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26 Apr 2006 : Column 285WH—continued

Health Services (Wiltshire)

2.30 pm

Mr. James Gray (North Wiltshire) (Con): This important debate about the crisis facing health provision in Wiltshire is being held against the background of the Secretary of State's visit to the conference that is being held by the Royal College of Nursing. She is trying to explain to those present why she declared on Sunday that we have never had it so good—or words to that effect—that the health service is safe in her hands and that this is the best year ever in its history. I simply say one thing to her and to the Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint), who is answering the debate. Although the Minister looked very fetching in her tracksuit bottoms in a photo opportunity yesterday, we need more than photo opportunities and spin from the Secretary of State. She and the Minister need only come down to Wiltshire to find out about the reality of the health service on the ground.

Incidentally, in that context, I was amazed the other day to hear that the Secretary of State has visited a grand total of 11 national health service institutions in her two years in the post, so it is hardly surprising that she knows precious little about what is happening on the ground.

Dr. Andrew Murrison (Westbury) (Con): Did my hon. Friend also hear that the shadow Secretary of State for Health, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), has visited 60 NHS hospitals in that time?

Mr. Gray : My hon. Friend is right. My hon. Friend the Member for South Cambridgeshire is assiduous in his attention to detail and in visiting institutions, but I am afraid that the Secretary of State is not, and she will have to spend more time on such visits.

The Secretary of State might like to start that process by coming down to Wiltshire, where I will show her a national health service that is not the best that it has ever been, but which is in meltdown. I use that expression with care, because I do not wish to alarm the ill, the infirm or the elderly, but health provision across the board in Wiltshire is in terminal decline, and it is important that we have this debate to bring that to the Government's attention.

The debate has come about because of the consultation paper issued by the Kennet and North Wiltshire primary care trust on the way forward. It discusses how to bridge the trust's £18 million-a-year deficit and the £28 million inherited debt that the Government are also forcing it to pay off. I should say straight away that every facet of the consultation paper is unacceptable. It offers three options, but all three are wholly unacceptable, and I shall return to that in a moment.

First, however, we should examine the consultation itself. If one is holding a consultation with the public, it should surely be possible for them to come back and propose a different option from those laid down in advance by the PCT. It should surely be possible for them to come back and say, "We want our community hospitals to be preserved as a whole." We have seven such hospitals in Wiltshire, and it must surely be
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possible for the public to come back and say, "We want all seven." At best, the consultation paper—I am referring to option three, for which I hope people will vote—will save two of those seven hospitals, but close five. Option one, which the Government and the PCT prefer, in effect closes all seven.

Mr. Michael Ancram (Devizes) (Con): My hon. Friend hopes that everybody will vote for option three, but would it not be better if everybody wrote in and said that all three options were unacceptable because they closed hospitals? In my constituency, for example, they will close Devizes community hospital.

Mr. Gray : My right hon. and learned Friend is of course right, and I shall make precisely the same point. We should ignore the tatty paper that the PCT has produced, which offers three equally unacceptable options. Indeed, I shall ask the public to ignore it and to write in to say that we want none of those options. None the less, of the three, number three is the best.

Let me return, however, to the consultation process itself. Mr. Nicholas Gilliard, the PCT's deputy head, and, more recently, Carol Clarke, its chief executive, have had a number of private conversations on the issue. They have made it plain to the editor of the local newspaper and at a meeting with groups of friends of the local hospitals that the PCT is determined that we should go for option one. Indeed, Carol Clarke said that she was the Margaret Thatcher of the national health service locally, so the lady is not for turning. She is determined that we will go for option one and that the PCT will close its community hospitals across the county.

Mr. Michael Wills (North Swindon) (Lab) rose—

Mr. Gray : I will give way in one moment. Irrespective of what one thinks of the substance of the consultation paper, the fact is that full-time employees, or servants of the state, stood up one week after the consultation was issued to say that their strong preference—as Carol Clarke said, the lady is not for turning—is for the worst option, or the meltdown option, and for all our community hospitals to close. The hon. Member for North Swindon (Mr. Wills) does not have any community hospitals in his area, but I will happily give way to him.

Mr. Wills : Does the hon. Gentleman regard the description of that lady as the Margaret Thatcher of the local NHS as a compliment?

Mr. Gray : I would of course view it as a very strong compliment, although I am not sure that it would necessarily be viewed as much of one in the halls of new Labour, in which that lady presumably seeks to work. The fact, however, is that she is determined to go for the worst option and to close the hospitals, irrespective of what the public might say in response to the consultation. That is what is so disgraceful.

As my right hon. and learned Friend the Member for Devizes (Mr. Ancram) said, I shall be asking the public in North Wiltshire to write in in their thousands and tens of thousands. I intend to deliver perhaps 100,000 letters, or at least signatures on petitions, to the Government
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and the PCT. Those people will not be asking for any one of the PCT's wholly unacceptable options, but telling the Government, "We want our community hospitals to be preserved as they are." If the consultation is genuine, and the Government are indeed determined to listen to our constituents, that option would presumably be available to them.

I will shortly have the honour of presenting a petition to the House of Commons. It will contain at least 30,000, and possibly 50,000, signatures, and I suspect that a significant number of others will write in to add their names to it. My suspicion, however, is that the so-called consultation is a sham and that no consultation is going on. The Government, or their puppet the PCT, have decided to cut, cut, cut our community hospitals and, in effect, to close all seven.

Incidentally, before someone turns round and says, "Don't worry. Chippenham's safe", let me say that under option one Chippenham community hospital will be left with only 20 stroke beds, and any vague resemblance to a hospital will be long gone. What is happening to Chippenham community hospital is what has happened to Malmesbury community hospital over the past two or three years—death by a thousand cuts, with the removal of one service after another. That is entirely unacceptable. Our area is predominantly rural, and 2,500 patients a year use our community hospitals. It is entirely unacceptable that those hospitals should be closed and, according to the consultation paper, replaced by what looks like souped-up GP surgeries. We want our community hospitals and we are determined to keep them.

In that context, I was very much encouraged by the consultation paper "Our health, our care, our say", which the Government produced on 31 January, and by what the Secretary of State said in it:

Conservative Members welcomed that statement. There was also a statement to the House of Commons, in which the Secretary of State said that the community hospitals were to be saved, which Conservative Members also very much welcomed. Even then, however, we pressed her a little and, by chance, I happen to have the Hansard extract here. She said:

Even then, I was not entirely certain that I could believe what I was hearing. I thought, "This is great news. The Secretary of State is on my side. We've won this battle. We're going to save our community hospitals." I therefore leapt to my feet to press her. I asked:

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That was a clear question. I asked whether she meant that she wanted to save those community hospitals. She said:

I challenge the Minister to say whether she stands by what the Secretary of State said as recently as 30 January, when she explicitly said that she believed that community hospitals were the way to deliver in Avon, Gloucestershire and Wiltshire—she named the area, and answered my specific questions—or does she stand by any of the three inadequate options offered in the consultation produced by the primary care trust last week? She cannot have it both ways. Either we keep the community hospitals open, which seems to be what the Secretary of State was suggesting, or we allow them to close, which appears to be what the PCT is now asking for.

The crisis in the health service in Wiltshire is not limited to the closure of the community hospitals, although that is its pinnacle. The crisis spreads across almost every aspect of delivery in the area. Only last week, the Royal United hospital in Bath announced that the dreadful shortage of money meant that it would have to sack 300 people and close up to 60 beds. The Great Western hospital in Swindon is inadequate for the numbers going there; there are huge waiting lists for a variety of procedures. Indeed, a constituent of mine, a retired fireman, used his redundancy money to pay for his wife's operation. It was a perfectly routine women's operation but it had to be done privately. That is a disgrace. That is not how we want our national health service to be.

