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25 May 2006 : Column 1741

One other aspect is worth mentioning. The Minister will know that existing PCTs will be dissolved in September this year—a fact that does not exactly promote long-term thinking, as existing board members and senior managers will, understandably, be worried about their future. I, and a number of my hon. Friends, would prefer such decisions to be taken by the people who will be around to implement them and deal with their impact. They should not be taken by people who will be able to wash their hands of the whole thing in September and move on to something else.

The Department has answered my parliamentary questions by confirming that the new PCT to be established in Gloucestershire from 1 October will not be bound by any decisions that have not been implemented by that date. I think that it would be better to wait, and I would be grateful if the Minister would say whether she and the Government agree.

It is worth spending a little time on explaining why the cuts, especially to the community hospitals, have generated such anger in the Forest of Dean. Local people feel a tremendous sense of ownership of their hospitals, and for a very good reason. Both hospitals have friends organisations that have raised tremendous sums, and that money has been spent on new equipment and on financing new buildings. When the PCT threatens to close hospitals that have been built, at least in part, by the community’s own efforts, there is justifiable anger.

I do not have time to go into tremendous detail, but it is worth noting that the friends of Lydney hospital have raised about £840,000 since 1990. The money has been spent on equipment for the hospital, and in several instances has contributed to significant hospital building. When the A and E department was built the friends contributed £225,000, and when GP beds were being developed the friends contributed £280,000. The community truly views that hospital as its own, and views with anger the proposal to close it.

Gloucestershire’s share of health funding is only 88 per cent. of the national average. The demand for health care in Gloucestershire does not reflect that. The change in the formula in 1997 increased the weighting for deprivation and reduced the weighting for the age of the population. I do not expect that to be fixed now, or even that the Minister will comment, but it is useful to put down this marker for the 2007 comprehensive spending review, when it can be addressed.

A delegation of GPs from my constituency came to see me yesterday after they had a meeting with Lord Warner at the Department of Health. They are working on a set of alternative proposals for the Forest. I understand that the proposals were of great interest to the Minister. However, if we do not slow down this headlong rush to cuts, it will be too late to implement those proposals, because some of the facilities will already have been closed.

Yesterday, when the Minister of State, the hon. Member for Leigh, replied to the debate on community hospitals, he said,

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He continued:

It seems to me that the proposals of the primary care trust move in the opposite direction.

The Minister also said:

that is, the well-informed debate called for by the NHS Confederation. I am pleased to have played my small part today in holding this one. He also said that during the summer a statement would be made about the amount of capital that the Government would make available for new community facilities. It would be criminal if that statement was made after the facilities in Gloucestershire had already been cut.

In response to the hon. Member for Stroud, the Minister said that the Government were planning

I agree with that, but if the Minister who is here today wants that vision to take shape in Gloucestershire, it is not enough to say the words; she needs to act.

At the moment the primary care trusts are heading in the opposite direction. By the time the Government make any announcement, the cuts will have been made. I urge the Minister to intervene and send a clear instruction to the strategic health authority and the primary care trust to stop, listen and think again. If she does that, she will have my thanks and that of my hon. Friends. If not, the people of the Forest of Dean and Gloucestershire will not forgive her, or this Labour Government.

6.18 pm

The Minister of State, Department of Health (Caroline Flint): I congratulate the hon. Member for Forest of Dean (Mr. Harper) on securing this debate on health services in the Forest of Dean and Gloucestershire. I welcome my hon. Friend the Member for Stroud (Mr. Drew) to the debate.

I appreciate that this issue is of great concern to the hon. Member for Forest of Dean and his constituents and I will do my best to respond. Within the framework of the national health service plan and other national guidance, responsibility for planning and developing local services lies with local health organisations. I am sure that he would agree that that is important and has been a change. It reflects the fact that there are different needs in different communities around the country. The health needs of one area may not be the same as those in another part of England. Even within a PCT area there can be considerable different challenges for different communities, which is why we place great emphasis on the issue of health inequalities. In particular, we look at health outcomes—life expectancy and the numbers of people being treated for cancer and heart disease—as one way of addressing different health needs. That is something that PCTs have to do.

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People might need to spend less time in hospital than 20 or 30 years ago, because as technology advances and medicine changes, conditions can be treated more effectively and quickly, thus enabling patients to return to the comfort of their homes and the support of their families. That has been a welcome development for many people over the last decade or so and the momentum continues, which is one of the reasons that so many more people can be seen as out-patients rather than in-patients.

More people want services outside hospital, closer to their homes. One concern about community hospitals in many parts of the country is that they were designed for a particular model, whereby older people spent more time in hospital rather than being supported in their own home. Some of the lengths of stay in community or cottage hospitals are unacceptable. They demonstrate a lack of joined-up thinking between PCTs, social services and other organisations that support older people by giving them a better quality of experience after their hospital treatment in their recuperation and rehabilitation in an environment closer to home.

Mr. Harper: The Minister makes a sensible point, although my discussions with clinicians in the two community hospitals in my constituency do not suggest that she would find the experience she describes. She referred to integration between health and social care, but none of the changes was made in consultation with social services and the county council—they came as just as much of a surprise to them. We certainly do not have that joined-up thinking in Gloucestershire.

