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The PCT is consulting on a significant reduction in the capacity of Potters Bar community hospital, which is a 45-bed community hospital that is barely 10 years old. It replaced an older hospital that was built in the 1930s but had become dilapidated. The hospital is in a new location. It is a purpose-built community hospital that provides services for all the residents of Hertsmere, including, of course, those of Potters Bar. Although the hospital now serves the whole of Hertsmere as opposed to just Potters Bar, which it used to do in the past, the PCT proposes closing 15 of its 45 beds and using the space that is freed up to relocate services already provided at other premises in Potters Bar. We must be clear about this: there is no question of providing new or additional services at Potters Bar community hospital. It is a case of merging two sites into one to provide both sets of services from the same premises. The premises that are “freed up,” in the words of the PCT, will be closed and sold, and the proceeds of the sale presumably used to address the financial position of the PCT.
However, Potters Bar community hospital will lose one third of its beds for good under the plans. The PCT has introduced consultation and said what it proposes to do about community health care to make up for the losses, but the proposals are being driven by financial cutbacks in response to a financial crisis. Nobody can say that if the PCT or any other health service provider were planning the best way to provide health care for the residents of Hertsmere they would begin by closing a substantial number of the beds at Potters Bar community hospital.
I can do no better than quote what the Government said about precisely such a situation. Their White Paper stated:
“Some community hospitals are currently under threat of closure, as PCTs consider the best configuration of services in their area. Where these closures are due to facilities that are clinically not viable or which local people do not want to use, then local reconfiguration is right. However, we are clear that community facilities should not be lost in response to short-term budgetary pressures that are not related to the viability of the community facility itself.”
That is precisely the situation with the Potters Bar hospital. Local people certainly want to use it. They value it for all the reasons that community hospitals are valued. It is particularly valued by elderly residents of Potters Bar and Hertsmere and those with chronic conditions.
There is
no question about the hospital’s clinical viability. It is a
modern facility. I have to confess that I
attended its opening, which might suggest that I have been here too
long. In fact, I have not been here too long. It is a modern
facility—it is almost brand-new—and the only reason that
its position is under threat is because of the financial predicament of
Hertsmere PCT.
My right hon. Friend was right to say that there is a question of trust, given what the Government have said about community hospitals. I put it to the Minister directly that if those words mean anything at all, and if the Government are to be trusted, Ministers must step in and do something about the situation at Potters Bar, which corresponds precisely with what they said. My simple plea is that the Minister will step in and assume responsibility for the Potters Bar community hospital to avoid a permanent loss of beds and a permanent loss of a significant part of the health care that is afforded to my constituents, which will come on top of all the other problems that have been outlined. Such a permanent loss to the residents of Potters Bar and Hertsmere will do serious, irreversible damage to the fabric of the health service in my constituency. I ask the Minister to step in and do something about it.
3.8 pm
Mr. Oliver Heald (North-East Hertfordshire) (Con): I join the general congratulations to my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) on obtaining this debate on the crisis in Hertfordshire’s health service. I wish to pick up on the point about trust that my hon. Friend the Member for Hertsmere (Mr. Clappison) made a moment ago. My right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) also spoke about it.
There are various categories of trust; for example, there is trusting the Government’s word in respect of their policies. The Government spend a great deal of time telling people in the mental health field that modern mental health provision is about early intervention, respite for carers, modern therapies and catching problems early—getting in there to help children and adolescents when they are pre-onset or at the onset of severe mental illness. I have taken a particular interest in that issue. In Hertfordshire, however, the Government are scrapping the early intervention service, the respite care and the in-patient therapies that are so valued, and they are cutting the child and adolescent health services.
The Government say that community hospitals can be valuable centres in which general practitioners can do things such as minor surgery. We have a community hospital in Royston, and there was a plan to develop it in the same way, but it is now on hold and has been for a long time. I have asked the Minister about the future of Royston hospital, but she says, “Ask the PCT.” However, the PCT is being scrapped and is becoming part of a larger PCT. If one asks the PCT, therefore, it says, “We don’t know if we’ll even be here.” The truth is that we cannot trust what the Government say.
