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Westminster Hall

Wednesday 2 November 2005

[Mr. Roger Gale in the Chair]

Community Hospitals

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Roy.]

9.30 am

Mr. Graham Stuart (Beverley and Holderness) (Con): I am grateful for the opportunity to speak about a highly regarded local service: the community hospital. I do so on behalf of all those whose community hospitals are under threat—sadly, a growing constituency throughout England—and, in particular, on behalf of my constituents, who want to defend two much-loved institutions: Withernsea and Hornsea community hospitals. There is a third community hospital—the Beverley Westwood—in my constituency, but fortunately that is not currently under threat.

Hon. Members will recognise that, in a predominantly rural area with poor roads, poor local transport facilities and an older-than-average population, this issue is of the greatest consequence. I plan to talk first about the situation in my constituency and then to discuss the national crisis in community hospital care. I shall not make any promises about how short my speech will be, because I have noticed that other hon. Members never seem to keep theirs.

Hornsea and Withernsea are coastal resort towns with older-than-average populations. On a good day, each is a 40-minute drive from the other and from Hull. Both suffer from poor transport infrastructure. Neither has a railway station. Hornsea does not have a single A road and has a patchy bus service. One elderly constituent told me that returning home to Hornsea from Castle Hill hospital in Hull once took her four hours using public transport—she left at 2 pm.

Each town has a community hospital providing beds and a minor injuries unit. Both enjoy tremendous local support: each has an active friends' group that raises many thousands of pounds to improve the experience of patients. The two hospitals are run by Yorkshire Wolds and Coast primary care trust, set up by the Government with a financial deficit from birth. During this year, the PCT has gradually lifted its prediction of deficit. At the beginning of the year, it was £4 million. Then it was £6 million and then £8 million and now, astonishingly, it is £11 million. That is all in less than six months. The PCT has undoubtedly been guilty of some financial mismanagement, but it has also reeled under the effect of national policies to which I shall return. Earlier in the year, it merged its management with East Yorkshire PCT, whose chief executive took over at Yorkshire Wolds and Coast, and, although technically separate, it has been run by a joint board ever since.

A review process into the viability of four local hospitals—Hornsea and Withernsea, in my constituency, and neighbouring Bridlington and Driffield—was instigated by Yorkshire Wolds and Coast PCT after it published details of the ballooning deficit. An independent
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consultant was brought in to produce a report on the viability of each hospital, and public consultation meetings were held in each town affected by the review. The conclusions of the first stage of the review, which ended in May, could not have been clearer. For Hornsea, it recommended closure, citing low bed occupancy and a significant and expensive programme of backlog maintenance.

That announcement had a huge impact on the region. People were understandably angry. They were also hungry for information. That is where the PCT let itself down badly. Throughout the review process, which has now lasted almost a year, it has been extremely difficult to determine its strategy. I asked for the brief given to the consultant for each hospital review. In Hornsea's case, he was simply asked to save £500,000 a year and to find a £1 million cash windfall. There was no mention of health improvements, just hard cash.

The PCT made out at "pre-consultation" meetings in March that it was awaiting the consultant's report on the hospitals. Those meetings were a farce, with residents given no steer as to what might be planned or the financial pressures facing the PCT. Residents were split into "workshops" and asked to talk about what they would like to see in their local hospital. They were distrustful, and they were right to be. I found out later that the PCT had received the report from the consultant for Hornsea in early November the year before.

After nine months, the PCT finally announced its proposals in September, with a three-month consultation period to follow. At a packed joint board meeting in Driffield with more than 300 people in attendance, it was announced that Withernsea minor injuries unit would permanently lose its overnight service and that the service would drop from 24 hours to 12. At Hornsea, the MIU would be closed and the number of beds reduced from 22 to 12.

The people of east Yorkshire are extremely angry. The East Riding Mail's "Hands Off Our Hospitals" campaign, with the help of various voluntary and community groups, has collected more than 15,000 signatures in protest at the threat to our hospitals. More than 1,000 people have attended protest marches. I pay tribute to the hard work of people such as Liberal Democrat Councillor Polly Worsdale, Independent Councillor Barbara Jefferson and Joan Heathershaw of the Hornsea residents' association—all in Hornsea. I pay tribute also to Councillor Richard Stead, Councillor Chuck Hunter, Councillor John Parsons, the town's mayor, Stuart Woodruff, and Edna Harknett in Withernsea. There are many more people involved. This issue has brought together people of every political persuasion.

The proposed closure of the Hornsea MIU would be a particular blow. The PCT has not sought to commission an enhanced minor injury service from the GP practice, so what will happen to patients? Why do the isolated, the poor and the sick have to pay the price for the mistakes made by the Government and unelected quangos? Local people want to know.

I will now turn to the national picture. According to the British Journal of General Practice, there are 471 community hospitals in the United Kingdom, containing 18,579 beds. Community hospitals contribute enormously
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to the quality of life of local people. In some areas, the community hospital is the only hospital service for many miles. They are close to people's homes, and patients enjoy the continuation of care provided by their own general practitioner or by local primary care teams. The low-technology environment in community hospitals generally proves more reassuring, especially to elderly patients.

One visit to Hornsea cottage hospital summed up for me the reason why people love their local hospital. I asked an elderly gentleman what it was like being in Hornsea. He said,

The Government have also recognised the important role that community hospitals can play. "Keeping the NHS local: a new direction of travel", which was published in 2003, stated:

It went on to say—remarkably—that the first principle that should guide any alteration in services should be

The Minister will, perhaps, explain whether that is what is happening in Hornsea or Withernsea at the moment.

Mr. David Drew (Stroud) (Lab/Co-op): Will the hon. Gentleman agree with me that one of the problems with community hospitals is that the relationship with the care sector, particularly care homes, has never been properly defined? There is an overlap of people, sometimes because of delayed discharges, and that can cause confusion because of the different pricing mechanisms that are in place. In a sense, community hospitals are free, although we know that the cost is higher, but within the care sector they are paid for. That matter needs to be sorted out as a priority.

Mr. Stuart : I completely agree with the hon. Gentleman. There is a huge issue related to tariffs and the way in which, when patients come out of an acute hospital to go to the community hospital, the PCT is financially rewarded for the service that is being provided. There are also issues related to care homes. As it happens, there is not one nursing home in east Yorkshire—that is another failure of care in the current situation. Opposition to cuts in Hornsea and Withernsea appears unanimous.

The Labour party's general election manifesto earlier this year pledged to

Despite the rhetoric, however, we find ourselves in a position where the threat of closure or service cuts looms over community hospitals throughout the UK. Along with Hornsea and Withernsea, Felixstowe, Aldeburgh, Henley-on-Thames, Wantage, Wallingford and Didcot are all under threat. We will hear about other hospitals later in the debate. Evesham hospital is to lose two wards. The maternity ward at Malmesbury is to go.
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There is a long list, which will be added to during the debate. We believe that there are about 90 community hospitals that face threats of cuts or closure.

Mr. James Gray (North Wiltshire) (Con): My hon. Friend mentioned the maternity ward at Malmesbury. He may not be aware that, thanks to cuts by Malmesbury PCT, the whole of Malmesbury hospital is under threat—not only the maternity ward. Does he agree with me that Malmesbury provides a superb local service for local people? It is not only maternity services that are under threat there—it is the whole hospital.

Mr. Stuart : I am grateful for my hon. Friend's intervention. That only goes to confirm the ongoing and growing crisis in our community hospitals.

