---

2 Mar 2005 : Column 307WH—continued

Health Services (Hemel Hempstead)

3.30 pm

Mr. Tony McWalter (Hemel Hempstead) (Lab/Co-op): I am glad to see that the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman)—the Minister for Thanet—is here. We shall be able to resume our discussion, and possibly our duels, on this matter.

I want to focus on acute services in my constituency. However, it is worth saying at the outset that there has recently been steady progress on many fronts on health in my constituency. For instance, in the past those who had had strokes were often left with very little support or assistance. However, recently a new stroke unit at Hemel Hempstead hospital has been offering a much-extended and appropriate service. I should like to place on the record my thanks to the many voluntary bodies that campaigned so hard for that, including Dacorum hospital action group, and to the Government for having the courage to increase national insurance by 1p to raise the funds to improve our health services.

Although similar developments for some other serious conditions are at an earlier stage in terms of effective provision, I am encouraged by the Minister's recent reply to me about the provision of nursing specialists for conditions such as Parkinson's disease and multiple sclerosis. In general, there has been a very welcome focus on the plight of those with chronic long-term conditions. For that group to be helped, health services need to be willing to have a close liaison with social services. Hertfordshire has been a leading authority in making progress in that area, with explicit Government support. A good Government produce real benefits, particularly for those groups of people who have reached a time of life or who are in such a condition that they need the help of others. In that regard, the Government are a good Government carrying out their mandate. However, it is inevitable that in an Adjournment debate I should focus on those areas in which the train looks a bit as if it is coming off the rails, and that is my intention.

As far as the community that I represent is concerned, the body that occasions so much grief is called the Bedfordshire and Hertfordshire strategic health authority. I want to make it clear that I realise that health provision needs to be planned outside the scope of a single constituency—or possibly that of a single county, although that would be more difficult. However, a lot of the complaints that I wish to make relate very much to the people who have been given that job and how they have chosen to do it.

It was pretty unusual that a newspaper advert by the Bedfordshire and Hertfordshire health authority—"Healthcare fit for Herts"—was taken to the Advertising Standards Authority, which found that the advertisement was deceptive. That is an astonishing thing to happen to a public body, and there ought to be much more public accountability when that kind of thing happens. Recently, that health authority had another shot: "Better care for sick children", it said. In that advertisement it talked about there being a bigger, purpose-built ward, although we know that beds for children in the area are going to be reduced from 35 to 26. That advertisement, too, will doubtless end up at the
 
2 Mar 2005 : Column 308WH
 
Advertising Standards Authority, but this time we would welcome the Minister's interest in the fact that a public body has used public money to give a demonstrably false impression to the public.

It has not simply been that. An edition of the Health Service Journal recently had a brief headline; the letter F was followed by three stars, which were followed by the word "off". One does not need to be a genius to work out what the stars stood for. That expression was used repeatedly by the chief executive of the strategic health authority and was directed at the chief executive of the West Hertfordshire Hospitals trust at a Christmas dinner.

The result of that exchange was that it made the headlines of the Health Service Journal, as it should, as an example of the sort of behaviour that should not be tolerated in public servants. It also occasioned the resignation of the chief executive of that trust, someone who had the trust of the community that I represent. The person who preceded the current occupant of the chief executive's chair of the strategic health authority, John de Braux, also had that trust.

The previous incumbent was Jane Herbert. She made every effort to understand the Hertfordshire health economy and the role that Hemel Hempstead hospital in particular, and the large undeveloped site next to it, could play in trying to secure improved health provision for the people of my constituency and those around it.

I put it to the Minister that not simply is such behaviour, on the face of it, at least problematic, but it is extremely strange that there seems to be no way in which that behaviour can be called into question, as it should be.

The advertisement that I mentioned gave what I can only call a pernicious interpretation of a health strategy that people have been using. The pernicious interpretation involves projecting forward to 2012, when, we are told, there will be marvellous new facilities at Hatfield and Watford. I have in front of me an artist's impression of a field, which is yet to be designated, and a wonderful new hospital at Hatfield. So far, so good. I hope that the people of Hatfield enjoy their new facility. That is not the issue. The issue is whether, as part of that strategy, we should be planning for a reduced service in certain areas of the county.

