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12 July 2006 : Column 463WH—continued

I come now to the changes that we are debating. PCTs are having to undertake substantial cuts. A front page story in the Hemel Gazette today concerns a letter leaked from a GP in my constituency highlighting that
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there might well be cuts in district nurses and health visitors in Dacorum PCT. Mental health, too, is an area of enormous concern. I want to pay tribute to my hon. Friend the Member for Broxbourne (Mr. Walker), who cannot be in the Chamber today because he is in Scotland on Select Committee business, because he has undertaken two Adjournment debates and worked tirelessly to raise the profile of the matter. Hertfordshire Partnership NHS Trust must reduce its spending by 5 per cent.—£5.6 million—despite never having been in deficit because the PCTs require it. We are seeing substantial cuts and both in-patient and out-patient services are suffering as a consequence. Another area that has been particularly affected is that of sexual health services. I hope that my hon. Friend the Member for St. Albans (Anne Main) will catch your eye, Mr. Hancock. She has worked tirelessly in this field and highlighted the many difficulties we face.

The issue of hospitals is perhaps the most emotive and the one that concerns my constituents maybe more than any other. Both of our hospital trusts are in deficit: East and North Hertfordshire NHS Trust has a deficit of £22.38 million and has announced 500 job losses, while my hospital trust, West Hertfordshire Hospitals NHS Trust, has a deficit that is even greater at £28.38 million and has already incurred about 250 job losses, with another 500 or so to go. In total, Hertfordshire hospital trusts will lose 1,250 jobs, and we are talking about not only administrators but health care professionals—doctors and nurses—whose jobs will be going as a consequence of the cuts.

I want briefly to give some history of the development of hospital services in west Hertfordshire. A few years ago, there was a process called “Investing in Your Health”, which considered the reconfiguration of hospital services in west Hertfordshire. It concluded that the way forward was to downgrade Hemel Hempstead general hospital to a non-acute site. That caused enormous concern to people in Hemel Hempstead and beyond, in my constituency and places such as Berkhamsted and Tring. My hon. Friend the Member for Hemel Hempstead (Mike Penning) has worked tirelessly to defend Hemel Hempstead hospital and has been a champion of the people of Hemel Hempstead on that point.

The conclusion was reached that Watford general hospital would be redeveloped and that acute services would be moved from Hemel Hempstead. I do not intend to re-open that debate, but I can fully understand why people who use Hemel Hempstead are worried about services being more distant. There was one consolation at the time of “Investing in Your Health”, which was that there would be a fantastic new hospital at Watford, and that services would not be moved until that hospital was built. The reality, however, will be somewhat different.

Services are on the move already. The birthing centre in Hemel Hempstead has closed, as has a ward for elderly patients, and there is more to come. Services have already been transferred to Watford, a hospital that I know well as I have had two children born there. Nobody, however big a fan they were of Watford, could say anything other than that it is a poorly designed site with outdated buildings, which is cramped and has little capacity. It is right next to Vicarage Road football ground, which I am pleased to
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say will be a premiership ground next season and is also used by Saracens. To get to the hospital on a match day is almost impossible, and even not on a match day it is difficult because transport links are not good. However, it is proposed that more services should be moved to Watford now.

I know, having asked the chief executive of the hospital trust, that during the course of the winter there were a number of occasions when notes were sent out to doctors, GPs and primary health care providers that Watford hospital was, effectively, full. That was in the winter and came before the closure of many of the acute services at Hemel Hempstead and their transferral to Watford.

How on earth will Watford cope in the interim period? By spring 2007, virtually all Hemel’s services will be gone. One might say that it is only an interim period of six years, but there is now severe doubt that we will get the new Watford hospital at all. It is supposed to be there by 2013. I will be grateful if the Minister can throw some light on the process. I know that one of her colleagues answered a parliamentary question on the subject in June, but it seems that we may have to wait some time before finding out whether the private finance initiative for Watford is to proceed. I sincerely hope that it will, because without it we will have the worst of both worlds, with Hemel losing its services but with no new facilities being made available for anyone in west Hertfordshire. I am greatly concerned about the matter, and I must ask how it has progressed.

Not long after being elected to this place last year, my hon. Friend the Member for Hemel Hempstead and I met the chief executive of West Hertfordshire Hospitals NHS Trust and its then chairman. At that point they were already talking about bringing forward the reconfiguration of hospital services from 2013, because word had come from the strategic health authority that deficits had to be reduced; there had been a change of focus. Indeed, the same would have been said by the primary care trusts—that there had been a change of focus last year.

I have given the Minister advance warning about my question, but when precisely did that change happen? I have been here only a year and I hope that I am not becoming a cynical politician, but we heard little from the Government before the last general election about the need to balance the books and to reduce the deficits. That change of focus seemed to occur, almost to the day, immediately after the general election. That is something that the Government must answer. Before the last general election, Labour had five marginal seats in Hertfordshire; it now has only two—and I hope the number will fall. None the less, the Government seem to have changed their focus. I should be grateful if the Minister answered that point.

