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At the meeting on Friday that all Gloucestershire’s MPs attended with health chiefs, it was made clear that the proposals are being driven not only by financial considerations, but by the short time scale in which balances must be restored. The health chiefs have asked for a longer time. If facilities are being cut and people
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must adjust to the changes that are being made, the Government should allow a little more time and provide a little more certainty about what is happening.

I repeat the plea that I made in an intervention on the hon. Member for Stroud that the partnership trust overview and scrutiny process should have the same symmetrical time scale—that is, 12 weeks. I say to the Minister in all sincerity that if we change the institutions where elderly people have been for many years, the very least we can do—a kindness that we can do for people in such a vulnerable position—is allow them plenty of time to get used to the idea of the changes that may well occur.

As I said, we in the Cotswolds faced the closure of our community hospitals way back in March, long before the big announcement a few Wednesdays ago about the other institutions. With regard to Tetbury and Fairford, the overview and scrutiny committee submitted a case to the Secretary of State on 16 March 2006. It has yet to receive a reply from her. When is a reply likely? If the Minister cannot tell me tonight, perhaps she will let me have a note.

I quote one paragraph from the letter from Andrew Gravells, the chairman of the overview and scrutiny committee, in which he states:

That is what worries me about this debate. We may close facilities in Gloucestershire, and facilities elsewhere that are facing the same budgetary pressures, and regret it later.

With modern technology it is possible to do more treatment locally than was ever possible before. For example, with digital X-ray technology, it is easy to send X-rays to a consultant sitting many miles away at the district general hospital and get advice as to the sort of treatment that should be given. It can then be given locally, instead of all the time wasted by the patient having to be taken, perhaps by ambulance, to the district general hospital on another day with another appointment, with all that costing a great deal of money. I urge the Minister to look into some of the modern technologies available and see what can be done locally.

As a chartered surveyor I am the first to suggest that we should not necessarily keep old Victorian facilities that cost a great deal of money in upkeep. That is not what I am suggesting. If they cost a large sum to maintain, for goodness sake let us sell them and build new facilities that are cheaper to maintain. In Fairford, where the local community has rallied round the League of Friends of Fairford Hospital, we have a very innovative solution. Since March, they have got a private sector provider involved, they have found a new site, they have been talking to the planners, who have given the matter favourable consideration, and it is possible for them to propose a package to provide a new modern day care facility, combined with doctors
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and elderly treatment services. The NHS would be charged a reasonable rate for those facilities. That seems a possible way forward for a number of our facilities in Gloucestershire.

Will the Minister lay out a blueprint of the pitfalls and the way forward for such a scheme? In particular, the League of Friends is asking how much of the proceeds of the sale of Fairford hospital they are likely to receive to put forward for the new facility. Such questions need to be considered. The Minister should consider this innovative proposal, as it might get her off the hook in similar difficult situations.

The situation of maternity services, about which the hon. Member for Stroud spoke, is one of the strands of the cuts that we are facing. As he said, he and I marched, along with 4,000 people, on a boiling hot day in Stroud on Saturday. We met young mothers and many of the children born at that hospital. About 400 young mothers a year have their children at Stroud maternity hospital. It is one of the few maternity facilities left in Gloucestershire, and if we lose that and the facility in Cheltenham, as the hon. Member for Cheltenham mentioned, all the young women will have to travel to Gloucester to have their babies. I was not making a disparaging intervention on the hon. Gentleman. I was trying to point out to him that if he is worried about the risk of patients travelling for 20 or 25 minutes from Cheltenham to Gloucester, the people from the north Cotswolds have first to travel to Cheltenham and then on from Cheltenham to Gloucester, so whatever the risk for his constituents, they are double for mine. If it takes 40 minutes to get there, I think it entirely possible that some babies, especially second babies, will be born in the ambulance long before they get to Gloucester.

I think that there will be an increasing tendency for young mothers to have their babies at home. I am not a clinician and will not comment on that possibility, but we have been told for years that young mothers should have their babies in hospital because better care can be provided there. I think that more and more young mothers will choose to have their babies at home, particularly when no clinical danger is identified in pre-natal and post-natal classes. I am concerned about the large unit in Gloucester, and the hon. Member for Cheltenham has already mentioned the risk of MRSA. A small unit would be useful, because many mothers will not need to stay in it for very long.

