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25 Jan 2006 : Column 453WH—continued
Healthcare Services (Shropshire)
2.30 pm
Mr. Philip Dunne (Ludlow) (Con): I am extremely grateful for this opportunity to the draw hon. Members' attention to the crisis that is currently engulfing the NHS in Shropshire and I am pleased that hon. Members from all parties are hoping to participate. That crisis is affecting not only Shropshire, but its neighbouring counties, and that is indicative of a systemic problem; one that has only just started to reach the public consciousness. That problem is the chronic mismanagement of the NHS, which stems from a sustained period in which the Government have imposed targets, interfered in clinical priorities and introduced new cost structures, while at the same time seeking to abdicate any responsibility for the financial management of health care at the local level.
The consequence of that crisis, and the reason why I have called this debate, is that all three community hospitals in my constituency—in Bridgnorth, Ludlow and Bishop's Castle—are under imminent threat of closure, along with the community hospital in Whitchurch, in the constituency of my hon. Friend the Member for North Shropshire (Mr. Paterson), about which I am sure we shall hear more shortly. That could result in the closure of all four community hospitals in Shropshire. Such things are, however, happening all over the country, not only in Shropshire.
I have joined the steering group of Community Hospitals Acting Nationally Together, which is a campaign group that exists to save community hospitals throughout the country. CHANT has evidence that 80 of the 322 community hospitals in England are at risk of closure or are threatened with substantial cuts in services, and I cannot overstate the impact that such closures would have on my constituents. With no hospital in an area of more than 600 square miles, and no hospital near the boundary of my constituency, many of my constituents would have to travel more than 30 miles to reach an acute hospital. The Minister may not know this, but given the lack of public transport infrastructure in much of Shropshire, it could take the best part of a day to make the round trip for an out-patient appointment or to visit a relative.
That is but one of a host of reasons why, on the first Saturday in January, more than 10,000 people marched through sleet and rain in all four of the towns where Shropshire community hospitals are at risk to support the continued provision of services at those hospitals. I addressed crowds of more than 4,000 people in both Bridgnorth and Ludlow that day and I am glad for the Minister's sake that it was me who addressed those crowds, not her, such was the clear strength of feeling. I do not know whether she has ever faced a crowd of that many people who were determined to preserve their hospital, but if she has not, I would be very happy to arrange a meeting—she would get the message soon enough.
To reinforce the point, I delivered two petitions on the Floor of the House last week. They contained more than 22,000 signatures—one third of the electorate in my constituency—in support of our community hospitals. Today, I have announced the results of a survey that I conducted among all the GPs in my constituency, and
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everyone who responded confirmed their full support for our community hospitals. The League of Friends of Ludlow Hospital has received letters in support of maintaining all existing services at Ludlow community hospital from all nine of the consultants who hold periodic clinics there.
Let me set the funding crisis in Shropshire in context by explaining the scale of the problem that our health care services face under the Government's funding rules for the NHS. Between them, the four NHS trusts in Shropshire and the unitary authority of Telford have a historic debt that is currently estimated at £36 million and are running a collective annual deficit of £25 million. Under the Government's current funding rules for the NHS, that historic debt must be repaid over the next three financial years and the annual deficit must be eliminated in the financial year starting in April. That means that the Government have tasked local health care managers with finding cuts of £37 million from the health care budget for the area of more than £400 million, which represents a cut of nearly 10 per cent. in the amount spent on health care in Shropshire effectively for each of the next three years.
I wish to ask the Minister three main questions. What went wrong? What does it mean to our local communities and, on a more positive note, what can be done? Two decisions affect Shropshire specifically, when the Government have to accept some responsibility over and above the overall impact of their so-called management of the NHS nationally. I refer first to the decision back in 2003 when the two trusts that ran the acute hospitals, the Royal Shrewsbury hospital and the Princess Royal hospital in Telford, were merged into a single NHS trust. At the time, the trusts had debts in the order of £6 million.
I understand from the new chief executive of the combined trust that it is clear from his review of the merger agreements and the drafts, in particular, of the agreements that part of the political price for securing public acceptance of the merger, which was controversial at the time, was for the debts to be assumed by the Government. At the last minute, that did not happen so, in my view, the Government shoulder direct responsibility for at least part of the historic debt, which has now compounded considerably.
Daniel Kawczynski (Shrewsbury and Atcham) (Con): On my hon. Friend's last point, one of my constituents, Mr. Frank Jones, cast the deciding vote to merge the two hospitals. Unfortunately, he died last month, but he had told me how much he was influenced by the promise that the debts would be written off.
Mr. Dunne : I am grateful to my hon. Friend for confirming the historic state of affairs.
David Wright (Telford) (Lab): I opposed the merger at the time that it took place, but I recall a debate in the House when the then Under-Secretary of State at the Department of Health, the Under-Secretary of State for Culture, Media and Sport, the hon. Member for Tottenham (Mr. Lammy), made it clear in response to my question that no deal was on the table to wipe off the historic debt. I agree with the hon. Member for Ludlow (Mr. Dunne) that there was certainly confusion between what was happening in the health economy in
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Shropshire and what was being said in London, and that it became mixed up in the debate about the merger proposals, which I say again that I opposed at the time.
Mr. Dunne : I am grateful for clarification of the debate in the House. From my understanding, it still stands that, in the penultimate draft of the merger agreement, the debt position was due to have been assumed by the Government.
Mark Pritchard (The Wrekin) (Con): My hon. Friend is generous to give way to so many hon. Members. To be helpful in the context of the comments of the hon. Member for Telford (David Wright), I know that in a letter dated 17 October 2004 the then Under-Secretary of State for Health said that there would be no reduction in services as a result of the merger. Clearly, reductions are on the way.
Mr. Dunne : I am sure that we shall be getting into the implications of the reductions during the debate.
The second issue that I hold at the Government's door is that there has clearly been chronic financial mismanagement within the acute trust since its formation. The scale of the financial difficulties of the trust only became apparent last year. Those directly responsible were finally found out and fired. It transpired that the chief executive of the trust had got his job on or around the time of the merger on the basis of a fake CV. The whole appointment process for senior administration and board positions within the trust was at fault. There was inadequate monitoring of the financial performance and control. Nothing was done about the mounting debt and deficit until they had escalated last year into the present crisis management. The whole sorry saga raises fundamental questions about the Government's failure to impose proper oversight of board appointment decisions, financial monitoring and the governance of NHS trusts.
Lembit Öpik (Montgomeryshire) (LD): I agree with the hon. Gentleman's accurate and erudite analysis of what has gone wrong. Does he also agree that one reason why we did not spot the problem before is because as parliamentarians we were misled by the management? In other words, to compound the developing financial crisis, there was also a cover-up; a cover-up that has now been terminated by the much more effective and transparent management who have taken over the trust's operations, and for whom I am very thankful.
Mr. Dunne : I am very pleased to see that the hon. Member for Montgomeryshire (Lembit Öpik) has joined this debate, because a number of his constituents use the services of Shropshire hospitals. The issue to which he refers pre-dates my appearance in this place, but I agree with the thrust of what he says. Had Shropshire MPs been aware of the position during the past few years, it is clear more would have been made of it at the time.
Daniel Kawczynski : I wrote to the Secretary of State for Health about the issue of the chief executive with the fake CV. In the Secretary of State's reply, she regretted
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its occurrence, she apologised and she promised to put in place a better system for checking the CVs of applicants for the position of chief executive. However, in her letter she appeared to take no responsibility for that travesty of justice.
