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The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I congratulate the right hon. Member for Maidstone and the Weald (Miss Widdecombe) on securing this debate on the proposed transfer of services from Maidstone hospital to Tunbridge Wells. Before I turn to the specific issues that she raised, I should like to take this opportunity to recognise the work across the whole of Kent in delivering good-quality services and to pay tribute to all the staff who are dedicated to that process. I am sure that she would join me in that.

All Members rightly attach the highest importance to developments in the NHS in their constituencies. It is important that local people are able to have local access to high-quality health services for users of orthopaedic and maternity services, as well as several other services that the right hon. Lady mentioned. As she knows, our policy is one of devolution to give local communities a real opportunity to plan and to develop health services according to their needs and demands. We have backed that up with significant additional funding. Over 2003–04 to 2007–08, expenditure on the NHS in
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England will increase on average by more than 7 per cent. a year over and above inflation—an increase of £34 billion.

The majority of that funding has been made direct to primary care trusts. In that way, we are putting resources in the hands of front-line NHS staff alongside their responsibilities for developing and running services. In the right hon. Lady's constituency, Maidstone Weald PCT will receive an increase in its revenue allocation of £36.4 million between 2003–04 and 2005–6. That represents a cash increase of 28.7 per cent.

The right hon. Lady raised several concerns, some of which touched on the proposed transfer of women's and children's services from Maidstone to Tunbridge Wells. I stress that those remain proposals and that no firm decision has been made.

The right hon. Lady concentrated most of her remarks on the trauma services and linked orthopaedic services. I can give her assurances on some of the matters on which she seeks them. I understand that she is a local Member concerned about what is happening in her patch. She graphically expressed her anxiety about the matter, and I understand that, but she need not worry about a unique voice, because many of us would say that she is a unique voice. I am sure that she is a unique voice on behalf of her constituency.

The joint Maidstone and Tunbridge trust has stressed throughout the discussions that the area and the people that it serves will always need two acute district hospitals. I emphasise the word "acute" because the right hon. Lady is worried that one will become totally elective. That is not the trust's intention: there will be one hospital in Maidstone and another in Tunbridge Wells, and they will work together in a complementary way. I understand that that can sometimes cause anxieties, and I am familiar with the situation from elsewhere, not least my constituency.

Miss Widdecombe: I accept that there will continue to be an accident and emergency unit at Maidstone, but the consultants' point is that it will be greatly reduced. All the orthopaedic trauma will go to Tunbridge Wells and the consultants point out that that cannot be done in isolation. Others will follow, and in the end, the unit will be so small that it will not deserve to be considered in the same way as a big general acute unit.

Miss Johnson: I appreciate the right hon. Lady's view, but both hospitals will continue to provide the bulk of acute surgical, medical, emergency and life-saving care for patients and each will need accident and emergency departments capable of dealing with minor and major illnesses and injuries. I am told that the strategic health authority has categorically stated that Maidstone hospital's accident and emergency department is not closing down or being run down.

I appreciate that issues such as training hospital consultants and doctors, and accreditation by the royal colleges need to be sorted out. That needs to be done locally to ensure that the mix of cases that goes to both hospitals is capable of sustaining the right accreditation by the royal colleges—for example, for accident and emergency accreditation purposes. I understand that the chief executive has met the majority of the consultants individually or collectively.
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We do not deny that some concerns have been expressed. They have centred around the misconception that all the surgical services would be transferred to the Kent and Sussex hospital. Some consultants were also worried that there might be pressure on them to express certain views. Notwithstanding that, some have genuine concerns about the future. We accept that concerns have been expressed, but I assure the right hon. Lady that the strategic health authority is committed to two full accident and emergency departments in the two district general hospitals and sustaining the mix of services.

The right hon. Lady mentioned the transfer of the chronic pain clinic. I am not familiar with as much of the detail as I suspect she is. I understand that some £600,000 of additional resources have gone into the clinic at Pembury hospital, to which it is to be transferred. Extra investment has gone into that pain unit, and I am sure that that creates an improved service. We accept that we need two accident and emergency units and two district hospitals. The question is about the division of some of those areas of specialty, which can be provided principally in one or another of the hospitals.

In the past few years, Maidstone hospital has had major investment in its eye, ear and mouth unit. There has been some £11.9 million of investment. The hospital has received £2.8 million for a new breast care centre; £2.2 million for a new emergency care centre; and £1.7 million for the orthopaedic unit. In Tunbridge Wells, the Pembury hospital and the Kent and Sussex hospital have received £3.5 million investment in more doctors; the chronic pain unit that I mentioned; some refurbishment of the maternity unit; and £1.15 million for a new MRI scanner. That shows that there has been a division of resources between the two sites.

The right hon. Lady talked about the pressure on junior doctor hours as a result of the working time directive, but there is a wider rationale. That rationale includes the following considerations: to improve the quality of services for patients; to reduce the number of cancelled operations, as currently one in five elective procedures are cancelled in Maidstone and Tunbridge Wells, which the trust and the strategic health authority are looking to improve on; to reduce the risk of infection by segregating all orthopaedic patients from surgical patients, which is highly important; and the development of on-call rotas that offer consistency of care. Among all the other factors are the fulfilment of the requirement to meet junior doctors' working hours under the European working time directive, and gaining efficiencies of full day-care elective theatre lists to reduce waiting times for patients. The provision of centres of excellence for patients that offer and are able to meet national standards of care and to attract highly skilled staff is also important. Making the best use of the consultant work force, with sub-specialisation, is also a factor.

The benefits for patients that the trust and strategic health authority are looking for are: ensuring that booked operations are not cancelled; reducing waiting time for operations; reducing the risk of infection following surgery; delivering rapid assessment, out-patient, diagnostic and day-case services at both hospitals; and ensuring that professional standards are
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consistently met. That shows that a rationale exists that makes clear the reasons for this discussion.

Currently, we have only a proposal before us, and I realise that, sadly, the right hon. Lady did not appreciate my right hon. Friend the Secretary of State's letter. I gathered that. He was being very fair in what he wrote to her, however, as he was pointing out that this matter was still up for discussion, and that the details need to be thrashed out. I understand that such discussions raise a lot of local anxieties, and I sympathise with local MPs and local people concerned about them. I have set out a number of powerful and important reasons why it is necessary to examine these issues, including the benefits that can be gained for patients from improvement of patient care.

I want to touch briefly on maternity services, because I want to assure the right hon. Lady that we are committed to good-quality, women-centred maternity care. We have a commitment to improving maternity services by modernising maternity units, increasing the number of midwives and giving women greater choice in childbirth. There have been huge advances. It is now much safer to give birth, and women are now actively involved in making decisions about the maternity care that they want to receive. As I am sure she is aware, we published a national service framework on 15 September, and under the standard, NHS maternity care providers and primary care trusts are required to ensure that the range of antenatal, birth and post-birth care services available constitutes a real local choice for women, including home births and midwife-led care, and midwife-led units in the community or on a hospital site.

Additional funding has been made available for refurbishments, including of hospitals in Kent, to improve the environment. I hope that the right hon. Lady will agree 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. They must be responsive to local needs and changing patterns, higher standards and the different services that can be provided as modern medicine advances. That is what we are seeking to achieve through the changes that are being implemented.

The matter in hand is still a discussion on a proposal, and I trust that the right hon. Lady will be able—

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