Martin Horwood: I did not mean to dismiss the hon. Gentleman’s concern about his constituents’ drive times and accept his point. My point is that the percentage increase in drive times is probably greater from within the urban areas. When I asked the chief executive of the NHS trust about second children—my second child was born within minutes of getting through the doors of St. Paul’s—and whether my child would have been born on the A40, he said that nature will take its course. Does the hon. Gentleman think that alarming?

Mr. Clifton-Brown: Yes; the situation will be even worse than the one I have described if babies are born in cars, rather than in clinical conditions in ambulances, as a result of the changes.

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Young mothers will have to travel further not only to attend the maternity unit, but to access pre-natal and post-natal care, which is a point that also applies to visits to young mothers who stay in hospital. It is difficult for hon. Members who represent urban areas to understand that public transport in areas such as the north Cotswolds is almost non-existent. It is difficult for someone who is about to have a baby and who may have other children with them to catch a bus from the north Cotswolds to Cheltenham and to change buses in Cheltenham to go on to Gloucester. People who are sitting in offices trying to plan larger and, in their view, better units sometimes fail to take into account the extreme difficulties of people who must travel to those hospitals, particularly when they do not have cars and live in rural areas. My PCT has estimated that every year patients in Gloucestershire travel 1 million miles to out-patient appointments. We are all concerned about global warming, and such distances seem distinctly unsustainable.

One other aspect of the matter has not been emphasised sufficiently in debate this evening. At Friday’s meeting with health chiefs, it was made clear that those people who are referred to the larger units in the acute hospitals in Cheltenham and Gloucester will be discharged more quickly, which means that they will require greater care. In the announcement several Wednesday’s ago, however, we were told that community nurses, health visitors, physiotherapists and other at-home services would also be curtailed. We have got a lot of vacancies for community visitors in the north Cotswolds, and I think that when some people are discharged from hospital it will be impossible to deliver their home help care package, which will cause them hardship. I ask the Minister to consider that point carefully.

I do not think that social services have been sufficiently involved in the discussions. As my hon. Friend the Member for Tewkesbury has said, the effect of the changes on other agencies has not been costed. As the hon. Member for Stroud has mentioned, a lot of voluntary transport activity goes on in my constituency. If patients are going to be discharged from hospital more quickly, they may be distressed and more difficult to transport. As we are finding from our constituency postbags, some of the people who have been discharged from hospital are not suitable for home care. That means that they must be readmitted, which is, again, an extra cost.

Mr. Drew: I worry about patients with dementia who do not need to be in a clinical setting but who may need to travel periodically to the centre of excellence, which is a problem with the proposal to provide one unit at Charlton lane. Many such people will have to travel by voluntary transport, which is a difficult thing to ask a voluntary driver to take on.

Mr. Clifton-Brown: I agree. The matter concerns patients going to and from hospital not only for treatment, but for consultations. The distances will be much larger than those currently travelled to the community hospital.

Will the Minister explain how my constituents in the Cotswolds will get better care closer to home? The Government and the PCTs have said that that will be the case, but I find it hard to believe if their community hospital is closed.

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Since I have been a Member of Parliament, the health service has been subject to constant reorganisation. When the Conservative party left office in 1997, there were area health authorities, which this Government reorganised into strategic health authorities. As has been said, there was one care trust for Gloucestershire, which was considered to be too big. It was reorganised into three primary care trusts, which are now considered to be too small and will be merged back into one PCT. Indeed, the SHA set up by this Government will be merged into at least two SHAs. All that reorganisation costs a great deal of money—it means that people are made redundant and that offices are closed. We should reorganise the health service now, but then we should leave it alone for 10 years.

Is the Minister sure that the figures that she has been given by her health service chiefs are robust, because we do not want another round of cuts in Gloucestershire? I do not think that the cost of rebuilding all those new facilities has been properly calculated, and I do not think that the current cuts will be the last, although I look forward to receiving an assurance from the Minister that they will be.

