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Peter Bradley: —and to develop the Princess Royal hospital and its ability to attract top consultants. But that has not happened. The merger has not even attempted to do that. It has been made clear to me, for example by David Nicholson, the regional director of the Department of Health in a letter, that the proposal is to merge two organisations managerially, and because of that, that the proposal cannot address issues of provision of services. The question that I would ask, and which my hon. Friend asked earlier, is how we can make decisions on one without regard to the other.

The consultation has been flawed from the outset. As we discussed earlier, it was initially launched just a fortnight before the PCTs' establishment, which fuelled suspicions of a fait accompli. Those have not yet evaporated. I am grateful for the Minister's intervention then. He will not be surprised that I am not so grateful for his subsequent decision not to intervene to ensure a proper integration between the consultation that has taken place on merger and the development of local delivery plans by the PCTs. Decisions about structures seem to have been afforded greater priority than decisions about the delivery of health care.

The consultation that we recently experienced was a shambles. It was inadequate and misleading. Material was poorly circulated. The consultation was poorly publicised. At public meetings, the staff representing the NHS often outnumbered the public. The presentation of a fait accompli often interfered with people's preparedness to contribute to the public consultation.

Telford and Wrekin council's health and care scrutiny commission has done a good job of assessing the consultation and the issues that have arisen. Its report states that it does not believe that

"members of the public and hospital employees have had an adequate opportunity to consider and respond to merger issues. It is concerned that the proposed merger has been presented as a fait accompli. It is unhappy that possible configurations involving the Robert Jones and Agnes Hunt Orthopaedic Hospital have been excluded. It is far from persuaded that a major structural merger can be contemplated without attending in more detail to related service implications."

The report goes on to state that staff at the PRH

"said they had not even seen a copy of the full consultation document."

With regard to GPs in the Telford and Wrekin area, the report says that

"they felt unable to form a view on the merger owing to their lack of information on the subject."

That was a problem shared by the voluntary sector. The document goes on to state:

"The Shropshire Council for Voluntary Services (CVS) considered that they had not received enough information about the proposed merger during this consultation process."

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Even the Shropshire and Staffordshire strategic health authority expressed serious concern. It stated that

"the recently-established SHA would have preferred public merger consultation to have been postponed until at least later this year. It was stressed the 'historical and political tensions' need to be overcome if a single acute hospital trust is to work effectively."

The scrutiny commission concluded:

"The Commission felt that the consultation failed to engage the public due to the very narrow terms of reference prescribed. The public were unable to debate the areas of most concern to them, i.e. service configuration and in the view of the Commission this meant the consultation was seriously flawed."

Those serious views expressed by the commission were borne out by the views expressed to me. A consultant at the PRH, Bruce Summers, wrote to me to say:

"I am by no means convinced that a merger will be in the best interests of patients who currently look upon the Princess Royal as their local hospital. My experiences over the last 13 years are such that I do not have any faith in a combined Trust Board and combined management to provide equity of healthcare for all patients in Shropshire."

Another consultant, Peter May, wrote to say:

"Only a minority of the Telford medical staff are in favour . . . In truth professional staff have been tired by the endless wrangling. There seems to have been an unstoppable pressure from above",

and adds in parenthesis that it is

"the same pressure that merged Redditch and Worcester, closing Kidderminster".

He went on to say:

"Telford fears that its hospital will be downgraded after merger."

The nursing union and other unions at the PRH said:

"We have now consulted with our members but there appears to be an air of apathy and expectance that the merger will go ahead regardless of our views and concerns."

Certainly from the soundings that I took among staff at the PRH, the overwhelming view was against merger and there was deep concern that their views were not being heard.

The same is true of GPs in my constituency. Graham Thompson, a local doctor, wrote to me to say:

"We feel that the share out is too lopsided in favour of Shrewsbury when in fact most clinical need is in the East of the County."

