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2.35 pm

Michael Jabez Foster (Hastings and Rye) (Lab): I am grateful for the opportunity to celebrate the health service in Hastings and Rye, and the improvements that have taken place in the past eight years. Primary care services have been transformed, and in the main, general practitioners offer a more comprehensive service than ever before. The Marlborough health centre that was opened 18 months ago by my right hon. Friend the Member for Airdrie and Shotts (John Reid) is a fine example of the co-ordinated services that can be provided at local level. We look forward to three other such centres in the town.

The local Conquest hospital is performing well. As a result of the hard work and dedication of our magnificent staff, no one waits more than 13 weeks for out-patient treatment—the average wait is six weeks—and no one waits more than six months for surgery, with an average wait of eight weeks. In the past two years, an MRI scanner has been replaced and a new CT scanner has been installed. We have an ageing population, but a new cardiac care unit ensures that local people have access to life-saving treatment in their own locality. All of that is possible because of the Labour Government’s reform and investment after years of under-investment. Our local primary care trusts—Hastings and St. Leonards and Bexhill and Rother—under the chairmanship of Marie Casey and John Barnes, with Toni Wilkinson as joint chief executive, have delivered precisely what the Government required.

The hon. Member for Bexhill and Battle (Gregory Barker) has remained in the Chamber, and I suspect that he will support what I am about to say. Hastings, which was the 34th poorest town in Britain, has received significant extra funding to take account of the more challenging health outcomes for people living in less affluent areas. Why would anyone want to change a system or programme of delivery that is working? Three distinct areas of concern arise from the strategic health authority’s proposal, which has caused disquiet—indeed, outright opposition—among local practitioners and the public. I hope that the Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), will assuage our fears about the restructuring of local PCTs, the funding regime and the targeting of resources, and the reorganisation of Conquest hospital services, including the accident and emergency department.

The future of our PCT is important to local delivery. The Government recognise the need to target resources on the most needy and to use local commissioning for that purpose, which is why they set up local PCTs, such as Hastings and St. Leonards and Bexhill and Rother, that can work to that end. Hastings and St. Leonards PCT has not only worked effectively over the past four or five years but is on budget. It has shared resources with Bexhill and Rother PCT, and has a joint senior management so that it can secure the benefits of local delivery on an appropriate scale. The outcomes, such as
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a fall in teenage pregnancies, have proved the effectiveness of that arrangement.

To fulfil the Government’s ambition of commissioning a patient-led NHS, the SHA suggested that there was a need to create an all-county organisation to the incredulity of local representatives, including MPs and the local councils. We have made our objections known, and I thank Ministers in the Department for insisting that the SHA consultation should consider retaining a local PCT in East Sussex to cover Hastings and Rother. That gave us considerable hope.

Unfortunately, although almost every organisation supported the retention of an excellent local service, the SHA has now recommended its original proposal for an all-county arrangement. The proposal is patently wrong and conflicts with Government policy. How can we possibly target poor areas if they must share their allocated resources with rich areas? That is not targeting at all.

My right hon. Friend the Secretary of State for Health, in answer to a parliamentary oral question, acknowledged that poor areas in rich regions face a particular challenge. The fact is that rich regions consume services at a much greater rate than their poorer neighbours. That is why the south-east of England is in such trouble. It is in the nature of the health service, and has always been, that richer middle-class areas will always create demand beyond their need and will soak up resources from poorer areas if they are given that opportunity.

My right hon. Friend the Prime Minister agreed at Prime Minister’s questions on 26 April to consider the proposal, and I hope that my hon. Friend the Minister has now had a chance to discuss it with him. I cannot overstate how seriously we view the issue. It would be a betrayal of Government policy to share out the resources that are intended to target the poor with the leafy glades of the west.

I know that, in other parts of the country, there are proposals for PCTs of a similar size as that proposed for Hastings and Rother but, in our area, the issue is even more important. The PCT in Hastings has managed to be in-budget and still deliver its objectives. Rumour has it that Sussex Downs and Weald—the PCT that would be joined—is £2 million overspent and that Eastbourne Downs PCT is about £8 million overspent. Why on earth should we pick up their debts?

