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“PCTs have to achieve in-year balance and recover 2005-6 deficits”.
They say that they have been told, unequivocally, that they have to do that. They told hon. Members that that was the case just last Friday. However, the Secretary of State, in a letter to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), said that trusts would be expected to make improvements this year and achieve month-by-month balance by the end of the financial year. That is quite a different thing.
In a statement last week, the Secretary of State said again:
“We are aiming for all organisations with deficits to reach monthly balance of income and expenditure by the beginning of April next year.”
She went on to say that in some cases, the worst ones will be allowed even more leniency. Who is right? Do the trusts have to achieve total balance for the year, including historic deficits, or do they have to achieve monthly balance by the end of this year? Because if the Secretary of State is right, the consultation paper in Gloucestershire has been launched on a false, even dishonest, premise.
Mr. David Drew (Stroud) (Lab/Co-op): The hon. Gentleman knows my position on this issue, but an answer to his question would greatly help the strategic health authority. When I saw Trevor Jones, the chief executive, 10 days ago he made it clear that if the strategic health authority was given guidance that the aim was a month-by-month balance, it would change its interpretation of the strategic framework. It is vital that my hon. Friend the Minister provides some guidance, because we may be working on false premises.
Mr. Robertson: I am grateful to the hon. Gentleman, and I know that he shares my concerns. He makes the point well: the strategic health authority is in touch with the primary care trust and providing instructions—I nearly said guidance—but we do not know whether they are correct. If we go by what the Secretary of State says—and that is in writing—the SHA’s interpretation is wide of the mark. I hope that the Minister will clarify the situation. I reiterate that the trusts should balance their books, but how long have they been given to do it? If it can be done over a slightly longer period, the cuts might not be necessary.
I wish to make a further point about top-slicing. The PCT covering most of my area in Cheltenham and Tewkesbury was actually in surplus last year. However, it is cutting front-line services to help to balance the books of others. That, it seems, is the penalty for achieving better financial management. As if that were not bad enough, the Government are forcing the Gloucestershire trusts to bail out the others under the same SHA to tune of more than £6 million.
In her statement last week, the Secretary of State said that
“that money will not be lost to those communities. It will be repaid, normally in the three-year allocations period.”
“I have stressed to the health authorities that the areas with the greatest health needs should be repaid first”.—[ Official Report, 7 June 2006; Vol. 447, c. 254.]
So Gloucestershire will actually lose that money, and if the hospitals are closed anyway they are not likely to re-open within that three-year period.
Martin Horwood (Cheltenham) (LD): Does the hon. Gentleman agree that there is added nonsense in the concept of repayment in that particular case, of which the Minister may not be aware? For Cheltenham and Tewkesbury PCT to ask for the money to be repaid to it by Cotswold and Vale is a nonsense, because the two will merge in any case. So the money lost to Cheltenham and Tewkesbury will never be repaid.
Mr. Robertson:
Indeed, this becomes more complicated because the three trusts are merging into one. I am not making a point about one area against
another, and west Gloucestershire makes up a large part of my constituency. However, it does appear that good financial management is being penalised by that top-slicing.
In fact, Gloucestershire loses out in the first place when it comes to funding. We receive only 88 per cent. of national average funding. That is supposed to be because we are healthier, but—as local health chiefs point out—healthy people live longer, and older people cost the NHS even more money. So where is the joined-up thinking in that particular philosophy? Where is the joined-up thinking about the NHS generally?
To follow up the point made by the hon. Member for Cheltenham (Martin Horwood), I should explain that when I was elected in 1997 there was one Gloucestershire health authority. At present there are three PCTs, but there is a proposal to revert to one; in other words, we are to go back to exactly where we were nine years ago, except that there is now another tier of bureaucracy—the pointless strategic health authority, which costs more than £5 million a year to run. Even that is being tinkered with, because it will cover a different area. The situation is ridiculous. A number of PCTs and hospital trusts, under a single SHA, are making far-reaching decisions. Those PCTs will not exist come October, and the SHA will not exist in its present form by the end of the summer, yet massive cuts are being planned by people who probably will not be in post to carry them out—or to carry the can for them.
I referred earlier to the consultation document published by the health chiefs today. They wanted a consultation period of only five weeks, but Members and some members of Gloucestershire county council managed to exert enough pressure to get the deadline extended to 12 weeks. That is still not a long time, but, farcically, it takes us to the point when the people making the proposals might all be seeking alternative employment. At the end of the consultation period, none of them might be in post, such is the nonsense of the situation.
As well as containing dubious phrases such as the one I quoted earlier, the document insults the intelligence of the people of Gloucestershire. Among other “motherhood and apple pie” questions, it asks:
“Do you think that helping people to stay fit and well is an important principle?”
For goodness sake, what kind of smokescreen, what kind of sham, is this public consultation exercise? Will the people be listened to or will their views be ignored, as they normally are?