"The NHS Plan: a plan for investment, a plan for reform", which was published in 2000, not only committed the Government to introducing 5,000 extra intermediate care beds, but stated that there was

Legislation gave PCTs explicit responsibility for funding most of the activities of the NHS in their areas. As the Under-Secretary of State for Health, the hon. Member for Birmingham, Hodge Hill (Mr. Byrne), said,

Mr. Ian Taylor (Esher and Walton) (Con): My hon. Friend has touched on an important point. Many of the communities that have community hospitals have contributed to them through fundraising. The friends of Thames Ditton hospital in my constituency have done that for Emberbrook care centre, only to see the number of NHS-taken beds under threat because of PCT cuts.

Mr. Stuart : The point is well made and applies in many of the constituencies that are represented by Members who are present.

The truth is that extra money has gone into the NHS. Over the three years of the 2004 spending review, NHS spending will increase by 23 per cent. That will take total spending on the NHS in England from £69 billion in 2004–05 to more than £92 billion in 2007–08. The Minister will therefore appreciate the public's desire to know why, in the light of record spending, their local hospitals are under threat.

Had the Government done more to ensure that extra NHS funding got through to front-line services, more than a third of trusts would not be in deficit, and the prospect of job cuts, closed beds and reduced services would not be looming.

Mr. Geoffrey Clifton-Brown (Cotswold) (Con): My hon. Friend has just touched on the nub of the problem. No doubt the Ministers will trumpet all that extra spending. The problem is that it is not getting to the front line.

My PCT inherited an historic debt. It has been told that it must meet the deficit by April 2006; it has no time to adjust. That is why nearly all the cottage hospitals in my constituency are now under threat of bed closures, if not ward closures, if not entire closures.
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Mr. Stuart : I thank my hon. Friend for his intervention. To channel anger at the situation at the PCT, however, is useless. As hon. Members will be aware, PCTs are not elected. They are wholly appointed bodies, and therefore the public cannot lay a finger on them. So much for the Government's commitment to accountability in the NHS.

People therefore turn their anger on the Government. What do Ministers do when the body that they appointed to run local health care runs up debts of millions and threatens the future of local hospitals? They throw up their hands and say, "Nothing to do with us."

The Prime Minister said in response to a question from my hon. Friend the Member for Mid-Worcestershire (Peter Luff):

The Government were careful to ensure that just one line in the entire "Shifting the Balance of Power within the NHS" document referred to PCT accountability. That line was vital, however. It reads:

That is indeed the case. National Government policy dictates how much money the PCT has and directs how that money is spent.

Anne Milton (Guildford) (Con): I would like to pick up on a point made about these budget deficits. The situation at Guildford and Waverley PCT is the same as that in many other parts of the country. With community beds shutting, people will either be admitted to acute trusts, where costs are higher, or there will be a cost-shifting exercise.

Does my hon. Friend agree that councils that are already struggling will have to pick up the tab for care at home or in the community? PCTs' deficits might be wiped, but social services and councils will have to pick up the rest of the tab.

Mr. Stuart : My hon. Friend makes several excellent points. The closure of beds and services at community hospitals will impact on ambulance services, which tend to be overstretched and unable to meet their targets, particularly in rural areas. That will lead to an increase in the inequity of health care in rural areas, where, as we know, the further someone lives from services, the less likely they are to use them.

A Government who are committed to equity should seek to ensure that not only people in cities but those in rural areas can access services. They must also ensure that savings in one area do not lead to increased costs in another. For example, the chief executive and chairman of the Hull and East Yorkshire Hospitals NHS trust told me that its bed occupancy is currently running at more than 100 per cent.

That is the backdrop in the acute sector at a time when hospital beds in Hornsea are closing. Elderly patients in Hornsea are now being turned away from beds there because the number of available spaces has been reduced from 22 to 12.
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We do not dispute that the NHS has extra resources. In the unreformed NHS, however, each and every PCT is having to face the fact that many Government initiatives have proved to be more expensive than forecast. Central targets for waiting time limits and GP out-of-hours arrangements are disastrous; dentists earn £250,000 a year on the NHS while patients, including many in my constituency, are denied care; and there are difficulties in implementing the new GP contract. All the initiatives have taken their toll. The new centrally negotiated GP contract has been remarkable in its impact—GPs have received huge pay rises for doing much less—but it has had too little attention. PCTs are reeling under the impact, but the Government say that it is nothing to do with them.

My hon. Friend the Member for Boston and Skegness (Mark Simmonds) questioned Ministers on 13 November 2001 in a Westminster Hall debate on Skegness and District hospital. He said:

He did not receive an answer from the Minister, but sadly we now know the answer—no safeguards and "Nothing to do with us." That is where the real anger lies. The proposals for Hornsea, Withernsea and countless other places are based not on clinical grounds but are the result of the PCT losing control of its finances.

When defending cuts to local services, the Government point out that PCTs are spending the money as they see fit to meet for local needs. Indeed, another Minister, the Under-Secretary of State for Health, the hon. Member for Birmingham, Hodge Hill, is on record as saying that

My response to that claim is, first, that local health managers are not enjoying the review process and the anxiety that it is causing residents and staff. They did not enter the profession in order to shut wards and close beds. They have been forced into that predicament by the Stalinist nature of Whitehall management. Secondly, a casual delving into the geographical and social character of my area will show that the PCT cannot possibly be looking out for the health needs of the local population. Instead, it is following the ever-changing edicts of a Government who still claim that is nothing to do with them.

The Government are keen to triumph with positive headlines for the NHS. When things go wrong, however, they tend to shrug off responsibility and lay the blame at someone else's door. That must not be allowed to continue. Ministers must start to find answers to this growing crisis. They should use the primary care consultation now being conducted; they should use the forthcoming White Paper; and they should use the desire to be Prime Minister or the Chancellor of the Exchequer.
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Whatever it takes, Ministers need to save our community hospitals. If they do not, a growing number of people will not forgive their attitude of, "Nothing to do with us."

Mr. Roger Gale (in the Chair): Many Members have indicated that they wish to speak, and one or two others who have not done so are rising. We have slightly fewer than 45 minutes before I start calling the Front Bench spokesmen at 10.30 am. I therefore urge hon. Members to be relatively brief.

9.48 am

Tony Baldry (Banbury) (Con): I will adhere to your stricture, Mr. Gale, and I can tell the House that the full text of any documents to which I may refer can be found on my website, www.tonybaldry.co.uk.

In its general election manifesto, the Labour party promised a new generation of community hospitals. During the summer, I tried to discover by way of parliamentary questions what was meant by a new generation of community hospitals. I was told that Ministers' thinking was at an early stage.

In desperation, on 13 October I wrote to the Secretary of State asking what was meant by a new generation of community hospitals, who would fund them, who would run them, who would pay for them—and whether they would have beds. I did not receive the courtesy of a response from the Secretary of State, but I did receive a letter from Lord Warner, a Minister of State in the Department of Health. I shall share with the House three paragraphs of his letter, and my response to them.

Lord Warner, being an elegant Member of the other place, started his letter with an apology:

I replied:

Lord Warner replied:

I responded:

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Lord Warner replied:

My response was:

Mr. Graham Stuart : I wonder whether my hon. Friend heard the announcement of the former Secretary of State for Health, before the general election, that new community hospitals would all operate within the NHS and would be run by primary care trusts. I wonder whether he has seen the flip-flopping of the Government on this matter.