My right hon. Friend the Secretary of State wrote to me on 30 January and I have her letter here. She told me that, for the years 2007-08 and subsequently, the funding for the Hastings PCT would be £1,552 per person compared with the national average of £1,388 to reflect the special needs for the provision of GP services in Hastings. It is self-evident that if we lose the ability to receive the money for Hastings through a local PCT, that promise cannot be sustained.

The second reason why such targeted resources may not arrive is the next point that I want to raise—the proposal to top-slice funding for our local PCTs by3 per cent. for the next two years. I have already acknowledged the significant increased funding that the local health economy has received. The promise, as demonstrated by the Secretary of State’s letter, was that in the case of Hastings PCT—the increases in Rother
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were similar—we would receive an extra 9.1 per cent. for this year and an extra 9.4 per cent. for the year after. That is more than £10 million extra for the next two years. Now the SHA tells us that, because ofthe need to balance the books in each of those years,3 per cent. of the budget will be withheld.

I well understand why the Government need to balance their books, but why on earth should it be fair to take from the poor, such as Hastings PCT, who have managed their budgets and give to the rich who have not? I have already mentioned the massive overspend in Sussex Downs and Weald PCT and Eastbourne Downs PCT. Furthermore, the overspend nationally appears to be about 1 per cent., so why should we who happen simply by misfortune to be in the south-east suffer more from an effective reduction of 3 per cent. compared with the national reduction of about 1 per cent.? I know that the Ministers have said that this will simply be a loan that will be repaid, but how will it be repaid? As a lawyer, I tell my hon. Friend the Minister that a loan means that there is either a programme for repayment or that it is a loan at will, which means that one can get the money back when one asks for it. What is it to be? What is the basis of the loan?

Surely it is wrong to disadvantage by administrative action areas such as Hastings, which the Secretary of State specifically says she wishes to advantage. It is the more galling when I say that Hastings PCT does such excellent work and within budget. If there is no Hastings PCT, who is the loan to be repaid to?

I come to my third point, but assure my hon. Friend that I have no vendetta against the SHA, although it may sound that way. However, it appears that, yet again, it is the villain of the piece. Earlier this year, we were presented with an SHA paper headed “Creating an NHS fit for the Future”. It claims to be a consultation on improving services in Surrey and Sussex. The paper is described as a consultation, but states that

I do not take the luddite view that nothing needs to change, but I believe that the SHA is starting from the wrong premise. In short, the proposals are that, in the future—from, I think, about 2009—acute services should be delivered at four possible venues: at super-specialist hospitals at one end and local health centres at the other. Quite right. There would then be two intermediate forms of general hospital: one sort dealing with major trauma and accident and emergency, and another sort having a subservient role, which in our case has been described by the local media as the cottage hospital option. The SHA proposes that, generally, populations of about 400,000 would be needed to support major acute accident and emergency centres.

In terms of the local delivery in my constituency, the East Sussex Hospitals NHS Trust is responsible for two general hospitals: the Conquest hospital in Hastings and Eastbourne district general hospital. Both have excellent accident and emergency provision, which local people wish to retain. Indeed, I would put it more strongly: that is not subject to negotiation. Of course, the SHA has not proposed the closure of major
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services at either hospital, but pre-emptive strikes are sometimes appropriate and prevention is always better than cure.

The problem is that the SHA suggests that major accident and emergency centres should operate across populations of about 400,000. That leads the residents of Hastings and Eastbourne, and their local newspapers, to read between the lines. They read that to mean that at least one of the hospitals will be downgraded. At present, both communities worry that it will be theirs. Both in Hastings and Eastbourne, local headlines refer to the downgrading to cottage hospital status. I took the view that that was nonsense. I asked the SHA to confirm that, whatever the changes, proposals for a cottage hospital were simply not on the cards. Imagine my surprise when I was told that open consultation meant that nothing could be discounted.