There is an unhappy situation in Gloucestershire. We are paying more tax to fund the NHS, yet we are losing our hospitals. The Government are piling billions of pounds into the NHS, yet a quarter of the country’s PCTs are in deficit. Local health chiefs say that they have to balance the books within the current financial year, yet the Government say that they have to achieve a monthly balance. The Government claim that they are reforming the NHS, but in truth they are merely tinkering with its structures. The net result is that the people of Gloucestershire, especially older people, children, poorer people, the pregnant and the mentally ill—in other words, the vulnerable—all lose out.
As I said at the beginning of the debate, I do not seek to blame the Government; I am trying to bring home to the Minister the strength of opposition in Gloucestershire to the proposals being made across the county. Will she clarify exactly what she is asking trusts to achieve financially this year? If she only does that we shall have made some progress, but otherwise the most vulnerable and the most in need will lose out.
7.23 pm
Mr. David Drew (Stroud) (Lab/Co-op): I congratulate the hon. Member for Tewkesbury (Mr. Robertson) on initiating the debate. This is the fourth such debate in which I have taken part over the last month: two of them were about health in Gloucestershire, the others were about maternity provision and community hospitals, which relate directly to my area, where I face the prospect of losing both.
Like the hon. Member for Cotswold (Mr. Clifton-Brown), I took part in the rally in Stroud on Saturday—I mentioned it to the Minister before we came into the Chamber. It is estimated that about 4,000 people were at the rally, at which both the hon. Member for Cotswold and I were able to speak. There was immense feeling about the proposals and I said that I would echo it in the Chamber—it could certainly have been heard at Westminster.
Earlier today, I took part in a meeting of the overview and scrutiny committee organised by the county council, which included representatives from the district councils. I have come straight from that meeting, which is why my brow is more furrowed than normal, and I want to raise with the Minister some points about the consultation on partnership trusts. As the hon. Member for Tewkesbury said, although we managed to extend the PCT consultation so that it takes place over 12 weeks, the consultation period for the partnership trusts—the mental health and learning disability trusts in Gloucestershire—will finish on 23 June, which is a mere five weeks. Without putting words into the mouth of the overview and scrutiny committee, it is fair to say that it is looking carefully into the discontinuity between the PCT consultation, which has yet to start formally, and the consultation on partnership trusts, which has reached the mid-way point, if not the final stage. I hope that the Minister will comment on that, as the situation does not make much sense; another £12 million has yet to be found from the PCTs and, given what they could later demand, that could have an enormous impact on the partnership trusts.
Mr. Geoffrey Clifton-Brown (Cotswold) (Con): The hon. Gentleman raises an important point, because there is no reason at all for the dissimilarity—for the general consultation to take 12 weeks and the consultation on mental health partnerships to take only five weeks. The overview and scrutiny process for mental health partnerships should be just as long because the mentally ill need more time to adjust to the changes that will be brought on them and those making representations on their behalf need more time to make their case.
Mr. Drew: I agree and make no apology for concentrating on that point, because that is the most urgent consultation. On Saturday, the hon. Gentleman heard a lady make a most emotional speech about the implication of the proposals for her nearest and dearest. People feel very let down because they have been given almost no time or opportunity to make their case.
The Chamber heard the request of the hon. Member for Tewkesbury that the Minister clarify whether we are talking about a month-on-month balance or historical deficits that have to be cleared in a matter of months. We need an explanation, because that is the nub of the problem we face in Gloucestershire.
There is a second problem and I make no apology for continuing to labour the point, because it is important: the relationship between Gloucestershire and its partners in the SHA. It is hardly acerbic to note that Gloucestershire feels let down by the fact that it happens to be in a strategic health authority, other parts of which have run up large deficits over a period of time. The hon. Member for Tewkesbury made several points about why that should not have been allowed to happen, but it has been allowed to happen. As a result, according to the operating framework that the SHA is passing down on tablets of stone, Avon, Gloucestershire and Wiltshire SHA is being asked to reduce its turnover by 5.3 per cent., against a national average of 3.4 per cent. That may not sound much, but there is still a problem. Some trusts in Gloucestershire have been in balance or close to balance, although it is true that Cotswold and Vale PCT, which is my PCT and that of the hon. Member for Cotswold, has been a problem for a long time, but that problem does not extend to other parts of the SHA. We are being asked to provide ballast across an area for considerable problems in the past. We know that, because about £175 million from the NHS bank has gone elsewhere into other parts of the SHA, not a penny of which was ever put into Gloucestershire, even though Cotswold and Vale has had its own problems. I ask the Minister for a commitment that we shall get some real figures—disaggregation of the figures—for the entire SHA, even in breaking it down within primary care trusts so that we know where the money has been spent as well as where the cuts are being levelled. It is vital that we know where the real money has gone and how that money can be accounted for.
I have one request from the overview and scrutiny committee, which I will put to the Minister. It wrote some seven weeks ago to the Secretary of State seeking clarification on budgetary issues. That was mainly in terms of the month-on-month balance. It has yet to receive a response from the Secretary of State. The committee seeks clarity and it wants to see the Secretary of State. I pass on to my hon. Friend the Minister that urgent request. The committee is now mid-way through the first of its consultations. Yet it could be labouring under a great misapprehension, as the hon. Member for Cotswold rightly said. The committee could be being asked to make a decision on something that is a false premise. There should be quick clarification.
