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Mr. Ian Taylor (Esher and Walton) (Con): Is the Secretary of State aware that in the eastern part of my constituency, it is not so much hospital closures that are taking place, as the downgrading of the services in those hospitals? For example, Epsom hospital is losing its general hospital status quite rapidly, and three community hospitals are being starved of revenue because the primary care trust is encouraging patients to move out of a general hospital straight home, which has led one local GP to say that there were unsafe discharges. There are serious revenue problems, so how will the Secretary of States announcement about her capital plan help my constituents?
Ms Hewitt: The proposals for Epsom involve the development of a smaller critical care hospital surrounded byI thinknine community hospitals or health care centre settings. More care will thus be delivered closer to patients homes, which will be much more convenient for them, but critical care and complex acute cases will be located in one specialist hospital facility. There has been wide consultation on that model of care, and it got widespread public support. The issue is not cuts in fundingI think that the hon. Gentleman suggested something of that kindbut the way in which the unprecedented sums that we are investing in the NHS, which will continue to grow by 9 per cent. this year and next year, are used to best effect for the local population, and how we ensure that when there is overspending, the NHS in the area comes back into financial balance and does not expect other parts of the country to go on bailing it out.
Mr. Graham Allen (Nottingham, North) (Lab): A little girl born this morning in the middle of the most deprived ward in my constituency will live 14 years less than a little girl born this morning in Wollaton, the prosperous ward next door. It will not surprise the Secretary of State to know which ward has a mega regional hospital, and which has no community hospital or facilities whatever. In that context, will she consider entertaining bids not merely from the local PCT, but from the collective local strategic partnershipsuch partnerships exist in each of the major cities in the UKso that we can move forward a lot more quickly? One of the most difficult points that was raised with me this morning when I tested the idea locally was anxiety about having private finance initiative-related schemes, or LIFT-related schemes, because of their long-term expense. Will she consider bids and offers from organisations other than PCTs, with a broader financial base?
Ms Hewitt: Yes, we certainly would consider such bids. My hon. Friend is doing outstanding work as chair of his local strategic partnership, so I thank him for that. The community venture model to which I referred earlier is precisely suited to a bid from a partnership of the kind that he describes. Capital investment could come from a variety of places, thus reducing the revenue implications for the NHS in future years. The model is good and it will help to address some of the shocking health inequalities that persist in our country, which are why we are determined to insist on fair funding for different parts of the country with different health care needs.
Mr. Malcolm Moss (North-East Cambridgeshire) (Con): Two in-bed units at Doddington community hospital in my constituency have already closed recently, in the teeth of opposition from GPs and the total opposition of local people. What price the much-vaunted boast of listening to local opinion, I ask myself. Does the Secretary of State agree that if GP practice-based commissioning is to mean anything at all, GPs should have a crucial say in what services are provided in their local community hospitals?
Ms Hewitt: As I said earlier, it is absolutely essential that local people are consulted. In many parts of the country, those consultations, which often take place on very difficult issues, have been extremely well led and conducted by primary care trusts, and they often lead to a solution being found that is better than the original options put forward. It is important that that happens and that GPs are closely involved. GPs who are closest to their patients are superbly qualified to act as not only advocates for those patients, but experts on redesigning services and bringing them closer to home. If services are redesigned they will change, so, for example, there might be fewer beds in some places and more in others. The reconfiguration of services, difficult and unpopular though it sometimes is, is part and parcel of creating the best possible modern health care service, so I would hope that the hon. Gentleman would support that.
Keith Vaz (Leicester, East) (Lab): I warmly welcome the additional money that the Secretary of State has announced and congratulate her on her victory over the Treasury in securing it. How will it affect the pathway project in Leicester? As she knows, that project will be downsized by £200 million and the downsizing will fall primarily on the hospital in my constituency, Leicester general. Will the reorganised PCT be able to apply for money from this fund to deal with any of the facilities and services that it will not be able to provide because of the reduction in funds for pathway?