I want my hon. Friend to say unequivocally that the Conquest hospital—and perhaps Eastbourne district general hospital—will not become a cottage hospital and that, although new and expensive services may well be provided in more regional settings, the existing provision will be maintained. That must include accident and emergency provision and I will tell her why that is so important. Hastings and Eastbourne have ageing populations and the infrastructure in the south-east, including the A259 coast road, is extremely bad. My hon. Friends in the Department for Transport are seeking to do something about that, but that will be some time off. The idea of travelling in an emergency—be it a heart attack or a serious road traffic accident—distances of perhaps 30 miles on those blocked roads is a bizarre interpretation of the expression “improving services”. That would be disastrous and could cost lives. It is a complete non-starter.

That worry has resulted in the “hands off the Conquest” campaign, which is being formed by the friends of the Conquest and led by John and Margaret Baker, who do so much work in the voluntary sector in supporting the hospital. That is very much supported by the local community and the Hastings and St. Leonards Observer is also currently running a campaign.

In conclusion, I suggest to my hon. Friend that the sorts of proposals that I have highlighted are, in terms of Government action, schizophrenic. On the one hand, the Government—through the then Minister of Communities and Local Government, my right hon. Friend the Member for South Shields (David Miliband)—quite rightly say that local is good and that we must make more decisions locally. On the other, they—or the SHA, at least—suggest removing local services and centralising health care organisation and delivery.

Gregory Barker (Bexhill and Battle) (Con): I congratulate the hon. Gentleman on securing the debate and assure the Minister that he speaks for the whole community in his analysis of the problems in Hastings and the Rother area. The arguments that he has deployed against the SHA are shared on a cross-party basis and I endorse his plea for the two-county PCT solution.

Michael Jabez Foster: I am grateful to the hon. Gentleman for his support, which endorses what I have
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been telling my hon. Friend the Minister: nobody that I can find in Hastings and Rye supports the SHA proposals and I suspect that that is the case in Bexhill and Rother, as well. I look to her for assurances that that absurdity will not be pursued. Will she at the very least say no to a cottage hospital? I could not persuade her officials to say that, but perhaps she will say it today. I want to make it clear that a clean slate, as it has been put, of this nature creates unnecessary alarm and despondency. I suspect that it was not the only reason why we lost Hastings borough council to the Tories last Thursday, but it did not help.

2.49 pm

The Minister of State, Department of Health(Ms Rosie Winterton): I congratulate my hon. Friend the Member for Hastings and Rye (Michael Jabez Foster) on securing the debate. He expressed eloquently the strong local feelings in his area. Obviously, I noted the cross-party support for his comments.

I join my hon. Friend in the warm tribute that he paid to all the NHS and social care staff working in his local health community. Their commitment to the continual improvement of the local NHS and social care services is certainly to be commended. I know about that from personal experience because I visited the Conquest hospital at his invitation in November 2004. I witnessed at first hand what can be achieved by adopting a multidisciplinary approach to improving services and was very impressed with what I saw.

The current NHS structure is under review as part of the “Commissioning a patient-led NHS” programme. The aim of the programme is to make long-lasting improvements to the NHS and to build on the improvements that have already been made through extra investment in new and existing services. As part of the programme, the number of primary care trusts and strategic health authorities will be reduced. My hon. Friend will know that plans have recently been announced to merge Surrey and Sussex SHA and Kent and Medway SHA into one organisation: the south-east coast SHA.

The approach that we are adopting will lead to stronger commissioning powers for PCTs, which will ensure that patients have access to the right care more conveniently and quickly than before. We also know that the mergers will lead to savings of some £250 million, which we will be able to plough back into front-line services.

My hon. Friend is obviously concerned about the PCTs in his area. The proposals for the reconfiguration have been subject to a 14-week local consultation, which ended on 22 March. As he knows, decisions about the reconfiguration of PCTs will be announced as soon as possible, once the results of the consultations have been considered and any recommendations reviewed.

