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9 May 2006 : Column 242

I consider that very significant. I should like us to get rid of a lot of political advisers, and to listen to the professionals, the patients and the public. The Government must ensure that replacements for the patient involvement forums are provided very soon, and that they have teeth and can do something. They are the very people who can help the NHS to be a genuinely patient-led service.

I will leave the last word to a retired consultant who wrote this to The Independent last Friday:

He went on to list the major problems.

he wrote,

7.49 pm

Kali Mountford (Colne Valley) (Lab): As usual, this is an interesting debate. At some points, it has featured the breaking out of an understanding across the House that all parties should be committed to the NHS. However, as I listened to the speeches of some Opposition Members, it occurred to me that they could will the ends but not the means for that understanding to grow. Conservative Members have been critical. They cannot pretend that their opposition to providing proper funding was not clear, given that they refused to vote with us to ensure that the NHS was properly funded. They said then that it should be made clear that there will be reform and value for money, and it was obvious that they were not in favour of increasing the salaries of NHS staff. During today’s debate, they are saying very loudly that they support NHS staff, including doctors and nurses, but they are still critical of the increase in pay.

Pay is a significant issue. Conservative Members have talked about motivating NHS staff, but we cannot motivate them without willing the means for them to feel valued. That must include a proper salary and a proper job design and structure, which has certainly been missing for many people. A nurse can now advance her career—or his career, given that nursing is increasingly a male occupation—from a starting salary of £19,000, through grades that used not to exist, and take on management and important clinical responsibilities that used not to exist. Such a structure makes it clear to nurses that they are highly valued.

Sandra Gidley (Romsey) (LD): I am curious to know which professions the hon. Lady thinks are lacking in direction and focus. Does she agree that although it is perhaps right to increase NHS pay, one problem is that the increased wage bill has not been linked to an increase in productivity? So we are paying more, but not necessarily getting anything for it, the prime example being the consultants’ contract.

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Kali Mountford: The hon. Lady is trying to have her cake and eat it, as ever, but that is the Liberal Democrat way, is it not? It is important —[Interruption.] The hon. Member for Beverley and Holderness (Mr. Stuart), who has been rather excited throughout the debate, should try to contain himself. He will doubtless get his opportunity to speak at some point. I await that with bated breath.

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

Kali Mountford: No, I am finishing my response to the point made by the hon. Member for Romsey (Sandra Gidley), which deserves an answer. We are entitled to expect results from consultants, but should such an expectation be included in their contract? There is a proper argument to be had about what should be included in the contract, and in my view, we should be able to demand certain outcomes from consultants. On the other hand, there are those who criticise the Government for insisting on certain outcomes. [Interruption.] The hon. Member for Romsey shakes her head. Perhaps she is not among those critics, but Conservative Members certainly have made such criticisms. They say that the medical profession should decide for itself how it operates its businesses. [Interruption.] The hon. Member for Beverley and Holderness decries my argument, but I have heard his own Front Benchers say, “Leave it to the medical profession. Free it up to do whatever it likes.” That is a nonsensical approach. However, the hon. Member for Romsey made a valid point and it is worthy of consideration.

It is very important that we motivate NHS staff and show that we value the work that they do. It is disappointing that they have other issues with us, and the House will be surprised to hear that I do not entirely blame them. Their concerns are entirely understandable. As someone who had to manage change in large organisations, I entirely understand how difficult it is for people to cope with continual change, which leaves them feeling in a state of flux. We need to do more to manage change.

I am not entirely convinced by the argument of the hon. Member for Northavon (Steve Webb), who said that the problem is that change is happening too fast. Some of my constituents would cry out for more and faster change if they felt that it would benefit patients. The question should be: what will bring about the best results for patients, not for doctors or managers? These are very difficult problems to grapple with. A continually changing NHS is having to cope with new treatments coming on stream, for example. We need to balance the NHS’s differing demands in a sensible way. Simply slowing down the process of change would not, of itself, be the answer.

