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14 Dec 2006 : Column 373WH—continued
“This department sees approximately 1000 patients each week.”
I am mindful of the time and I have taken10 minutes. I want to return to the point about pushing more services out to the community. In the longer term, there may be a sound basis for doing that, but we have yet to see any real evidence. Part of the reason why the sham of the consultation has been delayed once, twice and, I think, will be pushed back again is that there is no evidence to show. In my part of the country, Northiam surgery, for example, has been campaigning for three years. I have even been to see Lord Warner to try to get a minute amount of capital funding to expand the surgery. That could be done very well, but the funding is simply not available. Little Common surgery is a large practice and bursting at the gills. It simply cannot provide any more services at that location.
The same applies around my constituency and throughout the area. Practices simply cannot provide those services, and certainly not the same clinical standards that are currently being offered at Conquest and Eastbourne hospitals, yet we face the prospect of
more salami slicing. Nothing in the Minister’s assurance so far refutes the long-term prospect that Conquest or Eastbourne district general hospital will become little more than cottage hospitals.
We are very concerned about the health care in our area, and I hope that when the Minister winds up he will take on board the anger in my area that clinical arguments are being used to masquerade financial mismanagement in the strategic health authority and that people in my area, who can ill afford it, are having to pay the price.
4.46 pm
Mike Penning (Hemel Hempstead) (Con): As I said in an intervention, I am a proud member of the Select Committee on Health, which, earlier this week, issued a fantastic but damning report on NHS deficits. For the record, that Committee is Labour dominated with a Labour Chair.
“The Department of Health has begun to tackle the deficits.”
That is the good bit, but it goes on:
“However, we are concerned that ... current policies are encouraging short term measures that may further destabilise the situation and”
“in the ... long term interests of the NHS.”
Let us look at one example of short-term measures that are destabilising the NHS in west Hertfordshire. I am not the MP for Hertfordshire, but am proud to be the MP for Hemel Hempstead, which sits in west Hertfordshire. The acute trust that looks after my constituency is West Hertfordshire Hospitals NHS Trust.
The Minister referred to consultation on the future of facilities in my constituency. I must inform him that the consultation is over. It finished one month ago. The result was that 86 per cent. of the consultees who responded were opposed to the removal of services from Hemel Hempstead general hospital, which was built in the 1960s for the constituents of the new town and has been extended with funding. However, an independent review of that consultation was put to the trust’s board one month ago. The review was carried out by Clear and the gentleman who attended the meeting was John Underwood. Those of us who have been in the House in different capacities recognise that name because John Underwood was a director of communications for the Labour party before the current Government came to power. I understand that the company has carried out consultation and reviews of consultation extensively around the country and, every time, it came up with the conclusion that proposed cuts, which were opposed locally, should go ahead. John Underwood has another role: he is chairman of the Labour think tank, Catalyst.
I leave it to the House’s discretion, and its thoughts, whether that review of the health service in my area was independent when it was carried out by the Labour party on behalf of the Department of Health. I asked, naturally, whether that consultation specialist contract had gone out to tender. It had not. I understand that the company was appointed on the recommendation of the strategic health authority and the Department of Health.
Let us consider what the consultation, which was rejected by my constituents and local people, proposed. Hon. Members mentioned their concern that accepting cuts in maternity and in accident and emergency acute services is the thin end of the wedge. I am sad to say that my constituency is at the forefront of that thin end of the wedge.
Tim Loughton: How can it be at the forefront of a thin end of a wedge?
Mike Penning: It is very painful, I can assure my hon. Friend. Let us say that, sadly, we lead the way in cuts.
The acute accident and emergency department, which has received substantial investment over the past 15 years—first under the previous Conservative Government and then in the past three years under this Government—will be closed and moved to Watford. Along with it will go the brand new stroke and cardiac units, the MRI scanner and all acute facilities. Their closure marks the end of acute facilities in my general hospital. At the same time, the trust is going ahead with its removal of elective surgery to St. Albans. It means that in 18 months’ time, not one in-patient bed will be left in a general hospital that caters for the largest town in Hertfordshire. That is not reconfiguration, but closure—closure that will affect the day-to-day lives and prospects of my constituents.