Grant Shapps (Welwyn Hatfield) (Con): Has my hon. Friend had the chance to reflect on the fact that only two areas are now promised investment—Watford and Stevenage. Is there is any correlation between that and the occupancy of those seats?

Mr. Gauke: My hon. Friend makes a characteristically astute point. He has been a tireless campaigner for the
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new site at Hatfield. I hope that he has the opportunity to raise the subject later today. It was a PFI site, but it has already been downgraded and it may not proceed. Again, I hope that the Minister will be able to speak about that.

Hertfordshire is being treated poorly. Its funding formula is working against it, and it has crumbling and out-of-date facilities that may not be replaced. We have seen substantial staff reductions and plummeting staff morale, and services are being cut. The Government have not listened to the people of Hertfordshire for many years. I hope that they will listen today to what is happening there, because we are seeing the appalling running down of our services. As can be seen by the strong showing of Hertfordshire Members, the people of Hertfordshire will not tolerate it for much longer.

2.43 pm

Mr. Peter Lilley (Hitchin and Harpenden) (Con): I echo the tribute paid by my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) to NHS staff, who are dedicated, devoted and hard-working.

I have represented a Hertfordshire constituency for nearly a quarter of a century, and this is the worst crisis that the NHS has ever faced during that time. The words “cuts” and “crisis” have been used fairly frequently over the past 20 years, but throughout that time they meant a reduction in the anticipated growth in spending or employment. This is the first time that we have known a real crisis.

It is a crisis of jobs. The two hospital trusts that serve my constituency each plan to shed 500 jobs—a total of 1,000. That is clearly only the start, because those cuts meet only a portion of the savings that the trusts have been told to make. Those cuts include nurses and doctors as well as the vital staff who back them up.

It is a crisis of hospitals. Harpenden memorial hospital in my constituency is to lose all its hospital beds; effectively, it is to be closed as an in-patient hospital. It is clear that of the two hospitals that serve the East and North Hertfordshire NHS Trust, one is likely to be downgraded to little more than a cottage hospital. The promise of a new super-hospital at Hatfield that was floated and talked about assiduously before the election has now been downgraded from one costing £500 million that would have included a new cancer unit to one that will cost at most £300 million or £400 million; and within that envelope it will be impossible to include a new cancer unit—if it ever goes ahead.

It is a crisis of trust. At a public meeting that I chaired last September, my constituents expressed concern about rumours that the Harpenden memorial hospital might be closed. The PCT said at that meeting that it had considered all the options and that it had decided that it was an economic, efficient and caring way of providing health care for local people and that it wanted to build on that provision. Eight months later, it announced that every bed was to go. It is a crisis of trust in the management of the PCT.

It is also a crisis of trust in the Secretary of State. I asked her the other day why the East and North Hertfordshire NHS Trust will have to cut a quarter of its spending—£66 million of a total of £267 million over the next three years. She said that the Department
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did not require any cuts in its budget, just that it should live within its budget. However, the figures that I cite are from the press release of the national health service, so someone is not to be trusted. I fear that the Secretary of State must have been ill-informed. We therefore cannot trust what she says about our local health service.

It is a crisis of care. The new model of care is designed to discourage and if possible prevent GPs referring patients to hospitals. A target has been set for the number of such referrals to be reduced by 50 per cent. In six areas, the target is a reduction of 80 per cent. in the number of patients being referred to hospitals. I have no objection to people being treated at home or elsewhere better than or as well as in hospital, or even more efficiently. However, setting a target rather than saying that the Department would provide the best form of care, whatever the outcome may be, is dangerous. It makes it clear that this reduction in care is being imposed as a result of budget stringency.

At a street meeting last Friday, my constituents asked one question—why is this happening? If there has been such an increase in NHS expenditure, why for the first time in their recollection are 1,000 jobs to go? Why are hospitals to be closed? Why is care being rationed? They want to know. I cannot tell them. Will the Minister give us an explanation that we can give to our constituents?

2.48 pm

Anne Main (St. Albans) (Con): I almost do not know where to begin. Many of us share services; we do not all have our own hospitals or clinics. As a result, many of the cuts to services in other constituencies will affect my constituents. I was particularly touched by the tale of a nurse who lives in my constituency. She works in a thrombolysis unit in Hemel Hempstead. She told me that if that unit is relocated to Watford, nobody, including the staff, will have any confidence that the target of getting treatment within the target time of half an hour will be met. People who need to get there on a match day will not have that life-saving injection into the heart, whereas the system works in Hemel Hempstead.

Other shared services include podiatry and sexual health services. I have a number of letters from my constituents listing the cuts that they have been asked to face, some in my constituency and some just outside it. For example, there are the cuts in mental health services. I am sure that the Minister is only too aware that Hertfordshire has one of the highest incidences of mental health problems. We read about the amount of cuts for the adult care services—learning disability services, drug and alcohol services—and it beggars belief that that could be care in the community. Drug care services do not even bother tendering any more; they were being asked to provide so much that backed up the Government, even though they involve charities.