Caroline Flint: The hon. Gentleman is entitled to make that point, but I am trying to draw a bigger picture of the changes in demand for health services and their provision in the 21st century as a backdrop to some of the current discussions about how we should spend our money in the health service. Despite the challenges for community hospitals and the changes being discussed on the ground, we still see a role for them, in the right place, fit for purpose and, we hope, providing a range of services, some of which will enhance existing provision and some of which will be new, in a different environment, to meet patients’ needs.

Mr. Drew: As the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), said yesterday, the key criteria set out in the document of 16 February, “Moving care closer to home”, will be used to assess the value and viability of community hospitals. We want more detail about those proposals and I agree with the hon. Member for Forest of Dean (Mr. Harper) that we should not rush them. Will my hon. Friend the Minister tell us whether payment by results will be taken into account? That will be crucial in judging the viability of community hospitals, and indeed of the maternity unit in my constituency.

Caroline Flint: Payment by results is one of the reforms we introduced to ensure both that there are tariffs for care and a clearer framework in which to plan and provide services. I shall be happy to write to my hon. Friend about community hospitals and maternity care, where we are considering how we might
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expand the system. I am sure that he agrees about the importance of getting things right so that at each step of the way those commissioning and providing services understand what they can gain from the reform and how they can implement payment by results in the future.

It is down to primary care trusts working with others in the local health community—strategic health authorities, local government, community groups, Members of Parliament and councillors—to discuss and decide how best to deliver local services. All areas, including the Gloucestershire health community, have seen significant improvements in services and they are all continuing to improve.

Halfway through the 10-year NHS plan, there are tremendous improvements. Since 1997, the maximum waiting time for in-patient treatment has fallen from 18 to six months; the maximum waiting time for an out-patient appointment with a consultant has fallen from 26 to 13 weeks; and 98.8 per cent. of patients are seen, diagnosed and treated within four hours of arrival at accident and emergency departments. Some of our successes may have led to people forgetting what the situation was like 10 years ago, when waiting in accident and emergency departments lasted more than four hours and waiting for operations lasted more than six months—in some cases it took years. It is important to put that on the record. We are dealing with an adjustment in a period of improvement, not a period of regression.

We have a performance management system and a performance assessment system that requires the NHS to deliver both clinical and financial targets, and there cannot be a trade-off between meeting those requirements and reducing deficits. I know that the Gloucestershire health community is committed to providing sustainable, high quality services for its patients, and that the proposals are about securing patient services for the future while at the same time achieving financial stability.

That is really important for all those working in health care locally, including people who are working in organisations that are in deficit. Those deficits are not new. We have exposed deficits and made the situation much more transparent. The people who work in those organisations have to live with deficits on a year-by-year basis and the organisations that are balancing their books have to live with the year-by-year challenge of being asked to help out the organisations that are in deficit. That is traditionally how the NHS has run and managed its finances, but it is not acceptable any more. It leaves a cloud of uncertainty and insecurity hanging over everybody.

This year will not be the first year in which changes have been happening to services or services have been delayed because of the trade-off at the end of the year and the deficits that have existed for a considerable time. We have to get things right so that we can better plan for the future and give more security to staff and patients in planning their services, and so that we do not have a year-on-year trade-off to deal with debts. That is why it is important that financial deficits are dealt with. However, alongside that there is a parallel discussion about the sorts of services that we want and need for the future.

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Mr. Harper: I am grateful for what the Minister has said. No one is arguing that the deficits should be allowed to run on for ever, but there is a contradiction. Under the current structure, strategic health authorities and PCTs are trying to be in balance for the whole of this year, to clear all the historic deficits in this year and to cut another £6 million across Gloucestershire to pay for the top-slicing that the strategic health authority is performing to bail out areas that are in the worse shape. If the Minister is confirming that that is the case, I should tell her that that is not what the Secretary of State said in her letter to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley). She said that all that those concerned had to do was to improve the situation through 2006-07; they were not required to clear all the historic deficits. Those are two different things and they have a dramatic impact on what is happening on the ground. We need some clarity on that.

Caroline Flint: I appreciate the hon. Gentleman’s question. The strategic health authorities remain responsible for the performance management of their organisations and they have a duty to ensure that all trusts in their area achieve financial balance. The aim is for the NHS as a whole to return to financial balance by the end of 2006-07. A minority of NHS organisations might be unable to achieve a balance within that framework. However, all organisations that are overspending will be expected to show an improvement during this financial year and, by the end of the year, every organisation should have monthly income covering monthly expenditure. I am happy to
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write to him on that point if further clarification is needed and if that helps him and my hon. Friend the Member for Stroud.

The primary care trusts are investing in community services to increase the availability of care and treatment for patients in the Forest of Dean. I understand that there is a proposal to close Dilke Memorial hospital and an anticipated closure of Lydney and district hospital, too. However, in the longer term, the PCT is proposing a new community health facility to be developed on a new site in the Forest of Dean.

The hon. Member for Forest of Dean mentioned the consultation period. Cabinet guidelines are 12 weeks, but Department of Health guidance to primary care trusts and SHAs allows some variability, because clearly some issues may not require a 12-week consultation. I understand that, in this instance, the overview and scrutiny committee agreed to a shortened consultation period, but, again, I am happy to write to him on that.

Mr. Harper: The mental health trust consultation has started, but the consultation on community hospitals has not even been discussed by the overview and scrutiny committee—

The motion having been made at Six o’clock, and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Six o’clock.

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