On Monday, I went to a meeting to discuss the reconfiguration of children's services in my area; it was not a reconfiguration, but a contraction—from a significant number of beds to rather less. The pernicious interpretation of the strategy involves the idea of creating a hospital at Watford one day, costing, let us say, £330 million. It will be accessible by some kind of monorail from Hemel Hempstead, which will get people there in, let us say, 10 minutes. I suspect that if that were the case, there might not be too much worry in my constituency about the health facilities that people need being quite far away. As it stands, they could be enormously far away.

That does not apply only to health. In 1993, my local further education college was combined with a college in Watford. Then, all the services at Hemel Hempstead began to be contracted. As a result, there is little FE provision for my constituents, because Watford is too far away. Kids stay on at school doing unsuitable subjects, because the alternatives are non-existent.
 
2 Mar 2005 : Column 309WH
 

The Government say that they want national health service customers to have choice. My constituents want the choice of being treated in their local hospital, not only because it is convenient and gives them a good service, but because as things stand Watford is a hospital in the process of demolition. To move a service from a perfectly functioning hospital with a large number of new facilities to a hospital that is in the process of being demolished is entirely perverse.

If that is the strategy, one should at the very least make the best possible use of the excellent hospital at one's disposal, while perhaps reconfiguring services or doing demolition jobs at the target hospital. Indeed, that is exactly what has happened elsewhere in Hertfordshire in the relationship between Stevenage hospital and hospitals in the Welwyn-Hatfield area. Services have been established at Stevenage to try to ensure that at least Stevenage plays an appropriate role in the transition process, which is anything but finalised and has yet to get even an outline business case.

Why is not Hemel Hempstead playing such a role? The answer is, because we are severely disaffected with the strategic health authority. It wants to ensure that we are brought into line by effectively taking every decision as quickly as it can in what I can only describe as a malevolent way. There is no rational argument here. The language that is used and the advertisements that we are forced to plough through, all have the effect of marginalising the process of rationality.

One of the issues that we have tried to get across repeatedly—utterly unsuccessfully so far, but with the Minister's help perhaps that can change—is the fact that efforts are being made to get a regeneration programme going in Hertfordshire. I have taken a particular interest in that regeneration programme because there is land in my constituency that is in public ownership and not in the green belt. Without any infraction on amenity space it could provide a site for a significant programme of affordable housing for our youngsters and for the next generation.

That land is potentially available and yet whenever we mention that Hemel Hempstead might take some of the regeneration that Hertfordshire is expected to achieve, there has never been any suggestion of trying to improve the health infrastructure to service that enlarged community. That is not because it is not a reasonable thing to request, but because we have a health authority that is entirely unreasonable and deaf to rational argument. When I put those arguments to the strategic health authority board there was a stony silence. When the board asked whether there were any questions, the answer was "No." There were no questions, no interest and no engagement. The response was simply, "Mr. McWalter, you are from Hemel Hempstead. You are out of the loop and the quicker you get out of the room, the better." Well, we are not going away.

There is a desperate democratic deficit in all this. I sat in a room on Monday and people on a top table had the power of decision in these matters. Where was their democratic mandate? I represent a parliamentary constituency. I ought to have a say. But the people who were taking the decision included the chair of the local primary care trust. She voted in favour of these proposals. I think she was leant on somewhat, but I cannot believe that more than 1 per cent. of my constituents would vote in favour of these plans. The
 
2 Mar 2005 : Column 310WH
 
main political parties at the next election will all be opposed to them. If somebody stood at the next election on a pro-strategic health authority ticket—a "Consolidate Children's Services at Watford" party—I wonder exactly how many votes they would get. The only votes would be from people who accidentally put their cross in the wrong box. Yet the chair of the primary care trust voted for them and not for the huge majority of people in my area. That is a democratic deficit.

We are also told that the Government will not carry out any major reconfiguring of services. That is bad news for the strategic health authority because it really does not like Dacorum primary care trust. It is the oddball—the one that the authority could not bribe its way to get. I use that term not in the sense of personal benefits but in the sense that when Watford looked as though it would oppose the plans, along came a £330  million development to stuff its mouth with gold and ensure that it came into line. My constituency was never offered that. The reality now is that the strategic health authority has decided that our primary care trust does not need its own chief executive, so it will give us a joint one. Who with? Watford. Where is she based? Watford. There is a de facto joining together of primary care trusts to quieten further the voice of my constituents on these important matters.