I was interested to note that, in its press notice about the bed closures, the Royal United hospital said that we should not worry and that everything would be all right because it could rely on the community facilities around Wiltshire to cope with the pressure. Little did it know that the PCT would simultaneously be going out of its way to cut and then close the very community facilities upon which the Royal United was relying.

Steve Webb (Northavon) (LD): I share the hon. Gentleman's passion for the NHS. However, he will recall that, in the previous Parliament, the House had to vote for a penny on national insurance, which raised about £8 billion for the health service. I assume that he voted against. If he had had his way, what would be the state of the health service in Wiltshire now?

Mr. Gray : I am encouraged to hear that the Liberal Democrats are sticking by their one and only policy, namely a penny on this or a penny on that. It used to be a penny on income tax; it is now a penny on national insurance. They say, "Whatever your problems, when we form a Liberal Democrat Government, we will solve them."

Mr. Ancram : In light of that intervention, will my hon. Friend reflect on the fact that, although spending on the health service has doubled over the past nine
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years, health provision in Wiltshire has diminished? What does he think a penny on the national health service would achieve?

Mr. Gray : My right hon. and learned Friend makes an extremely good point. Any housewife knows that it is not how much one spends but how one spends it.

The figures for spending in Wiltshire are extremely interesting, and I am glad that my right hon. and learned Friend raised the matter. In reply to a recent written question, we were given the spending figures per head for Wiltshire compared to the rest of the nation. In 2004–05, the Government spent £917 per head in Kennet and North Wiltshire. I shall choose a few areas pretty much at random from that answer. I start with Sedgefield, the Prime Minister's constituency, where spending was £1,236 per head. In Derwentside, Durham and Easington, constituencies in the north of England represented by Ministers, spending was £1,200 or more per head.

Why should people represented by Labour Ministers have one third more spent on them than we do in Wiltshire? That is why we have such debts. That is why we have a so-called overspend. It is not overspending—it is underfunding. All we seek in Wiltshire is the delivery of a first-class health service free at the point of delivery. The Government have forced our PCTs to misspend their money in myriad ways and are preventing that from happening.

The crisis in the national health service does not affect only hospitals. We can see all sorts of other symptoms, such as the prescription postcode lottery. For example, a lady constituent of the hon. Member for North Swindon recently lost her battle in the High Court to get Herceptin to treat her breast cancer, although I think that she is to appeal. One of my constituents, a person by the name of Gray, by coincidence, is going through the same battle.

Mr. Wills : On a point of information, my constituent won her case on appeal.

Mr. Gray : I am delighted to hear it, but the fact that someone should have to go the High Court to extract from the Government the drugs that she needs to save her life seems to be indicative of the problem. There is a terrible postcode lottery in a variety of prescription factors.

National health service dentistry in my constituency is virtually non-existent. I recently won a small battle with the Department of Health over a technical detail that allowed an NHS dentist in Chippenham to preserve his livelihood—I shall not delay the House with it—but people in North Wiltshire are extremely lucky to find a proper national health service dentist, and more dentists are pulling out of the NHS as a result of the new contracts.

The ambulance service recently came up with more new Labour reorganisation. The Government love it. When something goes wrong, they do not put it right—they reorganise it. When I was first elected to my constituency about 10 years ago, I visited the Wiltshire health authority. I was told that it was terribly out of date, that it was a
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county organisation, and that we were going to have the latest thing—the primary care group. Large quantities of money were spent on creating primary care groups—IT costs, redundancies, management consultancy costs and so on. They then changed to primary care trusts, with more IT and consultancy costs and more redundancies. They then amalgamated two of the trusts—those in my constituency and in the constituency of my right hon. and learned Friend. Now they are bringing the PCTs back together into one big unit, which looks for all the world exactly like the old Wiltshire health authority. I have one question. Should we allow Bath at one end, and Swindon at the other, to become part of our PCT?

Mr. Wills : I hope to speak a little more on that subject later. On another point of information, I remind the    hon. Gentleman that we had a Conservative Government 10 years ago, so the idea that health service reorganisation is a function of what he called new Labour is wrong as a point of fact.

Mr. Gray : It is not a point of fact. I became a Member of Parliament on 1 May 1997. The hon. Gentleman will recall that the Conservative Government sadly lost power on that day. The reorganisation to which I refer occurred after I attended the Wiltshire health authority as the Member of Parliament under the new Labour Government. The hon. Gentleman is not quite accurate about that.

All those reorganisations cost a fortune. So what happened recently when we had a problem with the ambulance service? The Government did not put it right or sort it out. They decided to move the deckchairs on the Titanic of the ambulance service and amalgamate the Wiltshire ambulance service with the Avon and Gloucestershire services. What did we find then? One of the chairmen of the constituent parts of the new ambulance service resigned because he believed that the inherited debt of the new ambulance trust would be such that it could not deliver a decent ambulance service to the people of Wiltshire. There we have it: an amalgamation, a management change and the inability to deliver a safe ambulance service.

Steve Webb : I heard of that resignation. It was subsequently claimed that the person who resigned applied for the post of chairman of the new service but was turned down. What does the hon. Gentleman think of that?

Mr. Gray : I am not at all certain about the internal politics, but the fact is that he was chairman of one of the three trusts. He may have had a personal motive for resigning, but he nevertheless produced the figures to demonstrate that the new ambulance trust would have a huge deficit. If the hon. Gentleman is claiming that the amalgamation is a good thing and that his constituents would be well served by the new ambulance trust, he will fall by his words when we discover that it is not working. That was an extremely helpful remark. The Liberal Democrats are apparently in favour of the amalgamation and they will fall on the failure of the trust in months to come.

It is always the way: whenever there is a problem, the Government do not mend it, they reorganise it. We have seen huge amounts of management reorganisation over
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the years. That is where it has gone wrong. I pay tribute to the Government for spending more and more money on the health service, but the service has got worse and worse. I try not to use hyperbole and I do not exaggerate, but it seems to me that in Wiltshire the frail, the elderly and the sick are not getting the kind of health service that Beveridge foresaw for them. That sort of health service no longer exists in North Wiltshire. I believe that we are seeing the terminal decline of the health service. I do not believe that in 10 years' time we will have anything that even vaguely resembles a national health service in Wiltshire. I believe that this uncaring, despised and hated Labour Government are to blame for that failure. [Interruption.] It is not funny, Minister. Do not laugh about it.

2.50 pm

Mr. Michael Wills (North Swindon) (Lab): I start by congratulating my constituency neighbour, the hon. Member for North Wiltshire (Mr. Gray), on securing this debate on a subject that is of great importance to all our constituents. He deserves our thanks for giving us the opportunity to talk about it. I am particularly glad to have caught your eye, Mr. Gale, as when I looked at the massed ranks of Conservative MPs from Wiltshire opposite—I am pleased to see one Liberal Democrat present—I thought that there would probably be a need for some balance and perspective.

The hon. Member for North Wiltshire did not always succeed in his self-imposed task of avoiding hyperbole. Of course, the NHS can do better—it always can—but it is important to recall the extraordinary progress of the past eight years or so, as I shall do in relation to my constituency.

I am sure that my hon. Friend the Minister will clarify a number of points on national issues. I hope that she will find time to pay tribute to the extraordinary work carried out by everybody who works in the health service, such as ancillary staff, nurses, doctors, and admin and clerical staff, all of whom deserve our thanks. I hope that everyone in the Chamber will join me in congratulating them on the extraordinary work that they do on behalf of all our constituents.