Tony Baldry : It is grossly unfair that decision taking is now in complete limbo, which is made worse by the Government's failure to explain what community hospitals should look like, whether they have beds, or who will run them. Acute hospital trusts see those hospitals as a solution to bed-blocking. The strategic health authority is totally incapable of even answering letters about community hospitals, other than in the most general of terms, because they clearly do not know what Ministers' thinking is. Ministers do not seem to know what their thinking is about the future of community hospitals.

The last letter to which I draw my colleagues' attention is one signed by me and my hon. Friends the Members for Witney (Mr. Cameron), for Wantage (Mr.   Vaizey), and for Henley (Mr. Johnson) to The Oxford Times last Friday in which we state that the NHS in Oxfordshire is in freefall. The strategic health authority expects the Oxfordshire health economy somehow to save £35 million between now and the end of the financial year. Decision taking is in complete chaos, and there is a complete lack of guidance from Ministers as to what they expect. That is against a background of cutting and slashing over the next few months. It is absolute chaos.

I do not think that a Minister has been seen in Bicester since 1997, other than a fleeting appearance by the Home Office Minister to discuss the asylum centre. I would genuinely welcome the Minister to Bicester to talk to its people about community hospitals. Indeed, my Labour party opponent at the last general election invited Ministers to come to Bicester during the Labour party conference. They would be most welcome to try to explain the chaos to everyone in the Oxfordshire health
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economy. I am sorry that, given the time constraints, I have not been able to take colleagues through the full texture of the debate. As I say, please look at my website, which shows how chaotic decision taking is in the area of community hospitals in Oxfordshire and, I suspect, elsewhere.

9.55 am

Mr. Edward Davey (Kingston and Surbiton) (LD): Already the cases we have heard today have echoed my experience. I am sure that we are about to hear similar accounts from other hon. Members.

In August, the Kingston primary care trust announced, totally out of the blue, that it wanted to close Surbiton hospital. We were told not to worry and that that would be temporary. A new survey had been received on the roof and, because of one little leak in one room, the trust thought that there was a case for closing the hospital. The survey found that to replace the roof entirely, which was apparently the only option that could be considered, would cost £300,000 and bust the budget. Health and safety required that all the elderly patients in the hospital were moved out. Some had been there for years. The out-patient facilities were also closed. One can imagine the local uproar.

When people asked when the hospital would reopen, the PCT could not answer. There was no plan and no strategic approach, and people were concerned and suspicious. They went on websites and looked at what was happening in other parts of the country, and their suspicions grew.

Dr. Julian Lewis (New Forest, East) (Con): The hon. Gentleman is right to recount that tale, because it is replicated wherever we look. In Lyndhurst in my constituency, Fenwick hospital was "temporarily closed" because of a shortage of staff leading to health and safety concerns. Once that was rectified, did it reopen? Not likely.

Mr. Davey : I am disturbed, although not surprised, to hear that account. That is our worry in Kingston and Surbiton. Since that August shock, we have had meetings with the PCT. I have had private meetings. We have also held public meetings. We have held consultations and had meetings with the strategic health authority. I met Lord Warner to put the case and the whole process is ongoing. I do not think that the hon. Gentleman will be surprised to learn that, as a result of a long process, one is more confused than clear about the situation.

National policy impacts on such cases. The infamous letter of 28 July from Lord Warner to PCTs and strategic health authorities across the country has created such instability and confusion that the ability of local managers to plan and to take strategic decisions has, frankly, been taken away. That is not their fault but the fault of the Department of Health. All the cards have been thrown up in the air. That, as I shall explain shortly, has created lots of difficulties with knowing how GPs and PCTs can plan ahead.

There is also confusion when one tries to work out what the local policy is. When one tries to test the arguments about the roof and the health and safety issues, they do not stand up to scrutiny and one's suspicions are increased. In my meeting with
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Lord Warner, he explained that I had nothing to worry about, that the reorganisations would not impact on any local decisions and that he would require the strategic health authority for south-west London to take whatever decisions it needed to. Of course, the strategic health authority was pleased to have that ruling, although it is fighting for its life and is not even sure that it will be around in a year's time. It is nice to have those words from Ministers at the Department of Health, but how it will impact on the ground is, I am afraid, very different.

It seems to me that the local policy makers are driven by two factors: the confusion in national policy and another aspect of the proposed changes, which is the fact that the PCTs, however they are configured in the future, will not be direct providers of services. A lot of the PCTs and their management want to get in early and to divest themselves of services that they can push off into the local care sector or to other providers. [Interruption.] Hon. Members are saying from a sedentary position that Ministers have changed the position and are saying that PCTs "may" have to divest themselves of services. However, the managers on the ground are still fearful that their careers will be built around the number of services of which they divest their trusts. That may be how the ruling is worded, but the reality for the NHS bureaucrats is that they feel under severe pressure to divest their trusts of services.

The other issue that is driving decision makers, certainly in south-west London, is the budget. The strategic health authority for south-west London has been told that the sub-regional health economy must come in on balance this year and that all the different trusts in the area must sum to zero. However, one or two acute trusts, particularly St. George's in Tooting, have massive deficits. Everywhere else is expected to come into surplus to make up the difference. That is not in any consultation paper. It is not even admitted, when that obvious fact is pointed out. However, it is clearly driving what is happening. There is a desperate wish to make short-term savings, and bad long-term decisions are being made to balance the books by April. That is a real problem.

As to our local battle, I hope that through our arguments and the pressure that we exert we shall be able to prevent some hospitals from shutting in the short term, and that we can save out-patients, even if it appears that those concerned are determined to move in-patients. That, at least, will give my constituents and the community time to regroup so that we can develop an alternative long-term vision, to take up the Government's pledge to provide proper, modern community hospitals and to test their vision. We have a vision in Kingston and Surbiton of a modern, 21st century, state-of-the-art community hospital, which provides in-patient services but which also provides a portfolio of out-patient services—more than are provided on the site now—that could relieve pressure on the acute hospital at Kingston.

As an example, the audiology department is under huge strain, with the laudable digital hearing aid programme that the Government have set in train. However, it does not need to be offered on an acute hospital site. That service could easily be provided on a community hospital site. The community hospital movement needs to get a grasp of such changes to the
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configuration of services, and so do the Government. We can provide primary care services of that kind more effectively through an expanded and modernised community hospital movement, and in doing so save money and remove pressure from the acute services, whether in their car parks, their accident and emergency departments, or their diagnostic services.

Community hospitals are part of the solution, not part of the problem, as far too many people in the health service seem to think. Whether Surbiton or other community hospitals are at issue, I hope that the Minister will listen, and move fast to ensure that the reorganisations elsewhere in the health service will not get in the way of sensible long-term planning.

10.4 am

Sir George Young (North-West Hampshire) (Con): I congratulate my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) on his choice of subject and the way in which he delivered his speech. What he said touched a chord in many of us. The fact that so many hon. Members are present listening to the debate and hoping to take part shows how important a subject it is. I am delighted that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State, is here.

I want to be fair to the Government at the beginning of my remarks, as it is not clear to me from the debate that anyone else will be. They have put resources into the NHS, and I welcome that. There have also been improvements in the quality of the care received by our constituents. Indeed, I shall shortly be opening a new nursing home on the site of Andover hospital, jointly funded by the NHS trust and Hampshire county council. We can debate elsewhere whether the improvement in care has been commensurate with the increase in cash. We can also debate whether the increase has been fairly spread throughout England. I shall mention that in a moment.

