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The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing this debate on what is obviously a matter of great concern to his constituents. I join him in paying tribute to the staff in his area, including not only those on the front line but those working in the PCT, who are obviously committed to making improvements to the local NHS.
The hon. Gentleman expressed a number of concerns about the situation in his area. As I am sure he is aware, it is our policy, within the framework set out in the NHS plan and the "Shifting the Balance of Power" initiative, to devolve funding decisions to the front line. Oxfordshire PCTs received an extra £41.7 million this year and will receive an extra £134 million over the next three years to 2005–06. With that extra funding, it is for PCTs, 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 inequality and modernising services. They are obviously best placed to do that because they have specialist knowledge of the local community.
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As part of the modernisation programme set out in the NHS plan, many NHS economies and organisations are considering, with local stakeholders, changes to the way in which they organise their services. In doing so, they need to take a whole- systems approach that takes account of the contributions of different hospitals and primary, intermediate and social care providers. They need to work in partnership and to have genuine integration and joint planning of services.
To help the NHS to build those local solutions, in February 2003 the Department published guidance that set out the principles and approach that should be applied to all proposals for service change, as well as the various stages of the consultation process. The initial stage should commence with the local health economy engaging stakeholders—staff, patients and the public—and, ideally, the process should end with the local health economy moving on to implementation once a preferred option is agreed: of course, that is what Ministers would prefer. There may be instances where, for example, an overview and scrutiny committee of a local council refers decisions to the Secretary of State for Health, who can then call on an independent reconfiguration panel to investigate the situation and to offer advice.
As regards intermediate care, our policy aim is to maximise choice, control and independence for individuals, whether they live at home, in supported housing or in a care home. We know that most older people wish to live in their own homes for as long as possible, but that requires a wide range of high-quality support services and, again, good partnership between service providers.
I am aware that a great deal of excellent work is being carried out by PCTs and social services in Oxfordshire to improve intermediate care in the county by developing services for older people that are easy to access and are provided, where possible, in people's homes, whether it be their own home or a nursing home. In Oxfordshire, primary care trusts and social services operate a pooled budget of approximately £45 million. The aim is to ensure that resources are used in the best possible way to meet the needs of older people and people with physical disabilities.
As I said, health services will wish to respond to the changing needs of local people. I understand that that is why PCTs in the south of Oxfordshire decided to review the provision of community hospital services and intermediate care. The informal consultation paper, "South Locality Plan—The way forward for community hospital and intermediate care services", proposed options for improving levels of care, providing support to other parts of the NHS and providing sustainable services within allocated resources.
The south Oxfordshire primary care trusts took the view that the south of the county has traditionally offered a more bed-based service, given the number of community hospitals. There are established intermediate care support services teams in the PCTs but the service is not available to all areas. I understand that the PCTs' preferred option has been to develop equitable domiciliary care services in partnership with local authorities and in line with progress in north Oxfordshire. The services have jointly developed access to care and rehabilitation, which brings together NHS
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intermediate care support services and the rapid response, re-enablement and community rehabilitation services that social services provide. The idea was to offer rapid assessment of individuals followed by intensive home support.
In May 2003, before the informal consultation, the Oxfordshire health care system commissioned "Balance of Care", a survey of the health needs of more than 1,000 patients. Several issues were highlighted in the report that followed, including work force medical cover, emergency care, out-of-hours services and delayed discharges, which the hon. Gentleman mentioned.
I appreciate the concerns that the hon. Gentleman expressed about the validity of the survey and its subsequent contribution to the south locality plan. However, I understand that the aim of the informal consultation was to gather stakeholders' views. The hon. Gentleman may know that the strategic health authority currently recommends that PCTs do not proceed to formal consultation on existing options. The work is continuing with PCTs, in conjunction with the strategic health authority and local communities, including the local authority, to consider other care options for people in south Oxfordshire in the context of local community services.
Dr. Harris: Will the Minister confirm that that means that the immediate threat to cut the number of community hospital beds and close hospitals is effectively withdrawn and that she is referring to an instruction or recommendation to the strategic health authority not simply not to consult on the matter but not to go down that path?
Ms Winterton: Yes. The strategic health authority has recommended not to proceed with those options and to consider other options of care for people in the area. I understand that work is in progress to deal with some of the local issues that the hon. Gentleman raised.
I am advised that the strategic health authority is leading on supporting trusts in implementing the European working time directive. Trusts are promoting the "improving working lives" initiative, which encourages flexible working and the provision of opportunities for training and development. Significant effort is also being made to recruit staff to the community hospitals with a series of joint recruitment open days in some hospitals.
As I said earlier, it is our policy that PCTs, in partnership with other local NHS trusts and the strategic health authority, decide the priorities for the NHS locally. That is where specific local knowledge and expertise lie. It is not appropriate for Ministers to decide on the direction of travel and exactly how services should be reconfigured—we have made that clear. The NHS locally should do that. I hope that the hon. Gentleman, who introduced a debate that is so important to his constituents, will be reassured by the points that I have made, not only about the reconfiguration of services but the action that is being taken to deal with the genuine issues that he raised.
Question put and agreed to.
- Adjourned accordingly at one minute to Three o'clock.
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