Mr. Dunne : I am grateful to my hon. Friend not only for taking the initiative and posing those questions, but for raising the question of where responsibility lies for management of the NHS. Last week, I received a copy of a letter that had been sent to one of my constituents, not from a Minister but from an official in the Department of Health. The letter made it crystal clear that the Department has abrogated any management responsibility for the provision of services at a local level. The buck certainly does not appear to stop with Ministers.
I should like to address some questions about what the crisis means for health care in Shropshire. If the Government insist on forcing through those cuts, local health care managers have some unenviable decisions to make in the next couple of weeks. Management consultants have been drafted in to help present those choices in purely financial terms, which they set out in a report that was published in November.
Those are the same consultants who were responsible a few years ago for the report on neighbouring Worcestershire which led to the closure of Kidderminster hospital's accident and emergency department and thus to the arrival in this place of the hon. Member for Wyre Forest (Dr. Taylor), who I am delighted to see has joined us for this debate. I am sure that the Minister will have been briefed on the report. It has been the subject of much comment in Shropshire, very little of it positive, since many of the comparisons that the report seeks to draw do not reflect the health care realities on the ground.
Shropshire is very rural. My constituency is the most sparsely populated of all constituencies in the county. The sheer geography and demography of the area inevitably creates higher costs to provide acceptable health care services than the national average, especially in primary and community care.
For several years, Shropshire has not received funding settlements that reflect those cost pressures. Much of the report's analysis ignores rural costs, too. It ignores also the significance of Shropshire hospitals to the residents of mid-Wales, where many thousands rely on the Royal Shrewsbury hospital, in particular.
Lembit Öpik : That is the reason why I am present in this debate. The hon. Gentleman is right to say that we depend on the Royal Shrewsbury hospital more than on any other for our accident and emergency care and substantial services. Does he agree that the debate is about not only the people in Shropshire, but the more than 100,000 people who depend directly on the services of the Royal Shrewsbury hospital and cottage hospitals that he describes? We are looking for a response from the Minister to assure our constituents that their quality of life will not diminish as a result of a debt caused by no fault of the citizens themselves.
Mr. Dunne : I agree completely with the hon. Gentleman. In fact, I should go further: as I said at the
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outset, the crisis in Shropshire is indicative of a general malaise that is affecting the entire NHS. We have seen reports of deficits of £620 million anticipated for the current year, a figure that the Department of Health acknowledges. The most recent figure I saw was from the Royal College of Nursing, which estimates the deficits at £1.2 billion, a sum that will escalate in the future. The issue will have resonance well beyond this Chamber and our constituencies.
I want to concentrate on what some of the cost-cutting choices would mean to my constituents. I will touch briefly on each of the three community hospitals that I know well. Bridgnorth hospital serves the south-east of Shropshire. It has 25 beds and four theatre beds and employs 110 people. Last year, 700 in-patients, 11,000 out-patients and 13,500 minor injuries were treated at Bridgnorth hospital. After many years of hard-fought campaigning, Shropshire county primary care trust last year started a flagship redevelopment of the hospital to bring all health care services in the area on to a single site. That is very welcome in the community.
Construction is mid-way through on this £6.5 million project. Ironically, it is celebrated by an enormous sign on the hospital wall that proudly proclaims:
There are uncomfortable parallels with what happened in Kidderminster immediately after a substantial capital investment under this Government's stewardship. According to the management consultants, closure of the hospital would "save" a mere £600,000 a year. The hospital in Telford is nearly 20 miles from Bridgnorth, which has a population of 11,891. Last week, the petition that I have referred to was signed by 11,871 residents, who objected in the strongest possible terms to the closure of Bridgnorth hospital or a cut in services there.
The community hospital in Ludlow serves most of the district of South Shropshire. It has 72 beds and treats 810 in-patients annually, including those in the mental health ward and the maternity unit. The maternity unit is housed in a building that was originally the town's workhouse. It may even be one of those places often cited, although not by name, by the Secretary of State to justify the modernisation programme. Last year, the hospital treated 11,000 out-patients, including X-ray and physiotherapy patients. Doctors and other health professionals in the town and the surrounding area would like to see services at the hospital maximised to consolidate their activities on the site, as is happening in Bridgnorth. Instead, it is threatened with closure because that would save £1 million, according to the same management consultants' report.
The hospital is one of the largest employers in the town, with some 150 jobs at stake. The Royal Shrewsbury hospital is 25 miles from Ludlow, up a busy and dangerous road. According to the 2001 census, Ludlow has a population of 9,250. Last week, I presented a petition signed by 10,220 residents who were protesting at the threatened closure of Ludlow hospital or a cut in services there. Perhaps some people signed twice, such is their anger. I could hardly blame them.
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The community hospital at Bishop's Castle serves the south-west of my constituency and the area across the Welsh border. No savings have been assumed in the management consultants' report since Shropshire county primary care trust has advanced plans to close the hospital anyway, to offer its site to the neighbouring residential home operator and to commission nursing home beds, under the supervision of local doctors, from a redevelopment of the enlarged site. This time last year, there were 24 beds in Bishops Castle hospital; today only 18 are being commissioned. The threat posed by the review is that the number of beds will be reduced further, with the loss of up to 35 skilled staff. I am concerned to ensure that this proposal does not fall victim to the same cost-cutting mantra afflicting other services in the county. I will seek reassurance that the number of PCT-commissioned beds will not fall further and that the contract offered will be a genuine, long-term one so that rehabilitation beds with proper nursing care under doctors' supervision are maintained in Bishop's Castle in the long term.
The precedents are not encouraging. The old cottage hospitals in Broseley and Much Wenlock—both in my constituency—were turned into residential care homes some years ago. Each retained PCT-commissioned beds, but the number of beds the PCT committed to fund has gradually been whittled away over the years so that all remaining beds are once more threatened with termination, at the end of the financial year.
The so-called saving that will come from the closure of the three community hospitals amounts to £1.6 million. In my view, that is not a saving, but a mirage. It is a short-term quick fix with much longer-term and higher cost implications. It completely ignores the cost to the community of having to travel miles to visit their loved ones or an outpatient clinic; these are just some of the challenges posed by distance and rurality to health care outcomes. I have received many letters from constituents detailing the problems that closure of the hospitals would pose to asthmatics, diabetics, pregnant mums and the mentally ill, to mention a few.
People who live in those communities will still get ill, unfortunately. If community hospitals are closed, the acute hospitals will come under intense pressure. Admissions will rise and discharges will slow because the vital rehabilitation role of the community hospitals will have gone. That will reduce productivity in acute hospitals at a time when management consultants require significant improvements in productivity. The acute hospitals do not have the capacity to cope, especially not in winter. They are already operating at above optimal occupancy rates. I have hard evidence of that in an e-mail, dated 19 December 2005, from a senior manager at the acute trust:
"Shrewsbury and Telford Hospital NHS Trust are under acute pressure from emergency admissions and in the night were on the verge of declaring a major incident. I should be grateful therefore if you would consider all possible options before taking the decision to refer a patient for admission. The options will vary in the different areas and as the community hospitals will be endeavouring to accept as many transfers as possible from the Royal Shrewsbury hospital and Princess Royal hospital it would be preferable if you would consider intermediate care and rapid response as a first line although these services also have a limit on how many patients they can care for at any one time."