People with mental health problems often use homelessness services, and they have been cut back—for example, funding has been cut for the Open Door project in Bricket Wood. Funding has been cut to Grove House, the hospice in my constituency. Budgets for the elderly and mentally ill have been cut—£7.55 million. I have letters about the cuts from all the
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different services. Those are genuine cuts for my constituents, who do not understand how there can be extra care in the community and investment in health. As far as they are concerned, there is no investment in their health, just a hope that they will go away into a corner and not create a fuss about what are seen as some of the Cinderella services of our health service.

I have a letter about staff shortages in the foot health service that states:

that is, not caring in the community, but an actual reduction in department staffing. It continues:

that is, rationing health care.

I have written to the Minister about the issue of county sexual health promotion advisers. There used to be five in Hertfordshire; they went into schools, dealing with the issues at the sharp end, talking to pupils before they became sexually active. Such pupils may have had queries about sex or their relationships. We were then down to one last sexual health adviser post. Unfortunately, it seems that if we try to convince people that they can access services elsewhere, everybody says that somebody else is providing them and the post can be cut. The last post holder lost his job, despite active lobbying by his union and my writing on his behalf.

The gentleman in question met the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), at a chlamydia screening conference. She said that sexual health promotion was a core part of the Government’s choosing health initiative. We do not see that in Hertfordshire, where there is no longer a single sexual health promotion adviser.

People might say, “Well, go to your local sexual health clinic.” That would be interesting in St. Albans; people queue outside the door and into the car park. As I am sure the Minister is aware, sexual health clinics do not see only immediate constituents; people, for whatever reason—privacy, embarrassment or anonymity—will often travel across borders to go to clinics. My clinic in St. Albans and the clinic in Watford will serve the majority of people in Hertfordshire.

I have raised our belief that sexual health services in Hertfordshire are severely underfunded, despite a 1,500 per cent. increase in HIV infections, as well as other sexually transmitted diseases. As a result, a MedFash—Medical Foundation for AIDS and Sexual Health—review was undertaken; reluctantly, it seemed, but paid for by the Government. We were all terribly hopeful that it would deliver what we wanted to happen, but it was not to be. In fact anyone who knows the well respected Dr. Pat Mundy should be aware that she resigned because she was being asked to ration patient care and preside professionally over a service that was unsafe and subject to cuts.

Is sexual health one of the Government’s top six priorities in my constituency? I do not believe so. The
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trouble is that people wanting to use the services will not understand when they turn up and doors are locked against them. Are we really condemning people to an expensive, long illness of HIV/AIDS, for which we will eventually have to pick up the tab? Are we saying that young women may end up infertile and perhaps should seek the services later in life? Are we saying that we do not really care?

Today I was pleased to read in a letter from Dr. Mundy that the 48 per cent. rationing that was to have been asked for in Watford has been put on hold. I am sure that the Minister has seen the MedFash report; I urge her to stress that that is not a temporary political hold for political expediency and that it is a recognition of the cuts and shortages that have been going on year on year in health service provision in Hertfordshire.

As I said, we all share many of the services, so when a birthing unit closes at Hemel Hempstead or a thrombolysis service moves from somewhere else, or when the cancer services at the QEII hospital go, I care.

I shall not take up too much time, because I know that my right hon. and hon. Friends feel passionately about the issues, but there is one thing I really care about. Unfortunately, my constituency, along with that of Hemel Hempstead, seems to have a cash cow. I regarded it as an excellent local hospital, but unfortunately it is seen as a wonderful building site, which may well be used to pay off deficits. I am not talking about people being put in other areas to make best use of the system. We have just opened—I know it was not long ago, because I opened it—a brand new breast cancer unit in St. Albans, but we do not know whether we are going to keep it. During a hearing for a report of the Select Committee on Health, David Law was closely questioned by my hon. Friend the Member for Hemel Hempstead (Mike Penning). He was asked about where he was going to find his money and replied:

he was talking about my hospital.

That facility is going to pay off someone’s debts. I do not want some bean counter, who has been told to live within his budget, to ration health care. We are being asked to operate at 90 per cent. below national average, and we cannot do it.

St. Albans may be seen as a wealthy area, because it has high house prices, but I can point to areas of recognised deprivation, such as London Colney, in my constituency. They are on my council website. They have high immigrant populations and poor outcomes on health and cancer—many of the factors that this Government would accept indicate poverty. However, because they are in small localised pockets, St. Albans does not attract the funding as a whole, although the people need the services just as much.

I shall hand over to my hon. Friends now, but we are suffering huge cuts in our local services. People are not going elsewhere in the constituency, nor being cared for nicely at home. In St. Albans, we do not have a single NHS nursing care bed within our age care system—not a single one. I urge the Minister, please, to renegotiate
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the funding formula to take into account the fact that if we in St. Albans tried to meet our deficits, we would have no services. That is how it looks in my constituency.


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