I am also sure that the Minister will find time to talk about financing the health service. I note that for all the hon. Gentleman's elaborate critique of the current state of the national health service, he was short of constructive alternatives. I hope that some of his colleagues will come forward with practical proposals on how they would do things differently and better. I also hope that they will pay particular attention to the fact that as a party they are committed to a so-called third fiscal rule, which means that, axiomatically, they would spend less on public services than the Government. I shall be interested to hear how Conservative Members propose to improve the health service with such fiscal constraints.

I want to talk a little about my experiences of the health service in my constituency. I want to make it clear that this is my personal view, and I have not been put up to it by the Whips. I stress that my experience of dealing with the Minister's Department on behalf of my constituents has not always been happy. There is a certain carelessness from time to time, not from the Minister, but from some of her colleagues. I shall long
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remember the reply to a letter that I wrote on behalf of a constituent who was in severe and acute back pain and wanted to know why the services of her chiropractor could not be provided on the NHS. Two months later, I got a reply from the Minister in question—not the Minister who is present—which went on for three pages extolling the extraordinary progress and investments that the Government have made and about changes to the provision of chiropody on the NHS.

I have spoken in the House before about the disgracefully bureaucratic and sclerotic response of the Minister's Department to an imaginative and innovative proposal to give choice to the users of dementia services and their carers. I am disappointed that the Department did not respond more constructively to an initiative from front-line professionals in Swindon and the surrounding area, which was focused on delivering what the Prime Minister says that he wants.

Having said that, we should look back at how the NHS was in 1997 and consider the progress that has been made. Only the blinkered and the partisan could talk about this subject for nearly 20 minutes without mentioning the dramatic improvements. All the talk about meltdown is ridiculous when one considers the situation nine years ago.

I remember two middle-aged couples coming to see me in my surgery in successive weeks in 1998. They were desperate because they had been told that the husbands would have to wait more than six months for angiograms. They were under great stress because they did not know whether the husbands would need severe heart operations or what the prognoses would be. They had to wait six months because the resources simply were not available. That simply does not happen any more. The average waiting time for an angiogram in the Great Western hospital is three months, and many people are seen far more quickly than that.

In 1997—I am sure that all hon. Members will remember this—the acute hospital serving Wiltshire was the crumbling Princess Margaret hospital in Swindon. There was a £30 million backlog of repairs and no indication from the Conservative Government of where the money to pay for those repairs was to come from. There was only the most idle, footling discussion about replacing the hospital. We now have the brand new Great Western hospital, which is doing a splendid job. Of course, it is not perfect and there is room for improvement, but the comparison with the old Princess Margaret hospital is dramatic. I repeat that only the blinkered and the partisan would deny that.

The old hospital had waiting lists that stretched for months, and sometimes years. Waiting lists of in-patients grew by 40 per cent. in the last two years of the Conservative Government, and patients were being bussed to hospitals as far away as Birmingham and Southampton.

Mr. Ancram : I am sure that the hon. Gentleman does not want to be unfair. He says that the new hospital in Swindon is the work of the Labour Government. However, I do not think that he was a Member before 1997, because I represented a large part of his constituency then. Before that election, I recall being consulted on where the new hospital should go, by a Conservative Government who were determined to
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build one. Indeed, the site on which it was to be built was identified at that time. I am sure that he would like to pay tribute in that regard.

Mr. Wills : I am grateful to the right hon. and learned Gentleman, but I chose my words carefully. I said that there had been a lot of idle discussion from the Conservative Government: no practical plans were in place. I respect his longevity in the House and his great experience, and I pay tribute to his diligence as a constituency MP—I inherited many of his constituents, so I know that he was a very good constituency MP—but if he looks back at the record, he will see that no practical plans were in place. They were driven through by the Labour Government and were only possible because of their approach from the beginning to the financing of the NHS.

Mr. Gray : Will the hon. Gentleman pay tribute to Baroness Thatcher, who introduced the private finance initiative under which the hospital was built?

Mr. Wills : The hon. Gentleman has already made his views on Baroness Thatcher clear, but she has very little relevance to this debate.

The experience of my constituents in relation to the provision of hospitals under the last Conservative Government was not just that there were no plans in place to replace the Princess Margaret hospital. My hon. Friend the Minister and Opposition Members will remember that for many years Wiltshire and Swindon had a wonderful hospital in the Princess Alexandra RAF hospital in Wroughton, at which roughly one in 10 of my constituents were born. It provided a crucial resource in helping with hospital care in Swindon, and its closure added a 6 per cent. burden overnight to the services that the Princess Margaret hospital had to provide for my constituents in North Swindon.

When the Princess Alexandra hospital closed, as part of a defence review, the Conservative Government gave no concern to health care needs in that area. We can talk about closures and reorganisations, but at least when this Government reorganise health services, it is with the    intention of improving health care, although Opposition Members may disagree with us on whether that intention will be realised. The Conservative Government closed a hospital in Swindon for reasons that were nothing to do with health care. The closure was to get them out of a fiscal hole that they had dug by conducting a savage defence review.

Mr. Ancram : The hon. Gentleman has been very complimentary about me, and he will want to be fair about this. I strongly opposed the closure of the Princess Alexandra hospital, which was also in my constituency, as I thought it was the wrong decision. The idea was to give the facility to the hospital in Gosport, which is now also under threat. Everything that I said then is coming true.

Will the hon. Gentleman remind me whether at that time—before 1997—his party supported PFI as a way of building new hospitals?
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Mr. Wills : I am aware that the right hon. and learned Gentleman opposed the closure of the hospital; I think that locally, everybody did. My point was about the approach taken by his Government.

This Government support PFI, and as a result we have been able to build a lot of new hospitals. My basic point about financing the health service is that the Government are committed to provide more funding than the Conservatives would. The onus is on the Conservatives. Rather than whinging and complaining about what the Government are doing to improve the health service, if they have a better set of proposals they should let us hear them. We should not just have the critique, but let us hear what they are going to do, how they will manage it and how they will fund it.

It is not only the hospital service that is improving, and it is improving, whatever Conservative Members might say. We also have an innovative new range of GP services, and I want to talk about one example from my constituency, the Taw Hill surgery. It is an admirable surgery run by a dynamic collection of GPs who constantly look for ways to improve the service that they deliver to their patients. It is interesting what they have been able to introduce because of the funding provided by the Government.

The surgery offers retinal screening for diabetics, which identifies problems and allows for early treatment of the condition, saving many people's eyesight. A carpal tunnel and hernia service has been introduced. That used to be done under general anaesthetic in hospital, but it is now done under local anaesthetic and locally. There is an antenatal 3D ultrasound facility. Laser skin treatments were previously carried out 40 miles away in hospital and are now carried out at the surgery. Those four important services are now offered locally, and that is only possible because of the investment from the Government, which enables innovative, adventurous and forward-looking GPs, like those at the Taw Hill surgery, to deliver better services for their patients.

All that should be welcomed by Conservative Members. Instead of carping and criticising, we ought to celebrate the progress that we have made. Of course, let us look for improvement, but let us not paint a one-sided, whinging picture of what has happened in Wiltshire. Most objective observers agree that the situation is far better than it was. I am sure that my hon. Friend the Minister will say that further improvements are needed, as that is what the Government are determined to deliver.

3.2 pm

Robert Key (Salisbury) (Con): I start from a slightly different perspective. Perhaps I should have a text: "veniuntque abeuntque pueri, sed semper maneo", or "the boys come and go, but I always stay the same". I am perhaps the longest-serving Member for Wiltshire. I first attended Salisbury hospital in 1952 to have my tonsils out when it was a Nissen hut camp outside the city, on the hill. I have long-held and pretty fond memories of the health service.