This e-mail was sent to all GPs in Shropshire.
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On 5 January, the same manager appealed to GPs throughout Shropshire to suspend the referral of patients, saying that the trust
"are experiencing acute post Christmas break pressures and are currently operating at Level 4 of their Escalation Plan and will therefore potentially be declaring a Major Incident. Please could you once again consider the potential for re-routing patients."
Last week, a district councillor in Ludlow had evidence of acute hospitals begging to offload patients into the community hospital because they could not cope. The Shropshire ambulance service wrote to me to voice its concern about closure.
Mr. Stephen O'Brien (Eddisbury) (Con): I have been following my hon. Friend's argument closely and—before he moves on to the ambulance service—he quoted the expected saving from the threatened closure of the three cottage hospitals in his constituency as £1.6 million. According to my own research that appears somewhat illusory. I could not establish whether that was cited in the Finnamore report as a net figure, after taking into account all consequential ramifications and losses, or whether it was an estimate of the cash-flow saving, which is a year-on-year management issue, rather than one of true patient care delivery.
Mr. Dunne : My hon. Friend makes a characteristically strong point. I posed the same question to the author of that report, and I was assured that it was an estimate of a net saving. However, as I shall go on to say, there are many other ramifications for the acute trusts—including additional costs for the ambulance service—of having to cope with the extra bed-blocking and so on that would arise. The estimate is clearly based on very flimsy data; I shall return to that point presently.
The ambulance service is very concerned about the closure of community hospitals, because closure will place it under additional pressures. A letter to me from the ambulance service says that closure
"may produce an increase in demand and as Shropshire ambulance service resource configuration is finely balanced and matched to available resources, i.e. Acute Trust and Community Hospital facilities, this potential increase in demand may require additional funding".
These factors are not taken into account in the Finnamore report.
Personally, I believe that the costs of patient stays at community hospitals are less than at acute hospitals. When I sought a breakdown of costs for Shropshire hospitals in order to prove that point, I received the following reply last week in the name of the Minister, which I hope that she will not mind my repeating:
"There is no data collected centrally at individual patient per bed level. Data is collected on a finished consultant episode basis and at National Health Service trust level, within which one or more hospitals will operate."
The fact that those data cannot be given does not inspire confidence that such critical decisions for our community hospitals are made on the basis of proper information.
Our community hospitals are vital to deliver key Government health care priorities. In urban areas, care in the community may work without hospitals, but rural Shropshire does not have the pool of nursing talent that
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is needed to deliver such care. The community hospitals provide a hub around which community nursing services can be delivered. The management consultants' report seeks to reduce the cost of the district nursing skill mix within the Shropshire county primary care trust to the same skill-mix cost as Telford district nurses, who provide what is essentially an urban service. That entirely ignores the extra time and cost involved in serving a widespread rural area. Moreover, the current hiring freeze in Shropshire raises a host of questions about how the services will be provided in the coming years without trained nursing staff coming through the system.
The review has other implications, and I do not have time to go in detail into them all. However, I shall just mention the impact on mental health services in the county. Shropshire performs very well in financial terms. Its mental health team operates without deficit at substantially less than the national average cost of such provision—21 per cent. less, in fact. That is partly because most beds are in Shelton hospital in Shrewsbury, which is one of the last two Victorian asylums left operating in England. Much work has gone into developing advanced plans to replace it with a modern facility, but all of that is now on hold, so Shropshire now looks set to have the unique distinction of operating the very last Victorian asylum in the country.
Lembit Öpik : I am sure that the hon. Gentleman is aware that mid-Wales depends on the facilities in Shropshire for its mental health provision. Does he agree that we are jeopardising not just the welfare of individuals but their families and relatives as well, as a direct result of the under-investment in this absolutely essential service?
Mr. Dunne : The hon. Gentleman anticipates what I am going to say. It is absolutely true that the families of these most vulnerable people are those who will suffer from having to travel such long distances.
That has not stopped health chiefs insisting on finding savings of between £1.2 million and £2.2. million from next year's mental health budget, despite current efficiency. There are advanced plans for closure of the two remaining mental health wards, both at Ludlow and Whitchurch hospitals, placing further pressure on their viability, and presenting the families of existing patients and staff with enormous stress, not to mention the patients themselves, who, as the hon. Member for Montgomeryshire was saying, are some of the most vulnerable people in our community. In my recent survey of the GPs in my constituency, 87 per cent. regarded closure of mental health wards in our community hospitals as short-sighted, given the ageing demographics that apply particularly to Shropshire.
So what can be done? To try to adopt a slightly more positive note for the Minister, I shall set out three areas in which she could help local health chiefs in making such critical decisions. The first would be to acknowledge that the historic debts are a Government responsibility. Returning those debts to the NHS would clearly be the first choice, but a second best would be to provide a substantially longer period for their repayment. A 10-year repayment term would reduce the annual cuts by £8 million.
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The second way in which savings could be made without compromising the community hospitals is through prescription charges. I have discussed this with several doctors in my constituency. The recommendation in the management consultants' report gives rise to hope that significant savings could be made from reducing prescription charges, and many of the doctors believe that that could be achieved over time at no cost to health care quality and at relatively little cost to the community. Those savings would dwarf the notional savings from closing community hospitals.
Thirdly, I draw to the Minister's attention the fact that there is no mention of administrative savings in the management consultants' report. Given that the current reconfiguration consultations are under way for both the strategic health authority and primary care trusts in Shropshire, surely any review of health care spending in the county should take account of what savings can be made from those administrative reconfigurations before cuts in patient services are actioned.
I appreciate that I have been given a great deal of time, although there have been some interruptions. I conclude my remarks by saying that the Minister will doubtless give us in her winding-up speech a litany of how much has been invested and how many more doctors and nurses are now working in Shropshire than in 1997. Well before she embarks on that journey, I must tell her that the people of Shropshire will not wear it, especially when they see savage cuts in services or, God forbid, hospital closures.
The Prime Minister, we are led to believe, is looking to his legacy. In Shropshire, he risks being remembered as the axe man who has closed community hospitals, slashed hospital beds and cut off rural communities from local access to health care. I look to the Minister to ride to his rescue, and to offer my constituents and the people of Shropshire concrete evidence that the NHS is indeed safe in his hands.
In closing, I have a simple question for the Minister, to which I, and I suspect the many people in Shropshire who are listening to the debate, would be grateful for an answer in her closing remarks: will she instruct the strategic health authority to rule out the closures of Bridgnorth and Ludlow community hospitals as options for formal consultation? If she did so, she would make many thousands of people in Shropshire sleep easier tonight, and she would absolve the Prime Minister of blame for his legacy to Ludlow.
Mr. Roger Gale (in the Chair): Order. I intend to call Front Benchers at half past three. Five Back Benchers are standing, all with a constituency interest. I have no power to curtail speeches, but I do have the power to note if anyone is self-indulgent.
3.3 pm
David Wright (Telford) (Lab): Thank you, Mr. Gale. I will heed your advice.
First, may I congratulate the hon. Member for Ludlow (Mr. Dunne) on securing this very important debate and say how pleased I am that all five Shropshire MPs are present this afternoon to ensure that we have a comprehensive overview of what is happening in health
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services in Shropshire? It is also important to note that we are joined by hon. Members from the Welsh borders and by the hon. Member for Wyre Forest (Dr. Taylor), who obviously has had some experience in these matters in recent years.
