---

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): As one always does on these occasions, I begin by congratulating the hon. Member for Eastbourne (Mr. Waterson) on securing the debate. I very much appreciate the interest he takes in his local health service. I know that these are matters of great concern to his constituents and, although I did not agree with some of the points he made, I very much appreciate the thoughtful way in which he put his case and the energy that he puts into trying to support his local health service.

I, too, begin by paying tribute to all the NHS and social care staff working in the hon. Gentleman's local health economy. Their commitment to the continued improvement of his local NHS and social care services is to be commended. I was delighted that he began his speech by congratulating them—something that is all too frequently forgotten.

The national health service plan sets out a challenging 10-year programme for NHS reform. We must ensure that services are accessible and flexible and designed around the needs of patients locally. That is why it is now for primary care trusts, in partnership with strategic health authorities and other local stakeholders, to determine the best way to use their funds.

The East Sussex health and social care community faces significant challenges, some of which the hon. Gentleman mentioned. Some of them are common to communities up and down the country, while some of them are specific to East Sussex; for example, East Sussex has a higher than average proportion of people aged over 60—a point to which the hon. Gentleman referred. In some areas, the number is twice the national average. There is a higher than average demand for primary care services and an increased use of GP services, due in part to the older population, and significant challenges are associated with delayed transfers of care. As the hon. Gentleman said, it would appear that the area is the second worst in the country. However, I must chide him slightly, as he is a member of a party that is committed to repealing the Community Care (Delayed Discharges etc.) Act 2003, should it ever come to power. What would that do to help the situation in his constituency?

Despite those challenges, the NHS continues to achieve the national standards set out in the NHS plan. For example, as at April 2004, no patient in East Sussex was waiting longer than nine months for in-patient treatment, and no patient in East Sussex was waiting longer than 17 weeks for an out-patient appointment.
 
22 Jun 2004 : Column 1317
 

Charles Hendry (Wealden) (Con): What advice would the Minister give to one of my constituents—an 80-year-old lady—who has finally, after 18 months, had a hearing test? She has now received a letter saying that she is now on the waiting list for a hearing aid. She was told, "We cannot tell you how long your wait will be. Please do not contact us to find out", as that only distracts staff from doing the work that they should be doing. Is that a service of which the Minister is really proud?

Dr. Ladyman: I would certainly not approve of that type of contact with the hon. Gentleman's constituents. We should try harder to aspire to a much higher standard than that, but we have made tremendous efforts to modernise audiology services across the NHS. We have introduced a digital hearing-aid programme that is gradually rolling out, which will be concluded shortly. We are also making great efforts to improve the training and supply of audiologists. I very much hope that no one will suffer from that bad service in years to come. If the hon. Gentleman wants to write to me on the specifics of that case, I shall be happy to make inquiries and report back to him.

We have made some achievements and reached some important milestones. That is good news, but we want to go further. We want to build on those achievements and further reduce the length of time that patients have to wait for treatment and deliver better care services across the board. The health service and local stakeholders in East Sussex share that vision. To make that progress and to live within the resources that it receives, the NHS and all the health and care organisations in East Sussex must look carefully at the way that they work, and that is just what they are doing.

For example, the mental health trust has consulted on and adopted a new model of mental health service delivery that will improve prevention and provide early intervention and better access for patients. The East Sussex social services department has made radical changes to its structure, service delivery and commissioning arrangements. Eastbourne Downs primary care trust provides a range of services from a purpose-designed facility in Eastbourne that comprises a community stroke team, day hospital, in-patient step-up and step-down services and community rehabilitation.

Norman Baker (Lewes) (LD): Does the Minister accept that the Eastbourne Downs PCT, which serves my constituents in Seaford and Polegate, has a financial problem that prevents it from rolling out services to those communities, as they wish? Given the consequences of the belt-tightening that must be endured, Seaford—a town of more than 20,000 people—is not receiving the health services that it needs.

Dr. Ladyman: I am not aware of the specifics of that issue, but I can tell the hon. Gentleman that in general terms, which I shall repeat later in my comments to the hon. Member for Eastbourne who initiated the debate, all health organisations in the NHS must live within their means. If we allowed an organisation to overspend, the consequence would be that we would have to take money away from another organisation and another local community. So we allocate the money as best we
 
22 Jun 2004 : Column 1318
 
can, using as fair a formula as we can devise—we can debate the details of that formula—and then we must leave the PCTs to manage their funds and prioritise local services. I surmise that that is probably what that PCT and both hon. Gentlemen's local health organisations are doing in trying to balance their books.

Furthermore, partner organisations in East Sussex have developed a county-wide process of service review that is nationally recognised as being at the forefront of public and patient involvement. That clinical services review has considered eight different areas of the health service over the past 18 months. Each of those reviews has involved patients and has been appraised by clinical and patients reference groups. Those groups have made a number of recommendations that are now under discussion in the partner organisations.

An East Sussex clinical service review of children's services has been undertaken with the full involvement of both clinicians and the public. I understand that the recommendations in the report are based on recommendations by the Royal College of Paediatrics and Child Health and that they are currently being considered by the boards of East Sussex hospitals and PCTs. Far from being a matter of concern, the review process will ultimately lead to better care for everyone. Those who have been brave enough to engage in the process should be congratulated.