Ms Hewitt: My hon. Friend raises an important point. The pathway project in our city is a PFI project. At the moment, there is no reason at all why it should not continue under the private finance initiative. As he and I heard recently from a hospital chief executive, the aim is to provide far better services for patients from Leicester and Leicestershire with all the facilities in the original proposal, but with better value for money, so that the local NHS does not find itself in financial difficulties in future years. It will certainly be possible for the PCT to examine whether the new fund would also assist in improving community facilities, but whether it uses the new capital fund or PFI, one test, of course, is that the services and buildings must be financially sustainable for many years to come.
David Howarth (Cambridge) (LD):
May I return to the central question of the capital nature of the funding? How precisely will the availability of capital funding help Brookfields hospital, for exampleI have to say to the hon. Member for South Cambridgeshire (Mr. Lansley) that that hospital is in my constituency, not his, although his constituents use it? It has three wards that are threatened with closure because of a PCT revenue
deficit that amounts to some £45 million. Surely the two policies do not fit together, and on a day when closures are being announced, the new policy makes no difference.
Ms Hewitt: As the hon. Gentleman knows, there is, unfortunately, overspending in the NHS in Cambridge and Cambridgeshire. That must be dealt with because it is taking place despite the fact that there is more money than ever before and more growth money is coming in future years. Of course the NHS in his constituency is examining how it can reorganise services. I described earlier the situation in Norwich, where by reducing beds in some facilities and closing two of the older community hospitals, better services are being provided for patients and financial savings are being made that can be reinvested in other services. It seems to me that that is precisely what the hon. Gentleman should be supporting and expecting from his local NHS. The capital will help when what is needed is a reorganisation of services, perhaps across different facilities, the modernisation of existing old buildings, or the creation of a completely new facility that would, for example, allow services to be taken out of the acute hospital and provided more effectively, with better value for money, in the new facility. Although the capital cannot be used simply to cover overspending on the revenue account, it can certainly be used to support a reorganisation of services that will be more cost-efficient and thus help to deal with financial problems.
Mr. Michael Fallon (Sevenoaks) (Con): Given the turmoil being caused in south-west Kent by the threat to services at Sevenoaks hospital, Edenbridge hospital and Tonbridge hospital, and the fact that the Secretary of State is now allowing a year for primary care trusts to submit bids for the new capital, would it not have been more sensible to have announced a moratorium on any further closures until all the bids had been received and evaluated and the tariffs had been sorted out?
Ms Hewitt: No, I do not accept that at all. There are circumstances where it is clear that the local NHS has too many community hospitals or that some such hospitals are based in outdated buildings that no amount of capital can sensibly be expected to modernise. There may be too many beds in some community hospitals, or perhaps more staff could be working to support more patients in their own homes. Those are judgments that the local NHS needs to makeparticularly, but not only, in view of current financial difficulties. The White Paper at the beginning of January set out a very clear strategic direction, which we have reinforced with PCTs and strategic health authorities. The new capital fund will meet many of the requests for capital support that PCTs have put to us. Contrary to the repeated assertions of Opposition Members that we have had nothing but closures of community hospitals, the Community Hospitals Association has confirmed that for every closure in recent years, a new hospital has been opened.
Mr. Edward Garnier (Harborough) (Con): On a point of order, Mr. Speaker. May I draw a matter to your attention and seek your advice? On 4 July, I received a written answer from the Home Office in response to a question that I had tabled on 30 March. My first point is that that is lamentably slow. Secondly, if one looks at the content of the answer, there are good grounds for concern. My question was:
To ask the Secretary of State for the Home Department how many inmates were being held in open conditions who had previously been Category A or Category B prisoners on 31 December of each of the last 10 years.
This information is not held centrally and could only be obtained by examination of individual records at disproportionate cost.
It seems to me that that is precisely the sort of information that should be held centrally and that should be retrievable by the Home Office if it is to run a proper Prison Service. Furthermore, what on earth does the expression disproportionate costit keeps being thrown back at usmean? It is entirely subjective. I appreciate that you, Mr. Speaker, are as frustrated as we are in having to deal with these issues, but surely the Government should at least occasionally condescend to become accountable to the House.