Mr. Stephen O'Brien : And by MPs from Cheshire.
David Wright : Indeed, my apologies. I start by saying that I agree with the hon. Member for Ludlow that Shropshire has a unique rural structure, but it is also important to note that health care services were originally designed very much with that rural status in mind. There is a large hospital in Shrewsbury, as well as smaller community-based hospitals.
The advent of Telford new town in the 1960s placed greater pressures on the health economy in Shropshire; that is just a fact. Telford is now the largest town in Shropshire, and several of its wards exhibit significant deprivation. The community in Telford fought extremely hard throughout the '70s and '80s to secure a district general hospital, and it very much wants to protect it and ensure that it provides comprehensive services for the largest population centre in the county. That throws up significant challenges; that, too, is just a fact.
Because Telford is new and continues to grow, the challenge facing us is how to provide health services for a growing population. Telford is a regional housing growth point. According to the regional planning guidance and the local development framework, between 2001 and 2021 a net increase in housing provision of 20,300 dwellings is envisaged in the Telford and the Wrekin area. That is a significant number of new homes in the county, based in Telford. It is crucial that any design of services acknowledges that point. It is also fair to say, and I think I would get agreement throughout the House, that both Shrewsbury and Telford deserve full, district and general hospital services—the services that they have enjoyed for some years.
In setting the scene for this debate, it is important that we remember that staff are working hard in our hospitals throughout Shropshire and in Telford and the Wrekin; they do an incredible job and I pay tribute to them today. It is important that we manage this debate carefully, so we can sustain their morale and ensure that they continue to provide high-quality services to people at the front line. They deserve our thanks and I am sure that colleagues will join me in passing those on today.
It is also important to say that the two main acute hospitals are meeting six of the seven national targets laid down by the Government. They are meeting their access targets on in-patients and out-patients, 98 per cent. of people visiting accident and emergency are seen within four hours, and they are on-target in terms of beating MRSA. On cancer, they are meeting the 14, 31 and 62-day targets. They are following the Government's agenda on booking and they are signed up for "Agenda for Change". The only area in which they are failing is financial balance.
The hon. Member for Ludlow outlined in some detail a story—it almost sounded like fiction—about the management, and the financial mismanagement, of the health economy in Shropshire in recent years. I am
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delighted that we have a new chief executive and management team. Tom Taylor is a dynamic individual with whom all Shropshire Members can do business. He takes a constructive approach to what is happening in the local health economy.
It is important to consider some of the conclusions that the strategic review document has come up with. That document was produced on behalf of all the health trusts in the county. It concluded that the primary care trusts spend £20 million less than the national average on general acute and accident and emergency services, and £20 million more than the national average on community services and primary care. That is a real challenge. In examining the wider health economy, we must ensure both that primary care services and community based services are extremely efficient, and that our general acute and accident and emergency services are receiving the funding that they deserve. That is important in the context of the community hospitals debate, which the hon. Gentleman mentioned. I am concerned that if community hospitals close, we will not be able to deal with some of the bed-blocking problems that will arise in the acute sector. I hope we will not pursue that false economy.
The other conclusions of the strategic review of the two acute hospitals are that they are low-cost providers per patient, above-average performers in terms of patient activity, and their commissioners are driving down acute sector income. Interestingly, however, the hospitalisation rate in the county is still rising. Too many people are coming into the acute hospitals and not being dealt with in the community. That is a real challenge for us in terms of primary care.
It is also true to say that the two acute hospitals do not recover all the income for the work that they do. Under payment by results, our local hospitals would gain significantly, but we have a problem because we cannot wait for full implementation of payment by results. We have to sort out the financial issues as they are presented to us now.
The hon. Member for Ludlow went through a series of options produced by Finnamore, the financial consultants, in relation to the health economy in Shropshire and in Telford and the Wrekin. The options referred to a range of issues, including reconfiguration, rationalisation of sites and referral management—there is a raft of proposals. Finnamore produced what it called an abacus of options between lower and upper quartile levels of savings from each of those options. We need to pursue those options, but we have to bear several points in mind. Patient services must come first. There must be a more open dialogue within the county about what is happening in the health service in Shropshire—clearly there has not been the openness with elected representatives, officials and the public that we deserve and that would help us to understand what is happening.
The county must retain two district general hospitals with A and E services. I am delighted to say that, a week last Monday, at a meeting I attended with the Telford and Wrekin senior citizens forum, Tom Taylor, the chief executive of the acute hospital trust, made it clear that he is committed to trying to ensure that we retain those
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two hospitals with their A and E services. That is crucial. I should particularly like to hear the Minister's comments on that in her winding-up speech.
In any examination of the county's health economy, it is important that there is an understanding of the population trends that I outlined at the beginning of my speech. Telford people should receive the services that they deserve because it is a growing town and the largest population centre in the county.
We should focus on the points made by the hon. Member for Ludlow about options for resolving the financial crisis. I hope that the Minister will say something about historic debt, which we should reconsider. We must have greater brokerage on the time scale for the repayment of debt on which the acute hospital sector and, indeed, the PCT are working.
The hon. Gentleman's point about prescription charges is also important. We must get the maximum level of efficiencies and administration savings out of the system if we are to protect our acute and community hospitals and our primary care services. All five of the Shropshire Members want to achieve that.
Mr. Roger Gale (in the Chair): Order. I remind hon. Members again that there are four Members standing and not many minutes left. If Members can confine themselves to four minutes each, everybody will get in.
3.12 pm
Mark Pritchard (The Wrekin) (Con): I congratulate my hon. Friend the Member for Ludlow (Mr. Dunne) on securing the debate. I shall have to make my 10-minute speech in four minutes.
I shall address directly some of the comments made by the hon. Member for Telford (David Wright). He talked about sustaining staff morale. I suggest that one of the best ways of doing that is to retain existing services and allow staff to retain their jobs. We know that 280 jobs are under threat, including those of front-line staff such as doctors and nurses. That would, of course, affect front-line patient care. He also said that patient services must come first. Of course, both back-office support and front-line staff such as doctors and nurses are needed to ensure that patients continue to come first.
I do not believe that Health Ministers lie awake at night wondering how they can make life more difficult for patients or our constituents in Shropshire. The Government have introduced many well intentioned reforms to the health service, but unfortunately things have gone badly wrong across the country. There is no doubt that changes are needed to health care provision and the way in which customers, consumers and clients of health care view and receive it.
We have discussed increasing primary care and care in the community, or community care, and about having super-GP surgeries and a beefed up and thriving independent sector. That is fine in principle, but only if those things are in place before services at the acute hospitals are reduced. In my constituency, in which the Princess Royal hospital is located, we do not have super-GP surgeries or a thriving independent sector and—unlike Ludlow—we do not have community hospitals, although some of my Albrighton constituents use the community hospital in Bridgnorth.
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It would be easy for Members to say that we should have one or the other, but given the sparsity of the population and the size of Shropshire, which is the largest inland county in England, I think that we need both. One might say that that is unreasonable, but is it? Every week we hear the Prime Minister remind Members from the Dispatch Box that all the money from tax rises has gone to improve health and public services, particularly education and the health service. A lot of my constituents are saying, "Where has all the money gone? We have paid the taxes. We deserve the health services." Now, they are being asked to accept that they will have to pay more taxes over a long period but get fewer health services in return. It is a massive swindle of the taxpayers of Shropshire.
