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Mr. Bone: My hon. Friend was talking about extended waiting times. Is he aware that in column 897 of Hansard on 15 November, the Government motion stated that no one waited more than six months for NHS treatment? I have discovered that 397 people in Wellingborough have waited more than six months for treatment. Has he encountered similar cases in his constituency?

James Brokenshire: I am aware of services with considerable waiting times, some of which I shall highlight. Access is an issue, and if a target is not set for a particular treatment to ensure that someone is given a consultant's appointment or a diagnosis, there will be a long wait. In the London borough of Havering, it probably takes someone about a year to seek a digital
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hearing aid, given the demand and the available appointments. The issue has arisen in my hon. Friend's constituency, and it is a problem in Hornchurch and for my colleagues in neighbouring constituencies in Havering.

I was highlighting the issue of the Duchess of Kent day hospital and the gap in provision. A further problem was the delay in notifying patients of the closure. I understand that some staff were not in agreement with the decision and had reservations about the closure process, and the delay in notifying patients was exacerbated by the fact that the decision was taken just before the general election, so the primary care trust was unable to go through the usual processes of the overview and scrutiny committee of the local council.

If that is the case, the Minister might reflect on the entire process. If there is a significant change in health service provision, such as the closure of a facility, it seems odd that the calling of a general election should prevent health bodies from telling patients and local residents that that change is coming into effect. We ended up in the bizarre situation where the Duchess of Kent day hospital closed on 30 September, yet letters notifying patients of its closure went out only a week before. The report on a complaint that was made to the North East London Mental Health NHS Trust concluded that

Because of the hiatus that I have described, some of my constituents who were mental health patients receiving support from the Duchess of Kent had to form their own self-help group. I understand that in the past few weeks one patient who was using those facilities has unfortunately been readmitted to Mascalls Park, which is the acute facility dealing with mental health patients in the London borough of Havering. Although I could not say that that is directly connected, it suggests that if the therapies to help such patients are not in place, acute episodes may occur as a result, and people who need more significant care and attention may have to be taken into an acute hospital. That is not how we should be dealing with the care of mental health patients. We should ensure that care is available in the local community to support them, and provide the therapies that they need. I know that that is the thrust of general health policy, and I wholeheartedly endorse the provision of primary care support for mental health patients.

It is very bad that there is a gap in service provision for patients trying to access tier 3 support. I was assured in July that patients' needs for on-going clinical care would be met

I do not see it as timely or appropriate if there is a six-month hiatus in services and people have to wait that length of time for psychological therapies that they were previously receiving at the Duchess of Kent hospital, particularly as one in four people are likely to suffer
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from some form of mental illness during their lifetime. Does the Minister regard the provision available to people in my constituency as an acceptable level of care?

A further example relates to parentcraft classes for expectant mothers and fathers. As a young father with two little daughters—one of whom will celebrate her birthday tomorrow; I hope she will wake up to find daddy at home in the morning, as that would make her very pleased—I remember clearly how important the run-up to the birth of a child is in preparing for a traumatic situation, when things happen quickly. When people go into hospital, they are unsure about what is to happen and parentcraft and antenatal classes are important in helping us to understand what is likely to happen. In sharing our experiences with other expectant mums and dads, we realise that we are not alone and that there are support mechanisms to get us through a traumatic and difficult time. The Minister is nodding, so I am sure that she understands what I am talking about.

I was thus astonished a few months ago when I received letters from constituents pointing out that antenatal classes in the community were being stopped. Parentcraft classes were no longer being supported in the NHS, which would mean that expectant mums and dads had to try to find private or non-NHS provision. The Barking, Havering and Redbridge Hospitals NHS Trust accepted that there was a problem, saying:

In other words, the trust had to prioritise women in labour. Antenatal check-ups would not be affected; only the parentcraft classes would go. That may be all well and good in terms of service management, but I found parentcraft classes valuable and important and am disappointed, to say the least, that preparation for parents appears to be a casualty in the service.