Mr. Speaker: The hon. and learned Gentleman is seeking to debate some aspects of the answer, which I cannot do. However, on the question of the length of time Ministers take to answer parliamentary questions, I answered the hon. Member for Hemel Hempstead (Mike Penning) on a similar point of order yesterday. The Leader of the House and I are seeking to ensure that Ministers get replies to the House timeously. I have had the full co-operation of the Leader of the House on that matter.
Mr. Garnier: Further to that point of order, Mr. Speaker. I am most grateful for your answer, which I find extremely helpful. In your discussions with the Leader of the House, could you ask him to ask his ministerial colleagues to explain the basis on which they use the expression disproportionate cost? Unless that is explained and unless there is some factual basis for using the expression, it has no meaning.
Mr. Speaker: I have a background in the trade union movement and I recall that there was always a rule that the electrician did not do the plumbers job. Similarly, the Speaker does not do the Back Benchers job. It is for the hon. and learned Gentleman to pursue the matter in parliamentary questions and it would be a good idea if he did so. Otherwise, I am doing his job, which would go against my trade union principles.
Mr. David Wilshire (Spelthorne) (Con):
On a point of order, Mr. Speaker. I hope that I can raise my point of order without appearing to challenge your authority, as I am conscious of the consequences of trying to do so. During Prime Ministers Question Time today, you
stopped my hon. Friend the Member for Blaby (Mr. Robathan) from finishing his question. I do not wish to question your ruling in any respect, Mr. Speaker, or to seek in any way to open up the subject matter of that question. However, as I thought about what happened, I saw something that seemed to me to be new, as I had not encountered it during my 19 years in the House. I sensed two separate issues: one was the code of conduct for MPs; the other was the ministerial code. While I entirely accept your ruling, Mr. Speaker, it raised an approach that I have not come across, as I said, in my 19 years. Would you be willing to reflect on my points and decide whether it would be appropriate to provide some general guidance on how we should or should not approach Question Time in the light of what happened today?
Mr. Speaker: In a sense, I am grateful to the hon. Gentleman for raising that point of order, which helps me to explain the position. He mentioned how long he has been in the House and he will know that I have been a Member for 27 years and it is important to note that we have not always had a Parliamentary Commissioner, who is a new officer. We must recognise that every hon. Member is entitled to natural justice, which means that when Members put a matter before the Parliamentary Commissioner, they should leave it with him. Until such time as the commissioner reports back, it is inappropriate to raise the matter with the Prime Minister or any other Minister. We should bear it in mind that the question put to the Prime Minister was about a specific Ministerthe Deputy Prime Ministerand that there is nothing to stop any Member raising with the Prime Minister general matters relating to ministerial conduct or the conduct of an hon. Member. I say again that when it comes to specific cases, if any Member has a complaint before the Parliamentary Commissioner, it is only fairand the House would expect me to say thisto leave the matter to the commissioner.
Mr. Greg Knight (East Yorkshire) (Con): Further to that point of order, Mr. Speaker. Are you effectively saying that in respect of complaints that are before the commissioner, you will treat the matters that they deal with as though they were sub judice?
Mr. Speaker: Yes, that is exactly what I am saying. As far as I am concerned, the matters are sub judice, so in specific cases they should not be put before a Minister of the Crown while the Parliamentary Commissioner is looking into them.
Mr. David Gauke (South-West Hertfordshire) (Con):
On a point of order, Mr. Speaker. Further to the issues raised by my hon. and learned Friend the Member for Harborough (Mr. Garnier) about the delays in answers to Home Office questions, I know that you are well aware of our concerns. Indeed, I have experienced considerable delays in getting my own questions answered. I tabled a question on 25 May asking the Home Secretary
how many written questions tabled before 5 May remained unanswered. I received a holding response on 15 June, but I have still not received a substantive response a month later. That highlights the fact that it is impossible to evaluate how many questions have not been answered. I wanted to bring the matter to your attention, Mr. Speaker, and to underline our concerns about delays, particularly in the Home Office, in responding to parliamentary questions.
