, and that before we even start to formulate preferred options, we have a sense of sitting down right at the outset to design what services should look like—their essential features—and where they should be. In the NHS in the past, a preferred option would emerge and people were presented with it almost as a fait accompli."

To me, the consultation on Pershore is an example of old-style NHS consultation. A "preferred option" has emerged and people are being are being presented with it

"almost as a fait accompli."

The Under-Secretary went on:

"Consultation was sometimes simply the expiry of a period of time, people would do the first thing that they had thought of, and the process was not altered by the involvement of the public. The first underlying principle is that we develop proposals for change in consultation with local communities and that we start at the outset to think about what service redesign should look like."

Later, she mentioned the legal basis for the framework guidance in section 11 of the Health and Social Care Act 2001. She said that it

"places a duty on the NHS to make arrangements to involve and consult the public in everything that it does. Under that new statutory framework, the NHS has a duty to involve the public in planning and developing services and in making decisions about how services will operate."—[Official Report, 11 March 2003; Vol. 401, c. 56-7WH.]

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She said more but I shall not detain hon. Members with an overlong quote.

Section 11 of the 2001 Act, which should guide consultation on the future of services such as those at Pershore and Malvern, came into force from the beginning of the calendar year, but the guidance was published in February. The document is entitled "Strengthening Accountability". It includes a moving foreword by the Under-Secretary who will reply to the debate. It stated:

"To achieve our aim we will involve and consult patients and the public in how health services are planned and developed . . . Patient and public involvement is not an end in itself but a way of achieving three fundamental objectives: strengthened accountability to local communities; a health service that genuinely responds to patients and carers; and a sense of ownership and trust."

The conduct of the Pershore consultation sets a worrying precedent for the wider consultation in south Worcestershire and the later consultation on Evesham. That sense of ownership and trust simply does not exist. There is genuine doubt about the underlying purpose.

The document does not mention the financial implications but we all know that they drive the consultation. Subsection 6 on page vii, entitled "Executive summary" states:

"The overall aim of Section 11 is to make sure patients and the public are involved and consulted from the very beginning of any process to develop health services or change how they operate. This will lead to patient-centred care and improvements in the patients' experience."

On page 1, we read probably the most important single passage in the document, which leads me to raise the question of the legality of the process at Pershore. It states:

"Section 11 places a wider duty to involve and consult patients and the public . . . not just when considering a proposal but in developing that proposal".

I submit that the public have not been involved in developing that proposal. They are being presented with a fait accompli, or rather five separate ones that constitute the preferred policy of South Worcestershire PCT for Pershore hospital. That is very worrying. I genuinely believe that the Minister's fine words are being undermined by the nature of the consultation process at Pershore. The sense of ownership and trust that the Government rightly want to engender—the objectives are splendid and I do not disagree with them—is at risk as a result of how the process is being conducted.

On page 4 of the document, we read:

"Within the NHS, planning will be from the bottom up.


PCTs (and relevant care trusts), as lead planners will be responsible for creating local plans which describe health and service improvements in their area. These will be developed using local clinicians' knowledge as well as patients and the public."

Of course, the trouble is that what is being proposed at Pershore as well as in the wider consultation on the South Worcestershire PCT proposals for overall service provision in my constituency and those of my hon. Friend the Member for West Worcestershire and the hon. Member for Worcester constitutes not an improvement, but service reductions. We are consulting on service reductions at Pershore and across south Worcestershire's health economy.

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I try to be a fair man, but I find that difficult to understand. The hon. Gentleman rightly raised the question of the 1 per cent. job-destroying tax introduced by the Chancellor, which comes into effect this week. The hon. Gentleman asked, "The money is coming into south Worcestershire, but where is it going?" I too ask where it is going, because we are consulting on service reductions. I fear that that proves to me that spending more money does not always produce better services. The question involves the quality of that spend, which is what worries me about south Worcestershire, and Pershore in particular. Is the money being spent well?