That brings me to a very difficult problem. A lot of change is taking place in my own area. The hon. Member for Shipley (Philip Davies), who slid out of the Chamber earlier, drew the House’s attention to an independent candidate who stood on a ticket of opposition to change in the NHS. Incidentally, that candidate beat a Liberal Democrat in the local elections—a point that the hon. Gentleman failed to mention. I can understand why some people say, “We don’t want change in the NHS.” They have grown to value the NHS and they feel that it is best left as it
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is—until they hear of a new treatment, which they want “today”. Herceptin is a valuable example. At first, the primary care trust in my constituency refused to supply it, but after some debate about the savings to which its introduction could lead, the PCT changed its mind, and patients now have that choice.

That brings me to the question of where the balance should be struck. We have said that decisions should be made as locally as possible, yet when they are so taken—free from political interference, hopefully—do PCTs, which are charged with responsibility of consulting the public on such changes, listen sufficiently carefully? How should they then balance public demand against what clinicians tell them is best for patients? Conservative Members have put forward both sides of the argument. They have said, “Save my hospital, because I don’t want anything to change”, and in the very next breath said, “We ought to allow such issues to be decided locally, and we should be brave enough to shut down certain hospitals.”

The truth is that both positions can be right. Some hospitals have simply outlived their usefulness. St. Luke’s hospital, in my constituency, mainly cares for patients with mental health problems. Mental health treatment has changed enormously in recent years, and it is right to reconsider how we provide such care. St. Luke’s has acquired a new building that is closer to the general hospital, and it could be used in a different way. The administrative facilities could be moved into that building, thereby allowing new treatments to be delivered properly in a major hospital.

For some people, a major hospital is not a pleasant experience or a good place to be. It is better for those with mental health care needs, in particular, to be treated in their own homes by a community nurse or a community psychiatric nurse. Such decisions are the appropriate ones to take, but there are more difficult and demanding ones. Sometimes, the clinical need is not clear, and the community take a different view on what should be delivered from that taken by the PCT, the hospital trust or even the Member of Parliament. [Interruption.] I see that the hon. Member for Shipley has returned to his place, and I am very glad that he is here. When he stood against me in 2001, I enjoyed his company greatly. I also enjoyed it when he stood for election to the local council, and I am sorry to have to tell him that his friend, who stood and won, has now lost her seat. I am grateful to him for bringing to the House’s attention the fate of his own party and of the Liberal Democrats.

The independent candidate to whom I referred earlier won her seat fighting on a ticket of opposition to NHS cuts. It is easy to utter slogans about health, but it is not a responsible thing to do. [Interruption.] Conservative Members laugh, which may sound fine in a debate, but it is not a very sensible attitude to take. If we are to make proper decisions about local health care, we have to accept that those decisions will sometimes be difficult and that sometimes the public need to be listened to. Part of the argument about hospital reconfiguration in my constituency—which needed more care in the decision making—concerned maternity services. The hon. Member for Romsey and I have discussed the issue in the Chamber before. The way in which maternity services can be delivered is changing and that should be part of a plan, but it should not be the only plan.

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The difference between maternity services and, for example, mental health care, orthopaedic care, heart surgery or cancer treatment is that all those expecting a baby hope and expect that their experience will be normal and a family event. They do not necessarily consider it as a health intervention. In fact, it would be a bad thing if they did. Birth should be as ordinary and as happy an experience as possible.

Mr. Gray: I agree with the hon. Lady. It is important that maternity services are midwife-led and available in community hospitals. Given that that is the case, why have the Government closed the midwife-led maternity units in Malmesbury, Devizes and Trowbridge? Such units have been closed in seven hospitals across Wiltshire, so that the only places to have a baby are Bath and Swindon.