The changes will affect patient care. I should like to ask the Minister some brief questions. Can she guarantee that the accident and emergency unit at the Princess Royal hospital will remain consultant-led, not nurse-led? The hon. Member for Telford supported the principle of an accident and emergency unit and referred to the comments of the trust's chief executive that one will be retained at the Princess Royal, but nowhere has it been said that there is a cast iron guarantee that that unit will be consultant-led. It is no good people in the most densely populated part of the county—Telford and Wrekin—only having a nurse to patch them up, when for very serious incidents people have to be rushed by blue-light ambulance down to Shrewsbury. In extremis that will cost lives. If someone has a heart attack in Shifnal, Newport or Wellington in my constituency, by the time they get to Shrewsbury they may well be dead. That is hardly patient care.
Will the Government consider a debate on whether the two hospital trusts should de-merge? Has it worked? If it has not, let us have a mature debate about it. Let us de-merge the hospital trusts. It is a large county as hon. Members have said. We are a large county and we deserve a full district general hospital in both Telford and Shrewsbury and the other hospitals too.
Finally, can the Minister give a guarantee that there will be no land disposals at the Princess Royal hospital that would jeopardise plans for the new Severn hospice or the mental health unit that may well be placed on the site of the hospital? In conclusion, the Government's plans to rationalise, which is a euphemism for cutting services at the Princess Royal, are flawed. They will cost lives. I humbly ask the Government to rethink in the interests of patients and, indeed, their own interests, given that Telford is now a marginal seat.
3.18 pm
Daniel Kawczynski (Shrewsbury and Atcham) (Con): I feel extremely passionately about this issue, but the length of the debate has obviously forced me to shorten my speech. The Minister will know that I always treat Ministers with respect and courtesy, but I find it very difficult to do so today because of the way the situation is developing in Shrewsbury. We have excellent clinical efficiency at the Royal Shrewsbury hospital. Last week I brought Tom Taylor, the chief executive, to a meeting with the Secretary of State, who was delighted and surprised that the Royal Shrewsbury hospital had met the target of 62 days for cancer treatment because, as she admitted, it is an extremely difficult target to meet.
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Our problem is the hospital's £36 million debt, to which my hon. Friends have referred. I believe—I put this point as strongly as I can to the Minister—that a former chief executive got the job with a fake CV. The finance director covered up the losses, and he has had to go as well. Where are the checks and balances, if such a major hospital can be run by people who have fake CVs, and people who cover up debts? It is truly astounding. Surely the Minister must take some responsibility for the situation at the Royal Shrewsbury hospital. We would benefit to the tune of £15.3 million every year if we had foundation trust status—and the only thing preventing us from securing that status is our debts. I lay the blame for those on the Government.
I should like to raise two more points. Some specialist nurses came to see me at my surgery on Saturday. I shall not reveal what type of specialist nurses they are, for fear of revealing their identities. Many people who work for the NHS and come to speak to MPs are petrified of telling us about their experiences, because of the culture in which, if someone dares to criticise the Government, the Government will come down on them like a ton of bricks and they will lose their jobs.
The nurses who came to see me said, "Look, we're being paid on band 6 for our job, but if we go 15 miles down the road to Wolverhampton the same job is band 7." Therefore, they would be paid an extra £5,000 a year if they made a 15-mile journey every day, left the Royal Shrewsbury hospital and went to work in Wolverhampton. That is a huge threat to us in Shrewsbury, because if those people can be paid £5,000 a year more for doing the same job in Wolverhampton, they are likely to be poached, leave the Royal Shrewsbury hospital and go to Wolverhampton. That is all part and parcel of the regionalisation of health care provision.
In Shrewsbury a cancer clinical review is under way, and the talk is that although we are brilliant at cancer provision in Shrewsbury, the services could be moved to Stoke or Wolverhampton because the Government want larger catchment areas for those services. That is a tremendous threat, and I should like the Minister to look into it. I shall, of course, fight any proposals to move cancer services away from the Royal Shrewsbury hospital to Stoke and Wolverhampton. As the hon. Member for Montgomeryshire (Lembit Öpik) knows, it is not just my constituents who use the hospital. People all the way to Aberystwyth, on the Irish sea, come across the border to use it.
I want to keep my remarks within the time that you specified, Mr. Gale, so this will be my final point; it is for members of the public as well as hon. Members. I have just been visited by representatives of the Parkinson's Disease Society and other organisations. There are two neurologists in our two hospitals, for the whole of Shropshire—an area covering 750,000 people, if mid-Wales is included. In Germany an area of that size would have 20 neurologists, and in France it would have nine. I should like the Minister to take that point on board. Shropshire cannot survive long term with two neurologists to cover such a large area.
3.22 pm
Mr. Owen Paterson (North Shropshire) (Con): I congratulate my fellow Shropshire MP, my hon. Friend the Member for Ludlow (Mr. Dunne), on landing this debate. It is of great importance and real relevance to all our constituents.
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Before Christmas I went to a public meeting in Whitchurch, the town where I was born. There were 500 in the hall and at least 100 outside, standing in the cold. We had a petition, which my hon. Friend and I handed in last week, with 10,000 signatures—and it is growing, so I have not put it behind the Speaker's Chair. We had a march, with more than 2,000 people, on a freezing cold Saturday morning. That is an expression of feeling about the importance of primary care to my constituents, which cannot be ignored. We had representatives from Market Drayton, Wem, Ellesmere and Audlem, over the border in the constituency of my hon. Friend the Member for Eddisbury (Mr. O'Brien).
Those people are not just nimbys who want to hang on to their services. They have a real case. To bring the subject down to earth, I shall outline the example of Mrs. Schofield. She had a near fatal accident and was in an acute hospital for three months. She said:
"If I had had to stay in my acute bed for a further three months, this would have cost double the amount for my bed alone and added to the hospital waiting lists; I cannot see how, on this basis, closing our Community Hospital will save money. The local hospitals in this area i.e . . . The Royal Shrewsbury and The Princess Royal . . . will end up with dozens of 'bed blockers' because once the small community hospitals have been closed there will be nowhere to send the patients for rehabilitation."
Rehabilitation is vital. Mrs. Schofield had four months more rehabilitation in Whitchurch community hospital, and as she said:
That is a quick glimpse of the sort of service that those primary care hospitals offer. They take the pressure off the district general hospitals about which other hon. Members have spoken so eloquently.
That is flagged up in the famous Finnamore report, which states:
"An alternative approach to the community hospitals has been discussed that maximises the utilisation of community hospitals."
But, incredibly, it then says:
"The financial implication of this approach has not been modelled at this stage but this could be carried out at the detailed option development stage."
May we have a cast-iron guarantee that there will be a real study of the value of the community hospitals? My hon. Friend the Member for Ludlow flushed out the fact that the Minister does not have a clue what the comparative costs of running primary care and acute care are. Will she take up my suggestion, which was proposed by doctors whom I met over Christmas, that social services should run the hospitals? We know that the PCTs will not be able to be providers and that there is already 93 per cent., and sometimes 99 per cent., bed occupancy in Whitchurch. If there was better liaison with social services and better co-ordination, the needs of someone who has had a fall, or who wants a lift, a commode or another piece of equipment could be met more efficiently by the community hospitals.