At the local
level, we were promised a brand new, spanking great hospital in
Hatfield, which was going to cost £550 million, as has been
said. We were told that it would have cancer care facilities, which are
a crucial
issue in Hertfordshire. Now, however, we are told, “Oh no, you
can’t spend more than £250 million.” The whole
thing is in limbo.
It is well known that we have had a structural funding problem in Hertfordshire over the past few years. Before the 2001 general election, the then Health Minister, the right hon. Member for Southampton, Itchen (Mr. Denham), put an extra one-off payment into our local health system and said, “It’s a structural problem, and we’ll have to look at it.” However, nothing happened. Of course, he paid the money, but the Labour party won the election again, and no permanent review was done of the funding for our local health system. Every year for the past few years, therefore, a non-recurrent payment of £10 million has been made to our local health system. Now, we are suddenly being told, “Oh no, you can’t have any more money. You’ve got to manage within your budget.”
The Government know that there is a structural problem in Hertfordshire and in the East and North Hertfordshire NHS Trust—they made the non-recurrent payments. Now, however, they have the cheek to turn round and say, “Oh no, you can’t have any more money. You’ve got to manage.” That means that £66 million has to be taken out of our small East and North Hertfordshire NHS Trust over three years. Five hundred staff—or 10 per cent.—will go, including 150 doctors and nurses, and we will lose three wards at our two hospitals. Those are major problems, which the Government knew about.
Grant Shapps: My hon. Friend mentions the £66 million, but does he agree that the number seems to go up by £1.5 million a week? The chief executive briefed my hon. Friend on the issue just before me, but when I had my briefing last week, the figure had risen to £69 million. Does my hon. Friend have a projection for the end of the year?
Mr. Heald: Well, it will clearly be higher still. We really are in an appalling situation, and my hon. Friend makes an excellent point.
I come to my last point, because I hope that the Minister will be able to reassure us, although I doubt it. We are asking for nothing more than common fairness in Hertfordshire. It is true that the county is better off than some others, but we pay twice as much tax per head as people in the Minister’s constituency.
The Minister of State, Department of Health (Ms Rosie Winterton)indicated dissent.
Mr. Heald: Yes we do. In our area, the average is £5,820; in the Minister’s constituency, it is £2,710. We are therefore paying a lot of tax in Hertfordshire, but we are not asking for any more than anybody else. We are perfectly willing to accept that we should have a level playing field and a fair allocation of resources. However, while the Minister’s constituency gets £1,362 per head, we get £1,057, which is £300, or 30 per cent., less per head. In Hertfordshire, there are many people who are disadvantaged and there are also pockets of deprivation, as my hon. Friends mentioned.
Mr. Clappison: And learning disabilities.
Mr. Heald: Yes, there are also very high figures for learning disabilities and mental health problems. We therefore have real problems, and it is just unacceptable to say that we will be treated in such a mean and unfair way. Will the Minister look at the issue again?
3.15 pm
Mr. Mark Prisk (Hertford and Stortford) (Con): May I, too, congratulate my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke). This debate is very timely, and Opposition Members feel very passionately about the issues involved.
As the Minister will recall only too well, the Secretary of State told the Royal College of Nursing in Bournemouth in April that the NHS was enjoying “its best year ever”. That brought howls of derision from her audience, and rightly so, but it also generated real anger in my constituency. Over the past year in east Hertfordshire, we have had job losses, which my colleagues have described. We also face possible ward closures and longer queues for dentistry and cancer screenings, and there are real concerns about mental health services. To echo the points made by my right hon. and hon. Friends, let me tell the Minister quite genuinely that people in Hertfordshire no longer trust the Government with our health service—that is the reality.