At the other end of the health service is the treatment of older people. My particular concern relates to services based at St. George's hospital in the centre of my constituency. The Minister may be aware of some of the concerns about the future of St. George's hospital in Hornchurch that I highlighted on my website and during my 18-month-long campaign. The facility currently has about 177 in-patient beds, mainly for the rehabilitation of older people recovering from strokes and similar ailments. In spring 2004, the PCT published an outline business case setting out various options for the future of services at St. George's hospital. Its preferred option was simply to close the whole hospital site, with one or two small exceptions, and relocate all the facilities outside my constituency, at Harold Wood in the north of the London borough of Havering, because significant changes are taking place in the property estate of the NHS, with the opening of the new Oldchurch Park hospital in the neighbouring constituency of Romford. I note that my hon. Friend the Member for Romford (Andrew Rosindell) has joined us in the Chamber this evening. A new hospital is opening there, with the result that certain other facilities are due to be closed or reused in some way.

The primary care trust saw that as an opportunity to review services, and to examine the care of elderly people living in the borough and how those services
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could be best provided. Its preferred option was to relocate those services to Harold Wood. That was due in part to the fact that around a third of the 117 beds that are currently at St. George's hospital are allocated to the Barking and Dagenham primary care trust—two thirds are allocated to the Havering primary care trust. The Barking and Dagenham primary care trust has indicated that it wishes to move its beds closer to its local community. As a consequence, 60 of the 117 beds in all likelihood are to be moved off the St. George's site. Therefore, the facilities at St. George's, and how services are to be provided from there, needed to be considered.

The problem was that all that seemed to be happening without sufficient local consultation. When I contacted local residents to find out what they thought about the way services would be provided and what was important to them, they emphasised heavily the need to retain health care facilities on the St. George's site.

Let us look at the demographics and the way the area is changing. The Thames gateway area is partly within the constituency itself in south Hornchurch and Rainham. There is the prospect of a lot of housing development in the southern part of the borough. It is important that we retain a significant health facility in the centre of the borough. The problem is that, if all the resources and facilities were relocated to the north of the borough, which was what the primary care trust suggested, effectively people's journey times on the transport links across the borough would increase.

I do not see that as the most sensible way to proceed. If one is looking to provide a service that is at the centre of things, at the heart of the borough and close to where people live, St. George's is the right site to examine, particularly when we consider the fact that we are talking about elderly patients who may have relatives living nearby. We need to ensure that they are able to see their relatives and that they are given the best chance to recover and to get back into the community, which is what we all want.

Since all this started, there have been a number of delays in deciding what the future of the services at St. George's would be. That inevitably prompted me to ask a written question to the Secretary of State for Health recently. I was somewhat disappointed that the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), gave me a rather anodyne reply. I asked whether the Secretary of State would make a statement on the future of St. George's hospital. The response was merely that that was

That is true, but it is a little disappointing that it took the Department a month to tell me that. Given that primary care trusts are effectively creatures of Government and report to strategic health authorities, which report to the Department of Health itself; given that, as I have highlighted during this debate, the Secretary of State is bringing considerable direct pressure to bear as regards primary care trusts; and given that the matter is a significant concern to constituents living in the area, I was somewhat disappointed with that response from the Department.
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Whether this was a coincidence or not, however, within the past couple of weeks, the primary care trust and the strategic health authority have issued a joint press release basically saying that the decision on the future of the hospital has been delayed for another year, so there is continuing uncertainty as to the future of that site. The Minister may think that, from my perspective, that is all well and good because no decision has been taken to close the hospital, or to transfer services from the existing hospital site. However, I remain deeply concerned about the hospital's future. In the past fortnight, I have been told that bed numbers have reduced significantly and that some wards have closed. I assume that that is part of the reorganisation, with the withdrawal by Barking and Dagenham primary care trust of some of its beds from St. George's. From the feedback that I have received from some staff, it appears that that was not communicated to them as effectively as it might have been. Anecdotal evidence suggests that morale is currently low at St. George's and that there are fears of job losses.

