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Dr. Naysmith: I thank the hon. Gentleman for giving way, especially as I did not observe protocol and ask him beforehand, and he has very little time. When consulting his constituents, did he ask them what they felt about the potential downgrading of Southmead rather than Frenchay? I ask because all three district acute hospitals in the Bristol-south Gloucestershire area serve the population of south Gloucestershire.
Mr. Webb: Every question I asked invited people to reply "Yes, just Southmead" or "Yes, just Frenchay", or yes to both or no to either. All the questions were framed on that basis. I must be straight with the hon. Gentleman: most of the population in my constituency are on the Frenchay side. While Thornbury residents look somewhat more to Southmead, they still look to Frenchay as well. I chose to refer to Northavon in choosing a title for the debate because I wanted to represent the interests of my constituents. They want quality provision that is accessible, and for them that means Frenchay. I am saying nothing against Southmead: my wife used to work there and my children were born there, and it is a good hospital. What I am saying is that to withdraw A and E and, indeed, perhaps more from Frenchay would be seriously detrimental to my constituents.
The third element that I think the strategic outline case should contain is scope for improvement in community facilities. Here I think we have the potential for more agreement. We have an excellent if small community hospital in Thornbury, in my constituency. Recently, and sadly, a friend of mine died there. The care that he, and particularly his family, received at that community hospital was second to none. Relatives and friends could just pop in. The hospital was small and friendly enough to enable his favourite armchair to be brought from home. That is a quality of care that cannot be found in some huge hospitals.
I hope that whatever emerges from the strategic outline plan will build on those strengths and will not undermine them. What that means to me is that Thornbury hospital must stay and, at the very least, continue what it is doing, even if not necessarily in exactly the same way: I do not want to give the impression that everything must be set in stone. My constituents and I accept that some hospital buildings are inadequate, that facilities are inadequate and that serious investment is needed. However, the idea that that should involve bed cuts, cutting access to A and E or any cut in community facilities is unacceptable to me.
The biggest area where new community facilities are needed is Yate and Chipping Sodbury. There was a big response to my survey in favour of that. The idea has been discussed and kicked around, and although I do not get a clear sense of how it will look, my constituents want new community facilities there.
My constituents have sent a clear message. I have engaged with them and reported their findings to the House and to local health professionals. We do not say that things must not change—nobody in their right mind would say that. We want capital funding from the Government to upgrade, to keep Frenchay hospital in particular at the forefront of developments, and to see it move forward. I hope that, if the local trust can present a plan to the Department of Health for increased capacity, better access to quality accident and emergency services and better community facilities, the Government will reward it in the summer by accepting its proposals. If the trust does not present such ideas, I hope that the Department will tell it that it is not serving the local community as it should.
9.30 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I congratulate the hon. Member for Northavon (Mr. Webb) on securing the debate. I have listened to and appreciated his comments, not least because, as he remarked, I grew up in the area and know something of the local terrain. I pay tribute to all the staff in the local health economy area who, as he said, are committed to improving the local national health service.
In north Bristol, the health economy has already benefited from additional investment, and I shall give a few examples of that. A new children's high dependency unit opened at Frenchay hospital last November. It was funded by a grant of £858,000 from the Department of Health plus £800,000 a year from the local primary care trusts. A three-year project to improve and redevelop radiology services at Southmead has recently been completed at a cost of £2.5 million, including new equipment and building works. Now more than 130,000 examinations every year can take place using state-of-the-art diagnostic equipment. It is perhaps worth mentioning that the services provide more generally for the area because they are specialist facilities. I am sure that the hon. Gentleman acknowledges that they cover not only Thornbury residents but a wider scope of people from his constituency.
In January 2003, a new £600,000 satellite unit opened at Southmead hospital to improve the quality of life for renal dialysis patients. It provides 3,000 extra treatments a year for patients from a wide area.