In the district of east Hertfordshire that I try to represent, we face real problems with preventive services, such as those provided by NHS dentists. The PCTs tell us that they have tried to address the issue, but the combination of new contracts and uncertain funding has seriously undermined confidence among dentists and their ability to do their job. Some of my constituents travel 20, 25 and, in some cases, 30 miles just for a basic dental appointment. As a result, many people are being left behind, and that is particularly true of the elderly, who cannot make such a journey or afford to do so. I could go into that in greater detail, but I am aware that my hon. Friend the Member for Hemel Hempstead (Mike Penning) will want to make a contribution, so I shall be brief.
Mental health services are also under threat. We have heard that the Hertfordshire Partnership NHS Trust faces a £5 million cut, which is 5 per cent. of its budget. When we are told the reason for it, we find that the irony is that it is because of a general overspend. However, the trust has always lived within its budget and has never strayed beyond it in the five years since its inception. The attempt to cut its budget has seen the trust—
Grant Shapps: Punished.
Mr. Prisk: As my hon. Friend rightly highlights, the trust has been punished. Genuine concern has also been caused among what are probably the most vulnerable parts of our community. Clouds are hanging over good services, such as Signet house, Oxford house and the Seward Lodge day care unit, which are invaluable to our constituents.
As hon.
Members have said, the worst news was probably when we were told about
the 500 jobs that would be lost from the East and North Hertfordshire
NHS Trust. As my hon. Friend the Member for
North-East Hertfordshire (Mr. Heald) said, 150 of those affected will
not simply be managers, but doctors and nurses. Up to three wards could
well be lost at the two hospitals in Stevenage and Welwyn Garden City.
The best way of describing how people feel about that is a quotation
that I recently read from a local nurse, who said:
“Nurses are scared, upset and demoralised—they feel like they’ve worked flat out to deliver Government targets and this is their reward.”
With all those developments affecting the NHS in east Hertfordshire, hon. Members will see immediately how hollow the Secretary of State’s words sound to my constituents.
Part of the problem is the Government’s obsession with reorganisation. I have been a Member of Parliament for five years, and in that time the Government have restructured, de-merged, re-merged and reorganised the ambulance trust at least once and the PCTs twice. The new strategic health authority will be in its third incarnation—I thought that only Dr. Who could change his form so often. The whole structure of health care in Hertfordshire seems to be up for grabs. Chairs are delicately moved around, but nothing is done about the service. Reorganising and restructuring will make no difference if the fundamentals are not dealt with.
That leads me to my principal point. In Hertfordshire, the truth is that patients are not getting their fair share. NHS spending per person in Hertfordshire is just 90 per cent. of the average for England. On last year’s figures, the shortfall is £69 per person, which means that my constituency lost out by £5.2 million last year. For the county, it is £69 million in one year. Of course, it does not stop there. England itself is a poor relation when compared, for example, with Scotland. On last year’s figures, patients in Hertfordshire got only £614 per person, but Scottish patients received £855 per person. That is a gap of £241 per person or, in my constituency alone, £18 million in one year. It is an iniquity, which will appal many people, and to which I hope the Minister will respond.
Mr. Heald: Does my hon. Friend agree that it is also odd that people in the Secretary of State’s constituency get £1,306 per head, whereas people covered by the PCT that we share get £1,057 per head? Again, the first figure is 30 per cent. higher.
Mr. Prisk: I think that that leads quite accurately to the central point that concerns us all. We simply seek our fair share. We do not want better treatment, but we certainly do not want worse. Whatever the apparent wealth of our areas, whether that is measured by house prices or incomes, the truth is that an elderly person’s worry in Hertfordshire about whether they have cancer is as important as it would be if they lived in any other part of the country. That is the iniquity that we are dealing with today. I hope that the Minister will have the courage not to hide behind the usual platitudes that we hear from her boss, and to tell us the truth, and give us the assurances, that our constituents seek.
3.21 pm
Mike
Penning (Hemel Hempstead) (Con): I congratulate my hon.