There are also concerns about whether services are being scaled back even more. I said that two thirds of the 177 beds are allocated to Havering. That would reduce the number to approximately 117. However, it has been suggested that the number might decrease even further, to 90 beds. That makes the staff worried about what the future holds, especially given that the services at the day hospital appear to be reduced. That gives an impression—rightly or wrongly—that services are being scaled back slowly but surely. I am worried about that, and I would be angry if such scaling back were presented as a fait accompli and if, in six months, everybody told me, "Services have been scaled back; this isn't viable any more and we've got no choice but to close the hospital and reallocate resources"—to, for example, Harold Wood hospital, which was the PCT's preferred option.

There is also the problem of whether the site is being redesignated outside the green belt. Again, that gives the impression to the local community of a fixed agenda to close the hospital—whether now, in six months, 12 months or two years. I ask the Minister for an assurance that she will ensure that services are not run down and that the local community will not be presented with a fait accompli. I ask for a further assurance of proper engagement with the local community and proper consultation before any final decisions are made about services that are currently provided from the St. George's site.

I want to consider the future, especially the new Oldchurch Park hospital in Romford, which will act as the new acute hospital for the surrounding area. I greatly welcome the opening of the new, state-of-the-art facility and I look forward to that happening at the beginning of 2007. However, I am worried about whether it can cope with demand. The bed numbers at the new hospital will be fewer than the combination of those at the existing Oldchurch hospital and Harold Wood hospital, which the new Oldchurch Park is intended to replace. Although some additional flexibility has been built into the design so that it is possible to open a new ward if required, I emphasise that there will be fewer beds than in the two existing hospitals.

I appreciate that the plans are based on business and healthcare models that expect additional resources in the community. It is therefore argued that so many beds
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will not be needed because efficiencies in theatre use, better facilities and primary care mean that there will be sufficient space, beds, resources and facilities at the new Oldchurch Park hospital. I have listened to that argument, but I remain sceptical about it. Although various local improvement finance trust—LIFT—projects are being financed in the local community to put additional primary care resources in place, I remain worried that they will not go in early enough, given that the new Oldchurch Park hospital is due to open at the beginning of 2007. I am also concerned that patients' attitudes to the NHS and to the way in which they gain access to services will not be sufficiently changed to ensure that, when the wonderful, new, sparkling hospital opens in January 2007, it will not create additional demand and people will not view it as their gateway to the health service. That is particularly the case in areas such as Rainham and south Hornchurch, where access to GP services is not the best. Sometimes it can take longer to get access to a GP there, and they are very overstretched. I know that steps are being taken to address that problem, but it will take time. Looking at the services that will be offered by the new hospital will require a different mindset; there will need to be a step change in terms of how services are accessed. I am genuinely concerned that, when the new hospital opens, it will not be able to cope with the demands that are placed on it.

Theatre time is a key element in these arrangements, and it is extremely important that it should be used efficiently and effectively. I will continue to raise my concerns in this regard with the acute trust, to ensure that the necessary changes are implemented now, because they will need to be in place well before the new hospital opens. The new practices and approaches—the road testing, if I may use that term—must be well in place before the new hospital opens so that they are ingrained in the surgical teams, to ensure that the bookings and all the other arrangements run efficiently and effectively, and that we do not experience problems after the new Oldchurch Park hospital opens.

I prefaced these comments by welcoming the new hospital, but I am worried that the demand and the way in which services there will be handled will create additional pressure, when people see that it is there and seek to access health care at the site. However, I welcome its opening at the beginning of 2007. I also welcome the tireless hard work that so many health care professionals provide in Havering and in my constituency of Hornchurch. They work tirelessly to ensure that my constituents and those of my hon. Friends in Romford and Upminster receive a high quality of care. However, I am worried that they are not being given the correct support, motivation or direction to ensure that they feel motivated and positive about the services that they provide. I am sure that the Minister will tell us the amount of resources that have been put into the local and national health service, but given the issues about access to health care that I have mentioned, I am worried that those resources are not getting to the front line to ensure that those issues are dealt with effectively and that all patients get the quality and standard of care that they expect and deserve.
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9.23 pm

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