In addition to being fair, I want to be realistic. I recognise the case for change in the buildings that the NHS uses. Patterns of treatment change, lengths of stay reduce and medical science advances and becomes more specialised. Critical mass is needed for a district general hospital; there cannot be one in every town. New guidelines on safety indicate what operations can take place where. Old buildings are, of course, expensive to run, and more care can be provided at home. Therefore, the NHS needs to be responsive to the changes.

Against that background, my local trust produced a consultation document on the future of my local community hospital in Andover. That should have been an opportunity to discuss how the extra cash that is going into the NHS might be used to expand and to improve the services in a fast-growing town. Andover War Memorial hospital, as the name implies, was built by public subscription after the first world war when Andover was a fraction of its present size. It is a much loved institution with dedicated staff, but parts of the building are now seriously substandard. It provides a portfolio of services—minor injuries, maternity, out-patients, therapy and diagnostics—but for anything more serious one has to go to Winchester. Some 67,000 people look to Andover for hospital services, and that number is about to go up.
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The people of Andover and I would like the consultation exercise to result in the provision of a wider range of high-quality services in a modern building, reducing the need to travel to Winchester. I echo the point that was made by the hon. Member for Kingston and Surbiton (Mr. Davey). The problem with dependency on Winchester is that there is no direct train service, the bus service is infrequent and the journey lengthy, and there is nowhere to park. As Andover overtakes Winchester in population size, we see the review as an opportunity to move the centre of gravity of NHS service provision closer to the population that it serves.

We are not after a new district general hospital. We just seek improved and rebalanced terms of trade. However, there is deep concern in the town that we will not get that. People suspect that the consultation exercise is driven as much by the need to save money as by the need to improve care. The document says:

As a result, there is a lively and broad-based campaign to fight for the hospital, led by Derek Robinson. The local paper, the Andover Advertiser—I mention it in the hope that it will mention me—has given extensive coverage to the debate. Public meetings have been packed.

There is reason for that concern. The annual report of my primary care trust, which arrived yesterday, says that to balance the books in the current year, it has to save more than £11 million. Last year, it ended up owing £17.5 million while being owed £4.5 million. The financial position of what is called the health economy in Hampshire is deeply serious. The fear is that there will be no resources to modernise Andover hospital and that, in order to cut costs, more services will migrate to Winchester. At the heart of the issue is the formula for distributing the cash. I hope that the Minister will say that she is able to review that formula. Hampshire gets about 80 per cent. of the England average, and with that we cannot provide the quality of care to which people are entitled. Therefore, we have financial recovery plan following financial recovery plan. We have now been told to rub out the deficit in the current year. In Andover, we are ambitious but realistic. We want a fair outcome from the consultation exercise, as my hon. Friend the Member for Beverley and Holderness does from his.

I want to end by raising a key issue that is not unique to Andover, and which could affect every constituency with a community hospital that needs renovation. I refer to a policy that is wholly indefensible, and which the Minister can and should change today. Part of the site of Andover hospital is to be sold. I have no philosophical difficulty with that if all the new services that we need can be provided on a smaller footprint, and the capital receipts from the disposal can fund them. The land is to be sold in two years' time for £1.5 million—the estimated best price in the open market. However, that is less than the book value, which district valuers have assessed at £4.2 million. I do not know how they arrived at that figure; I should have thought that a building providing health services at nil cost had a negative value.

At this point in the dialogue, an uninvited guest arrives, namely the Treasury. The Treasury has spotted the gap between the open market value and the book
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value and has demanded what it is pleased to call an estate impairment charge. It is not even prepared to wait until 2007 to get its pound of flesh. More than £500,000 is being added to this year's deficit for the alleged injury being done to the NHS estate.

That is Treasury theology taken to an absurd degree. That tax on disposal is a major disincentive to rationalisation and is going to lead to a reduction in services in the current year. I have pursued the matter twice with Ministers, and their replies are straight from "Yes Minister":

They continue:

The Government have recognised that that is nonsense, because they have set up a separate fund to compensate the trusts that have to pay the charge. Sadly, the Treasury has got at that fund, too, and it meets only part of the cost, leaving a £500,000 shortfall this year in Andover.

Let us sweep away this nonsense. If land and buildings are surplus, they should be sold at best value, but let us not accentuate a bad problem by allowing that absurd theology to add to the burdens of heavily indebted trusts. If nothing else happens this morning, let the Minister at least recognise that absurdity.

10.11 am

Mr. Geoffrey Clifton-Brown (Cotswold) (Con): I am glad to catch your eye, Mr. Gale. I am grateful to my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) for raising this important subject. I am also grateful to the Minister for being present, and I have forewarned her of one or two of the questions that I shall ask. I am glad to see that my hon. Friend is recovering. Judging by the way he waved his arm this morning, he is clearly not in pain, so someone must have been treating him properly.

Gloucestershire has a problem, in common with many of the areas represented by Opposition colleagues—there are a great many Opposition Members present, but very few Government Members, which must tell us something about this debate. All my cottage hospitals—Tetbury, Fairford, Bourton-on-the-Water, Moreton-in-Marsh and, to a lesser degree, Cirencester—are threatened with bed closures, ward closures or complete closure. The reason is that Cotswold and Vale primary care trust inherited a £5   million historical debt and has been told that it cannot overspend at the end of this financial year—it must close that deficit, come what may. The only way in which it can make up that amount on a £100 million budget is to close either wards and beds or complete hospitals.

As my right hon. Friend the Member for North-West Hampshire (Sir George Young) said, PCTs are being bribed with the possibility of new and better facilities. However, given that PCTs will all be merged—that is likely to happen in Gloucestershire before it does in the
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rest of the country—I do not think that some of those new facilities will ever emerge. My first question to the Minister, therefore, is how many PCTs in the country achieve financial balance without any external support? My contention is that most have a financial deficit.

Following on from what the hon. Member for Kingston and Surbiton (Mr. Davey) said, I note that 70 to 80 per cent. of admissions in many areas are to the local hospital, whether it is a community or acute hospital. In Gloucestershire, that figure is down to only 10 per cent., which leads to an absurd and unsustainable situation, because people are travelling 3 million miles to get to their out-patient appointments. Clearly, that is unsustainable and undesirable, and the problem will not be solved by April. The ultimate solution must, therefore, be to keep community and cottage hospitals open, operating at full capacity and treating people to the best of their ability, whatever that means in terms of modern scientific developments and modern diagnostic possibilities.

The Government are changing their system for measuring the viability of local hospitals and moving to a system of payment by results and practice-based commissioning. I therefore have two questions for the Minister. First, what work has the Minister done to see whether cottage hospitals will become more or less viable when they move to the payment-by-results system? My second question relates to practice-based commissioning, which, we are all told, is to be the new saviour of our cottage hospitals. Under this new system, there will be a plurality of providers, but what will happen when no provider comes forward to run the local cottage hospital? What safeguards will there be as regards the over-mighty foundation hospital? In Gloucestershire, the problem is that it is sucking in all the resources and making cottage hospitals even less viable. What safeguards will there be to prevent predatory action by the over-mighty foundation hospitals?