It is too early to say what decisions will be made, but I can assure my hon. Friend that the recommendations will be assessed against the criteria set out in “Commissioning a patient-led NHS”. One of those criteria is the need to strengthen relationships between health care organisations and local authorities by
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bringing their boundaries closer together. At present, about 44 per cent. of PCTs are coterminous with local government boundaries. We hope that that number will increase significantly due to the reconfiguration of PCTs. The rationale is that a better framework will be provided to enable organisations to work together more closely to tackle priorities, such as reducing health inequalities and improving care for those with long-term conditions.

I am aware of the concerns that my hon. Friend has expressed very forcefully about the future of his PCT. I know that he has expressed those concerns in communication with my noble Friend Lord Warner, the Minister with responsibility for reform. I hope that I can assure my hon. Friend that we are aware not only of his concerns, but of those expressed by people in other parts of the country. We are trying to work as closely as possible with SHAs and Members of Parliament to ensure that those concerns are reflected. We are doing what we can to address them.

Michael Jabez Foster: What respective weight does my hon. Friend give to the SHA proposals and elected Members’ proposals? Many hon. Members feel and are worried, perhaps wrongly, that the SHA is taken more account of, even though it is not an elected body.

Ms Winterton: We are examining a number of considerations. We examine the results of the consultation. We take into account the views of Members as part of that consultation process. It is important as well that we consider the criteria that we have set out to ensure that where we are looking for improvements through reconfigurations, they are met.

My hon. Friend has rightly drawn attention to the increase in spending on the NHS under this Government. That has been reflected at local level, not only through increased investment but through improvements in patient care. There have been reduced waiting times and improved patient outcomes. As he said, that is thanks to the extra investment and the dedication and commitment of his local staff. There has been extra investment, but I am aware also that despite that, the health economy in East Sussex is facing some financial difficulties.

My hon. Friend knows that strategic health authorities within this context are responsible for delivering overall financial balance for their local health communities. We want to see them working in partnership with local health providers to determine how best to use the funds allocated.

I understand that in helping the SHA to do that,3 per cent. of all PCT budgets in Surrey and Sussex are to be top-sliced for 2006-07 and 2007-08 to help create a reserve so that the SHA can record financial balance across the region. I am informed that the Surrey and Sussex SHA is working to define a process and timetable for repayment of this funding where this is considered appropriate. The criteria for this repayment will be based on whether each PCT is already receiving its fair share of funding under the capitation formula and whether the individual health community has received a net benefit from the funding.

In the meantime, I am informed that the SHA will be considering how it can assist areas such as Hastings
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and Bexhill with capital resources to develop the local health infrastructure and to recognise the initial sacrifice being made in terms of revenue allocation.

My hon. Friend asked for further information on this issue. I understand that Candy Morris, the chief executive of Surrey and Sussex SHA, will be writing to him with further details of the SHA’s overall financial plan and the process in relation to this issue.

I now respond to my hon. Friend’s comments on the future of the Eastbourne district general and Conquest hospitals. As he is aware, the Surrey and Sussex SHA is currently working with local people, local government and other stakeholders to produce plans for modern health care services that are clinically and financially sustainable. This work began in 2005. The SHA is looking to ensure that local people and stakeholders have opportunities to get involved in developing the plan at the outset and on a continuing basis. These plans have been discussed with partners, patients and the public. I understand that they will be supported by
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a discussion document that is due to be published by the SHA towards the end of May.

In the meantime, I understand that work on the options for settings of care will continue, and this work will include an analysis of clinical and economic viability, of access and travel issues, of deliverability and of how the options fit with national policy. I understand that the SHA expects to begin full public consultation on the developed options in the autumn.

I cannot give my hon. Friend the specific assurances that he has asked for, but I will ensure that the strategic health authority is made aware of the comments that he has made today. I hope that I have been able to give him some reassurance, however. I know that he has been in touch with Lord Warner about the reconfiguration. The SHA will write to him with further details of the financial aspects of the matter, and I will ensure that it is made aware of all the comments that have been made today about the proposed local changes.

Question put and agreed to.

Adjourned accordingly at Three o’clock.


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