Kali Mountford: In fact, my community disagrees with the PCT. The community wants an ordinary maternity unit in the local hospital and does not want a midwife-led unit, so we are on opposite sides of the argument. My personal view is that midwife-led units can, in the right circumstances and with the right support, be of great benefit. Midwives are the right people to make decisions and help a mother through all prenatal care, the delivery of the baby and some of the postnatal care. The relationship that can be built up over a period of time is valuable to a safe birth and important in helping mothers to take decisions that lead them away from unnecessary interventions, such as elective caesareans. As soon as a pregnant woman visits the local maternity unit, she sees shiny pieces of equipment and thinks, “Oh my God, I need some of that. It is bound to all go wrong and I want to ensure that I am as near to that equipment as possible.” That has been the undercurrent of the debate on health.

Some people in the community claim that the issue is cuts in public spending on health, but nothing could be further from the truth. In fact, the argument started five years ago when the health authority took a decision against the advice of the hospital, which wanted to move maternity services into one huge unit—a sort of super maternity unit. We rejected those plans, although the hospital claimed at the time that it was a matter of clinical need. The hon. Member for Wyre Forest (Dr. Taylor) has mentioned clinical need, but the problem is that clinical decisions are not always straightforward. Clinicians argue about them all the time. Indeed, clinicians from all over the country came to my constituency to argue about the best way forward for delivering babies. There is not only one point of view or one way of delivering excellence. That is fine, if the community backs the eventual decision. If everybody in my community demanded a midwife-led unit, I would not blame them for doing so, because it could be an excellent move. However, if it were introduced against the wishes of the community, we would have a problem, because it would be set up to fail —[ Interruption. ] The hon. Member for Westbury (Dr. Murrison) laughs, but—

Dr. Andrew Murrison (Westbury) (Con): That is a bizarre argument.

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Kali Mountford: It is not a bizarre argument, because we would be introducing a service for a public who do not want it. Does the hon. Gentleman really expect that a young mother would decide not to go to a hospital where she could get all the intervention that she thinks she might require and that she has become used to over the years? My constituency has one of the lowest rates of home births. It is not the norm for mothers there to elect to have that form of delivery, nor is it the norm for them to consider midwife-led units. If such a unit is set up without a proper explanation of how it can benefit mothers and without proper support, does the hon. Gentleman think that they will elect to go there?

Dr. Murrison: The hon. Lady obviously has not listened to my hon. Friend the Member for North Wiltshire (Mr. Gray), who argues in favour of midwife-led maternity units. In my constituency, as in his, such units are being closed, and there are huge ructions in the community as a result. That is probably what she is trying to say and, if so, we may have found a point of agreement.

Kali Mountford: The hon. Gentleman misunderstands. I am saying that there is not only one way of delivering maternity services, nor is there only one public view on them.

Mr. Gray: We want the choice.

Kali Mountford: I accept that, and my constituents want the choice. However, they do not want the option that is being presented to them, after a lengthy consultation, by the PCT. The PCT received a petition with 50,000 signatures and 2,000 postcards from my constituents—the proposal covers three constituencies—and a different petition with 30,000 names. Despite that, it came to its bizarre conclusion because the clinicians thought that the best way forward was to separate out maternity services, send potentially difficult cases to another hospital in a different town and have only a midwife-led unit in Huddersfield. The community said, properly, that it was used to what it already had and did not buy into the PCT’s suggestion. The hon. Member for North Wiltshire (Mr. Gray) said that his constituents value their midwife-led unit, but my constituents do not yet agree with him. They demand the choice, and perhaps that is where we agree.

Mr. Gray: The hon. Lady is doing a masterful job in making up for the shortage of Labour Members wishing to speak, so I am sorry to encourage her further. However, she is missing the point entirely. Seven hospitals across Wiltshire are being closed and there will be no choice for mothers. The units will not be midwife-led or use any other system, because her Government are closing those hospitals. Why?

Kali Mountford: The hon. Gentleman needs to think again about how he presents his argument —[ Laughter. ] Well, Opposition Members laugh, but they are misrepresenting the case. It is the primary care trusts who are charged with the task of consulting the hospital trusts and making the decisions. It was a clear decision by the Government that such decisions should be made locally, and that is where the next dichotomy arises. The community in my area want one thing, but the PCT and the hospital trust have come to a different
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conclusion. I want decisions to be taken locally that take account of the community’s views. Where do we go from there? Well, we go to the Secretary of State, who then acts as an arbiter.