Friend the Member for South-West Hertfordshire (Mr. Gauke) on obtaining
the
debate, and my right hon. and hon. Friends who represent Hertfordshire
constituencies on showing the House and our constituents how much we
care about their health care.
The national health service was created as a level playing field. It was there for all those who needed health care and could not afford to pay for it. On the estates where I grew up in north London, the hospital was the focal point of the community, because that was where people could go when they needed help. Many people in the areas of north London where I was brought up moved out to Hemel Hempstead in the 1950s, to the wonderful new town with its gardens, hospital and college, and all the facilities that they perhaps struggled to get before.
A wonderful acute general hospital was built in Hemel Hempstead in the 1950s. Smaller hospitals were closed and the full acute hospital was created. It fought for 30 years, under different Governments, to find out whether it was safe and would remain. Eventually, 10 or 12 years ago, it was concluded that it should be left alone, and investment was put into it, which meant huge amounts of money, under Conservative and Labour Administrations. A brand new stroke unit was built; huge investments were made in the cardiac unit; and a maternity unit was built up, which then closed, after which a new birthing unit opened—no one quite understood why, but there was an election in the middle, so perhaps we may assume that that had something to do with it. That hospital is a facility that is there to be used.
Great Ormond Street hospital was there to deal with the need for specialist care for children, and people who needed specialist cancer care could go elsewhere. My wife is presently visiting the Royal London hospital, because it has the best haematology department, whose services she needs. That is not what we are asking for in Hemel Hempstead. What we wanted, and what we have, is an acute hospital.
I shall probably be the last hon. Member to speak in the debate before the Front-Bench spokesmen make their speeches, and that is right, because what is happening is terminal for Hemel Hempstead. The acute hospital will go. If the trust gets its way, next spring it will send the bulldozers in to Hemel Hempstead hospital. It will become a housing estate. If we are lucky, I am told, we shall have an independent sector treatment centre—a surgery centre for elective surgery. I have plainly said that I do not want an ISTC. We have three theatres and an elective surgery unit. We have five theatres at St. Albans, doing the job now.
As I understand it from the evidence given to the Select Committee on Health, on which I have the honour and privilege to sit, the rules for ISTCs are that they are not permitted to create a demand; an ISTC is supposed only to replace something that is missing. What is happening in our part of Hertfordshire is that a demand for an ISTC is being created by knocking down a hospital and five theatres, an out-patient department and an elective surgery department at St. Albans. We must ask why.
Several of
my hon. Friends have discussed the fairness of the funding formula. I
think that it is unfair that the Minister has been picked on for the
fact that
her constituents receive more than mine, because there are some
constituencies, such as Sedgefield, where people get £300 to
£400 more per head than my constituents. I do not know why.
Evidence was given to the Health Committee about that last
week—by the way, we in my constituency got about £960 per
head of population last year, rising to about £983 this year;
some constituencies get as much as £1,600 per head. That is
shameful when it is to be hoped that patients will, in the end, be
treated similarly for the same ailments and problems.
I have a problem in Hemel Hempstead because, as a London overspill town, it has areas of serious social and economic deprivation. That is not just because of the Buncefield disaster—after which the hospital’s emergency services did fantastically well in treating the injured; God forbid that the hospital should not have been there, which would have meant going to the emergency centre at Watford. Perhaps some of those people would not be alive now, because two people were very seriously ill after the explosion.
What would it take to clear the deficit and to decide, “We do not need to do this”? The chief executive, in the presence of my hon. Friend the Member for South-West Hertfordshire, said that the closures would not take place if there was no financial problem. What is happening is not reconfiguration; it is cuts. We are trying to get more out of less. It is that simple. We will move all acute services to Watford; we will not go ahead with the promised private finance initiative building; we shall put in portable buildings. Eventually we dragged from the chief executive the truth about the life expectancy of those buildings. It was 40 years—instead of the promised new hospital.