Mr. Drew : I declare an interest as a governor of an over-mighty acute trust. Does the hon. Gentleman agree that there is a problem? Our county has a dysfunctional system. The hospital of someone who lives in Gloucester or Cheltenham is the district general hospital, yet we are fortunate to have community hospitals. Part of the problem is that there is an urban and a rural split, which is very difficult to make sense of in health provision. Does he agree that we need to consider that problem very seriously?

Mr. Clifton-Brown : I entirely agree with my neighbour. Part of the problem is the differential in funding. Foundation hospitals receive an amount that is well in excess of inflation, whereas cottage hospitals are being starved of funds. Many other colleagues have referred today to the rurality of some areas in Gloucestershire, which are 25 to 30 miles away from the nearest district general hospital. That is a real problem in the middle of the night. I know of someone who died because they did not get to the district general hospital in time.

We do need to make better use of cottage hospitals. They are the long-term viable option and the environmentally friendly option, and they are the best option for the patient. The Minister and the
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Government were elected on the manifesto of strengthening our national health service. It is quite unacceptable that some people in this country are receiving a national health service that is vastly superior to that received by others. There should not be a postcode lottery. All areas, particularly the rural ones, should be fairly treated by their national health service. The formula for distributing the money should not be skewed, as it has been, so that ratings for the elderly and rurality are lowered. It is simply not fair that some hospitals in our large cities are thriving, but other hospitals in our rural areas are closing.

10.17 am

Mr. Jeremy Hunt (South-West Surrey) (Con): I shall talk about health inequalities, as they go to heart of the debate.

There are two different concepts of health inequality. The first is when one primary care trust receives less per head than another. The second is when two PCTs receive broadly the same amount, after weighting, but choose to spend their allocation differently. One PCT might spend more money on prescription drugs, another might spend more on acute care, and yet another more on community hospitals. One PCT might use its resources more efficiently than another.

David Taylor (North-West Leicestershire) (Lab/Co-op): Will the hon. Gentleman give way?

Mr. Hunt : May I develop the thrust of my argument, because I want to base my contribution on what the Secretary of State said last week? In essence, the Government are saying that the problems in community hospitals are caused by the second type of inequality; that differing local priorities or poor financial management are the culprits. I contend that the problem is the first type of inequality, in that PCTs in certain parts of the country do not receive the amount that they need to deliver expected levels of health care because of fundamental flaws in the weighting formula that allocates funds to different areas.

David Taylor : I should point out that there are more complex and sophisticated reasons for differences in the per capita funding of PCTs, not least age, profile, morbidity and other social statistics. Does the hon. Gentleman accept that an ideal system will not necessarily deliver comparable amounts per head even to adjacent PCTs?

Mr. Hunt : I accept the hon. Gentleman's point. Let me explain why I believe there to be a problem in the weighting formula. Guildford and Waverley PCT serves one of the most affluent parts of the country, and I fully accept that people there are relatively healthier, but against that must be weighed the fact that it is one of the most expensive areas of the country in which to deliver health care and it also has a much higher proportion of elderly people.

Guildford and Waverley PCT has received generous increases in spending. The spending for our area increased by 9 per cent. last year, and is due to increase
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by 8 per cent. this year—increases of £18 million and £19 million respectively. Despite that, it is in crisis. Cranleigh hospital, which is the community hospital in the constituency of my hon. Friend the Member for Guildford (Anne Milton), faces closure. The number of beds is being cut back in Haslemere and Farnham community hospitals. A specialist rehabilitation centre, Milford, which has an enormously long track record of helping elderly people from the area make a complete recovery after strokes, also faces closure. The PCT is currently closing one-third of the community beds as an emergency measure, despite the fact that that flies in the face of the agreed local NHS strategy.

What is going wrong? The PCT has apparently been overspending and it is being asked to reign in that spending. However, considering the funding allocations, it is spending 9 per cent. less than the national average, despite the higher cost of delivering health care in the area, but the funding formula after the weighting states that it is still spending too much. This year it is spending £16.3 million more than it should be, but the weighting formula states that it should be spending 17 per cent. less than the national average.

Let us be clear: according to the formula, the Department of Health expects one of the most expensive areas of the country for delivering health care, with a much higher proportion of elderly people than average, to deliver that health care by spending about a fifth less money than the national average per head. Why is that? It is simply because the weighting formula states that people in the Guildford and Waverley PCT area are healthier than those in other parts of the country and therefore it needs less money.

However, the effect of such a huge disparity in funding is not to decrease health inequalities but to increase them. For example, waiting times for ear, nose and throat surgery is up to 13 weeks in Manchester but up to 26 weeks in Surrey; people have to wait up to 15 weeks for breast surgery in Leicester but up to 24 weeks in Surrey; for trauma and orthopaedics in Sedgefield, to take a random example, people have to wait up to 13 weeks, but in Surrey they have to wait up to 36 weeks. In trying to eradicate health inequalities, the weighting formula needs to consider not only health outcomes, such as mortality rates, but access to health care. If it focuses only on health outcomes it ends up creating equality, but by punishing the most vulnerable people who happen to live in more prosperous areas by making it massively harder for them to access health care.

I say to the Minister that it is very easy to look at areas such as Surrey and paint them in one's mind as a uniformly prosperous place, but nothing could be further from the truth. Although the proportion of socially deprived people in such areas may be lower, those that are disadvantaged are often far more vulnerable than those in areas with widespread deprivation because they do not have access to many of the grants and funds targeted at more deprived areas. When waiting times are increased and access to community beds is decreased, wherever it is, the people who suffer the most are those who have the least and they are the ones who will suffer if the funding formula is not changed.
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The Minister and I both support a well funded and fair health service, and in that spirit I ask her to recognise that many of the problems we are discussing are caused by a flaw in how funds are allocated. Of course, we need to take account of social deprivation, but we also need to take proper account of the cost of delivering health care and to promote fairness in access to health services. Sometimes mathematical formulae are designed to balance conflicting objectives fairly but they can also have perverse consequences, which is what is happening now.

10.24 am

Mr. James Gray (North Wiltshire) (Con): In the few moments left I want to congratulate my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) on securing this important debate. The number of hon. Members who have wanted to take part in it shows the importance of the issue. However, the resignation of the Secretary of State for Work and Pensions, the right hon. Member for Sheffield, Brightside (Mr. Blunkett), will take this debate off the front pages tomorrow if the information from my pager is correct.

I will mention just two anecdotal situations in my constituency in order to give my hon. Friend the Member for Forest of Dean (Mr. Harper) a few moments to expand on the subject. First, the hospital in Malmesbury is under great threat. Several wards have already been closed; the maternity unit has been closed; the X-ray unit is being removed despite the fact that the friends of Malmesbury hospital paid for it in the first place. It appears that Malmesbury hospital will be closed; consultations are being taken on the matter but the likelihood is that anything that looks vaguely like a hospital will be closed. Why is that?

I had a most interesting experience in the summer when I visited something called the Avon, Gloucester and Wiltshire strategic health authority. It is unclear to me what a strategic health authority is. I said to the chief executive, "What is it? What do you do?" and he said, "Well, we are strategic," and I said, "Well, I'm glad about that."