I hope that the Minister gets the message. It is absolutely out of the question to consider the option of saving £800,000 a year, which is a completely bogus
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figure in my opinion. It is politically a non-starter, and I would like the Minister to say today that she accepts that.
The Minister knows about my patch. She kindly met doctors from Ellesmere and Wem in July, who told her that with better primary care centres they could reduce referrals to the expensive acute hospitals, where costs are running up, by 20 per cent. The doctors gave her a telling example: diabetes will double in the next 20 to 30 years, and whereas 75 per cent. of diabetics in Shropshire are treated by GPs, in Birmingham 75 per cent. of diabetics are treated in district general hospitals. It is impossible to imagine the impact on the two main acute hospitals if the ratio for treating diabetes, let alone any other ailment, were the same as that in Birmingham.
As for the financial position, we touched on savings, which were flagged up in the report and show possible productivity gains of £10 million; the possible figure for prescribing is £10 million, for referral management £2.5 million, and for reconfiguration £2.1 million. My deal is that for enhanced primary care, and an absolute guarantee not to touch the community hospitals, I would go along with any sensible efficiency savings within the two main acute sites, so long as they did not reduce services. To my constituents it would not matter which of those sites provided the services, because in either case it is a 15-mile drive.
I was alarmed by a report in The Sun by George Pascoe-Watson, under the headline "Blitz on NHS big spenders". It stated:
I believe that it referred to a letter from the Secretary of State last night to me and to other hon. Members stating that KPMG are to be brought in, "driving large-scale financial turnarounds". Like the hon. Member for Telford (David Wright) and my hon. Friend the Member for The Wrekin (Mark Pritchard), I admire Tom Taylor, who has come in to an appalling mess, which was the result of thoroughly bad mismanagement. It is laughable that we had a chief executive who had faked getting a first at Nottingham university. We may not like what we hear from Tom Taylor, but he tells it to us as it is, because he has had time to get a grip on the problems. The last thing we want now is a lot of expensive busybodies from KPMG muddling around with yet more meetings. If anybody understands how to sort out the mess it is Tom Taylor and his team.
I want to know how long the busybodies will be in, how much they will cost and who is going to pay for them. I very much hope that it will not be the trust. I hope that it will come out of central funds, run by the Minister.
In my last two minutes I want to ask the Minister about mental health in Shelton. How far advanced are the plans to redevelop the second to last Victorian asylum?
Finally, the picture is not all gloom. There is a world-class hospital in my constituency at Gobowen, which is in the top tier for cleanliness and already has three-star status. There were only two MRSA cases per 10,000 patients at the Robert Jones and Agnes Hunt hospital, which is going for foundation status. However, one of the brakes on gaining that status is the fact that it needs
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clarification of the tariff for work done to put right mistakes made in other orthopaedic hospitals. Only four orthopaedic hospitals in the country can do that work, and my local hospital needs to know the details. May I bring the chairman and the chief executive to see the relevant Minister to discuss this matter so that they can push on and get foundation status? I invite the Minister to come to Shropshire at any time, and we will show her the value of primary care, and how to take pressure off the expensive acute hospitals.
Mr. Roger Gale (in the Chair): Briefly, please, Dr. Taylor.
3.29 pm
Dr. Richard Taylor (Wyre Forest) (Ind): I shall briefly make two points in support of the 20,000 people in south Shropshire who used to use Kidderminster hospital but who no longer do so, and who will now be subject to the double whammy of losing their minor injuries units and community hospitals.
First, may I ask the Minister about the credentials and experience of Finnamore consultants? For Worcestershire they have suggested some quite ridiculous changes, which the acute trust immediately threw out and will not include in its paper. Their suggestions for community hospitals are completely ridiculous: they are not common sense, they do not make economic sense and they do not fit in with Government guidelines on keeping the NHS local, which are well worth referring to.
The only other thing that I shall say in the brief time available to me is how pleased I was to hear that the hon. Members representing the acute hospitals in Shrewsbury and Telford did not try to paint a picture suggesting that we should protect acute services at the cost of closing community hospitals—something that was tried in Worcestershire.
I should also like to tell the hon. Members for Telford (David Wright) and for Shrewsbury and Atcham (Daniel Kawczynski) about an article by Andy Black, the well-known hospital management consultant, which appeared in the British Medical Journal in January 2004. In it, he said:
"If the price of moving the complex emergency to an appropriate centre of expertise is that this patient is accompanied by another nine or 10 patients who are not complex acute cases then another set of problems is launched."
Wyre Forest has seen those problems, which have been very difficult. There has been loss of access and loss of quality.
Finally, I commend the independent reconfiguration panel, which can be brought in to advise on such matters, and which will act as an independent impartial adjudicator.
3.31 pm
Lembit Öpik (Montgomeryshire) (LD): I, too, congratulate the hon. Member for Ludlow (Mr. Dunne) on securing this debate. I express my solidarity with those who have raised concerns on a cross-party basis, or on a non-party basis in the case of the hon. Member for Wyre Forest (Dr. Taylor), who is, indeed, a champion of the people. Those concerns are shared in Shropshire and across the border in mid-Wales.
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On 13 April 1998, the Royal Shrewsbury hospital saved my life. I had a very serious paragliding accident, in which I fell about 30 m, broke my back in 12 places and smashed my ribs, sternum and jaw. It was a 64-mile journey to the Royal Shrewsbury, partly by car, but primarily by ambulance, and there is no doubt that the hospital's quick, expedient and highly professional service prevented me from dying that day. As a result, I am forever in its debt. It so happens that it was me who had that experience, but thousands of other individuals in Shropshire could have a similar one. I am sure that such people would testify to the benefits and importance of community hospitals. Indeed, it was Llanidloes hospital that initially stabilised my condition so that I could travel the remaining 48 miles in the ambulance to Shrewsbury.
Hon. Members are therefore completely right to talk about the essential nature of what could be described as a hub-and-spokes infrastructure. The district general hospitals provide certain facilities—they have been accurately described, so I do not need to repeat them—while the community hospitals play an essential supporting role. It is little wonder, then, that so many thousands of people marched—once again, on a cross-party basis—to defend the facilities in Shropshire, and I pay tribute to the hon. Member for Ludlow for working with Matthew Green and Labour representatives on those marches to show that this is not a party political issue, but a people political issue. In that sense, the Minister can be in no doubt that no one is trying to score points off the Government—[Interruption.] To be precise, I am not trying to score points off the Government. People are, however, working hard in the interests of those whom we all represent.
On the specifics, there is no question but that there was a cover-up. Members of Parliament and others were misled about the financial circumstances in the trust and in Shropshire, to such an extent that one would not need parliamentary privilege to say so. Indeed, it was a scandal, and the individuals concerned would not dare to sue anyone who condemned them unreservedly for playing roulette with the services in the area. As has been said, Tom Taylor has already secured the trust and recognition of hon. Members from all parties in a way that his predecessor did not. I have a slight difference of opinion about who is to blame for that, but the Minister will be delighted to know that I do not blame her. It would be difficult for her to keep such a detailed eye on various appointments throughout the country that she or, indeed, many of the rest of us, would spot a fake CV or someone who was utterly hell bent on getting a job through false means.
