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6.53 pm

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I congratulate my hon. Friend the Member for Hemel Hempstead (Mr. McWalter) on securing this Adjournment debate. He is a doughty fighter for his constituents; he has been fighting this battle for some time with vigour and determination, and I suspect that whatever I say tonight will not change that by one iota. He will continue to fight for his constituents, and they should be proud of him and grateful to him for his efforts on their behalf.

In case I run out of time at the end of the debate, I shall start by saying that my hon. Friend is right: Ministers do not use Adjournment debates to change local health policies. Local health priorities and the planning of local health services have been devolved to local areas, under our plans to shift the balance of power away from Whitehall, so I am not in any position to direct in one way or the other. Until such time as certain criteria are met and the Department of Health is asked

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to intervene, I have no powers to order any such things. What I can do is ensure that my hon. Friend's words are read carefully by those who are in a position to take a decision in Bedfordshire and Hertfordshire, that they reflect on them, and that they take account of his views. I shall certainly do that.

I can give my hon. Friend a further reassurance that the next stage of the process is to produce business plans, which will be worked up for both options. It is not true to say that they will both be worked up in the same detail, but they will both be worked further to a certain point. A decision will then be taken and the preferred option will be worked up in even greater detail. I can assure my hon. Friend that his concerns about the sums adding up and the relative costs of the proposals will be aired during that process, so he will continue to have opportunities to express his views if his constituents are still dissatisfied by the decisions.

I shall say more about the local decisions in a few moments, but it is important to state for the record that the NHS cannot stand still. It has to change if we are to improve it. The health care system is under pressure. Patients are still waiting too long for their operations—despite the dramatic fall in waiting times that has been announced this week, which is surely welcomed by everyone—and many hospitals are still in a poor state and need updating. We also need to recruit and retain more doctors and nurses. We have not only to increase capacity, but to raise clinical standards generally. It is not just more of the same that we need in the health service, but a radical re-look at how services are provided.

The NHS plan set out a challenging 10-year programme for NHS reform. Far-reaching changes are often necessary to provide the best possible services for patients. 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 economies and organisations are considering, with their local stakeholders, changes to the way in which they organise their services. I believe that we all recognise that hospital services need to change if we are to continue to fulfil patients' needs and improve access.

Services cannot remain static for ever, but have to be responsive to local needs and changing clinical practice. There are, of course, several different pressures on the service, and providers of health services have a responsibility to live within their means. Those issues and many others need to be taken into consideration in planning changes to services.

As I said earlier, it is our policy, within the framework set out in the NHS plan and the "Shifting the Balance of Power within the NHS" initiative, to devolve funding decisions to the front line. It is now for primary care trusts, in partnership with strategic health authorities and other local stakeholders, to determine how best to use their funds to meet national and local priorities for improving health, tackling health inequalities and modernising services. They are in the best position to do that because of the specialist knowledge they have of the local community. That is why Ministers no longer have the power to direct local services in quite the way that my hon. Friend requested of me at the end of his speech.

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I believe that my hon. Friend will agree that within Bedfordshire and Hertfordshire, some health services—particularly the major hospitals in Hertfordshire: the Watford, Hemel Hempstead, Lister and Queen Elizabeth II hospitals—do not represent the standard of care and treatment that we expect to see in the 21st century. Indeed, I recently visited the four acute trusts in Bedfordshire and Hertfordshire and saw for myself the services and fabric of those environments. That is why the NHS in Bedfordshire and Hertfordshire undertook an extremely comprehensive and far-reaching consultation—a two-year process, reviewing a number of services and taking into account future trends in health care, national policy and best practice from around the country.

The formal document "Investing in Your Health" and its associated consultation ran from 3 March to 1 September 2003, having been extended to allow for a parallel consultation on cancer services in north London, run by the North-West London strategic health authority.

During the consultation period two options for the future reconfiguration of hospital services were proposed; both entailed retaining six major hospitals in Bedfordshire and Hertfordshire, including Hemel Hempstead and Watford general hospitals. Under option 1, Hemel Hempstead would be a major acute hospital caring for people requiring emergency treatment. Under option 2, Hemel Hempstead would treat out-patients and people requiring planned operations and medical procedures, although accident and emergency services would still be retained.