The residents of Watford, Welwyn and Hatfield, St. Albans and other parts of the country were duped. They were made promises that there was no intention of keeping. The funding formula problem—the deficit—has existed for years. Ministers in Select Committee and chief executives of other trusts have argued that the problem is one of management. The managers are not doing their jobs properly. How can that be, when the trust has been changed three times, the PCTs have been changed and the whole of the strategic health authority has been changed? They cannot all be bad, surely. Surely there must be one good manager somewhere in the NHS, because, clearly, they do not have such a problem in other areas. There is clear evidence, however, that areas without so many problems get a lot more money.
I want to close by explaining exactly what will happen to the Hemel Hempstead hospital. We have a full acute hospital with out-patients, elective surgery and, most importantly, as was explained earlier, the acute blue-light facilities, for those who need them. There are 250,000 people relying on the accident and emergency unit at that hospital. It is proposed that all of that should go by next Easter. The whole site will be up for redevelopment. I know that, because I was lucky enough to find out that the trust had had meetings with my local council asking what it could build on the site; I know, because eventually at the Select Committee I dragged from the chief executive the information that the land and facilities will be surplus to requirements. Surplus to requirements—it is a general hospital, which people rely on!
Lives are at risk. I am conscious of the need to leave time for the Minister’s response, but we are not playing a numbers game. We are not saying that some people are nasty and some are good. We are talking about ordinary people, who deserve the NHS that was created many years ago as a level playing field. Watford is in the premier league; it is a fantastic result. The Saracens are doing very well. Hon. Members might like to try going down the A41 from Hemel Hempstead at any time without a blue light. I drove blue-light emergency vehicles and I know how difficult it is. They will not get there. The Government are putting lives at risk.
My hon. Friend the Member for Welwyn Hatfield (Grant Shapps) invited the Minister to visit the hospital in his constituency. I shall not do that, because thousands of my constituents have invited the Secretary of State, but she is too busy. I asked to see her diary and she was too busy to show me that, too. It is a disgrace, and lives will be lost.
3.29 pm
Dr. John Pugh (Southport) (LD): I congratulate not only the hon. Member for South-West Hertfordshire (Mr. Gauke) but all hon. Members who have spoken so emphatically about their fears for their services. I shall not comment in detail on the local circumstances—I defer to their greater knowledge on that subject—but I shall make some general remarks, as the issues affecting Hertfordshire emphasise some familiar themes and common problems that occur elsewhere.
The hon. Gentleman originally drew to our attention two problems. One was the problem of underfunding, which seems to affect all services across the piece, and the other was the problem of hospital reconfiguration, with the hospital trusts having substantial deficits, in excess of £20 million. The Government’s response to deficits is usually that trusts should get a grip and balance the books, which of course always travels with a presupposition that we already have a fair formula across areas and even within areas, between institutions. However, I see no evidence that we have yet arrived at that state.
There is also another common phenomenon in Hertfordshire, which is that of a number of smallish hospitals in clusters, with pressures on all services.
Mike Penning: I do not think that the hon. Gentleman has been to my part of Hertfordshire, but we do not have a small hospital. The Watford general hospital is not a small hospital and neither is the QEII hospital. They are massive acute hospitals, not little community hospitals, as he is describing them.
Dr. Pugh: I was not suggesting that they were community hospitals, but the descriptions are relative, and we could compare them with St. Thomas’ hospital over the river from here.
I am familiar with the
scenario, because I come from an area where there are two hospitals
that I would describe as relatively small in NHS terms and that are
separated by the sort of distance that separates some of the
Hertfordshire hospitals. I am fairly familiar with the problem—I
know that hospitals belong to distinct communities, I know that travel
between them is rarely ideal and I know that there is strong community
resistance to changes in local hospitals. I also know that when change
takes place, there is an unconvincing process of local consultation
that satisfies nobody and buys nobody off.
