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Anne Milton (Guildford) (Con): I should mention that I have an interest in that my husband is a doctor who is employed by a primary care trust.

I want to talk about two things: first, the budget deficit in my PCT, Guildford and Waverley; and secondly, the implications of the deficit. All too often in this place, we end up talking about money and services and slightly lose sight of the people who ultimately suffer as a result. I agree with the right hon. Member for Rother Valley (Mr. Barron) that the NHS has become a political football. Indeed, that is what took me out of it, having worked for 25 years as a nurse, in the hope that I might change something for all its staff.

One of the most striking things that has ever been said to me was during a conversation that I had with a doctor who worked in NHS management when I was making a speech about the NHS. He got very angry with me and said, "You know, Anne, you've got this all wrong. My job isn't about making people better—it's about
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balancing the books." It is very sad that doctors now feel that that is their aim. Last year, Guildford and Waverley primary care trust in my constituency launched a document called, "Modernising your local healthcare". It is no surprise to me that local people are cynical about that and say, "Modernising local health care, probably not; balancing the books, probably yes." They feel that it is all about chucking in a bit of modernising of local health care to make everything feel better.

Guildford and Waverley PCT is facing a budget deficit of £16.3 million. I do not doubt that its desire is to modernise health care and to improve health services for local people, but its aim is to cut its costs and to balance its books. In fact, it now has an imperative to balance its books because we are living in a very competitive climate. In Surrey, five PCTs are to be reconfigured down to one PCT. Many people are competing for many fewer jobs. There have been articles in the press and the health service journals about that. Senior managers in PCTs that are to be reconfigured tend to get the chief executive job at whatever level—strategic health authority or PCT—if they balance the books. Everybody who works in the health service, particularly in PCTs, understands that. In fairness, one cannot blame the staff for looking at it in that way. They have mortgages and bills to pay and families to look after. It is worth considering whether it is really a good thing for the Government to be reconfiguring PCTs given that that will result in an incredible loss of focus for the staff involved.

In December 2005, the British Medical Association said in one of its briefing papers that serious questions have to be asked about where increased NHS resources are going, and that it is not a good idea to make kneejerk decisions about the reduction or closure of services in response to short-term funding problems. The Secretary of State recently said:

Mr. Graham Stuart: Is my hon. Friend aware that supporters of community hospitals increasingly see that statement as a sick joke?

Anne Milton: I agree with my hon. Friend. Many people view it as not only a sick joke but a desperate situation for many community hospitals throughout the country. The Secretary of State continued:

That has yet to happen and I understand that some community hospitals have already shut because the first aim of the primary care trust is to balance the books.

In Guildford and Waverley, several community hospitals are at risk, including Cranleigh Village hospital in my constituency. That hospital is held in much affection. The staff often live locally and it has been effective because, as many hon. Members know, people do much better and their health outcomes are better if they are looked after close to where they live, in the community, so that their local friends and relatives can visit them. Cranleigh Village hospital is so loved that a hospital trust was set up some years ago to raise money
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to build a new hospital. A substantial sum of money has been raised, a local benefactor has donated land and detailed planning permission has been granted. The project will go ahead, but only if community beds are provided on site. That is a condition of donating the land.

The innovative and groundbreaking project will be put at risk should community beds in the hospital at Cranleigh close. One sometimes wonders whether we still have a national health service. I urge hon. Members to consider how often Ministers, including the Secretary of State, refer to "the health service", not "the national health service". The beds in Cranleigh are being kept open only by voluntary donations. The community in my constituency remains sceptical about the Government's motives when such projects are put at risk and community beds close. Many hon. Members have alluded to the complex reasons for deficits. The right hon. Member for Rother Valley spoke about inherited budget deficits, which is a problem in my constituency.

We also have an older population and the demands and needs for health care are high. I, like many of my constituents, find it difficult when PCT board papers include statements such as, "We need to manage demand" or, "We need to undertake less activity." Surely that means that people are getting less of the health care that they need. There are some serious problems with the funding formula in the south-east, as was mentioned earlier.

We must take a much longer-term view because it is estimated that, in 2020, half the adult population in the south-east will be over 50.

Adam Afriyie: I recently chaired a health-care question time for the Windsor, Ascot and Maidenhead area. It was striking that the NHS trust and PCT are finding it hard to deliver services or plan ahead because the Government have failed to set the tariffs or the settlement for this year. Does my hon. Friend share my concern that, without secure future finance, it is hard for any hospital or trust to provide a decent service to patients?

Anne Milton: My hon. Friend is right. It is hard to plan, and that leaves staff in an insecure position and many patients, especially the elderly, feeling vulnerable.

Front-line staff are experiencing incredible job insecurity and loss of morale. If one does one's best to deliver health care yet all one hears is budget cuts and posts being frozen, it is difficult to carry on and do the job. Many front-line staff are not only doing their job but covering for the posts that have been frozen in their trust. They also read stories in the newspapers that the trusts for which they work—in the community or the acute sector—are not paying, for example, the bread bills because the financial position is so serious.

I should like to say a little about those who have to carry the can for the cuts. For many people, being looked after at home is good not only for them but for their families. However, trusts that cut services or try to balance their books simply by shoving the burden on to local social services and patients' families do nobody any good. That aspect of the debate is not being properly aired. If people are looked after in their homes
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because community beds are closing or the trusts cannot keep people in hospital, somebody—often families or social services—will have to bear the burden. We have heard nothing this evening about the problems that social services already experience through their financial constraints.

I urge the Minister to listen carefully and not spend her summing up talking about what the Government have invested in the health service. It is about not only what you put in but what comes out. I still do not understand what is happening to all the money because, in Guildford and Waverley, nothing is coming out at the other end.

8.6 pm

Michael Jabez Foster (Hastings and Rye) (Lab): I believe that it is a good idea to balance the books. We should compare the massive record investment since 1997 with the real-term cuts—

Mr. Graham Stuart: Will the hon. Gentleman give way?

Michael Jabez Foster: No, because the real-term cuts during the Tory years are a fact, certainly in our area. The debate takes place in that context.

The Labour Government have targeted the areas of greatest need, such as mine in Hastings and Rye. Year after year, we have received increases in funding, which has meant a sea change in the area that I represent.

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