However, as the body politic, it is our responsibility to make sure that the citizens who evidently were not responsible for the debt problems do not end up being the victims of those debts. Others have already described the consequences of the debts and I hope that the Minister will take seriously our worries that, in Tom Taylor's efforts to resolve the enormous eight-figure debt, he is not forced to compromise the services that have so eloquently been described by others today.
Will the Minister respond to the suggestions either to write off the debt or to renegotiate the repayment period for the reasons that have been given? Secondly, will she comment on the hub-and-spokes arrangement that is so important in rural areas and which has done so much
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good for individuals? I wish to highlight the importance of recognising that it is cheaper to put people into a community hospital bed to recuperate than it is to force them to go to a district general hospital because of the lack of community hospital spaces. Moreover, maternity units themselves are highly treasured by the communities and, once again, ease a further burden on the district general hospitals.
In non-technical language, community hospitals do lots of bits that do not have to go to the big hospitals. That is one reason why they are cheaper, why they are loved by local people and why I believe that they aid convalescence, especially for the elderly. They find it easier and less stressful to be in the more homely environment of a community hospital where their relatives and friends can visit them more easily than being transported many tens of miles on occasion to a hospital that, by its nature, will tend to be a less personal and slightly more sterile environment in which to recover.
My third and final point concerns the various alternatives to save money, one of which is productivity savings. The hon. Member for North Shropshire (Mr. Paterson) estimates that £10 million could be saved. I consider that perhaps £7.5 million could be saved, but let us recognise that we are to some extent splitting hairs on the detail because, if the Minister cannot provide us with an assurance that the Government will be amenable to helping us resolve such a crushing debt problem in other ways, services will necessarily need to be cut. It is not Tom Taylor's fault. His only crime is to be honest with the public and the politicians. It is not the public's fault. Their only crime is to live in an area that has had its health services mishandled to some extent and, by virtue of rurality, they pay more for health services because there is no other way in rural areas.
As we hear the Minister's response, we will be listening to see if she is willing to debate the facilities with us. There is no downside for the hon. Lady in working with us on a cross-party basis. There is an enormous downside for the local population if she does not. I think that she can show that the Government are serious about the promises that they have made repeatedly on the Floor of the House to work in the interests of the public and to ensure that the significant investments that they have made in the health service are actually used to enhance it, a situation that is the antithesis of what faces Shropshire at the moment.
In thanking the Minister in advance for acceding to every request that we make today, I also invite her to visit the facilities that we are discussing. She would perhaps be whinged at a little bit, but she would also be praised a lot for being willing to go and see what we are discussing. She could be a heroine and if she takes that route, we will be the first to sing her praises.
3.40 pm
Mr. Stephen O'Brien (Eddisbury) (Con): First, let me add my congratulations to my hon. Friend the Member for Ludlow (Mr. Dunne), who secured this important debate. All four of my Shropshire hon. Friends, as well as the hon. Member for Telford (David Wright)—together they represent all the constituencies in
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Shropshire—have championed and campaigned for their constituents and local health services without fear or favour. I should declare that I am a patron of CHANT, which was referred to earlier.
As we heard in the outstandingly powerful speech made by my hon. Friend the Member for Ludlow, there are four trusts responsible for health care in Shropshire, under the umbrella of the Shropshire and Staffordshire strategic health authority: the Shrewsbury and Telford Hospital NHS Trust, covering the two hospitals; Shropshire County primary care trust; Telford and Wrekin PCT; and the Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry's world-famous orthopaedic hospital.
Shropshire's financial problems, which arose across those four trusts, consist of a £36 million accumulated debt, which, by Government edict, must be paid off over the next three years. That will necessitate instalments of £12 million per annum, and a current annual running loss of £25 million. That will be £18 million from the Shrewsbury and Telford Hospital NHS Trust—today announced as being one of the 18 that needs urgent intervention, alongside my local PCT in west Cheshire—and £7 million from the Shropshire County PCT, which the Government requires to be in balance by April 2007. On those figures, the trust needs to find £37 million a year after current spending.
Finnamore Management Consultants, already rightly doubted in an interesting contribution by the hon. Member for Wyre Forest (Dr. Taylor), has put together a report on how to achieve those savings from a current total budget of £400 million. Its findings would amount to a cut in Shropshire's health funding of an eye-watering 10 per cent. in each of the next three years. Whatever the Minister says, not one Member of this House—let alone one citizen of Shropshire, south Cheshire in my constituency or mid-Wales—will believe that a cut of that size will not lead directly to deep, harsh cuts in patient services.
So why is it the Government's fault and liability that the beleaguered patients of Shropshire have to suffer that bill and lost patient and health services? As we heard, the chief executive of the Shrewsbury and Telford Hospital NHS Trust was sacked for incompetence, and was subsequently found to be a fraud. The financial director has gone, too, as he was complicit, and the Labour crony chairman has also chosen to resign. That, to start with, is pretty damning evidence when looking for where liability lies. That is all the more important as it is in that trust that the vast bulk of the deficits were allowed to balloon.
The two PCTs are running at a deficit of £2 million, the Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust is running at a deficit of £5 million, but the Shrewsbury and Telford Hospital NHS Trust is running at a deficit of £29 million. The largest debt in Shropshire comes from the trust that was administered by a fraud. In substance, the position is not changed by the Government's new payment-by-results regime, which shifts £15 million per annum of the acute trust's annual running costs to the PCTs.
Who, it is fair to ask, designed the structure? Who set up the processes and the standards for the appointment of the key people at the top of the very organisation that incurred the debt, people who have now all gone? Who
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set the targets by which those people were judged and had to manage? The answer to all those questions is clear: we need look no further than the Department of Health, the Minister and her predecessors under this Government. In addition, in the light of the confused expectations that the historical debt would be assumed by central Government, why should the people of Shropshire and the dedicated front-line staff—doctors, nurses and many others, including some of the managers—have to pick up the tab of Government and Whitehall failings?
The Government must own up to their serious failings in respect of the people of Shropshire, and they must recognise that the contingency fund is there as a Government self-insurance policy—albeit that it uses taxpayers' money, centrally—to fund its contingent liabilities. This is a contingency, as it would be in any walk of life. There has been a manifest failure of Government policy, and of the processes ensuring the provision of adequately managed patient services for the people of Shropshire, my constituents in south-west Cheshire, and people across the border in Wales, notwithstanding the incredible confusion that devolution throws up.
There is a clear line of responsibility, but this Government seek instead to duck their liability, and to pressure the local trusts and force them to look in on themselves. Thus to save £37 million per annum, Finnamore has suggested various cuts. One is to close or to threaten the community hospitals at Bishop's Castle, Ludlow, Bridgnorth and Whitchurch. Whitchurch serves hundreds if not thousands of my constituents in Marbury, Malpas, Tushingham, Cholmondeley and the whole southern district of Eddisbury.
Will the Minister say whether she is aware of the enormous public outcry and the outrage at the idea of closing those hospitals? Using the very apt analogy of the hub and spoke that the hon. Member for Montgomeryshire (Lembit Öpik) just used, has the Minister noticed that the whole wheel comes off if one takes away the spokes?
Given the petitions of more than 10,000 names being presented to the Secretary of State, crowded public meetings and huge marches—I pay tribute to my colleagues and others for their campaigning—this simply does not make political sense. Nor does it make financial sense. It saves only a notional and, as we have heard, largely illusory £2.4 million a year of the total amount required, despite an estimated net figure, but excluding the intended consequences, let alone the unintended ones that we can all predict and which were very ably outlined earlier in this important debate. That will put even more pressure on the already hard-pressed acute trust.