8.18 pm

The Minister of State, Department of Health (Caroline Flint): Because of the curtailment of business earlier, this debate has been rather longer than the normal half hour, and all hon. Members present have taken advantage of the opportunity.

The hon. Member for Tewkesbury (Mr. Robertson) has mentioned that the consultation document “The Future of Healthcare in Gloucestershire—Proposals for Developing Sustainable NHS Services”—I downloaded my copy earlier today—states that part of the core remit of those involved in developing and supporting health services locally is to promote good health. It is important to have that written down. As Public Health Minister, I would say that for too long, and too often, health improvement and promoting good health have been the poor relations in terms of providing treatment in our NHS services. In my 12 months in this post, I have begun increasingly to realise that we could do more not only to prevent people from having the conditions that mean that they go into hospital in the first place, but—now that technology and drugs are better than ever before for a person who has had, for example, a heart attack or cancer—to make the step change in helping that individual to look after themselves, having had possibly the best treatment in the world, and to keep themselves fitter and healthier for longer.

Martin Horwood: Given the Minister’s responsibility for public health, is she concerned about the fact that savings proposal 15 is a cut in the public health promotion budget for smoking cessation?

Caroline Flint: I am glad that the hon. Gentleman makes that point. Historically, part of the problem is that public health has often lost out when pressure has been brought to bear on PCTs from the acute sector. As we move to a different place in which projects, programmes and interventions have an impact—in some areas, public health promotion could be better in
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terms of outcomes—we must have a discussion about how many of our services should be provided in hospitals, and how many of the services that are provided in hospitals should have a better link to community services, particularly for people with long-term conditions.

This lunchtime, I was at a conference with the Local Government Association. We are continuing to work, more than ever before, on looking at the role of public health in relation to the way in which local government runs its business. Factors such as the development of housing, safer communities and the general environment all have a role to play in public health. As for smoking cessation, next year we will put in place legislation that will make most public places smoke-free. That will be a major contribution to changing the culture around smoking.

To achieve a more mature, wide-ranging and long-term view of public health, we need to tackle the traditional situation in the health service whereby funding has overwhelmingly been directed towards those in the acute sector at the expense of those in the community. Painful choices are being made because of the need to deal with the deficits in a minority of organisations. That is causing problems even for PCTs that are in balance. My own PCTs in Doncaster—an area with huge health challenges—are in balance. In 1997 they were having to bail out other sectors of the NHS, but that was based on previous ways in which funding was organised and so was not done transparently—it was a fix designed to make everything look all right. It was not all right then, it was not all right in 1987, it was not all right in 1977, and it is not all right in 2006—but now we have an opportunity to try to get it right once and for all.

I will deal as best I can with the points that hon. Members raised about financial balance. However, the important point is what will happen if we continue to stick our heads in the sand and do not deal with the problems that we face.

As health services change, people’s needs change as well. In relation to the consultation launched today on the different services in the Gloucestershire area, I will not deny for one minute that there is clearly a financial imperative. I have read the document and had discussions with hon. Members and health professionals in other regions that I cover, and it is clear that in trying to find a way forward we have to take into account people’s understandable commitment to the health provision that they perceive that they are getting at the moment, as against what they might want in future. Those may be two different things. Someone who is 80 might want something very different from someone who is 60, and very different from what I, as someone in my 40s, might want when I am 70, 80 or even older. Part of this process—I am aware that it is a difficult one—is the honest discussion that people need to have about the services currently provided, and the shortfalls and problems involved, as against what else would be on offer.

Mr. Laurence Robertson: The Minister is absolutely right that we need a modern health service; I have said myself that it should not be a sacred cow that we are frightened to touch. But if it is right to cut management
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costs by 15 per cent., for example, that should be done anyway; we should not have to get to this crisis point. People will not accept that these changes are being made for the right reasons, because they read in the press that the NHS has severe financial problems and is cutting, not planning. The problem is that local health chiefs are not planning. The current situation is a reaction to their being told by the strategic health authorities that this year they have to balance all the books or else. The Minister is right to say that we have to move services on—I have no objection to that.