I shall deal with the local issues that the hon. Gentleman raised shortly, but first I should like to point out that we all acknowledge the pressures on the NHS, not only in his constituency but throughout the country. We want not only to increase capacity but to improve clinical standards generally. We do not want more of the same but a radical re-examination of the provision of services. We want to design services around the needs of the patients and I was interested by the hon. Gentleman's comments about, for example, the strength of the cottage hospital experience.
It is our policy, in the framework in the NHS plan and in the "Shifting the Balance of Power" initiative to devolve more funding decisions to the front line. It is for primary care trusts, in partnership with strategic health authorities and other local stakeholders to determine the best use of their funds to meet national and local priorities for improving health, tackling health
inequalities and modernising services. They are in the best position to decide how to do that because of their specialist knowledge of the local economy.I am sure that the hon. Gentleman agrees that we all acknowledge that hospital and community services need to change if we are to continue to fulfil patients' needs and improve access. Services should not remain static for ever; they need to be responsive to local needs and changing needs. There are several different pressures on the service. However, providers of health and community services have a responsibility to live within their means. Those issues and many others need to be taken into consideration. Biggest is not always best. Indeed, we have already had an example of that. We need to recognise that patients want more, not fewer local services. We need to focus on redesigning, not relocating.
Perhaps it is worth mentioning the quality of the building stock at both hospitals in north Bristol, which the hon. Gentleman did not touch on. Frenchay and Southmead hospitals both have serious needs in building terms that must be addressed. They both have accident and emergency departments. There is a hospital with a major A and E department in the centre of Bristol, the Bristol royal infirmary.
The hospitals are between four and seven miles apart. Services are duplicated and fragmented across the two sites of the North Bristol NHS trust. They are cramped and rundown health centres. The current configuration makes it difficult to work effectively with primary and social care.
The current configuration means that there are particular difficulties in complying with national standards for clinical services, in particular for emergency patients, children, cancer patients, cardiac patients and those requiring specialist care. Therefore, the status quo is not an option—it cannot remain. There is clear scope for improving performance and, as I have said, the way in which health and community services in the 21st century are to be provided is less focused on hospitals than may have been the case in the past.
I come to the point that the hon. Gentleman made about the strategic outline case and the process. The outline case will be considered by all local NHS boards in April and the proposals will then go out to public consultation later this year. Although he talked about engagement and mentioned consultation, a very informal stage of the process has taken place in his area, in which he has been actively engaged recently. As part of that process, the local overview and scrutiny committee board will consider the matter as well. The plans will be transferred under normal processes to the strategic health authorities, which will ensure that a fair process is followed. They will not necessarily come to Ministers or to the Department. That is under the "Shifting the Balance of Power" arrangements that I mentioned earlier.
Mr. Webb: Just for clarification, central Government presumably need to decide which strategic health authorities get the very large amounts of capital funding that we are talking about, or is it the case that every strategic health authority gets a big capital budget and will then make the decision on the local projects?
Clearly, the local trust was under the impression that the Department of Health would determine which five of the 11 bids went forward. Has it got that wrong?
Miss Johnson: As I understand it—this may prove not to be as accurate as it could be—it will be for those bodies to decide under normal circumstances. If there were some contest, as it were, there could be a question of a ministerial decision but normally the decision would be made at strategic health authority level.
The hon. Gentleman talked about his own survey and the future discussions and consultation. The local NHS in Northavon has embarked, with the local NHS in Bristol, on developing a Bristol health services plan. We need to have a range of options, and it is important to be able to engage the wider public in those discussions. Those will include developing acute services on either Southmead hospital or Frenchay hospital, with an associated development of a range of primary care and community-based services, as he mentioned. About six options are being canvassed.
The hon. Gentleman raised some real concerns about the proposals and has obviously taken a lot of time to compile the results of his survey. That is why I am grateful for the opportunity to assure him that no decisions have yet been made about the configuration of services. Indeed, the proposals are still being discussed as part of the engagement exercise that I mentioned, and that is being undertaken locally. Any decision will be made only once formal consultation has been completed. That is expected to start later this year.
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