The proposal certainly does not make medical sense. The long-term rehabilitation and mental health units lost will exacerbate, not reduce, the problem. As we know, because of the misdirection and the mismanagement engendered by this Government, their agencies, their quangos and other creatures, 80 of the 322 community hospitals in this country are under threat of closure so that trusts throughout England can meet their financial deficits. That is a direct hit on patient services, and is laid firmly at the Government's door.
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So far as Shropshire is concerned, if the Minister feels that she cannot, without the Chancellor's sanction, access the contingent fund to meet the Government's own liabilities—I have outlined the chain of causation—at the very least will she now stand up and undertake to extend the payback period to 10 years? In the best-case scenario, £25 million of annual savings can be attained without closing these valuable community hospitals.
Increasing efficiency to improve performance to the upper quartile level in the Robert Jones and Agnes Hunt trust and in the acute trust will yield savings of about £5 million in the former and up to £7.5 million in the latter. An additional £2.5 million could be saved by improving efficiency in the operating theatres of the acute trust. Further, a reduction in over-prescribing, in the light of a survey of GPs in Shropshire who recognise the extent of this inefficiency, would lead to a saving of approximately £10 million a year. I am very grateful to my hon. Friend the Member for Ludlow for conducting that survey.
There is the £25 million. The Government could then write off the £12 million in historic debt for which they are responsible, and the job would be done. Patient services and community hospitals would be saved, thanks to the support of all the Shropshire MPs of all parties. There just may be a chance of making good the ills of the Government's own making without inflicting real cuts on the front-line patient services for the people of Shropshire, all of whom have been so ably represented in the Chamber today in this crucial and urgent debate. We just have to hope that the Minister has both listened and learned.
3.48 pm
The Minister of State, Department of Health (Ms Rosie Winterton) : I, too, congratulate the hon. Member for Ludlow (Mr. Dunne) on securing the debate. All contributions from hon. Members on both sides of the House have illustrated how important health is to our constituents and how important it is to have a good national health service. That, frankly, is why the Government make the national health service such a high priority.
My hon. Friend the Member for Telford (David Wright) paid tribute to the hard work and dedication of NHS staff in the local area. I certainly add my thanks to those staff for their hard work. I totally reject the allegation made by the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) that we would go around attacking people if they complained about conditions. Indeed, the introduction of the whistleblowers charter has indicated our view that that attitude is not the right one at all. The hon. Member for Montgomeryshire (Lembit Öpik) brought his own experiences to the debate to illustrate the importance of our health services.
I certainly recognise that the health community in Shropshire faces a challenging financial situation; there is no doubt about that. I am not going to reel off figures on doctors and nurses as the hon. Member for Ludlow said I might, but I point out that the increases in funding in recent years have meant that the two PCTs—Shropshire County and Telford and Wrekin—are receiving record levels of resources.
This year, Shropshire County primary care trust has been allocated £276 million, a cash increase of £23 million on the previous year. That kind of increase
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has been made available locally and will continue, to reach something like 19 per cent. over the two years within the local area. I think that Telford and Wrekin's percentage increase was the eleventh largest in the country.
That is some of the background to the new investment. I hope hon. Members accept that; the hon. Member for Montgomeryshire was kind enough to acknowledge it. However, there is still a grave difficulty with the financial challenges faced locally. One of the major factors in the financial position is the Shrewsbury and Telford Hospital NHS Trust, whose end-of-financial-year deficit could be something like £29 million.
As the hon. Member for Eddisbury (Mr. O'Brien) said, there has been poor financial governance at that trust. That view was backed up by the external auditors' investigation and the strategic health authority's own independent report, published on 27 October last year, that made 35 recommendations, all of which were accepted by the SHA and the trust. I am glad to see that the trust has put together an action plan to meet the recommendations. As many hon. Members said, a new management team is in place. It was heartening to hear hon. Members praise the new chief executive, who has taken over in what are obviously difficult circumstances.
Beyond that financial report, as hon. Members have said, a current review is taking place that has been commissioned jointly by Shrewsbury and Telford Hospital NHS Trust, the Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Shropshire County PCT and Telford and Wrekin PCT. Hon. Members have talked about local interest in the services, and that indicates the importance of the decisions being taken at local level.
It is important that people should be consulted about the options available and able to make their views known without some idea that, as some hon. Members have in a sense suggested, we from Whitehall and Westminster then overrule them. The whole principle is to make sure that transparent decisions are made at local level and that the priorities reflect the needs of the local community. In its initial work, to which many hon. Members have referred, Finnamore advanced a series of options for the future of health services in the county. The purpose of the report was to look at the baseline provision of services in the area, consider the options for long-term provision of quality services and financial balance, and look at the implications for each organisation and consider acute service provision, as well as community services. The work is being developed further. Some of the options may not be practical, but they have been included in the report for pre-consultation, to which hon. Members are responding. However, beyond that, the options can then be further developed with key stakeholders.
Any proposals for change will be subject to a 12-week formal public consultation; then, if there are significant changes, there is a statutory duty for organisations to
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consult the local overview and scrutiny committee. The hon. Member for Wyre Forest (Dr. Taylor) referred to the fact that the matter can still go to an independent reconfiguration review panel. There is a system in place for looking at the options.
Dr. Taylor : Will the Minister give way?
Ms Rosie Winterton : I really want to finish, if the hon. Gentleman does not mind.
Because these things may come before the Secretary of State, it is difficult for me to respond to all the comments about hospitals, but I can refer to a couple of matters. For example, my hon. Friend the Member for Telford and the hon. Member for The Wrekin (Mark Pritchard) said that the chief executive of the PCT has, as I understand it, said publicly that he would like the accident and emergency departments at both hospitals to be retained. If that suggestion went forward, it would go through the public consultation process. My hon. Friend has had a long-standing dialogue with the chief executive on that matter.
The hon. Member for North Shropshire (Mr. Paterson) mentioned community hospitals being handed over, perhaps, to local authority control. Under "Commissioning a Patient-Led NHS", we will make it possible for local authorities, acute trusts or the voluntary sector to manage community hospitals. However, I have to emphasise again that that would be a local decision. I understand, from the strategic health authority, that the current review is considering that as a possible option.
I should like briefly to move on to the historic deficit and the idea that the Government should meet it. I hope that hon. Members will understand that there has been massive, increased investment in the NHS, but we need local NHS bodies to ensure that they are dealing with some of the financial problems that they are facing. Simply to hand money over means that somewhere else in the NHS has to find it; there is no other place that it can come from. It is important to be honest when we are discussing that matter. That money would have to come from other areas.
Hon. Members talked about the period of paying back. The SHA has to consider the local health economy and look at ways to meet the financial balances. In some instances they can be extended, but that would be an SHA decision.
Finally, the turnaround teams that hon. Members have mentioned will be important in helping local trusts to manage some of the problems. I have visited places where teams have been working with staff and managers and I should like to reassure hon. Members that that should not be seen as a threat; that arrangement is to give assistance to sort out some of the problems about which hon. Members have talked.
Mr. Roger Gale (in the Chair): Order. This is not an easy room in which to work. Will hon. Members who are leaving please do so quietly?
25 Jan 2006 : Column 475WH
25 Jan 2006 : Column 477WH
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