I should also declare that I am going to be extremely nice about the health service in South Wiltshire, as I shall shortly be testing it myself. I have an operation booked with the excellent national health service to look
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after my problem. I shall be throwing away my walking stick and leaping around Westminster shortly. Having said that, I am going to take a slightly different approach to the problems. The crisis that we face in Wiltshire is caused by the crisis management of debt and projected debt and by the unclear boundaries between health service provision and social service provision. That, as far as the south of the county is concerned, is the biggest problem.

It is also an issue of accountability. Over the past six months or so, we have seen the closure of the Amblescroft unit for elderly, mentally ill people, the Greencroft centre as a day centre for disturbed people with a wide range of problems, as well as the community nursing plan service and the hospital alternatives team. We have seen the closure of the Shelwork factory run by Action for Blind People and the Shaw Trust centre for people who are visually impaired and disabled. We have seen a lot of such closures.

At the heart of that has been the great distress caused to the people and families involved. A lot of lessons have been learned. When I have raised such issues, I have received nothing but courtesy from Ministers. When I raised the closure of Amblescroft and the Greencroft centre at oral questions on 7 March, the Secretary of State immediately said that she would look at the specific cases. She did, she got back to me and I received a charming letter from the Minister who is with us today, in which she also pursued those points. It all came back to the problems of accountability. The Secretary of State and the Minister both rightly said that a lot of money was being spent and that decision making on individual projects and expenditure must be matters for local decision.

There is a problem. County councillors faced with picking up the bill, as the national health service will not pay for what it previously paid for, are liable to surcharge. They cannot just go on running up debt ad nauseam. They have not only the electors breathing down their back, but the district auditor. That is a problem for them.

The primary care trust, the acute trust and the mental health trust all have executive and non-executive directors. They have to take responsibility as they are remunerated—not very generously, but they are remunerated—but they are blushing violets. It has been with the greatest difficulty that I have persuaded people to realise that a lot of people in the community are appointed by the NHS Appointments Commission to look after the interests of local people. Nobody knows who they are and when things go wrong they keep their heads down. That is wrong.

I have tried to encourage the non-executive directors of our local health trusts in Salisbury and South Wiltshire to put their heads above the parapet and to explain what is going on. I challenged one of them, who I know very well, and said, "You know what is going on. Surely you can come out and say that when Amblescroft closes no one will be out on the street, because you will have to pick up the pieces." The reply was "Oh no, we have been told not to say anything, because that would indicate liability. We have been instructed to say nothing to anybody." That is a shame, as it inhibits accountability. It is wrong, and it should not happen.
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When we consider what has been going wrong in Salisbury, we should remember that a tremendous amount has been going right in South Wiltshire. The health service is in good heart. We have moved on from the Nissen hut era, I am delighted to say. We have been through a number of different sites and have seen rationalisation and massive delay. The one thing that has characterised the health service in South Wiltshire has been change after change. It has normally been a question of administrative change and financial procedures. Often, clinical procedures and policies for the treatment of people have changed. Occasionally, as in the crisis of the past few months, we have seen the chief executive of our primary care trust—an excellent public servant—trying to persuade us that the problem is solved because they have found a new and clinically better way to treat people that, surprise surprise, will cost less in the long run.

That does not help the people who write to their Members of Parliament in terms such as this:

at Amblescroft

That illustrates my problem with the boundaries between health and social care.

Another note from a constituent on 17 March reads:

It is at the edges that it really feels bad when things go wrong. It is not the robust clinical directors, who can run our magnificent hospital and make the best possible use of every penny that the taxpayer provides under whatever Government, who suffer. It is the people who are not going for straightforward surgery who suffer. It is the people who have problems with their mind who suffer. Perhaps they have mental health problems. Sometimes they are not in that category. However, it is always the people at the edges who suffer. That is why we must be particularly careful. I believe that there is a future, and we must ensure that it comes to pass when we get through the current crisis.

I congratulate my hon. Friend the Member for North Wiltshire (Mr. Gray) on raising this issue. He has put it in passionate terms as it affects his constituency. My constituency is not seeing the closure of cottage hospitals. We have none; we have no cottage hospital-type facility. I wish we did. It has been suggested that the Amblescroft unit, which has closed, would make an ideal community unit as a sort of halfway house. We
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should not be seeing the closure of the hospital alternative scheme and community nursing, and that is without consultation with the GPs, incidentally.

There is a tremendous future, but it is no good pretending that everything is fine or that money alone will solve the problem. The issue is all about the sort of management that we want to see. Of course, that must be extremely efficient, but not to the point of harsh delivery and harsh, sudden decisions that have huge consequences for a small number of vulnerable people in our communities.

The health service in South Wiltshire is strong. It has always been good and will get better because of the people who work in it. They include consultants who are attracted by the quality of life and therefore do not wish to move on to further their careers in London teaching hospitals or even Southampton. They want to stay where they are to serve the people of South Wiltshire. That is why the number of consultants in Salisbury has doubled in the 23 years for which I have been the Member of Parliament. It is why the morale among all the people in the heath service, whether clinicians, porters, cleaners or administrators, is so high.

The one thing that dashes everyone's hopes is management by crisis, which we have been seeing recently. I hope that before too long we will be through that phase and back on track towards ever better health services for the people of Wiltshire.

3.13 pm

Mr. Michael Ancram (Devizes) (Con): I congratulate my hon. Friend the Member for North Wiltshire (Mr. Gray) on securing the debate and on the powerful way in which he made his case. The hon. Member for North Swindon (Mr. Wills), whom I am glad to see is back in his place, asked us to praise those who work in the health service, and I do so unstintingly. The midwives, nurses and doctors do an enormously important and very hard task, and on many occasions they are asked to do much more than any of us would be prepared to do in the hours that are given to them. However, I want to say this to the hon. Gentleman, and it comes not from Conservative politicians, but from the doctors, nurses and midwives in my constituency, who are up in arms about what they see as the undermining of local health services. They are the dedicated ones who are saying to me, "Please stand up in Parliament and speak for our health services, because they are in danger of being destroyed." I hope that he will respect their views.

It was not Conservative politicians who booed and heckled the Secretary of State for Health the other day when she went to meet Unison. It was those who work in the health service who did that, because they are desperate. They suddenly see so much of what they believe in and of what they have worked for being undermined and destroyed. I say this to the hon. Gentleman in all seriousness. I shall not make a very party political speech. I listened carefully to the Secretary of State the other day when she said that this was the best year for the health service ever. I listened carefully when the Prime Minister said that we are, through our reforms, going to create a health service that will provide for people what they want, not what they are given. I start from that point.
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The patients in my constituency, my electors, want their two community hospitals, their two minor injuries units and their maternity service, but that is not what they are offered. My hon. Friend the Member for North Wiltshire rightly spoke about the so-called consultation document. I say "so-called" because I have been in politics long enough to know what something is about when it sets out options with a preferred option—it is a little bit of cosmetics to cover a decision that has already been taken.

The first option, which is set out in the document as the most favourable because it saves the most money, leaves no community hospitals in my constituency. Savernake and Devizes would close. It leaves no minor injuries units in my constituency; both of those would close as well. It gets rid of the maternity unit in Devizes. It offers "consideration of"—not even a promise—a primary care centre. That is the new idea of glorified GPs' surgeries. There would be only one—for 100,000 people in the Kennet area. The hon. Member for North Swindon tries to tell me that I should go around saying that my health service has improved. I would like to see him try to make that argument in those circumstances.

Mr. Wills : The right hon. and learned Gentleman will forgive me if I ask for clarification. I am not sure who he is blaming for this state of affairs. He segued elegantly from blaming the Government to blaming the PCT for a local decision. With all due respect, he cannot have it both ways. Either he believes in localism, in which case a local organisation—the PCT in this case—is taking local decisions for local people, which he may disagree with, or he thinks that the national Government should intervene, in which case he is at odds with his party's much vaunted adherence to localism. I am sure that he will say that it is both, but can he clarify which is his position?