In Wiltshire, the PCTs, and the primary care groups before them that were broken up from the Wiltshire health authority, are being brought back together in something that looks much like the old Wiltshire health authority. What do we have on top of that? We have Avon, Gloucestershire and Wiltshire strategic health authority, which I went to see. It has a huge office in my constituency with a car park jam-full of BMWs. I asked the chief executive, "Why are you closing our hospitals and cutting our services?" and he said, "Oh, that is all to do with this, that and the other." I said, "I'll tell you what it's got to do with: it's to do with the fact that you're employing all these fellows here in their BMWs. I'll tell you what to do: sell this great huge building in the middle of Chippenham, fire all these fellows, close down the strategic health authority and get back to the old Wiltshire health authority."

What we are seeing—we have heard about this from my colleagues across the patch this morning—is deep, damaging, hated cuts in NHS front-line services, and their replacement by bureaucracy and management. I say to the Minister: cut all that nonsense and spend the money—she must spend the money—on front-line services.
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10.26 am

Mr. Mark Harper (Forest of Dean) (Con): I am grateful to my hon. Friend the Member for North Wiltshire (Mr. Gray) for allowing me time to speak briefly. I shall discuss the two community hospitals in my constituency—the Dilke Memorial hospital and the Lydney and District hospital. They are both supported by active friends' groups, which have raised a great deal of money not only for medical equipment at those hospitals, but, particularly at Lydney, for the physical infrastructure of the hospital.

I echo the concerns of some of my colleagues. Like many other PCTs, the West Gloucestershire primary care trust faces a significant financial problem this year: it has a deficit from last year, its previous forecast was for a deficit this year and it has been told that it must close all of that gap in this financial year. The trust is reviewing community health care in the area, and, although I am reassured that it wants to protect the community hospital facilities, I fear that its financial predicament may force it to take a different decision. It was expected to make proposals this autumn for community hospital provision, but it made it clear earlier this year that it would be unable to bring forward those proposals, ostensibly because it was unable to produce them locally in time.

Given what colleagues have said, particularly my hon. Friend the Member for Banbury (Tony Baldry), it is difficult to avoid concluding that part of the problem is the direction that the trust is getting from the centre about the national strategy for community hospitals and, as my hon. Friend the Member for Cotswold (Mr. Clifton-Brown) said, the fact that all the PCTs in Gloucestershire are likely to be merged into one, which means that a great deal of management time is being expended on future structures instead of front-line services.

My constituents and I are concerned that despite the trust's best intentions and the fact that it wants to provide community facilities, resources are being taken out of the West Gloucestershire PCT area, which covers my constituency, and sucked towards the acute hospitals in Gloucester and Cheltenham, because the trust has to close its financial deficit, because its most recent financial report, in September, said that its financial position had deteriorated and because its largest service agreement with the acute hospital trust, which, as my hon. Friend the Member for Cotswold said, runs the hospitals in Gloucester and Cheltenham, means spending £382,000 more than planned with that trust. The outcome of all that is that, despite not wanting to, local decision-makers might be forced either to close one or other of the community hospitals, or—

David Taylor : The hon. Gentleman talks about the trust's resources being transferred to general hospitals in Cheltenham and Gloucester, but can he confirm to the House that residents of the Forest of Dean area do not use those hospitals and will not benefit from improved resources there?

Mr. Harper : Of course they will, but my constituents do not want those improvements to be paid for at the expense of our community hospitals. We do not want to see community hospitals damaged by a focus on acute hospital trusts.
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10.30 am

Steve Webb (Northavon) (LD): First, I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) not simply on securing the debate, but on the gracious and fair way in which he presented his case. I thank him for paying tribute to the people of all the political parties in his constituency who have worked together. When local political parties can work together on these campaigns, they are all the more effective. I thank him for his remarks.

Much of what the hon. Gentleman said resonated with hon. Members. We have all had similar experiences. There was the consultation that was not, where we already knew what the outcome would be. He mentioned the manifesto pledge to have a new generation of community hospitals. The rhetoric is one thing, but the reality appears to be very different. In my area the argument for merging two district general hospitals into one super acute tertiary hospital is that it will do more in the community. At the same time, however, community provision is under threat. It is certainly not a joined-up piece of government.

The root cause of our debate is the Prime Minister's announcement that he is not planning to stand again for election. Now he is in a hurry. He wants a legacy. That means reform has to happen quickly. Primary care trusts have to get their books balanced by next April instead of having several years to sort things out because everything has to be rushed through so that we can see health reform implemented and the Prime Minister's legacy in place. Were there not such a hurry, many of these transitions could take longer and people would have time to adjust. Some trusts are in surplus but we do not hear about them. Those that are in deficit, instead of having time to adjust as they would once have had, are having to scramble to cut costs at every opportunity. Community hospitals are in the front line of those cuts.

Anne Milton : Does the hon. Gentleman agree that there is so much focus on structure rather than service delivery? That is the gap between Government and local people, which is why we have heard stories from many hon. Members today about local people raising funds to support their community hospitals. In my constituency, local residents are raising funds not only to build but to own their local hospital, Cranleigh village hospital, because they are concerned about service delivery, not structure.

Steve Webb : I am sure that the hon. Lady is correct. Indeed, we have heard many examples of where it was local subscription that enabled a hospital to be built. In the case of Tetbury hospital in the constituency of the hon. Member for Cotswold (Mr. Clifton-Brown), which I visited recently, the local community is the source of the hospital and runs it, as far as I understand. Very often these community hospitals have benefited hugely from popular local support.

I saw the Secretary of State for Health on Saturday night in Birmingham, listening intently to what people were saying. If they were telling her that they want to keep their community hospitals, I wonder what her reply was. It is one of those consultations where one wonders how much is just for show and how much difference it will make. My hon. Friend the Member for
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Kingston and Surbiton (Mr. Davey) cited the example of Surbiton hospital, which is temporarily closed. However, as we have heard from the hon. Member for New Forest, East (Dr. Lewis), these things can sometimes become permanent. It is a worrying trend that my hon. Friend highlighted.

The hon. Member for Banbury (Tony Baldry) highlighted the absurd situation where the Government seem not to know where they are going with their policy. They have announced a policy, and if anyone had read the Labour manifesto they might have been attracted by that policy. It clearly was not thought through and they are apparently back peddling on it with remarkable speed. It must be a world record.

The right hon. Member for North-West Hampshire (Sir George Young) raised the alarming issue of the treatment of land sales. That worries me because in my area when the Frenchay hospital land is sold off to pay for improvements elsewhere it would be absurd if we not only lost our hospitals, but we were taxed on the undersale of the proceeds. I should be interested to hear the Minister's response to that point.

Mr. Davey : Will my hon. Friend give way?

Steve Webb : I had better not as I am very tight for time.

The hon. Member for Cotswold, my constituency neighbour, mentioned the important issue of what payment by results means for cottage hospitals. By definition, smaller hospitals are likely to have higher than average costs. If they are receiving payment only at a tariff level—an average costs level—they will make a loss on everything that they do. PCTs may make up the difference in some way and bale them out, but if they are broke that will not happen. Do they have a long-term future under a tariff-based payment-by-results system? The hon. Gentleman raises a good point there.

The hon. Member for South-West Surrey (Mr. Hunt) referred to the problem of how we work out how much an area should get and the inequalities that can result. He raised the important issue of the cost of delivering health care. It is not only about deprivation. If it costs more to deliver health care in a particular area, it is important that that is fairly represented in the formula.