Many people in the country are seeing the benefits of having a Government who have had a passion for health and a commitment to improvement, to making an investment in our health services and to changing tack from the story of asset stripping and provision reduction that characterised health in the 1980s and 1990s. That resulted in proposals that all Hertfordshire hospitals should close, that there should be only one and that the system should be much smaller to be economical. We fought off the report proposing that, called "The Right Approach", and we fought off a number of other threats.

This debate is not about the closure of Hemel Hempstead hospital but about service displacement, irrationality, profligacy and an authority that should be much more democratically accountable than it is now. I ask the Minister to review the events that I have described with a view, as I have asked before, to suspending those who treat people in such a way, to inquiring into the falsehoods perpetrated in advertisements and, eventually, to giving us some people whom we can trust to listen to our arguments.

3.48 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 yet again securing a debate on this matter. I know that it is of great concern to him and his constituents. I responded to the debate that he secured in December 2003, I have had meetings with him, and my officials and I have studied the reports that he has written in recent months. He has for many years been a fervent supporter of his local hospital and the services that it provides. Whatever else his constituents may have concerns about, they can be sure that they have a Member of Parliament who is tireless in campaigning on their behalf.

Like the people of Hemel Hempstead, my hon. Friend is eager to secure the high-quality health services that any community should expect. That vision is shared by
 
2 Mar 2005 : Column 311WH
 
the Department of Health and the local national health service in Bedfordshire and Hertfordshire. I am sorry that he feels that advertisements placed by the strategic health authority have been unfair or misleading. Misleading adverts should not be placed, and I shall be interested to hear the views of the Advertising Standards Authority.

It is a fact that we need to change if we are to improve. Our health care system is under pressure. Patients are still waiting too long for their operations, and many hospitals are in a poor state and need updating. My hon. Friend is absolutely right. The huge amount of money that the Government are putting into health care is driving improvements nationally, including in his constituency, but we still have a lot to do, and those pressures need to be addressed. That has been the case for many years, but we realise that we in Whitehall cannot make decisions about local matters, because we do not know areas as well as local people do. That is why, under our "Shifting the Balance of Power" policy, we pushed decision making down to local areas.

Frankly, across Beds and Herts some health services, particularly the major hospitals, are unlikely to be able to deliver the quality of, and continuous improvement in, care that we expect in England in the 21st century. In West Herts the situation is particularly acute, with the local trust zero star rated. The NHS cannot accept that, and the local NHS is right to demand that it be addressed. That is why there was an initial process to consider changes in health care in the area. That was followed by a formal public consultation known as "Investing in Your Health", which ran from March to December 2003.

Due process was followed in that matter. When local NHS organisations have under consideration a proposal for service change they must comply with the consultation requirements of sections 7 and 11 of the Health and Social Care Act 2001. Section 7 requires the   NHS to consult relevant overview and scrutiny committees on service changes that are of a substantial nature. Nobody disputes that the changes described by my hon. Friend are of a substantial nature. Section 11 requires NHS organisations to consult and involve patients, the public and their representatives in the planning and development of services, and in decisions affecting the operation of services.

Following the consultation process, the scrutiny committees had the opportunity to refer the issue to my right hon. Friend the Secretary of State for Health for intervention. They did not do so. As a result—I know that this will and does upset my hon. Friend—even if he were able to convince me of his case, I have no basis for intervention in this matter. It was a matter for local determination, and decisions must now remain with the local NHS.

During the consultation period, two options for the future reconfiguration of hospital services were proposed. Both entailed retaining six major hospitals in Beds and Herts, including Hemel Hempstead and Watford general hospitals. As my hon. Friend is aware, option 2 was preferred, which would mean a new hospital at Hatfield with a cancer centre, and development of Watford hospital as a major acute hospital and Hemel as a major non-acute hospital.
 
