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David Taylor: As one of the two rapporteurs on this issue from the Environment, Food and Rural Affairs Committee, may I ask the right hon. Gentleman to exempt from his sweeping condemnation of the Rural Payments Agency the middling and ordinary staff who are working their hardest under the most difficult of circumstances, with a computer system that fails to deliver? They are not responsible for this problem.

Mr. McLoughlin: I totally accept that point. I attended the debate about those problems in Westminster Hall, which the hon. Gentleman also attended, and I acknowledge the work that he has done and the time that he has spent considering this matter. I am not blaming the staff, but I am blaming the management, and obviously, the Secretary of State has blamed the management, because she sacked the chief executive. It seems that the responsibility ends with the chief executive, and not with the Ministers who were responsible, I am afraid, for ignoring the advice given by this House and instead listening to officials. There is confusion about what the two ends of the Department are up to. As I have said, many farmers have contacted me, including one, Mr. Cotterell, who said that the trouble is that there is a 31 March deadline for farm waste grants, and unless he can have a confirmed payment from the Rural Payments Agency, he cannot apply for the other grant. It seems that neither of the two sections in the Department knows what the other is doing.

Those are some of the problems that my constituents are facing as a result of Government promises. When the time came for road resurfacing to happen, a letter arrived saying that it had been reviewed, it was not affordable and it was not going to go ahead. In the Rural Payments Agency, there is chaos. Bovine TB and other issues affecting my constituents leave them frustrated. They believe that the Government do not care about the rural environment, and if they did care, they lost interest a long time ago. Those serious problems face many ordinary people in my constituency, and I hope that the Government take measures to put them right in the not-too-distant future.

1.53 pm

Mr. Andrew Turner (Isle of Wight) (Con): It is a great pleasure to follow my right hon. Friend the Opposition Chief Whip, and I certainly endorse his remarks about the failure of the Government to take appropriate care of and interest in the rural economy. I think that I exempt the Under-Secretary of State for Environment, Food and Rural Affairs, the hon. Member for South Dorset (Jim Knight) from that. The problem is that he does not have sufficient clout in his Department, and his Department does not have sufficient clout within the Government, to ensure that the needs of the rural economy are properly taken care of.

The contributions this afternoon, particularly that of my right hon. Friend the Member for West Derbyshire (Mr. McLoughlin), have demonstrated the value of this
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kind of debate. It is a great pity that there are only three such debates a year. The Deputy Leader of the House and my right hon. Friend the Member for Maidenhead (Mrs. May) are responsible for that issue, unlike most of the issues raised in this debate. May I suggest to them that we should repeat this kind of debate whenever the business of the House collapses? If the business of the House collapses at six o'clock, and we are not due to finish until 10, we should have a debate of this kind, in which Members who perhaps have not been called at Question Time and have not had the opportunity to have a Westminster Hall debate or to catch your eye, Mr. Deputy Speaker, or that of Mr. Speaker or the other Deputy Speakers, could raise matters. There could be a member of the Government on the Front Bench taking note, perhaps with messages sent back to the appropriate Departments, or with the Departments watching the debate on television, so that they can send notes to the member of the Government on the Front Bench, who can be inspired to respond to the issues that right hon. and hon. Members on both sides of the House think are important on that day. It is far better to deal with these issues immediately than to save them up until the end of term or to wait in the hope of catching your eye, Mr. Deputy Speaker.

In making that recommendation, may I also apologise to the Deputy Leader of the House, my right hon. Friend the Member for Maidenhead and you, Mr. Deputy Speaker, in case I am unable to attend for the wind-ups of this debate? I hope that I shall be able to attend, but, obviously, it depends on the duration of the debate, and I have business elsewhere later.

First, I want to follow up an issue that I raised in business questions, and which I believe that the hon. Member for Somerton and Frome (Mr. Heath) raised in an earlier business questions: who takes responsibility for the health service? The Leader of the House responded in business questions today that responsibility for the health service is divided between the Secretary of State and local managers. He said rightly that the Secretary of State cannot possibly take responsibility for every individual decision of local managers up and down the country. I would accept that, were it not for the fact that the Secretary of State appoints the people who appoint those local managers, instead of the local managers being answerable locally. Indeed, the Secretary of State intervenes at almost every conceivable stage in the local management of the health service, by setting targets, trying to abolish postcode prescribing, raising salaries, imposing the European working time directive and a range of other methods, which make it much more difficult for local managers to manage their health service in a way that is acceptable to local people.

As one might expect, I want to give as an example what has happened on the Isle of Wight in recent years. Shortly after I was elected, I was presented with a document that set out the needs of the island's health economy for more money. It is generally accepted that we are fortunate to have St. Mary's hospital on the Isle of Wight, largely owing to the pressing and hard work of my predecessor, Barry Field, and of course to a Conservative Government who agreed to its rebuilding. It is a district general hospital that serves between a third and a half of the population normally served by a district general hospital, and is funded accordingly.
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It is understood that living on an island has certain disadvantages, although they are hugely outweighed by the advantages, but one of those disadvantages is that not all services are available as easily as one might expect. However, the Government have been pouring on to my local hospital additional responsibilities that do not necessarily result in better patient care. The hospital already had other responsibilities, and it takes a certain number of people to man a maternity unit regardless of the number of births with which it deals. We cannot have a hospital, or an island, without a maternity unit—we cannot expect a population to survive without one. It is largely because of our need for a maternity unit that we still have the hospital, because of the other services attached.