Mr. Ancram : I am happy to do that in the course of my remarks because I am not someone who makes a criticism without trying to suggest a solution. I am sure that the hon. Gentleman will want to wait and listen to that.

Devizes hospital closes under all three of the options offered, so the people of Devizes are given three options, none of which suits them—none of which, in the Prime Minister's words, provides them with what they want. That is why I am advising them to ignore the consultation options and to write in to say that they want their community hospital retained. When I was elected in 1992, we were promised a new one. From then on, under the Conservative Government and the Labour Government, we were told that we would get one, but then suddenly, out of the blue, the hospital is to go. The people of Devizes feel betrayed not only by the local PCT, but by this Government.

I refer to what is happening as vandalism. As my hon. Friend the Member for North Wiltshire said, the Government talk about their belief in community hospitals, but proceed to stand back while community hospitals are closed. The reason for their closure is not that they are not needed. It is the reason that stands behind the whole of the consultation document: they have run out of money. That is the truth. This is not about better health care or reforming the health service. It is about how we deal with a deficit—a deficit that
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should never have arisen. The Government have poured money into the national health service—they have doubled the money over nine years—but my constituency has seen less and less provision during that time. That is a real question that the Government have to answer. I shall come on to how I think they can.

All I can say to the hon. Member for North Swindon is that to talk about the best year for the health service ever is, in my constituency, a cruel jibe. It is a cruel jibe to the people who look to the health service to care for them, and to the people who work in the health service. I attended a meeting the other day in Devizes about the potential closure of the hospital there. The people who were most vocal were the people who run the hospital, the people who run the maternity unit, the doctors themselves. Those people are saying, "This is not what we believed the Labour Government meant when they said that they were going to save the national health service in 24 hours."

The simple truth is that we have been underfunded. I shall explain how I can make that claim and I hope that the Minister listens. I went to see one of her predecessors five or six years ago about the maternity unit and the hospital in Devizes and I talked about underfunding then. We have been underfunded in three ways. First, we are required to pay for the deficit caused by a misjudgment in 1992 in the Royal United hospital in Bath relating to its IT systems. That historic debt has grown and grown and now all PCTs are being asked to bear their share of it. That is nothing to do with us or our health provision, but we are being penalised for it. That is one reason that the debt has accumulated over the years.

I told the Minister's predecessor years ago, "Write that off. Give the new PCT that you have invented a chance to succeed and at least we will see whether the reform you are putting forward is going to work." Unfortunately, my plea fell on deaf ears, but I make it again because that change would have a significant effect on the way in which the reformed PCT could move forward.

The second reason—the Minister must know about this—is that we never received our full eligibility for capitation. Year after year, we have fallen short of it, and I am sure that my hon. Friend the Member for Westbury (Dr. Murrison) will make that point in his speech. We have been underfunded. No one makes any quarrel about that. We have not had the money that we deserved.

Thirdly, we have been underfunded because proper account has never been taken of the problems of being in a rural area. Why do I say that? Last year, as the Minister knows—I am sure that she will make a big thing of this—that problem was recognised. We got a 3 per cent. increase in recognition of what is called rurality. That in itself recognised that we were underfunded in the years before, when rurality was not recognised. During those years—I have to admit that some of them were under our Government—that underfunding became cumulative, our debt got bigger and bigger, and now we are being penalised for that. Will the Minister examine that underfunding? There is no point telling my PCT in its current or reformed state that it has to meet the deficit. Unless the fundamentals
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are dealt with, we will be back here in four years' time facing more cuts. The system cannot work because the basis on which it is funded is not realistic.

Mr. Wills : I rise to support the right hon. and learned Gentleman on that point. I am grateful to him for outlining the reasons for underfunding in such analytical detail. May I add to his plea on the issue of the funding of deficits by PCTs that did not accumulate those deficits? Swindon PCT is extremely well run and in balance, but it is being asked to fund deficits for PCTs that have not been so well run. I agree with my hon. Friend: this problem must be sorted out because it creates enormous ill feeling. I am happy to rise in support of that point.

Mr. Ancram : The hon. Gentleman referred to me as his hon. Friend and I take that as a genuine compliment. He and I have known each other for a long time and we try to work together on various issues. However, I say this in all seriousness. When the Prime Minister says in Parliament, as he did fairly recently, that he knows that people in his constituency believe that the health service has improved, I do not deny it. However, as my hon. Friend the Member for North Wiltshire pointed out, funding there is one third higher per head than ours. I suspect that, if we got that level of funding, we would not be facing such problems and my constituents might also be saying that the health service has improved.

The point is that we are not getting the funding that we should and as a result, we are facing total medical vandalism. My constituents will end up with one primary care centre. Their hospitals, minor injuries unit and maternity unit will have gone. How can anyone argue that that is not a health service in decline, on a local basis?

I make the plea again. If we are to argue that the health service is about providing service for all equally, and that it should be free at the point of delivery and free at the point of need, it is wrong to have a situation where the Prime Minister's constituency gets more than mine without any justification as to why his constituents need more medical care than mine. Someone told me the other day that it is to do with urban deprivation, but I can tell hon. Members that there is rural deprivation too. It may not be quite so obvious, but it exists and my constituents have as much right to care as others in the country do.

We are considering what is essentially a reform based on the need to cut expenditure in our area. That is totally wrong. It is short-sighted and in time we will find that the health service has been cut to such an extent that it cannot be revived. I hope that the Government will reconsider the matter. I hate to use historical analogies, but listening to the Secretary of State say that the health service has had the best year ever, and listening to the Prime Minister say that everyone knows that it has improved, reminds me of nothing more than the wonderful music Nero played on his fiddle as Rome burned.

3.25 pm

Steve Webb (Northavon) (LD): I congratulate the hon. Member for North Wiltshire (Mr. Gray) on securing a debate on the important issue of health care
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in Wiltshire. I want to address important issues about health care in Wiltshire, but I have to say that I find it gut-wrenching to hear the Conservative party talk about the NHS in the terms we have heard this afternoon, when they opposed £8 billion of the money that is currently being spent. When I intervened on the hon. Gentleman on that point, he said, "The Liberal Democrats say spend some more money". But he proceeded to say, "We only get £900 or so per head in Wiltshire. If only we got what they got in Sedgefield, it would all be fine." He appears to be looking in two different directions at once. Either he thinks that Wiltshire needs more money, or he does not.

Mr. Ancram : It does.

Steve Webb : The right hon. and learned Gentleman says that it clearly does. When I asked the hon. Member for North Wiltshire why he voted against the £8 billion that is currently spent, he gave no answer because he obviously does not have one.

Mr. Gray : I have two perfectly sensible answers. Item one: it is not about how much one spends, but the way one spends it. Item two: there is one cake, and we are talking about the way in which the cake is carved up. From the figures I cited earlier on, it appears that the cake has been carved up substantially in favour of Labour-represented areas such as Sedgefield.

Steve Webb : There we go. We get two inconsistent points of view. The hon. Gentleman said that it is about not how much one spends, but the way one spends it. Why could the £900 per head in Wiltshire not be spent more effectively?

Mr. Gray : It's both.

Steve Webb : The hon. Gentleman says it is both. He cannot hold these two positions simultaneously. What is needed is more money, but apparently it is right to oppose a tenth of current NHS spending, which is more than was raised by the penny on national insurance that he also opposed. Imagine the cuts to Wiltshire health services without that extra tenth of spending. That is what he voted for, and that is extraordinary.

Mr. Wills : I thank my hon. Friend for giving way—everyone is my friend today. I wondered whether he heard any Conservative Members suggest practical ways in which money could be spent more effectively.