On page 7 of the document, there is a list. It states:

"Pressure to change services may come from any number of starting points—both negative and positive. Some examples"

of why a consultation such as that at Pershore may need to be conducted are

"outdated buildings and facilities; new standards . . . evidence of what works, workforce pressures",

and so it goes on. There is no mention of deficits or of budgetary problems, but they are driving the process here, which is perhaps why the consultation is being conducted so urgently and so cack-handedly and why, worryingly, it appears to be contrary to the law of the land passed by this House of Commons only two years ago. We also read:

"The principles behind this should be:


designing services with local populations, not for them;


solutions developed for health communities rather than individual hospitals or organisations".

That leads to my other point about the Pershore consultation in particular. We have two documents, entitled "Modernising Health Services in Pershore" and "Proposed Changes to Healthcare Provision in South Worcestershire". Members should study the fifth proposal of the second document, on community hospitals. They might expect to read about modernising health services in Pershore, but no. There is no cross-reference at all. The proposal talks entirely about the joint health and social services day rehabilitation unit at Evesham community hospital. The proposal is not to make changes, but to send the bill to the county council. The unit cannot be afforded any more, so the proposal is to send the bill to a hard-pressed county council that has already had to increase its council tax enormously just to stand still on service provision. Fat chance of that.

So, where is the joined-up government—I think that is the phrase—in relation to Pershore? I repeat: the document refers to

"solutions developed for health communities rather than individual hospitals or organisations".

Surely there should be one document, "Proposed Changes to Healthcare Provision in South Worcestershire", which would put Pershore in that broader context, but that has not been done. The consultation on Pershore's future is panicky and individual. I will not quote the legislation, as I am sure that the Minister knows what section 11 does, although I have it here if he wants it. It is clear that a duty is imposed on the PCT, which it is not meeting.

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I am grateful for the opportunity to speak in this important debate, but I must begin to draw my remarks to a conclusion. The document on Pershore shows every sign of being cobbled together in a great hurry. As a cheap debating point, I note that "Monday 31th" March is an interesting date for a meeting, but the real, important point is that the consultation process ends so soon—in four weeks.

The other document hints at—indeed, if read carefully, makes more explicit—the reason for the Pershore consultation. It identifies three aims:

"To improve performance . . . To provide an equitable, safe service . . . To 'live' within our NHS budget, and remove the £5.7 million recurring deficit".

That, of course, is the issue.

This document makes five proposals, three of which involve sending bills to the county council and two of which involve cutting services. I will not talk at length about this because it does not relate specifically to Pershore, but I consider the cut in the GP counselling services outrageous. It is a simple cost-driven measure with no obvious clinical logic. Although a reason is presented in the document, I do not accept it.

People in Droitwich Spa and Evesham have raised with me the proposal to abandon all pulmonary rehabilitation services in Malvern. I believe that those services are based in a Malvern hospital. The question was asked:

"What is happening to the pulmonary rehabilitation service in Malvern?"

The answer was:

"This is being reviewed separately within the PCT involving our Professional Executive Committee of GPs and Primary Care Professionals."

We hear fine words about joined-up services, rather than solutions for individual services. Here is a service provided in Malvern and serving the whole of south Worcestershire—Worcester, Droitwich and Evesham—and here is a fudge. We are talking about not a separate review, but a proposal to remove the only pulmonary rehabilitation nurse serving south Worcestershire. Meanwhile, trusts north of that area are considering employing such nurses, because they recognise their value in reducing the number of emergency admissions.

The crucial aspect of the Malvern service is that it serves the whole county, and allows a reduction in the number of emergency admissions in winter. Many emergency admissions are caused by respiratory diseases, but the trust is thinking of sacking the nurse in order to deal with its budgetary problem and ending a service whose users are understandably worried. This is not just a Malvern problem; it is a south Worcestershire problem.

Other proposals will reach the Minister's desk—proposals relating to Worcestershire, but extending beyond Pershore and Malvern—in the coming weeks and months. There will be further consultation. If the pressure on Pershore and Malvern and the whole south Worcestershire economy is to be relieved, the trust must be given a longer time in which to pay off its deficit. If it is forced to pay it off in a single year, there will be cuts and a loss of confidence in the process whereby the future of health services in my constituency and that of my hon. Friend the Member for West Worcestershire is

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dealt with and consulted on. I urge the Minister to reflect on whether the consultation should be halted and begun again, in accordance with the law.

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