However, the need for a maternity unit cannot be measured simply by the number of births. It must be measured more in terms of the basic need to man the unit, and I fear that the system that allocates resources between hospitals does not take account of that basic need. Another example is an accident and emergency unit which requires a consultant to be available at all times. Owing to the imposition of the European working time directive on my local hospital, we need to employ more consultants, without more resources, in order to provide that unit.

The position has been recognised for a long time by my local health managers. For months, indeed years, I have been saying to them, "Come on, we must make the case for more resources to the Government." They have put me off and put me off, on a number of occasions. For what they consider to be good reasons, they have said, "We are going to try a different approach. We are going to try to economise, try to introduce efficiency savings, try to displace some services to the mainland, and try to amalgamate." I am pleased to say that the amalgamation was agreed earlier this week, between the primary care trust and the hospital trust. Let me say for the benefit of the hon. Member for North Swindon (Mr. Wills), although he is no longer in the Chamber, that the new set-up will take on adult social services in the fullness of time.

That shows that such things can be done. It seems to me, though, that managers in the health service—and, indeed, chairmen and directors—have received the message that it is inappropriate to make representations through a Member of Parliament for changes in funding arrangements. That is what I understand from what I have been told. There appears to be no appetite—certainly there has been no appetite in the strategic health authority or the Department of Health—for difficult messages conveyed by local managers through their Members of Parliament. Managers may press them through the bureaucracy of the national health service, but if they go through Members of Parliament they are likely to have their heads chopped off.

I consider that unacceptable. Sir Ian Carruthers, who was chief executive of my strategic health authority and that of Dorset and Somerset, has now been elevated to the post of acting chief executive of the national health service, but I am assured by the new acting chief executive of Hampshire and Isle of Wight SHA, Eileen Spiller, that there is no such imposition on local managers. She says that they are free to give evidence to Members of Parliament, which they may use in the House and elsewhere, on how the allocation system, for
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instance, should be changed. It has not happened, though. The evidence is there, and can be obtained. Certainly it could be obtained five years ago, so there is no reason why it cannot be updated and obtained now. It does not seem to be acceptable, however, for it to be produced.

We hear that in the current year 200 staff have been lost to St Mary's hospital and Isle of Wight Healthcare NHS Trust. Today, I think for the first time, it has been admitted by officials of the trust that no further cuts can be entertained without a significant reduction in the quality of patient care available on the island. That information was on the Isle of Wight radio website today. I have concluded that it was possible for the trust officials to say that partly because they have made as many cuts as they can, but partly because Sir Ian Carruthers has been moved to a higher post. The acting chief executive of Hampshire and Isle of Wight SHA assures me that bad news may be presented by senior health service managers.

There are, of course, bits of bad news that I too present from time to time, and I thank those who provide me with that information. An example of bad news has been, in the past, the lack of NHS dentists on the Isle of Wight. I must thank the Minister of State, Department of Health—the hon. Member for Doncaster, Central (Ms Winterton)—first for admitting that it was unacceptable for people to have to cross the Solent to find NHS dentists, secondly for coming to the island and ensuring that real efforts were made to appoint more of them, and thirdly for allowing, or perhaps ensuring, the appointment of 14 more of them over the past 12 months. That is excellent. The only problem is that the number of people who are no longer registered with NHS dentists has not fallen over those 12 months but risen, because more and more dentists are leaving the NHS.

Taken together, the 24,000 people who have registered their need for NHS dentists on the Isle of Wight and the 36,000 or so who are already on NHS dentists' lists make up only half the population of my constituency. So half the population have no prospect of securing NHS dentists, 30,000-odd have NHS dentists, and, we are told, 24,000 are likely to obtain NHS dentists—not while those 14 are being appointed, not within 12 months of their being appointed, not, in fact, until two years have elapsed since their appointment.

That is an entirely unsatisfactory level of service to my constituents. It reflects very badly on the Prime Minister that he made a promise back in 1998 or 1999 on which he could not deliver. He should have checked. He made a promise that by the end of 2001, everyone would be able to have access to an NHS dentist. He could not deliver on the promise, and he should have known that when he made it. It was a promise made either flippantly or with malice, to mislead. I am sure that it could not have been the latter, and it reflects ill on the Prime Minister if he made it in other circumstances.

The most damaging cut, potentially, that my NHS trust has made over the past 12 months is the withdrawal of payment of fares to people who need radiotherapy. The fares were paid to enable them to cross the Solent and attend a hospital in Southampton. The health
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service estimated the saving at a meagre £38,000, which could have made the difference between people undergoing radiotherapy and not being able to afford it.

I am pleased to say that Isle of Wight council—which, as I said earlier, is now under Conservative control—stepped in, and provided money to meet the shortfall. It really is disgraceful, however, that in days when Ministers talk of equal access to NHS services, those who are poorest cannot have access because they cannot afford it. It really is disgraceful that pensioners cannot have access to radiotherapy services. It is disgraceful that they cannot be accompanied by their husbands or wives when they attend for such services, because they cannot afford the journey.

The more the health service is centralised and, indeed, the more choice the Government give patients—I accept that that is a good thing—the more people will fail to gain access to the services that they want or need. I believe that the Government should address that issue before appointing new health service bureaucrats and setting up new health service quangos.

I am very proud of the work that the Isle of Wight council has done, not only in stepping in to fill that breach, but in several other areas. I do not often boast about my local authority—I did not have the opportunity to do so until May last year—but, to paraphrase my hon. Friend the Member for Henley (Mr. Johnson), I went to the trouble of helping the Conservatives get elected, so I am entitled to boast about them. They inherited a near to failing local authority with a near to failing education system—

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