Caroline Flint: I thank the hon. Gentleman for that constructive contribution. I have met representatives of the strategic health authority and the primary care trusts. I hope that it is generally agreed that we cannot manage the health service from the centre, because the needs of one area are different from those of another and are affected by factors such as health challenge and geography. The decisions are best made locally.

Perhaps some decisions should have been made previously, but people did not make them. They thought, “We don’t need to face up to that difficult decision. We’ll leave it for a couple more years. We’ve got some more funding coming from the Government. We’ve gone from £30 billion to £60 billion, and to £90 billion for the NHS in the next few years.” The last sentence is the only mantra that I shall recite in the debate but it is true, and worth saying. People may have put off making decisions, but when somebody says, “Hang on, we’ve got sort out these finances, because you can’t carry on like this,” perhaps they will suddenly start to take notice. I am sure that the hon. Gentleman and others will make those points locally. I am sure that they will be raised with existing personnel and in the context of future reorganisation of PCTs. Managing the current position and, as the hon. Member for Cotswold (Mr. Clifton-Brown) said, ways in which to ensure that it does not happen again, will be considered. That is the Government’s ambition. We would be a foolish Government if we wanted to revert to the problems again and again.

That is why we believe that, difficult though it is and unpopular though it may be in some quarters, we must grab the agenda and deal with the problem—because it is clear from examining the information on some of the trusts that have got into deficit that unless the problem is tackled firmly, they do not get out of it, and it gets worse.

Mr. Drew: I wholeheartedly support what my hon. Friend says. We are examining the detail of the White Paper “Our health, our care, our say”, especially the part of it about which I have asked her previously, about moving “Care closer to home”. She confirmed from the Dispatch Box in a previous debate that maternity services would be judged according to community criteria. May I push her a little further and ask whether that is true of mental health and learning disability services, which are also set in a community context? The partnership trust believes that they should not be judged by the same criteria, which I find strange, given that the people to whom they apply are most in need of being close to their locality and community. Will my hon. Friend say a little about that?

Caroline Flint: If someone has mental health or learning difficulties, or a long-term condition such as
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diabetes, or is recovering from heart treatment, it is clear from “Our health, our care, our say” that there is an appetite for services closer to home, for those provided in non-traditional ways and for some creativity in establishing partnerships to provide services—with the voluntary sector, local authorities and other groups. That also applies to prevention services.

In several parts of the country, we are pioneering health trainers—a role that can take a variety of forms. They could be people from the community who will act as ambassadors. They may have suffered from a specific condition, or had, for example, a heart attack, and are therefore well placed to talk to others in that position about what they can do and what support exists to keep them healthy. Similarly, others could act as supporters and buddies. The opportunity exists not only for employed personnel to fill that role, but for others who simply want to give something back to their community. I shall raise the issue that my hon. Friend mentioned with the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), because she leads on mental health services.

It is fair to say that for too long, insufficient thought has been given to integrating services for those with mental health problems with those of other providers in the community. The tendency has been to provide stand-alone services in a mental health service context. When I consider my constituency, my leisure centres and community organisations and groups, there is the challenge of whether those services meet the needs of different vulnerable groups in our community. That is important for people’s general well-being.

Treatment, and how we can provide the best treatment for the range of mental health problems, is another matter. Again, that must be decided locally. However, I shall get my hon. Friend the Member for Doncaster, Central to follow up some of the points that my hon. Friend the Member for Stroud (Mr. Drew) made this evening.

Mr. Clifton-Brown: I hope that the Minister will answer the core question about the criteria that the PCTs are being set—whether we are considering monthly balance or clawing back the deficit. The deficits have not arisen suddenly; they have existed for a long time. My constituents want to know why the crunch has suddenly come now, because that gives them the impression that the NHS is not budgeting properly. If the Chancellor can budget in his Red Book for a three-year programme, why cannot the NHS do that?

Caroline Flint: There are all sorts of reasons why some organisations have got into financial problems, as the hon. Gentleman will be aware. The traditional approach to this issue—which has been taken by this Government and previous Governments—was to shift resources around the health economy to bolster different organisations and help them out. My first meeting with the then Doncaster health authority involved discussions on that very issue. We talked about helping out other parts of South Yorkshire using the balances and surpluses in Doncaster.

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