Steve Webb : To be fair, the hon. Member for North Wiltshire mentioned one clear waste of money, which has been the process of going from health authorities to primary care groups to primary care trusts to the reinvention of health authorities, which is pretty much the same as the number you first thought of. That process has cost a lot of money. No one could dispute that. That money would have been better spent on front-line patient care.

Clearly, there has been waste, but I take the general point of the hon. Member for North Swindon (Mr. Wills). We hear the comments made, but there are
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practically no suggestions. There is no suggestion of an overall increase in NHS funding in comparison with present levels as far as I can see. There is a suggestion that Wiltshire and other areas get more and the north of England gets less, but I remind Conservative Members who have spoken that the Conservative Government presided over a system—as all Governments do—where the more prosperous bits of the country get less per head on average, and the less prosperous bits get more. I do not accept the idea that a Conservative Government would do anything different because they did not when they had a chance to do so. I hope that the electorates of Wiltshire and beyond have long memories because 18 years passed by and those issues were not addressed.

Mr. Ancram : The hon. Gentleman says rich areas should get less and poor areas more. Does he realise that a survey on rural deprivation in Wiltshire was carried out by a well known local Liberal about six years ago precisely in order to show that the concept that a rural area such as Wiltshire was richer than other areas was wrong? Is the hon. Gentleman going to deny that and chuck it in the basket because it does not suit his case?

Steve Webb : So why did the Conservatives not address that point during 18 years in office? The people in Wiltshire are no doubt told that if they vote Conservative they will get more money for health care in Wiltshire, but I do not suppose Conservative candidates in the north-east of England, who obviously have no hope of getting elected, go around saying, "We will take money off you". That is very mysterious.

I have some common ground with other hon. Members. The hon. Member for Salisbury (Robert Key) made a measured and thoughtful contribution, which raised some serious points, in the midst of a lot of good things happening in the NHS. Like others, I have huge admiration for the work of those in the front line of the NHS.

The hon. Gentleman rightly said that there are real problems related to the health and social care boundary. That is a major problem and I hope that any reorganisation of PCTs will not undermine successful joint working between social services and health. It is less of an issue in Wiltshire, where the merging of PCTs at least increases the chance of coterminosity between social services authorities and health authorities, but that is not the case in my area, where the Government will undermine the existing links and break them. He made that important point, and I think one other.

Mr. Gray : Will the hon. Gentleman give way?

Steve Webb : I have rather less time than other hon. Members have had. I have only five minutes, but I shall give way.

Mr. Gray : I am most grateful to the hon. Gentleman for giving way, but I think that in fact, he has plenty of time. I forgot to mention one problem that we have had recently with the primary care trust. It has withdrawn from joint ventures with the county council. Wiltshire county council is already bearing between £3 million and £6 million, and it looks like it will get worse. It means that either the council tax will have to go up,
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which it presumably cannot do because of capping, or valuable services for the most vulnerable in our society will be cut. That is the reality.

Steve Webb : I do not have any problem with that point, because in my judgment those budgets should all be pooled. The idea that we try to draw arbitrary dividing lines, with the resultant shifts in budget, is absurd. It is a long-standing problem.

The hon. Member for Salisbury alluded to the pace of reform. He was right to do so, and his point needs expanding. The front-line staff in Wiltshire face initiative after initiative and change after change, and they get almost no notice. For example, they receive payment by results and per procedure, but they do not get told how much it will be until they are into the financial year in which they have to act.

The hon. Gentleman also rightly talked about reacting to financial crises, rather than having a measured, long-term reform process. We are almost six years into a 10-year NHS plan. Had the Government set out a 10-year vision at the start and then steadily reformed in a manner that was announced in advance, so that the trust could respond to the new incentive structures and make measured, long-term plans, we might have got much further. Instead, there is a sudden change in the financial rules and a requirement to sort out decades of deficits and problems in weeks. It is gross mismanagement, and it comes from the top.

That situation is interesting. The hon. Member for North Swindon referred to his local primary care trust being in balance and that being synonymous with being well managed. He complained that the trust was bailing out others in deficit, and that they, by definition, according to him, were not well managed. It is not like that. There are all sorts of reasons why some trusts are in deficit and others are not. I am sure that the quality of management varies, but there is a weak correlation between deficit and poor management.

Almost all trust costs are determined centrally. The GP contract, consultants contract, "Agenda for Change" and the tariff are all set centrally. The trusts are given centrally determined costs, they are then given centrally imposed targets, and when the numbers do not add up, they are told that they do not manage efficiently or effectively.

Dr. Murrison : By that token, is the Liberal Democrat position that the cuts announced by the PCT should be made? That is the logic of the hon. Gentleman's argument.

Steve Webb : The logic of my argument is that more effective financial health service management by the Government would have prevented the deficits arising in the first place. Much financial imbalance and dislocation in the health service is caused by having to deal with sequential and constant reform. It has wasted huge amounts of money, and the responsibility for it lies with central Government.

What do we do about that, and how are the people of Wiltshire going to see improved health services? One thing that they will not do is benefit from fake, sham consultation.
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Mr. Wills : Will the hon. Gentleman give way?

Steve Webb : I had better not, because I am running out of time.

The British public have been consulted about health as never before—and ignored as never before. As the right hon. and learned Member for Devizes (Mr. Ancram) said, a consultation that does not even provide the option of keeping the community hospital open, is no consultation at all. Along with other Members present, I am a patron of the Community Hospitals Acting Nationally Together group. It has highlighted effectively the Government's rhetoric that community hospitals are right, and the reality that hospitals are shutting throughout Wiltshire, Gloucestershire and elsewhere. There is a disjunction between what the Government say they believe in and what is happening.

The Secretary of State says "More community facilities and more hospitals", and the Labour party manifesto says "More community hospitals". But in reality, up to all Wiltshire's community hospitals are closing. Will the Minister clarify the connection between the two? The Secretary of State says it, so why is she not making it happen? What is she doing to deliver that promise? The reality for the people of Wiltshire is quite the contrary, and I agree that the consultations are a sham.

My final observation is about national and local decision making. The people of Wiltshire should frame the health services for Wiltshire. There must be national standards and a national context, but, as far as possible, decision making should be local. It should be local and democratically accountable, not, as the hon. Member for Salisbury said, performed by non-executive directors who have been told to keep their heads down, and whom nobody elected and nobody can get rid of. That is where I differ from the Government, who claim to devolve, but keep the power in the centre and set so much of the local framework that there is little local discretion. It is also where I differ from Conservative Members, whom I do not think want elected, democratic accountability in the national health service. Again, when given the opportunity to introduce it, they did not.

If local decisions are taken about the national health service, as they should be, elected, not appointed, people should oversee them. I am not clear whether that is the Conservative party's position, and I hope that their spokesman will clarify it.

3.35 pm

Dr. Andrew Murrison (Westbury) (Con): We have had a lively debate, and it has been good to hear so many right hon. and hon. Friends, mainly, and other hon. Members contribute to the debate. Money lies at the heart of this matter, as with everything, but it is about not simply the total of money spent on the health service in Wiltshire, but how that money has been spent. It is a cause for regret that the hon. Member for Northavon (Steve Webb) spent most of his time laying into the previous Conservative Administration, without offering anything positive—a Liberal Democrat vision, if you like—for health care in Wiltshire. No doubt, it will be noted by those in the county who might be foolish enough to consider supporting the Liberal Democrats.
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At the heart of the funding allocation for our county, as elsewhere, lies the resource allocation weighted capitation formula. It is an 87-page document that I do not recommend to anybody. From the formula, it is clear that for a number of reasons, Wiltshire gets a relatively raw deal, chiefly because of its cost drivers, which are not adequately reflected in the formula. My hon. Friend the Member for North Wiltshire (Mr. Gray) read out some of the comparisons in funding that Wiltshire can expect, and what applies elsewhere. It is clear that we lie far down the funding league table. Of course, money matters; it would be foolish to suggest otherwise. However, the issue is also about how that money is spent, and that is chiefly what the Conservative debate has been about this afternoon.