I should like to cite one example. We have already heard about Withernsea, Hornsea, Bicester, Surbiton, Tetbury, Fairford, Moreton-in-Marsh, Cirencester, Haslemere, Farnham and Malmesbury—a long litany of threatened community hospitals. To that I would add Thornbury in my constituency, and following the precedent set by the right hon. Member for North-West Hampshire, I praise the Thornbury Gazette, for its support for the "Save the Thornbury hospital" campaign. I do that because the hospital has just two wards, one of which—a mental health ward for elderly people—is being lost. We are left now with one ward on which the number of beds is being cut. It is death by a thousand cuts. The question is: how long will such hospitals survive? At present, the service is provided by the primary care trust. As we have heard, in principle, PCTs may end up not providing services. Is it going to be a private hospital or a voluntary hospital? We just do not know. There is a huge amount of uncertainty, which is damaging local communities and patient care.
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I do not think that any of us are defending the status quo. As the right hon. Member for North-West Hampshire said, none of us is saying that the service should not change or evolve. The service needs key-hole surgery, but it is getting amputation with a rusty hack-saw. That is what is going on in the health service at the moment. By all means, let us have evolution and new roles for community hospitals. Let them, as my hon. Friend the Member for Kingston and Surbiton suggested, take on new services and new local means of delivering health care.

Sandra Gidley (Romsey) (LD): My hon. Friend referred earlier to the lack of joined-up thinking. Would he agree with me that there is a huge role for community hospitals to take patients who are currently inappropriately in the acute sector?

Steve Webb : That is very much the case. In Thornbury hospital, the range of services providing, for example, intermediate care means that people can see someone close to home. Relatives and friends can just pop in rather than make a long bus journey to make a formal visit. That is good for patient care. It surely ought to be at the heart of the debate, rather than finance-driven cuts.

It takes breathtaking mismanagement for the Government to allocate record sums to the NHS, and for us then to see cut after cut throughout the land. That takes some doing. The way forward must be to begin with the patient and the community. If changes are needed, let us make them in co-operation and genuine consultation with local people, listening to them first, rather than producing blueprints long before the consultation begins that are then rubber stamped at the end of the process. We should not try to set our community services in aspic. They need to evolve and change, but what is needed is an imaginative approach, looking at all the good things that community and cottage hospitals can deliver: the potential for what somebody once called a patient-led NHS.

10.38 am

Dr. Andrew Murrison (Westbury) (Con): We have had a fantastic debate today; I cannot remember the last time that I saw so many colleagues in Westminster Hall: we can call it a truly packed event. It is a particular pleasure to see the shadow Secretary of State for Health here, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley). That is a mark of the importance that we place on the issue.

We have heard a great deal about the threat to patients and carers, and I can admit straightaway to an interest in that there are four community hospitals in my constituency, each of which is, in one way or another, under threat, two of them directly now. There are three on the periphery of my constituency that are similarly under the spotlight. It is an issue about which I feel strongly. We have heard little about the staff who work in such hospitals, and it is worth while putting on record that they are wonderful people who are experts in their field, and who operate in what we might call the less glamorous fringes of our health care system. They deserve our thanks and admiration.

We have recently conducted a good deal of research on the matter, and I am happy to announce the results of that research. As of this morning there were
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89 community hospitals in the country that we believe are under threat of closure or being seriously scaled back. However, it is worse than that. There is a clear correlation between primary care trusts with big deficits and community hospitals that are threatened with closure. That puts a lie to the notion that the exercise is about reconfiguring health care in the interests of local people; it is actually about reconfiguring health service budgets. We must be clear that that is what we are dealing with. That is important because it removes the responsibility from PCTs and puts it clearly where it should be, with the Secretary of State for Health. That is where it should be.

When I saw the Secretary of State a few days ago, she was keen to impress on me that such matters were for local decision making by PCTs; they had nothing to do with her. The fact that we have found a strong correlation between PCT deficits and community hospital closures shows that that is an issue not for local decision making but for Ministers. They must understand that, and must take responsibility for the closures that we have shown are happening throughout the country.

We know what the public think; we are in the age of consultation. It was clear from the national bed survey in 2001 that there was overwhelming support for community hospitals. Indeed, the NHS plan said that we would get 5,000 intermediate care beds. It would be interesting to hear from the Minister where she thinks they are— that was poorly defined in the document. However one defines intermediate care beds, it is difficult to see where they have landed up.

I have read the 2005 Labour party manifesto. The small part that deals with health underscores the NHS plan and promises, as others have said, a new generation of community hospital. From where my colleagues and I stand, we cannot see a new generation of community hospitals. We see what we have closing down day by day. I shall be interested to hear from the Minister about the new generation of community hospitals. Where will they be? What will they look like? Will they have any beds in them, or will they be the GP mega surgeries or polyclinics that the Government are so keen on? Is that what they really mean by community hospitals? I suspect that there might be some confusion about what is meant by a new generation of community hospitals. If the Minister means souped-up primary care practices, she needs to say so, so that the public are clear about what was meant in the Labour party manifesto of just a few months ago.

I share the exasperation of my hon. Friend the Member for Banbury (Tony Baldry), who has been kind enough to give me a copy of Lord Warner's extraordinary letter of 17 October. Lord Warner, the Minister of State, clearly does not have a clue about what he is going to put into community hospitals. My hon. Friend might like to know that the then health Minister, the right hon. Member for Barrow and Furness (Mr. Hutton), wrote to me on 22 March and gave his definition of community hospitals, saying that the important thing is not the building but the services that it provides.

So in March I am told that the services matter, not the bricks and mortar; in May the Government commit to buildings without knowing exactly what will go in them, and by October not only do we find community
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hospitals closing at an alarming rate, but the Government, clueless and consulting as ever, still have no idea what they are going to do with the new buildings that they promised just five months earlier.

That lack of direction gets worse. As others have said, in March Sir Nigel Crisp put out his extraordinary document "Creating a Patient-led NHS", in which he ordained that PCTs would divest themselves of the direct provision of services. Yet we have had no news about where community hospitals will lie in the new scheme of things. What does the Minister think? Can we, at long last, have a sense of direction? Will acute trusts take over—if so, please will she say so—or will the private and not-for-profit sectors take on the hospitals? There would be a certain irony if they did, because that is where they came from in the 1940s. Institutions that had been supported and nurtured by local communities for many years, often the gifts of benefactors, were taken on by the NHS, and the communities that handed them over felt that they were putting them into safe stewardship. Now, under this Government, many of those community hospitals are closing their doors.

I add my tribute to those that have been paid to the leagues of friends and others who support such hospitals. Huge voluntary effort goes on in my constituency and throughout the country. The Minister needs to take on board the views of those who support and, frankly, subsidise health care in such a fantastic way.

Dr. Julian Lewis : I thank my hon. Friend for coming to my constituency. In New Forest, East, in New Forest, West and in Romsey, five community hospitals are under threat. What does he think about a consultation process whereby the leagues of friends generate a 41,000-name petition and hand it to the chief executive of the PCT, who, on going back into his building, is reliably overheard to say, "Where is the nearest bin?" That is what happened.

Dr. Murrison : I agree with my hon. Friend and I was happy to add my name to the early-day motion that he tabled on this subject. I would like to tell him about the consultation that was conducted in Warminster four years ago. It was a fantastic comprehensive exercise, involving no cost to the Treasury, but it was ignored by health policy managers. I need not tell my hon. Friend what the survey showed: there was overwhelming support for Warminster hospital.