The overwhelming preference after the consultation process was for option 2, which proposes developing five of the existing hospitals in Bedfordshire and Hertfordshire and building a new state-of-the-art hospital in Hatfield to replace the Queen Elizabeth II hospital in Welwyn Garden City and provide a new cancer centre. I assure my hon. Friend that I have been given an assurance that "Investing in Your Health" went through two scrutiny processes locally, both of which confirmed that people are happy with the process and the outcome. In addition, a joint scrutiny process followed in relation to cancer services specifically. It is expected that the final meeting will take place this month.

I am aware that option 2 was not the option of choice for my hon. Friend and his constituents, but I am sure he will agree that the important thing is to focus on health outcomes for everybody. The proposed new model of care will mean more resources going towards caring for people closer to home and in community settings. A cancer centre will be located in Bedfordshire and Hertfordshire so that patients do not have to travel outside the two counties for treatment. The quality of health care will be improved by allowing hospitals to specialise in certain fields of medicine to create local centres of excellence, and by moving planned surgery to dedicated "surgicentres".

I assure my hon. Friend that if, at the end of the process, option 2 is confirmed as a way forward, Hemel Hempstead hospital will continue to have a future. I am informed that it will receive capital investment of about £25 million for its development into a modern, high-quality, major hospital, specialising in planned surgery. Indeed, when I visited the hospital in October I saw for

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myself where some investment has already been delivered; for example, there is state-of-the-art magnetic resonance imaging, and a fracture clinic and dermatology treatment centre opened their doors to patients at Hemel Hempstead general hospital in March. That investment in new clinics means that patients and staff have a new treatment area. The final phase of the project, the construction of a new X-ray reception area, opened at the end of July. The Hemel birth centre opened on 31 March. It is a self-contained unit run by midwives, offering a supportive, "home from home" environment in which mothers can give birth.

I can also reassure my hon. Friend that under the proposed option 2, the hospital's accident and emergency department would remain open, although patients with serious or life-threatening conditions would be taken to larger trauma centres at Watford, Luton or Dunstable hospitals.

My hon. Friend has expressed concerns about the cost of option 2, but I am assured that the health authority employed a firm of consultants who carried out an assessment of the financial implications of the overall affordability of the proposal for the health care system of Bedfordshire and Hertfordshire. That report, which is in the public domain, demonstrated that from projected total revenue in excess of £2 billion, the cost differential between the two options was about £10 million, or about 0.5 per cent. It also means that under option 2 more patients will be treated locally rather than large numbers of patients having to travel outside their health area.

I share my hon. Friend's concerns about access to the hospital, but I understand that English Partnerships is working with West Hertfordshire Hospitals NHS trust to develop a comprehensive development strategy that could deliver about 130 key-worker homes on land adjoining Hemel Hempstead hospital.

As I mentioned earlier, it is our policy that primary care trusts, in partnership with other local NHS trusts and the strategic health authority, decide the priorities

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for the NHS locally. That is where specific local knowledge and expertise lies, and it is not appropriate for Ministers to decide on the direction of travel or how services should be configured—we have made that clear. It is right that the local NHS should do that.

There is still a great deal of work to be done on the development of business cases and plans before the Secretary of State gives his final seal of approval. The next stage involves producing a more detailed analysis of the proposals. A strategic outline case must be written and it must meet four criteria before it can be approved. The plans must be affordable, achievable and accessible, with proper human resources.

I hope that my hon. Friend the Member for Hemel Hempstead will understand that it would not be appropriate for me to comment further on this matter in case, following the local process, that would pre-empt any future ministerial decision that may be necessary. However, I assure him that the Department, and Ministers, will continue to work with the local NHS to review the progress of the local economy, and to ensure that the difficulties that are faced remain manageable.

I hope, therefore, that my hon. Friend the Member for Hemel Hempstead, who introduced this important debate and who continues to work with the local NHS to build a better future for the residents in the area, will accept my assurance that the sums that he said were needed will be provided. The process will continue, and I know that local health managers will welcome further discussions with him and his constituents. Some people in the local health economy may still have to face difficult decisions, but I hope that we can all agree that what will emerge from the discussions and the change of configuration will be better for everyone, and better for the health of all the people living in Bedfordshire and Hertfordshire.

Question put and agreed to.

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