Even the Telford and Wrekin PCT, which in the end voted for the merger, wrote to me in the following terms:

"That decision will not be made with enthusiasm; the PCT remains as concerned to avoid any drift of services or 'centre of gravity' to the Shrewsbury site as I know you are yourself."

That is hardly a ringing endorsement. That view is held not just by those in the medical community, but by people outside as well.

I received a letter from Lilleshall and Donnington parish council, which suspects that

"funding will be diverted from the Princess Royal Hospital, to aid Shrewsbury, thus devaluing"

the hospital's

"ability to serve Telford and its surrounding areas."

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Similarly, Wrockwardine Wood and Trench parish council in the constituency of my hon. Friend the Member for Telford wrote to me to say:

"we are now in danger of having"

our hospital

"taken away from the area. We need more services in Telford and Wrekin, not less."

Again, those are hardly ringing endorsements for the merger proposal.

David Wright: Does my hon. Friend agree that the process could have been positive had a development plan been in place for the Princess Royal hospital? Significant development land is available at the hospital and the way in which it is designed means that services can be added on to existing wings. We can still make the process positive, but we must have a development plan.

Peter Bradley: My hon. Friend is right. There is a lot of land at the PRH and it has a huge potential. There is also a great deal of commitment in the local community. Staff at the PRH are anxious that they are not being allowed to fulfil their potential in serving their community. The hospital has difficulties in securing and retaining staff, especially consultants, because it has relatively little to offer. That in turn feeds our constituents' anxieties because they think that in the absence of specialisms and a development plan, the future of their hospital is in doubt. The merger proposal makes it difficult to dissuade them from that point of view. Many regard the proposal as the thin end of the wedge because it omits to discuss the future of the hospital and does not set out a development plan. That is why we are worried that a merger before a redistribution of services in the county will lock in the imbalance to which I referred. That is one reason why I believe that I would betray my constituents and their interests if I supported it.

One further issue only came to light in recent days. In the past we have been reassured that even if Shropshire health authority let us down and the merger proposal was not accompanied by a development plan, the introduction of PCTs and their commissioning power would give Telford and Wrekin PCT an influential say in the future of our hospital and an important role not just in underpinning its future but in helping to develop its future through its commissioning power and funding. As I said, however, despite the generous increase in funding for the PCT over the next three years—I acknowledge that 34 per cent. is at the top of the range—and the 14 per cent. increase in capital investment over the next three years, we are starting from an annual deficit of £12 million, which means that we are 9 per cent. short of our fair share.

The spend per patient in Telford and Wrekin every year through the national health service is about £719, which compares with a national average of £819. That severely compromises the commissioning power of our primary care trust with regard to the Princess Royal hospital.

As I understand it, the problem has further intensified in the past week. As recently as March, the strategic health authority confirmed that, as I believe has previously been the practice in hospital mergers, the

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NHS would write off at the point of merger the accumulated debt of the two hospitals, which amounts to about £4 million or £5 million. As of 11 April, when a meeting took place between the health authority and the PCTs, the rules have been changed so that any debt recovery is within the strategic health authority area and not the NHS as a whole. That will come as extremely unwelcome news not only to Shropshire but to Staffordshire, which will have to pick up its share. It will also be unwelcome not only to the acute sector but to the primary sector, which will also have to reach into its already pressurised budgets to find its contribution. Yet again, the purchasing power of our PCT and its ability to support the future of our hospital will be still further undermined.

The Government rightly have a vision of the NHS that puts patients first. Of course I applaud that, but I suggest that the plans that are currently before us meet the needs of the bureaucrats before those of our community. What is worse is that, without cast-iron, copper-bottomed assurances about the future of our hospital, they could prove disastrous for my constituents.

If the Minister cannot find it in himself to reject the proposal or defer it until the issues that I have raised are properly considered, a well-conceived argument for merger is advanced and the health service communities and wider communities are properly consulted, I entreat him to give us assurances not only that the Princess Royal hospital will not be undermined by the merger that is currently being contemplated, but that the hospital will be developed and expanded to meet the needs and expectations of its staff and the community that they serve.

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