I will concentrate rather more on the partnership trust, the mental health and learning disability trust in Gloucestershire, which is mid-way through its existing
consultation. What is the trust being asked to save? I have already said that the national average is 3.4 per cent. in turnover. The SHA is asking us to save 5.3 per cent. in turnover. The partnership trust is being asked to save 12.8 per cent., which is £9.6 million, of its planned expenditure. I do not know whether that means one and the same as turnover. However, I take it to be that an even greater amount of savings is required of the partnership trust than anything else that is being required within Gloucestershire, and maybe within the entire SHA.
As the hon. Member for Cotswold said clearly, about 36 per cent. of older people’s services for mental health and learning disabilities are to be cut. That is a huge reduction in expenditure. It is all driven by the mad idea that we have to come into balance. I do not know where the figures come from for the partnership trust. That is given the historic overspend, which I did not know was there until suddenly it appeared, and the deficit that is coming this year. I do know where the £2.2 million comes from, which is the contribution to the NHS recovery programme. That seems so unfair given the other cuts that have to be made.
It would help me and other Gloucestershire Members who are in their places this evening to know exactly where the figures come from and why a small trust—a specialist trust—is being asked to make a disproportionate contribution in trying to come back into balance. This makes a big difference to my constituency because of the potential changes at Weavers Croft. It is not likely that Weavers Croft will close completely but it will lose its beds. We do not know the impact of the beds that were brought across from Bourton ward in Cirencester, in the constituency of the hon. Member for Cotswold. As far as I know, that has never been evaluated given the impact that that had when we had some 120 beds for older people’s services. We now intend to cut the number to 65 if the proposals are adhered to.
I move on to the Tyndale centre in Dursley in my constituency, where we have already lost day centre provision. That has been lost also at Weavers Croft. There must be questions about whether those facilities will ever be picked up and from where they will be run. As was rightly said by the hon. Member for Tewkesbury, we must focus on the impact, which will be dramatic on social services. I heard the social services committee make a presentation to the overview and scrutiny committee. I was not clear whether anyone has undertaken a detailed impact analysis of the changes that are being proposed. If that has not been undertaken, somebody should see that it is. In this place, we would never allow the nature of proposals to be given superficial treatment, which is what they appear to be receiving. That is not a criticism of the overview and scrutiny committee because it is saying that it has unclear and scanty information about the different proposals.
The organisations in the voluntary sector need to be brought into the process. Underneath the radar, as well as the institutions that are much loved and being fought over, many other changes are being proposed. For example, it is proposed that there should be a 50 per cent. further cut in the passenger transport service. In Gloucestershire, if someone does not have a car they have no quality of life. If someone does not
have a car and he or she is ill, it is unclear how they can get to the necessary services. The local newspaper—I refer again to the lady who spoke on Saturday—ran a particular campaign to try to get her to Cheltenham. Visiting took two hours and the situation was difficult for her. Is that something that people can and should be asked to do?
I could go on much longer about the impact on maternity provision. There will be future debates in this place and I have no doubt that, if we do not get satisfaction, we shall go on to examine some of the other service provision, such as the community hospital closure programme, including the Berkeley hospital, which will not save any money because the idea is to move Berkeley up to the Cam and Dursley area. In some instances that makes sense because that is where the larger population is. However, I am not in the mood to agree to a cut in provision when we have no money, apparently, to re-provide a better service anywhere. It would be daft for any Member to say, “I can see that that will be a good move.” We are being asked to make dramatic cuts without any possibility of new investment coming into the county. It would be ludicrous to go along with the proposal unless we have some clarity on what needs to be done.
I ask my hon. Friend the Minister to provide clarity so that we can nail tonight what we mean by coming into balance. We must examine the particular problems of the strategic health authority. These are matters that are serious to Gloucestershire. We feel unfairly treated because of the nature of the SHA with which we unfortunately happen be placed. We need clarity also about the series of consultations that are being held so that we understand more about the impact analysis. That is clearly not happening at present. That is all to do with the speed at which the changes are being driven through. The direction may be right, but we need to separate the direction from the financial imposition. We certainly need to separate it from the speed at which people are being asked to make drastic decisions that have an impact on the young and the old and everyone else who is either a carer or someone who really cares for the facilities in question.
I hope that my hon. Friend the Minister has listened to these difficulties. She will hear about them from hon. Members on both sides of the House. I hope that she will realise also that this is not a party political issue. All the parties are united in Gloucestershire. We need some help, otherwise we will see services lost that have been in place for a generation and more, and for no purpose whatsoever.
7.38 pm
Martin Horwood (Cheltenham) (LD): I congratulate my hon. Friend the Member for Tewkesbury (Mr. Robertson) on securing this important debate. As my parliamentary neighbour, the hon. Member for Stroud (Mr. Drew) has said, there is all-party agreement and all-party concern among the people of Gloucestershire about the effect that this financial crisis is having on us. I must declare an interest, in that my wife works for Cheltenham and Gloucester primary care trust. Her job is at risk along with everyone else’s. I am certainly not pleading on her behalf this evening.
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