What hon. Members have described is happening throughout the country. I suspect that I shall not have time to say much about sham consultation exercises, about "Your health, your care, your say", which culminated in Birmingham this weekend, and about the myriad regional events held in the run-up to that. All I will say is that it is a betrayal of people's trust if they are invited to take part in a consultation and have their say, but what they have to say is ignored; if people are selective in which surveys they pay attention to; and if people are selective about those whom they invite to contribute in the first place, as is the case with the current survey, which we understand is to inform the White Paper later this year. We will not hold our breath on that, given that if we put rubbish in, we will get rubbish out.
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I would like to nail the lie about cost. With respect, I take issue with the hon. Member for Northavon (Steve Webb), because I think that he is wrong. If we cost the patient journey properly and consider case mix properly, we will find that community hospital costs are substantially less than costs that accrue to treatment in acute units. Those figures are available and are quite stark, and I commend them to the hon. Gentleman. I would also like the Minister's comments on that. At the moment, individual PCT chief executives take decisions on their own bit of budget, usually faced with deficits and adverse district auditor reports. They are obliged to make cuts where they can. That is their duty, what they are employed to do and their legal obligation. They have no choice. We must not blame them; we must pin the blame where it should properly reside, which is with Ministers who have got up this system whereby PCTs find themselves in deficit. They, not PCTs, are driving the closures, and it is important to know that.

The Minister will say that the situation is down to individual PCTs and local decision making. However, one thing that she cannot avoid responsibility for is public health. Just in passing, I point out that 10 days ago we heard about the contingency plan for epidemic flu, which highlighted the gross shortage of beds that we will have in the eventuality of a pandemic. The Minister cannot absolve herself of responsibility for allowing for bed space. It seems bizarre, at a time when we are clearly so short of bed space for the emergency that the chief medical officer says will arise, that we should even contemplate closing down intermediate care beds in the way in which that is happening.

We have had a fantastic debate today, the best that I can remember in this place. If the Minister has any doubt at all about the feelings of people in our constituencies, I invite her to visit any one of them that has been represented here today. If she comes to west Wiltshire, she will be sure to get the message.

10.49 am

The Minister of State, Department of Health (Ms Rosie Winterton) : I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) on securing the debate. It has raised a number of interesting issues and it certainly shows the depth of feeling that there is about      community hospitals. The Labour party's manifesto commitment to building a new generation of community hospitals, to which many hon. Members have referred, shows that we understand the important role that they can play.

David Taylor : As my hon. Friend will have heard, there are justified concerns about community hospitals, but does she agree that the comment by the hon. Member for Banbury (Tony Baldry) that the NHS in Oxfordshire is in free-fall is no more than hyperventilating and posturing, given that expenditure and investment are doubling over a decade?

Ms Winterton : My hon. Friend makes an astute point, and I come now to the issue of increased expenditure. What is encouraging about the debate is the fact that many Conservative Members, as well as the Liberal Democrat spokesman, the hon. Member for Northavon (Steve Webb), have agreed that expenditure on the NHS has increased; nobody has said that it has decreased.
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There have been comments about the formula, but given the consensus that expenditure on the NHS has increased dramatically, it is important to recognise that the Government expect proper financial management of that expenditure. It was the hon. Member for Beverley and Holderness who said that there had not been proper financial management in the past. Were any other political party represented here to be in government, I cannot imagine it simply saying that there was no need for good financial management. Quite honestly, that would do patients and the public no good at all. I hope, therefore, that we can agree on the need for good, rigorous financial management.

Tony Baldry : I am not sure whether the Minister was concurring with the hon. Member for North-West Leicestershire (David Taylor) that concerns about reducing spending in the Oxfordshire health economy by £35 million in one year were, as he put it, no more than hyperventilating and posturing. I would welcome the Minister coming to Oxfordshire, but the point is that, although we all accept that public finances must be properly managed, it is simply impossible to make slash-and-burn cuts in one year. The Oxford Radcliffe Hospitals NHS trust cannot find savings of £35 million between now and April, but the strategic health authority was incapable of telling us whether Ministers would be willing to allow those savings to be made over a period of years. When one writes to Ministers, however, they say that the issue is the responsibility of the SHA. What is driving us all mad is that we can find no one in the system who will take responsibility for anything.

Ms Winterton : Perhaps I can come to the process of consultation on reconfigurations. If we agree that it is important that trusts deal with the financial deficits, we then come to the issue of how they deal with them. Let me briefly answer some of the questions asked by the hon. Member for Cotswold (Mr. Clifton-Brown), of which he gave me notice. Of 303 PCTs, 170—56 per cent.—are in financial balance, with no planned support. If we take account of those with some financial support, we see that 70 per cent. are in financial balance. Some 25 per cent. have deficits, but the majority of those are quite small, although some trusts have larger deficits. I hope that that is helpful in answering the hon. Gentleman's questions.

Mr. Graham Stuart : Do the Government accept any responsibility for setting up PCTs in the first place and, in the case of Yorkshire Wolds and Coast primary care trust, for the deficit from the beginning, or is everything the PCTs' fault? Do the Government continue to say, "It's nothing to do with us"?

Ms Winterton : If PCTs have inherited deficits, that is, as I said, because there have been problems with financial management. It is absolutely right that the Government should deal with that.

As for the consultation on the proposals, the hon. Gentleman described a process in which the PCTs had been talking to local people; it sounded quite thorough.
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However, he said that he did not feel that there was any accountability in the process, and that PCTs seemed already to have made up their minds. I have two comments: first, our clear position is that PCTs must rigorously consult their communities. Secondly, it is important that when decisions of the sort in question are being made PCTs should have in mind the general thrust of national policy.

We have made a clear commitment to community hospitals within that general thrust, but the PCTs will, at the moment, be dealing with the financial deficits that they face, and considering how best to provide services within that context. In some instances that will mean difficult decisions. I agree with the important point that arose in the debate, which is that we need greater transparency in the deciding of priorities in different areas. There has been discussion of health inequalities and the differences in population mix between areas. That is an important aspect of the way forward to the development of a modern, reformed NHS.

I remind hon. Members that there are overview and scrutiny committees. I am not sure how many of the reconfigurations that have been mentioned today have been referred to them. In addition, I have been working on patient forums, focusing particularly on approaches to be used when there is a closer relationship between local authorities and health authorities. Many hon. Members have referred to changes in the provision of the relevant services nowadays, and many of them gave good examples of improvements that could be made. However, accountability is an important point and we need to think carefully about how to improve it.

Steve Webb : Will the Minister give way?

Ms Winterton : I will not give way. There are only two minutes left, and I am aware that I have not dealt with all the points that hon. Members have made. I want to set out some principles. The White Paper consultation that hon. Members have alluded to has been thorough. Many hon. Members have asked what the Government's vision is for community hospitals, but it is difficult to say that before the consultation that we have talked about has been carried out. [Interruption.] Six months ago in a manifesto, yes.

We have committed about £100 million to developing community hospitals. It is ludicrous to think that we can finalise all the details in such a short time. We have made it clear that we have ideas about some services, and hon. Members have come up with ideas today. Examples are the possibilities for day surgery and diagnostic services. It might, indeed, be possible for GP or dentistry services to be offered in community hospitals. The important point is that we are committed to considering a new generation of community hospitals, backed up by investment, but we want to consult thoroughly on the services that people want locally. It will vary by area.

I acknowledge that that is happening against a background in which PCTs are closely examining the services that they offer, to deal with financial deficits. However, it would be wrong to claim that those deficits should be ignored.
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