Mr. Wills : Will the hon. Gentleman clarify the basis of his point? He seems to be making several different points all in one. Is he talking about what he considers to be the relative unfairness of Wiltshire's funding, the absolute sums involved, the way in which whatever money is allocated is actually spent, or all of the above? Will he remind the House of the increase in NHS funding that Wiltshire has received since 1997?

Dr. Murrison : The answer is all of the above. Of course it is, and I thought I made that clear. The hon. Gentleman will also remember that the Opposition went into the previous election pledging to match the Government's spending on the national health service—a point that the Liberal Democrats might like to bear in mind.

It is important to remember that the issue is about not simply spending money. That is a lazy way to approach the issue. If we were to approach it in that way, as the Liberal Democrats do, we would not move on at all. The question is about how we spend the money. In Wiltshire, it is not clear whether the money has been and is being spent in a way that will maximise the effect for patients.

We have talked about the primary care trust. My view on the way in which it has contributed to the sorry pass in which we find ourselves are best left outside the Chamber. It would be unfair simply to lay into the primary care trust. Ministers need to own the issue, not least because of their stated commitment in the White Paper, "Our health, our care, our say: a new direction for community services", which appears to be completely at odds with what is happening on the ground.

The Minister must know that the preferred option of the Kennet and North Wiltshire and West Wiltshire primary care trusts is to close all community hospitals, with one particular exception. That is the reality. How on earth does it marry with the intentions laid down in that White Paper, which is just weeks old? It simply will not do. I shared the delight of my right hon. and hon. Friends when I read that document. It is rare for a member of the official Opposition to be delighted in such a way, but I genuinely was when I came to paragraph 6.42, which laid out clearly and categorically—no ifs, no buts, no margin for error—the Government's support for community hospitals.

Such support accords with the views of the vast majority of my constituents. Frankly, I do not need a sham consultation exercise to know what people in my
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constituency want in respect of local health care. Surely none of us does who keeps an ear to the ground in our constituencies. I am sure that that goes for all Members here this afternoon. We know what people want, they tell us all the time, and it is not just the usual suspects but also those so-called hard-to-reach groups that the Minister says she is so keen to listen to. I presume that it is for those people that she has held hugely expensive consultation exercises across the country. We listen to those groups just as much as we listen to anybody else, and they say that they want the model of health care that is, in fact, supported by that document, yet the primary care trust—the Minister's vicars on earth in Wiltshire—are doing something completely different. Ministers surely must understand that that is not acceptable, yet so far I have not seen any measures by Ministers to curtail what is happening on the ground.

I hope that the Minister, who has listened carefully and attentively to what has been said this afternoon, will go to her officials and ask them, through the strategic health authority, to try to work out exactly what the PCT is doing in Wiltshire and to try to accord it more realistically with her Government's policy in the White Paper. I sincerely ask her to do that, and, if she does, I shall be the first publicly to shower her with laurels in Wiltshire. I am sure that her party would benefit, not that it would do her much good.

Mr. Ancram : Does my hon. Friend agree that, if the Government were to tell the PCTs to do something different, they would have to deal with the areas of underfunding that I discussed? The consultation document sets out the financial position. At present, PCTs are working within such restrained budgets that they have to make many unpleasant decisions that fly in the face of what the Government want them to do.

Dr. Murrison : I entirely agree with my right hon. and learned Friend, and I share his disquiet at the behaviour of some non-executive directors, who I believe should represent the views of local people. Too often, I find that they have been taken into the organisational big tent and will not speak up on behalf of people, and that is a worry. If they have a value at all, it is precisely in articulating the concerns of local people. They may have a view, of course, and they may feel driven by logic in a particular direction. Nevertheless, their function surely is to articulate the concerns of local people. However, often, we find that that is not happening, and that is a great pity. I take his point entirely.

I suppose that I feel for the PCT and its officials, as they are trying to balance the books, and that cannot be easy. It is our function to shout and scream when we see a problem that involves money. I hope that the Minister will listen to my right hon. and learned Friend's comments, particularly in respect of the write-off, which is only fair. It took me, as the MP for Westbury, quite a long time to work out exactly how the deficit had arisen and how on earth had we come to that point. I have no doubt that, without the deficit, the options document would not have been necessary. As hon. Friends have said, it is clear that it was driven not by a desire to improve health care in Wiltshire but by the need to sort out the deficit, which is largely historically driven.

Mr. Wills : The hon. Gentleman did not exactly address the question of the right hon. and learned
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Member for Devizes (Mr. Ancram), but I would be grateful if he did so. The right hon. and learned Gentleman is making a case that Wiltshire is underfunded. I would be grateful for clarification as to whether Conservative Members are arguing for even greater investment in the national health service overall, so that Wiltshire can get its due share and be able to deal with the financial issues, or whether they are arguing for a reallocation of some of the existing pot to Wiltshire, and, if so, from which part of the country they are seeking that reallocation.

Dr. Murrison : It is clear from the fact that so many health trusts in Wiltshire are in deficit that it is not simply because of bad management. It would be a bizarre statistical quirk were there to be so many trusts in Wiltshire that were in deficit for that reason. Trusts try to benchmark their provision of services against other trusts, so I am driven to conclude that there is a problem with the resource allocation weighted capitation formula. I hope that we can look at that to ensure that the cost drivers in Wiltshire are adequately reflected. Given that it is so low in the league table of spending, I believe that it gets less than its fair share. I would say as a constituency MP but also as a Front-Bench spokesman that the formula does not adequately reflect some of the cost drivers. I hope that that answers the hon. Gentleman's point.

I would like to turn to how we can make the best use of our resources. Shutting down community hospitals simply will not work. If the case mix is right, community hospitals are, in fact, cost effective. I have made that case repeatedly in the Minister's presence, and I rather hoped that Ministers might look into it. The data are available, and it is simply not sufficient to say that money will be saved by closing down community hospitals, as the costs are passed on somewhere else. They are passed on to acute hospital trusts, yet the cost of treating someone in a community hospital is probably one third the cost of treating them in hospitals such as the Royal United, the Salisbury District or the Great Western.

Costs are also passed on to social services, and we are seeing that big time in Wiltshire. My right hon. and hon. Friends have received a letter from Councillor Jane Scott, the leader of Wiltshire county council, in which she makes the point that the PCT, which has a turnaround director in place and the district auditor breathing down its neck, is passing costs on to social services. One may say that that is well and good, that the PCT is putting its books in order, but the truth of the matter is that the cost to the public purse of treating and managing people in need is not being affected one jot. It is simply an accounting exercise in passing costs elsewhere, in many cases to bodies that are more expensive for treating a condition or set of conditions, in the case of the elderly and the long-term sick. Everybody loses: the public purse does not benefit, patients do not benefit and, my word, carers do not benefit at all.

One of the problems with passing costs on to social services—putting people at the door of social services—is that carers bear much of the burden. That burden is uncosted. As far as the state is concerned, it is a free good. We are all guilty, all too often, of ignoring that, but a great deal of what is happening in Wiltshire at present will, unfortunately, result in carers picking up much of the tab.
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One or two hon. Members mentioned so-called super-surgeries. They appear quite often in the consultation document to which we have referred. It is interesting that when one gets on the phone to speak to those at the PCT who are responsible for the document and asks them precisely what they mean by super-surgeries or primary care centres, they are not too sure. At the end of the day, what it boils down to is a large general practitioner surgery. We are not clear about precisely what services will be offered on the premises.