My personal view is that we should have an independent inquiry into the issue. PCTs must take their responsibility for their communities seriously. They are charged with the duty of consulting properly. In this case, no fewer than 100,000 people—assuming that people signed only one of the petitions—made their views known, and if the PCT does not take account of that, it should look closely at the way in which it makes decisions —[ Interruption. ] Opposition Members are giggling and perhaps they will share the joke with the House when they make their own contributions. Why do Opposition Members think that it is funny that I want to champion the cause of my community, which has had a dreadful experience with a consultation with the PCT?

I have had several meetings, and a debate in Westminster Hall, about this matter. I am unhappy that my constituents will not get the service that they are demanding, but also at issue are important questions about how we set up the local delivery of health services. How do we charge PCTs with the task of making sure that those services are what is wanted by the people who, through their taxes, pay their wages? That should be a simple question for Opposition Members to understand, but ensuring that we have a democratic NHS might be too difficult for them.

The hon. Member for Wyre Forest said that clinicians were the only people who should take such decisions, and that the balance must lie somewhere between the outrage exhibited by Opposition Members on the one hand and that expressed by Labour Members on the other. He may be right about that, but arguments about the local delivery of the NHS should not cause us to blame the Government for local decisions, nor to do the opposite—that is, scurry back to the Government about every local decision that we do not like.

The argument is difficult, but there is one matter about which I agree with Opposition Members, so perhaps they should not giggle quite so much. The hospital trust in my area is being reconfigured, but changes in the PCT are also being considered, as I shall explain.

The PCTs have more money to spend in our communities than ever before, and they control huge budgets for the delivery of community services to our constituents. That is valid and valuable but, when PCTs were being set up, I argued fiercely that they should be as local as possible. I was very glad that it was decided that my PCT should be very small, as my community is very different from the ones that surround it. I thought it important that my constituents’ views about how their money is spent on their health services should be taken properly into account, and I still do.

My right hon. Friend the Member for Rother Valley (Mr. Barron) spoke about health inequalities. The inequalities that exist between my constituency and that of my hon. Friend the Member for Huddersfield (Mr. Sheerman) are very stark. Given that PCTs are being reviewed, it is important that the proposed new structures are looked at.

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I have made a counter-proposal and I hope that the Government will listen to it. It should be clear to the House that I place great value on giving people in the community a say in how the NHS is run. I understand why a bigger PCT could deliver better value for money, and why bigger management teams could be slimmed down. However, I fear that that approach could cause us to lose something that I value very much—community involvement in the NHS. The House may not value that as much as I do, but I believe that that is how we can make sure that what is delivered is in the best interests of my community.

My proposal is that we look at how we can build a smaller, locality-based form of PCT into the overarching management committee that covers a number of PCTs. I have discussed the idea at length with my right hon. Friend the Secretary of State and other Ministers. The advantage would be that funding for each area could be ring fenced and so deal in part with the problem raised by my right hon. Friend the Member for Rother Valley. That is, people in richer areas would not be able to raid the funds of the poorer areas.

There is a huge difference in how the two PCTs in my area are funded. The per capita funding has been greatly reduced for people living in areas where health inequalities have had less impact, whereas it has been greatly improved for the poorest people. That has to be right, but my fear is that a much larger PCT would have an adverse effect on the management of health inequalities.

Such problems matter. If we do not think about patients’ experience of the NHS, value what they say about what they want and stop the richest raiding the funds of the poorest, how can those who need the most get what they need? I hope that Ministers and the Secretary of State will look carefully at the proposals for the Kirklees PCT, and the proposals that I have made about making the best use of resources. I accept that an over-arching executive board would be cheaper than having three separate boards, but we must retain the important and valuable role played by non-executive board members. Their work as advocates for their local communities will mean that, when future consultations are held about the provision of health services in my area, people can be assured that they will get value for money and the health service that they crave.

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