That leave be given to bring in a Bill to make provision about the reduction of greenhouse gases; to promote energy efficiency and the consumption of renewable and low carbon energy in the commercial and public services sectors; to provide for the Secretary of State to report to Parliament on energy usage in the commercial and public services sectors; and for connected purposes.
The Bill is, in essence, a simple measure. It requires the Secretary of State to take reasonable steps to ensure that, by 2010, the amount of energy usage in commercial and public sector undertakings reduces by at least 10 per cent. compared with 2005, and by a further 10 per cent. by 2020. It also requires the Secretary of State to take reasonable steps to ensure that such reductions in energy usage are not at the expense of higher carbon intensity in the resulting energy use.
The measure requires the Secretary of State to produce a report on targets to be achieved for the production of heat and electricity for use in the commercial and public sectors from renewable sources, combined heat and power and microgeneration. It also requires the production of an annual report to set out progress towards those targets and state whether they are, in the Secretary of States opinion, likely to be met, and if not, what additional steps he or she proposes to take to ensure that they are reached. We are all aware of the pressing need to take action on climate change. The most effective way to reduce emissions from energy use that contribute to climate change is to use less energy, and to use what we do more efficiently. We know that the prime users of energy are in the domestic sector and in the commercial and industrial sector in heating and powering the daily life of business and industry.
We also know that we need to redouble our efforts to tackle climate change. That is now acknowledged with vigour in all parts of the political spectrum. Against that backdrop, it is worrying that the latest predictions about UK CO2 emissions are far from encouraging. The UK will reach and exceed its Kyoto commitments and I was proud that the UK Government aimed to go beyond that by introducing their domestic commitments on CO2 emissions.
In February, the Department of Trade and Industry published its updated projections to 2010 about UK energy use and CO2 emissions. According to those, the UK was, at that time, on course to undershoot by 9.4 per cent. its domestic target to reduce CO2 emissions by 20 per cent. below 1990 levels by 2010.
In the following month, the Government published their revised climate change programme, the purpose of which was to put us back on track to achieve that 20 per cent. CO2 reduction. That was acknowledged to be a challenging aim and the document that was produced included a comprehensive series of proposals about how to get back on track. However, the long-awaited document did not appear, at the time of its publication, to be able to achieve that. It was estimated that the new package of measures announced in the programme was
sufficient to deliver emissions reductions of only between 15 to 18 per cent., leaving the UK still 2 to 5 per cent. adrift of its target.
More recently, Cambridge Econometrics added to what might be termed the gloom with the publication of the latest edition of UK Energy and the Environment, which contained its updated forecasts of energy demand and CO2 emissions. The forecast was extended for the first time to 2020. Its conclusion was that, even taking into account the additional measures announced in the updated climate change programme, UK CO2 emissions would reduce by only 14 per cent., compared with 1990 levels, by 2010. In other words, unless more is done urgently, we will undershoot our domestic CO2 target by 6 per cent.
Beyond 2010, Cambridge Econometrics predicts that carbon emissions are set to rise slightly in 2010-15, but to level off thereafter to 2020. The expected levelling-off between 2015 and 2020 is due to a decline in power generation emissions, but that is offset by the continuing growth in carbon emissions from the commercial sector and transport.
The Government already accept the primacy of the aim of ensuring that we use less energy. I hope that, when the energy review is published, measures to introduce energy management arrangements for consumers of electricity and gas will feature strongly. In 2003, the energy White Paper described energy efficiency as the
cheapest, cleanest and safest way
of addressing all the UKs energy policy objectives. Subsequent Government pronouncements have continued to highlight the critical role that energy efficiency must play in reducing our carbon emissions.
Furthermore, in the energy efficiency implementation plan, which was published a year after the White Paper, DEFRA explicitly acknowledged that action on energy efficiency measures in the commercial sector had been intermittent and restricted and
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