I have been accused of being sentimental about bricks and mortar when discussing community hospitals. What is more sentimental—what represents more of a preoccupation with bricks and mortar—than someone saying that they will set up a primary care centre without saying what will be done in the building? The consultation document states that screening services will be carried out, which is very nice, but, scratching a bit further, the precise form of screening is obscure. We understand that there will be GP-run dermatology clinics, but GPs are perfectly capable of running clinics from their existing premises. We understand that optometrist-run assessments will continue locally for patients with cataracts. As it happens, Westbury community hospital, which is scheduled for closure, has an extremely well received cataract service that recently treated Christopher Booker, who talked about his experiences positively in the press recently.

Mr. Wills : Will the hon. Gentleman give way?

Dr. Murrison : I have been rather generous in giving way, but I will do so one last time.

Mr. Wills : The hon. Gentleman has been very generous, and I am grateful to him. I want to help him. If he wants to know what these surgeries can deliver, I invite him—and indeed the Minister—to Taw Hill surgery in my constituency to see exactly what can be done with a forward-looking super-surgery.

Dr. Murrison : I would be delighted to visit, and I thank the hon. Gentleman for the invitation. It is amazing what living in a Labour marginal seat can do for someone, if I may put it that way. I am not aware of any such premises in my part of the world. I would have to ask him precisely how the super-surgery—I assume that that is what it is—to which he refers deals with the core of primary care, which is the care of the chronically sick and the elderly.

Time does not permit me to wax lyrical about primary care, how it should be and what damage the Government are doing to it, but the heart of primary care is having to deal with the long-term sick and the elderly. I am afraid that it is those groups who stand to suffer greatly from the amalgamation of GPs' surgeries into so-called super-surgeries that will reduce choice and make access much worse.

I am afraid that mental health in my constituency is heading south, both literally and metaphorically. We are losing Charterhouse, which has 26 in-patient beds for the elderly mentally infirm. My constituency is losing all four of its community hospitals. We are losing 60 beds at the Royal United hospital. The common thread in all those closures is the effect on the elderly, the
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mentally infirm and the most vulnerable. In what way is this the best year ever for my constituents, for Wiltshire and for the NHS?

3.52 pm

The Parliamentary Under-Secretary of State for Health (Caroline Flint) : I have less than 10 minutes to speak, so I probably will not be able to take interventions, and I might have to write to people on a number of the issues raised. I congratulate the hon. Member for North Wiltshire (Mr. Gray) on securing the debate. Clearly, the Conservative, Labour and Liberal Democrat parties are represented here today by champions for their local communities, and that is right and proper.

If I could make a point about the comment made by the hon. Gentleman on my activity yesterday, it is fair enough for me as Minister with responsibility for public health—that is my main role—to preface my contribution by mentioning something that has not been discussed much today. I want to talk about why it is so important that, at the heart of the discussion on what hospitals provide and what more could be provided in the community, there should be debate about whether we are prepared to challenge the traditional ways in which our health services have been provided.

There has been an emphasis on treatment, which has improved enormously over the past 10 to 20 years in terms of drugs, technology and so forth. The area that has not been given attention is the role that we can all play in public health to prevent long-term conditions that have to do with how people live their lives. More could be done on that. That is a challenge for all of us, because—many hon. Members raised this point—that is about how we can best meet people's needs, get ahead of the curve, and ensure that there are facilities closer to where people live, particularly those in communities that, because of health inequalities, are not accessing services. How can we change their futures? By considering that, we could get better health outcomes, but we also have to challenge the thinking on where finances are directed. We have to think about how we can turn around our thoughts about the health service to prevent and to manage long-term conditions. Importantly, we should also think about shifting some funding from the acute to the primary sector in working on prevention.

Something like just 2 per cent. of NHS spend, which we know is at historically high levels, is currently defined as being on the prevention side. The challenge for all of us is to think outside the box about how those services are provided. I have no problem with what I am doing in promoting public health, because that is at the heart of changing the way that we think about health services.

Performance across Avon, Gloucestershire and Wiltshire has improved. The Secretary of State, backed by the Prime Minister, was trying to put in context the fact that, in a number of areas, certainly when I became a Member of Parliament in 1997, uppermost in people's minds were waiting times, the amount of time that people spent waiting in accident and emergency, cancer and heart disease, and poor service. That was eight, nine
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or 10 years ago. In all those areas, there has been improvement. In the constituencies of hon. Members present today, there were two patients waiting more than six months for in-patient treatment this February. That is compared with more than 11,000 people waiting more than nine months in March 1997. As of December 2005, there were 12 patients waiting 13 weeks for out-patient treatment with a consultant, compared with nearly 14,000 patients in May 1998.

In December 2005, 99.2 per cent. of people with urgent suspected cancer referrals from GPs were seen by specialists within two weeks of referral. Also in December 2005, 98.8 per cent. of patients were seen, diagnosed and treated within four hours of arrival at accident and emergency. I believe strongly that some of that is to do with extra resources. However, I also pay tribute, as other hon. Members have done, to staff, not only for their hard work, but for their willingness to look at their traditional working practices and think about how they can deal with them differently. That is about not just the acute sector and hospitals, but primary care. For example, we all know that there are significant numbers of people who go through accident and emergency whose needs could be dealt with elsewhere in the community.

Dr. Murrison : Will the Minister give way? I will be quick.

Caroline Flint : I will take just one intervention from the hon. Gentleman.

Dr. Murrison : I entirely agree with the Minister's comments about health care workers, but a very senior member of the cataract team at Westbury community hospital, who has been instrumental in the way that the Minister describes, came to see me recently, and she was distraught at the way in which the service is being shut down.

Caroline Flint : I hear what the hon. Gentleman says, but I cannot respond to that straight away, although I am happy to look into it. I will try to get on with my response to comments made by other hon. Members.

A point was made by the hon. Member for North Wiltshire about the consultation process. I understand that there was lengthy public engagement prior to the consultation. That complied with the requirement to consult the public that is set out in section 11 of the Health and Social Care Act 2001. The oversight and scrutiny committee was consulted, too.

As for what is next, and the options on the table, the OSC can apply for independent review if it believes the consultation process to have been flawed, or it can apply for judicial review. That is also an option for local people. I have had a look at the document, but I am not here to sign up to any particular option. Some hon. Members have left parts of the consultation document out of their contributions. Those parts include considering having new neighbourhood teams to cover all community areas, and providing 24-hour access and new primary care centres.

My hon. Friend the Member for North Swindon (Mr. Wills) made a point about the opportunity to provide services currently provided in hospitals in super-health
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centres that include GP practices. I have seen that for myself. I have been to practices where there is not only a GP practice and hospital-based services, but pharmacies and opticians, and they are connected to a network. Therefore, there is a lot in the document that addresses the need for community-based services and the way in which they can be fit for the future. Of course, community hospitals have a role in that. The Secretary of State did say that they had a role, but she said that they had to justify it and say how they would meet future needs and provide a range of services, and that is right.

My hon. Friend the Member for North Swindon talked about progress in his area. I would just like to acknowledge my hon. Friend the Member for South Swindon (Anne Snelgrove), who is here this afternoon. Her local primary care trust's finances are in balance. I am not saying that the problem is always poor management; some poor managers have left, leaving others to pick up the pieces. However, there are questions to be asked about why PCTs in some areas can balance their budgets, consider how they are operating and improve.

There is a distinct lack of understanding about health inequalities and the needs of communities on the part of those on the Conservative Benches. [Interruption.] Well, I am afraid that there is. There has been no acknowledgement that there are certain needs that have to be met in terms of health outcomes. I am sure that there are health inequalities in their areas, and I hope that, if services are organised, the needs of those communities can be met.

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