2 Mar 2005 : Column 312WH
 

I appreciate that that is not the option preferred by my hon. Friend, but this is not about winners and losers; it is about benefits for users of health services across the two counties, and that was the major driver for change. Following on from the consultation process, last April and again in June Department of Health officials reviewed the deliverability of the proposals decided on by the local NHS, and they were satisfied that they were deliverable. In particular, they were satisfied that the two proposed major acute developments could fit on their proposed sites and meet the highest NHS design and space standards; that the proposals were properly costed and likely to be affordable within a reasonable projection of the health community's resources; that the authority had already completed a significant public consultation, in which the proposals were supported by the vast majority of stakeholders—I accept that that does not include my hon. Friend and his constituents—and that the trusts and the strategic health authority understood the challenge of delivering the scheme, and were committed to making the necessary project management resources available.

An earlier peer review by the capital investment unit for the London strategic investment unit formed similar conclusions. As a result, the scheme was approved by Ministers and announced last July. The scheme is now finalising its procurement strategy and recruiting to its project team so that it can develop its outline business case with a view to procurement commencing in 2006 or early 2007, and construction potentially starting in 2009. I want to assure my hon. Friend that under option 2, Hemel Hempstead hospital has a future and will receive investment of around £25 million to develop it into a modern, high-quality major hospital specialising in planned surgery.

I also understand that Dacorum primary care trust is developing plans for the site, including an intermediate care facility and possibly a general practitioner surgery and mental health in-patient facilities. I am assured that Hemel hospital will have more patient contacts than Watford and will continue to play a vital role in health service provision for the people of Hertfordshire.

My hon Friend raised concerns about the children's consultation process. May I state clearly that no decision has been made? I understand that Bedfordshire and Hertfordshire strategic health authority has honoured the commitment given during the "Investing in Your Health" consultation process to talk with local people about how it achieves the services laid out in option 2. I am pleased to note that over the past few months the health authority has been listening to the views of local people on the proposals and important issues, such as the opening times for the Hemel children's accident and emergency unit and the design of the new units.

At a meeting held on Monday, which was open to the public, the proposals on the children's review were unanimously agreed. My hon. Friend might have views as to whether the chairman of the local PCT should have agreed them, but the fact was that they were unanimously agreed. Some of these proposals include a children's rapid assessment unit at Hemel hospital open 12 hours a day, every day, alongside the main accident and emergency department; a rapid referral clinic run alongside the children's out-patient departments at Hemel Hempstead and Watford, offering an alternative
 
2 Mar 2005 : Column 313WH
 
to treatment in accident and emergency; a new, specially designed children's day unit at Hemel Hempstead hospital, staffed by specialist children's doctors and nurses and providing planned treatment and surgery; an enhanced community nursing team to ensure that more children could be cared for at home; and a children's in-patient ward at Watford hospital.

I would advise my hon. Friend to get access to the national service framework for children, which we have recently published, and compare the proposals with the best practice that is set out in the national service framework. If he does not believe that the proposals match that best practice guidance, that would provide him with valuable ammunition with which to challenge the proposals.

I also appreciate my hon. Friend's concerns regarding the single chief executive for the two local primary care trusts, but may I remind him once again that that is a local decision for the local PCT trust board? I understand that both PCTs are happy with the current arrangements.

My hon. Friend also raised concerns about transport around Watford hospital. I am aware that a transport and access group, drawn from a range of bodies, is studying how public transport can be improved.

In the final minute available to me, I shall deal with the points made by my hon. Friend in respect of the national position and put them in context. The latest round of revenue allocations to PCTs, covering the period 2006–07 and 2007–08, were announced on 9 February 2005 and represent a £135 billion investment in the NHS over two years. That is equivalent to an average increase of 9.2 per cent. for 2006–07 and 9.4 per cent. for 2007–08—an average of 19.5 per cent. over the two years. As a result of the 2006–08 allocations, Dacorum PCT will receive record increases in funding. For the current three-year allocation period, covering 2003–04 to 2005–06, Dacorum PCT has received a total increase in its funding of over £33 million, which is an increase of 31.8 per cent. For the two-year allocation period covering 2006–07 to 2007–08, the PCT will receive a total increase of £28.2 million, which is an increase of 18.5 per cent.

I realise that that will provide little comfort to my hon. Friend, who will continue to campaign passionately for Hemel Hempstead hospital, and I have no doubt that between now and any political events that may come up in the near future, he and I will be discussing it further. I hope that we will continue this debate in the Chamber after those political events and that his constituents continue to have a wonderful constituency MP who works hard on behalf of the people who put him here and will continue to do so in future.

---