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Mr. Andrew Lansley (South Cambridgeshire) (Con) rose—

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. It is not the convention for Front Benchers to intervene in an Adjournment debate.

Mark Pritchard: My hon. Friend mentioned his intention to me before the debate, and I would have been happy to give way to him. However, I accept your ruling, Mr. Deputy Speaker, and I will move on.

The other primary care issue that I wish to raise is that of mental health services. So often, people suffering from mental health problems are pushed to the back of the queue and the bottom of the pile. My concern is that the pressures on the local primary care trusts in Shropshire mean that many people facing mental health problems are not being treated, and I hope that the Minister will address that issue as well.

I want to touch on neonatal services too. The Minister is aware that there is a fairly new maternity unit at the Princess Royal hospital—nice clean beds, nice paint on the walls and so on—but there is no expertise for dealing with mothers and babies who have complications. If a mother gives birth at the unit and there is a complication, she and her baby have to go at high speed, with blue lights flashing, to Shrewsbury to save her life or the baby's life. Given the demographics of Shropshire, unless that issue is addressed, inevitably—but God forbid—a mother and/or child will, unfortunately, lose their lives.

I have raised serious issues, and we are in serious times, so I hope that as the Government appointed the previous chairman and a series of chief executives they will take responsibility, accept that the buck stops with them and reconsider funding in Shropshire. The problem is not just the financial mismanagement of the previous trust; it relates to historical per capita underfunding for Shropshire patients—my constituents—over many years, going back to 1997–98. That is the key issue, and it should be addressed urgently.

10.16 pm

The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate the hon. Member for The Wrekin (Mark Pritchard) on securing the debate. As he said, it is one of a number of debates, in which he has taken part, reflecting the situation in his constituency. Obviously, I, too, have participated in those debates, answering for the Government. The
 
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hon. Gentleman and my hon. Friend the Member for Telford (David Wright) have invited me to visit their area and I understand that arrangements are being made. I am looking forward to the visit.

The hon. Member for The Wrekin raised several concerns to which I shall respond, but it is important to remember some of the improvements that have been made to health services in his area. He referred to national insurance contributions, and I remind him that although the Conservatives voted against increased NICs, NICs have actually massively increased investment in the national health service: from £33 billion in 1997 to about £92 billion by 2008. That investment has led to improvements in his area, which I hope that he will recognise.

In 1998, 91 patients waited more than 12 months for in-patient treatment, and 339 patients waited between nine and 11 months, at the Royal Shrewsbury Hospital NHS Trust and the Princess Royal Hospital NHS Trust, which were merged in October 2003. Now, no English patients wait more than six months for treatment at English trusts in Shropshire.

Out-patient waiting times have been reduced. Nobody waits more than 13 weeks for an out-patient appointment in Telford and Wrekin PCT. A total of 100 per cent. of urgent referrals for suspected cancer are seen by a specialist within two weeks, and 100 per cent. of patients who want to do so can see a general practitioner within two working days, or a primary care professional within one working day. Mortality rates for heart disease and cancer have been cut dramatically in the area.

Like the hon. Gentleman, I pay tribute to local staff for their extremely hard work and commitment in helping to make those improvements, but they would not have happened without the extra investment that has been made.

That is not to say that there are no challenges in the area. I shall set out the background to the current position. In October 2003, two trusts merged to form the new Shrewsbury and Telford Hospital NHS Trust. At that time, their combined deficit was approximately £4 million, but by the end of the financial year the deficit had increased to £7 million. In 2004–05, Shropshire and Staffordshire strategic health authority agreed to provide the trust with brokerage of £2 million, on the condition that the trust broke even in that year. Throughout the year, the trust sent returns to the SHA, which was closely examining how the deficit was being handled, but at the end of the year the trust changed its forecast to a £3 million deficit. Then, extremely unfortunately, as the hon. Gentleman said, the external auditors found that, in fact, the trust had run up a £10 million deficit, so at that time the trust had a total deficit of £19 million.

As the hon. Gentleman knows, there was an independent inquiry into the financial management and governance at the trust, which was extremely critical of the former chair, the chief executive and director of finance, all of whom had resigned in the meantime. A new management team is now in place, and I know that the hon. Gentleman thinks highly of them.
 
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Mark Pritchard: I do admire the new senior management team, but does the Minister agree that if the team is to continue to have the support of the local Member of Parliament and of the public, it needs to be transparent and open in its dealings, and that it is not helpful when it sends out mixed messages about the future of the accident and emergency ward?

Ms Winterton: I shall deal with the question of A and E services, but I have looked at the consultation that has taken place and I think that the management have been quite open.

As I said, the trust is forecasting a further deficit of more than £10 million in the current year. The situation is serious and it must be addressed. I believe that we are seeing the whole local health community come together to work out, in consultation with the local community—which has an important part to play—how to manage the situation for the best. Decisions have to be made and acted upon, and I believe that the process being undertaken now is leading in that direction.

The review now being conducted takes in the whole of Shropshire and is considering what can be done to achieve clinical improvements and financially sustainable health services throughout the area. The local NHS commissioned Finnamore Management Consultants to examine a range of options and in November and December last year, a pre-consultation was held involving key stakeholders. The hon. Gentleman pointed out the level of local awareness, which shows that there has been a considerable amount of consultation. What is being considered now is how to assemble a strategic service plan involving all four NHS organisations in the area, with the two PCTs taking the lead on consultation.

Turning to the future of the accident and emergency service at the Princess Royal hospital, it is difficult to comment on the proposals, because it may fall to the Secretary of State to make decisions on them at a future date. I can only repeat the answer that I have previously given to the hon. Gentleman—the trust's new chief executive has made it clear that he would like accident and emergency departments to be provided at both hospitals. I can confirm that the "hot and cold" site option, in which one hospital would deal with emergencies and the other with routine scheduled operations, has been dropped following advice from the joint overview and scrutiny committee, and it will not be submitted for consultation.

Mark Pritchard: Can the Minister rule out the option that the accident and emergency ward at the Princess Royal hospital will change from a doctor-led unit to a nurse-led unit?

Ms Winterton: It is not possible to rule in or rule out a proposal that may be made later. However, I can repeat the chief executive's view for the hon. Gentleman. The "hot and cold" site option was floated, but it has been dropped.

The hon. Gentleman spoke about paediatrics, mental health and neonatal services. Difficult decisions have to be made about service delivery, and we must look at what is most clinically appropriate in different areas. Specialist centres are important, and they are sometimes
 
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the best way of delivering care. The issues should be discussed openly, and the options thoroughly considered. It would not be right to make a decision here and now, because it is for clinicians, managers and local people to look at the available options, but they should always remember that what is important is patient safety. The highest-quality services should be provided on the advice of clinicians and others.

Surveys show that only 11 of a total of 84 trusts have considered making small cuts in mental health services. I am not sure whether the hon. Gentleman's trust is one of those considering that option, and I am happy to write to him with further details. As I have said, the 11 trusts were going to spend £893 million, of which £16 million has been earmarked for service reductions. It is, however, a small percentage of the overall amount spent on mental health.

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