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Mr. Graham Stuart: Does the hon. Lady agree that the problem is not just that closures in community hospitals will cause bed blocking, but that overstretched ambulance services—many of which are already struggling to reach their targets, not least in rural areas—will be further inconvenienced and schools, such as the Hornsea school in my constituency, will use ambulances for minor injuries, taking those services away from people who need them more?

Sandra Gidley: Ambulance services have frequently been a target for underfunding by other trusts. Again, a lot of this boils down to having good overall strategic management that can ensure that ambulance trusts are funded. As I mentioned earlier, the BMA survey showed that the possible reductions in patient transport can cause great problems for many patients.

As well as the problems posed to patients by closing community hospitals, what has not been pointed out is the effect on social care budgets. If patients are treated at
 
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home, instead of in community hospitals, they become liable for all their personal care needs. That involves means-testing and patients paying money that they probably can ill afford to pay, but they are often unable to think about that when they are trying to recover from an illness. The burden on social services departments has not been mentioned today. We could have a parallel discussion of the problem of moving patient treatment from health to social services and the impact that that has had on social services budgets, many of which are over-spent.

Anne Milton (Guildford) (Con): Does the hon. Lady agree that we need to discuss the serious issue of the cost shifting that will go on as a result of the closure of community beds? Indeed, a lot of local councils are already very concerned about their budgets for next year. One way to wipe out an NHS deficit is simply to dump it on local councils.

Sandra Gidley: I agree with much of what the hon. Lady says. The big problem is that local health trusts do not talk to social services departments when such changes are made. That causes huge problems. One Liberal Democrat policy at the last election was to develop a much closer melding of health and social care budgets, thus helping with some of those problems. In the proposed reorganisation in London, PCTs are starting to work with local authorities, but it is disappointing that the Government seem to want to break down the good working relationships that already exist.

The Minister of State, Department of Health (Jane Kennedy): The hon. Lady might like to talk to her colleagues who run Liverpool city council, where relatives of the users of local authority social day-care provision, which is being closed down right across the city, have appealed to me to see whether we could find a way for the PCT to take responsibility for social services from the local authority. That is not exactly the best example of a local authority working in the interests of people in need of social care.

Sandra Gidley: The Minister's point reinforces my assertion that such perverse decisions would not need to be made if the budgets were combined.

The Government claim that patient choice is all important. The Liberal Democrats believe that choice should not be artificial, such as that offered by the delayed choose and book scheme. Choice should involve a variety of provision available to all. That is particularly so with maternity services. A woman should have the right to choose between a home birth, a birth in a midwife-led unit or to be under the supervision of a consultant.

On Monday, the National Childbirth Trust called on the Government to take urgent action to protect the future of birth centres in the UK and cited examples of recent service cuts, one of which has been mentioned by the hon. Member for Fareham (Mr. Hoban). Other places affected include my area of Romsey, and Petersfield, Southport, Malmesbury and Wakefield. The
 
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trust points out that because of staffing issues and financial constraints, a full range of maternity services is available to only a minority of women in the UK.

The Secretary of State will be aware of the Labour manifesto pledge:

Government policy emphasises the importance of choice by stating:

and

I could wax lyrical about the benefits of midwife-led units, but I will restrict my comments to asking the Secretary of State to investigate the problem and come to the House to inform us what action the Government are taking to reverse the situation.

Kali Mountford: Did the hon. Lady read, as I did, the report by the health service commissioner published earlier this year about the need to make maternity services more locally based? Is she aware that NICE is reviewing midwife-led services to ensure that there are also safe outcomes? Should we not be ensuring that there is a proper balance between locally based services and ensuring that the outcomes are safe for both mother and child?

Sandra Gidley: I am not quite sure what point the hon. Lady is making. It is quite insulting to midwives who work in midwife-led units to suggest that those units are somehow more dangerous to women. Many women have perfectly safe births in such units. Midwives are the experts on birth, so I find the hon. Lady's comments rather strange. However, of course, we must wait for the NICE review.

I am alarmed that some of the cuts that are apparently the easiest to make are those to aspects of the public health and preventive health agendas. I was interested by the Secretary of State's closing remarks because although she said that public health was a Government aim, that does not seem to be shown by the situation on the ground.

I shall cite a local example. Owing to the deficits, a local hospital wanted to cut cardiac rehabilitation classes, which offered people post-operative exercise and re-education about their lifestyle. They were a good aspect of the preventive health agenda. There was public uproar and the decision was reversed.

There is excitement in my profession of pharmacy about the new pharmacy contract, but that is tempered by the fact that many primary care trusts do not have the money to develop new services, especially if there is an underlying deficit.

Justine Greening (Putney) (Con): The hon. Lady makes a valid point. In the London borough of Wandsworth, our primary care trust has a substantial deficit of £8 million. In fact, that deficit is one of the things that is stopping its proposal to reopen Putney hospital, which was shut under this Government. However, £300,000 a year is being spent on keeping the
 
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site secure while we decide what will happen, and that valuable asset is not being used. Does she agree that that is a disgrace and a waste of valuable taxpayers' money?

Sandra Gidley: Sadly, hon. Members have cited many examples of taxpayers' money being wasted. I have sympathy with the residents of Putney.

Surely it is short-sighted not to think about funding the new pharmacy contract when approximately a third of all hospital admissions are drug related and many people live with long-term conditions that could be managed more effectively with a little help. Pharmacies can deliver obesity-management and smoking-cessation services, so a golden opportunity is being squandered when such services are not encouraged and possible long-term savings are not being achieved. Other Cinderella services include mental health services and those involving mainly older people, such as stroke services.

Liberal Democrat Members will support the Conservative motion because it must worry us all that unprecedented amounts of investment have not been accompanied by improved patient outcomes across the board, and that the Government are spectacularly failing to monitor, control or improve the situation.

Several hon. Members rose—

Madam Deputy Speaker: Order. May I remind all hon. Members that Mr. Speaker has imposed an eight-minute limit on all Back-Bench speeches?

5.29 pm

Laura Moffatt (Crawley) (Lab): I decided to apply to take part in this very important debate because, first, as a former nurse, I worked in the national health service for more than 25 years, and, secondly, I am one of the Members of Parliament whose acute trust has the highest deficit in the country. I want to contribute to trying to understand deficits, how they come about and how we in this House have a responsibility to explain properly what is happening to the new health service of today. Sitting in this Chamber, laughing, joking and joshing is not the way to tackle very serious matters.


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