There are usually two drivers for reconfiguration. A clinical driver to do with the concentration of expertise is usually cited in evidence, and there is usually a financial driver. The financial drivers on hospitals involve not only deficits but other things, such as the working time directive and the junior doctors’ contract, which put additional pressures on hospitals in all areas. None the less, people in Hertfordshire are quite justified in fearing reconfiguration, because reconfiguration and all that it evokes has a pretty poor reputation across the NHS.
Looking at the SHA consultation on reconfiguration in 2003 from an external point of view, I thought that an attempt was being made—although probably not a successful one—to give everybody a little piece of the action or to satisfy everybody, if I may put it like that. Clearly that effort failed and was replaced by something much more unacceptable. In my neck of the woods, with two hospitals separated by the same sort of distance as between Watford and Hemel Hempstead, we have already lost obstetrics and paediatrics in Southport.
Anne Main: The hon. Gentleman talks about the same distance as between Watford and Hemel Hempstead, but would he agree that the Minister should ensure that if any service is to be moved to Watford, the road configuration should be altered—which is exactly what we were promised—before any development of the hospital takes place? Perhaps the Minister knows better than I do, but I have yet to see any details of that road configuration or that road investment.
Mr. Mike Hancock (in the Chair): Order. That sounds like another speech.
Dr. Pugh: That is absolutely the point that I would re-emphasise, as similar problems are faced in many areas. In my neck of the woods, where two hospitals are owned by the same trust, the road is an issue and travel is the one thing that is most ignored.
I was not surprised to find, on looking into the matter, that the offer that was originally made in the 2003 consultation has been further downgraded. At one stage there was talk of having a birthing unit in Hemel Hempstead and using it to spread good practice elsewhere, but I understand that that is now unlikely to happen. As the hon. Member for Hemel Hempstead (Mike Penning) said, the best that will happen is that an ISTC will emerge. That is a common pattern in different places, with the same meaningless consultation forming a backdrop. Scrutiny and review sections of councils debate things, but the financial position continues to deteriorate.
We can
anticipate the Government’s response, which is also fairly
familiar. In most such debates, the Government will say that people
ought not to be wedded to bricks and mortar, that services can be
delivered in the community and—to a lesser extent—in
secondary care, that institutions have to co-operate,
that clinical networks have to be delivered and that people will travel
for the best possible
service.
However, that aspect of Government policy does not hang together with something that was cited several times in the consultation, which is the Government’s own policy of keeping the NHS local, which produced a well-known pamphlet that is much cited but rarely acted upon. That policy recognises that although people are ready to travel for specialist care, they expect to find many services locally, particularly A and E services and those that look after people with chronic conditions that involve repeated journeys to hospital. Additional travel in such cases means extra trauma. Someone who has to go further to an A and E department might not arrive with a long-lasting problem or even with a major trauma, but for someone travelling with a child to A and E who is not sure what is wrong, every extra mile is a very unpleasant experience.
People do not mind clinical networks, if that is what the Government want, but they want the clinical networks that suit them and their clinical needs. As it is, reconfiguration across the piece normally results in health authorities presenting a menu, a rather bogus form of consultation taking place and, when it is completed, people often choosing to go in unexpected directions, rather than to the hospitals to which they were expected to travel in the first place. As many hon. Members have said, the backdrop is often the need for a quick financial fix, which discredits any reconfiguration proposal whatever.
Mr. Lilley: On a point of order, Mr. Hancock. Is the hon. Gentleman’s speech in order, as it is not about Hertfordshire?
Mr. Mike Hancock (in the Chair): The hon. Member is entitled to put a view about the consultation, but I remind hon. Members that we are about to have a Division and it would be appropriate to give everyone a fair chance to speak in this debate.
Dr. Pugh: I shall finish shortly, as I said I would, although I also said that I would make some general remarks that would probably apply to Hertfordshire, as well as to other places.
If there is a mistake—as there must be—it is not beginning with community needs. The public are not stupid; they know that they cannot have everything everywhere. However, they want good quality, timely and accessible services but, as hon. Members who have voiced their opinions so far have made clear, Hertfordshire is not getting them.
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