The hon. Member for Eastbourne raised issues about potential service changes and sought assurances, particularly on children's services. I assure him that no decisions have been made, but the changes are clearly very important to the development and improvement of local health services in the future. Any major change in service proposed in this area, as in all other areas, would require a full public consultation and ratification by the health overview and scrutiny committee. Anyone who misrepresents the position or engages in scaremongering for political gain—my intelligence from the local area suggests that that is being led by the Liberal Democrats—should be ashamed. Those people are not putting patients first and applying the objectivity that local people deserve.

The objective of the review is that health and social care services are transformed from high levels of institutionally based provision to a wider range of flexible and integrated services provided by multi-professional people in locally based facilities. That model of care is proven to provide real benefits for patients in terms of health and independence. The local delivery plan describes how the NHS and social care community will deliver the NHS plan over the next three years and it has been agreed by all NHS organisations in the area. In addition, the East Sussex county council cabinet has endorsed the overall direction of travel, which envisages a reduction in the number of avoidable admissions to hospital, shorter lengths of stay in hospital, reduced hospital capacity and reinvestment in community facilities, in particular in intermediate care.

Underpinning the local delivery plan are 10 key work streams which can roughly be described under three headings: short term, medium term and long term. In the short term, the NHS and its partner organisations need to work together to make the most of the resources that they receive. I understand that work is progressing
 
22 Jun 2004 : Column 1319
 
that will see improvements in procurement, moves toward more shared services, and more efficient use of the NHS estate.

In the medium term, new patient pathways will be designed. They will increase community services and thus reduce the need for hospital admission. The challenges associated with delayed transfers of care need to be addressed. For example, I understand that last week 10 per cent. of the acute hospital beds in East Sussex were occupied by patients who no longer required hospital treatment. That is not good enough. Although the NHS and the local social care services are working together to address the issues, the hon. Gentleman must direct some of the blame towards the local council, which has a responsibility.

The NHS and social care community in East Sussex are also refocusing services for older people. That includes developing services that encourage health, prevent unnecessary hospital admissions, minimise in-patient stays and maximise independence. Those services will be person-centred, closer to home, focused on rehabilitation and provided by a combination of professions. The closure of All Saints hospital must be seen in that context. Refocused services that allow the generation of more community and home-based provision are what people want.

The closure of All Saints hospital is a local issue. I am glad that the hon. Gentleman admits that it was unsuitable for the purpose and needed to be closed. I am aware that it was closed at the end of March as it did not provide safe and appropriate services for elderly patients. The closure released resources that have been and are being reinvested in community-based intermediate care in the Eastbourne Downs PCT area. That strategy is in line with our agenda for social care. In fact, we have announced that we are writing a new vision for adult social care. Three key principles will underpin and drive forward that new vision. They are that services must be person-centred, proactive and seamless. We have not always listened to what people want and need. We have created cultures and structures that have generated dependency. The challenge now is to offer people choice, control and empowerment. We must value their abilities. We must ditch the culture and language of need and dependency, and create services that empower people, which is exactly what the team in East Sussex are trying to achieve.

Finally, the hon. Gentleman expressed concern about the financial position of the East Sussex health economy. The local delivery plan includes a three-year financial recovery plan amounting to £26 million. The health service has received significant additional resources, and annual expenditure must remain within
 
22 Jun 2004 : Column 1320
 
the resources allocated by Parliament—a point that I made to the hon. Member for Lewes (Norman Baker). If one part of the health economy is allowed to overspend, another part must pick up the tab, which simply is not fair. Between 2003–04 and 2005–06, the four primary care trusts in East Sussex will receive an increase of £130 million for health care services. In the constituency of the hon. Member for Eastbourne, Eastbourne Downs PCT will receive an increase of £47 million over three years, which represents a cash increase of 29 per cent, so there is no reason why it cannot manage and deliver high-quality care. All NHS organisations must understand that having received their fair share of resources they have a corresponding responsibility to manage them effectively without relying on bail-outs from the centre or from other parts of the NHS. They must manage within allocated resources.

It is the responsibility of strategic health authorities to deliver overall financial balance for their economies and to ensure that each and every body achieves financial balance. The health community has already made significant efforts to bring the financial position under control, and will continue to do so while ensuring that adequate and safe services are delivered to local people. The hon. Gentleman asked me four questions, the first of which was whether I took a close interest in these matters. My ministerial colleagues and I always take a close interest in such reviews, but under "Shifting the Balance of Power", those matters are to be decided locally. It is no good my colleagues and I thinking that we can run the whole health service from our offices in Whitehall, as we do not have the local knowledge and expertise to do so. We have therefore shifted many of the health service's resources to primary care trusts and local bodies, and we expect local service reviews to address local challenges on the basis of local knowledge and expertise. The hon. Gentleman needs to raise the state-of-the-art rehabilitation unit that he wants with local service commissioners. If they decide that that is the way forward, they would not encounter any argument with us at the centre.

I have addressed the black hole, as the hon. Gentleman called it, and it is important that local services tackle it. There is consensus about the way forward on managing the budget locally, and I am pleased that agreements have been reached. The hon. Gentleman talked about budget pressures that affect patient services, and it is important that we ensure that that does not happen. I am sure that given the increase—

---