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7.43 pm

The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): I congratulate the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) on securing this debate on the proposed closure of the pharmacy department at the Royal Victoria hospital in his constituency. I know from the press cuttings that he has been a staunch defender of the interests of his constituents.

The NHS plan sets out a challenging 10-year programme for NHS reform. Far-reaching changes are inevitable to try to provide the best possible services for patients in that context, and we all acknowledge the pressures on the service, not only in Kent but throughout the country, that result from trying to increase capacity so that patients can have ready, quick and responsive access to services. We want not only to increase capacity, but at the same time to raise clinical standards generally.

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We must ensure that services are accessible and flexible, and we want to design services around the needs of patients. As part of the modernisation programme, many NHS trusts are considering changes to the way in which they organise their services. We all recognise that hospital services need to change if we are to continue to fulfil patients' needs and to improve access. Matters clearly cannot remain static for ever. There are a number of different pressures on the service, including providers of health services having to live within their means. Those issues, and many others, need to be taken into account as the health service changes.

The right hon. and learned Gentleman mentioned the financial difficulties that the area faces. I might say that those difficulties go back a considerable way. Over the next three years, services there will benefit from an increase in investment of around 30 per cent., which is similar to other areas—the biggest ever single investment in the NHS—but I recognise the pressures that the whole health service is under. We have a long way to go in terms of increasing capacity after, dare I say, many years of under-investment and a lack of capacity in the system. In the right hon. and learned Gentleman's area, that means a 9 per cent. increase for the Shepway primary care trust and an 8.9 per cent. increase for the Ashford PCT. We have backed the NHS with record levels of sustained investment.

Through our policy of devolution, we have also placed our strong faith in those who know the NHS best—that is, the staff, patients and people in the local community. Rather than running the NHS by central diktat from Whitehall, it is our policy that primary care trusts, in partnership with local trusts and the strategic health authority, and with their specific local knowledge and expertise, decide the priorities for the NHS locally. That is the context in which to place this debate. The Government provide the funding and it is for the NHS locally—the stakeholders and the patients themselves—to decide how best to use the resources. It is not appropriate for Ministers to decide, in every part of the country, and for every trust, on the direction of travel and how services should be configured. We have made that clear. During the past year, I have made it clear as a Minister at this Dispatch Box on at least four occasions. Primary care trusts, in partnership with local trusts, the strategic health authority and patients, must be responsible for doing that.

Given that context, it is right and proper that I return to the detail of the issues that the right hon. and learned Gentleman outlined. The Royal Victoria hospital, which is part of the East Kent Hospitals NHS trust, is a community hospital with 41 rehabilitation beds and 16 stroke unit beds. It has a minor injuries unit, a one-stop neurology clinic, day hospital and a range of out-patient services. It employs approximately 237 staff, and I want to thank them and to pay tribute to the hard work that they do for their community every day.

The trust has made significant progress over recent months, and I should like to spend a few moments outlining that. I know that the right hon. and learned Gentleman sees problems but, whatever he says, there have been improvements to NHS services in the area. The trust has achieved the Government's access targets for having no patients waiting longer than 12 months for in-patient treatment and no patients waiting longer than 21 weeks for out-patient appointments. In addition, the

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trust has significantly reduced waiting times in its accident and emergency departments and reduced its waiting list size.

That is not all. The trust is investing in services across the whole of east Kent that will contribute to further improvements in standards and performance. For example, a new £1 million breast screening unit at Kent and Canterbury hospital was opened in May, and a medical ward with an additional 26 beds was opened in January. Last year, a new CT and MRI scanning unit was launched at William Harvey hospital in Ashford. There are also new initiatives to improve the delivery of primary care services. In the right hon. and learned Gentleman's area, nurse practitioners in Shepway are helping to reduce waiting times and improve the service for patients. They are working well to deal with minor health problems, and patients continue to have the opportunity to see a doctor if they wish.

There are significant developments and improvements in the provision of health care in east Kent. However, I am aware of the significant deficit that faces the right hon. and learned Gentleman's health community in the next few years. I am therefore delighted that everyone has come together to work out a financial recovery plan. I understand that there will be calls to wipe the slate clean and start from scratch, but that is not realistic. The NHS must exist within the available funding, and NHS organisations that overspend should and must repay organisations that have had to forgo resources in order to fund the overspending. We cannot wipe the slate clean. Such an approach would be perceived as penalising those with good financial management performance. It would convey all the wrong messages about responsible managers and move things in the wrong direction.

We recognise that some individual health bodies face financial pressures. Local circumstances may allow the phased recovery of deficits over several years. Clearly, any such arrangements would have to be subject to the agreement of local providers, commissioners and the managing strategic health authority. In addition, we have provided £100 million in support through the NHS bank to several organisations with the most serious financial problems to ensure the continued delivery of patient services.

I am advised that the pharmacy department at the Royal Victoria hospital employs four people and dispenses approximately 19,000 items a year compared with 400,000 items a year dispensed by the East Kent Hospitals NHS trust. The trust, which is responsible for the hospital's services, has reviewed its pharmacy services to help tackle the financial position and to adapt to the changing ways of delivering clinical support services. I understand that the trust is supported by its partner primary care trusts and the strategic health authority.

Although the pharmacy department at the Royal Victoria hospital is fully staffed, the trust has an overall shortage of pharmacists. That means that the trust regularly employs expensive locum staff to cover its vacancies. The proposal to close the pharmacy department at the Royal Victoria hospital has been

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made because the local health community believes that concentrating the service on other sites in the trust can achieve better value.

I am advised that the individuals employed in the pharmacy department are crucial to the proposal and are being fully and properly consulted. It is proposed to fit existing pharmaceutical staff at the Royal Victoria hospital into vacancies on other sites, where not only could their expertise be fully used, but staff development opportunities are more readily available. I understand that two of the four staff at the pharmacy department in the Royal Victoria hospital have expressed a willingness to be relocated to an alternative site.

The right hon. and learned Gentleman says that he is worried that the proposal is simply about money. It is true that the trust has a deficit and that reorganising pharmacy services will save it money. However, it is not simply about saving money. I am advised that the approach has benefits for patients. For example, the pharmaceutical requirements of the hospital's in-patients will be assessed in future by a pharmacist on the ward who has access to the patient's record.

Throughout the country, hospital pharmacy services are being re-engineered to provide services that are designed more around the patient's needs. That is part of the Government's commitment in "Pharmacy in the Future", which we outlined and has much support in the pharmacy world.

The Department's medicines management framework, which covers the clinical and cost-effective use of medicines, promotes decision making across local health economies. Medicine management is an organisation-wide issue on which managers, prescribers and pharmacists need to work together to ensure that patients get the best from their medicines.

I can give the right hon. and learned Gentleman some examples from across the country of pharmacy services that are being reconfigured to the benefit of patients.

Mr. Howard: If the contention is that medicines can be provided to hospital patients in a more effective way by doing away with existing pharmacy units and using some of the methods that the Minister has suggested, why on earth are those methods not being introduced in the other hospitals for which the East Kent Hospitals NHS Trust is responsible, in which there is a shortage of pharmacists, rather than in the Royal Victoria hospital in Folkestone, which is the only hospital—so far as I am aware—that is the subject of such proposals?


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