I speak with some experience—I hope—because for many years I was a fireman. One duty in which I trained and specialised was attending road traffic accidents. I can say to the Minister with confidence and knowledge that if one does not have an accident and emergency unit with back-up acute facilities, including intensive care—that unit is closing—and a high dependency unit, lives will be lost.
I am sure the Minister will say that the problem is going to be addressed with more paramedics and acute ambulances. I asked the outgoing chairman of the ambulance trust—good job I asked the outgoing chairman; he would not have been allowed to speak to me or tell me the truth if he were staying—how many new ambulances we will get. The answer was none. How will we keep people alive and transport them not only from my constituency, but from St. Albans, which has already lost its accident and emergency unit, past the most dangerous junction of the M1—junction 8, where there are more accidents than anywhere else in the south—to Watford?
Let me provide the Minister with a geography lesson. Watford has a football ground, Vicarage Road, which is the home of Watford football club. A few months ago, I pushed a hospital bed with several thousand of my constituents from a hospital in my constituency.
Mike Penning: It was a very big bed; there was a coffin on it to symbolise how many lives would be lost.
We pushed that bed from the hospital in Hemel Hempstead to Watford general hospital. Fortunately, Watford were not playing at home. I wish Watford every success and I hope that they stay up, because they are struggling in the premiership. However, Saracens
rugby football club was at home, and it has crowds of about 3,000 to 4,000. There was mayhem, but not because of the demonstration led by my constituents. Incidentally, the demonstration was not party political. I am sure that there were as many Labour supporters on the push as there were Conservatives, although I am not so sure that there were too many Liberals present. Perhaps that is not fair because the parliamentary candidate was there—I apologise; it is just that there are not that many Liberals in my part of the world. Anyway, there was chaos because the police have to close the roads around Vicarage Road when there is a home game.
Andy Burnham: First time there was a big crowd there.
Mike Penning: The Minister can be derogatory towards the town of Watford. My constituents will be conscious of that remark, too.
The most important thing is lives. If one closes the roads, how does one get an ambulance into Watford? Hemel Hempstead hospital is in the heart of the town, with the best road links anywhere in Hertfordshire. The investment has been made, but the decision has been made to close the hospital completely. The Select Committee report said that the measures were short-term, and I passionately believe that. I asked the trust chief executive whether he would make such devastating cuts to services if the trust were not in deficit and if the strategic health authority and the Government were not forcing it to cut back so much to rebalance its accounts. The director of medicine, who is brand new to the area, stood up at the meeting and said, “Of course I wouldn’t. These clinical cuts would not be taking place if it were not for the deficits of my trust and PCT.”
The Minister knows that I raised the matter with the Secretary of State in Select Committee hearings. I asked her whether it was fair that people in her constituency in Leicester receive about £400 more per head than my constituents. As we heard, she said that the people in Hertfordshire are healthier than people in Leicestershire. It was the most astoundingly arrogant comment I have ever heard from a Secretary of State. However, no Opposition Member and none of our constituents is calling for parity throughout the country. We are not saying that everyone should receive exactly the same funding.
In my constituency, we would need less than £100 per head to bring us inside the deficit, and none of the cuts would need to take place. We could discuss clinical need and reconfiguration based on clinical effectiveness, but we are not doing so. We are discussing them based purely on the fact that the trust in my constituency does not receive enough money to look after the acute needs of my constituents. That situation is in the public domain, and it is wrong.
The Minister has said that with modern technology we can treat more people in the constituency, get them out of hospital quicker and look after them. I have heard other Ministers say the same in the Select Committee and in the House. That would be interesting in west Hertfordshire if it were not for a leaked letter from the PCT to GPs, saying that it is
going to make district nurses redundant because it cannot keep them on and balance its budget.
The Minister cannot have his cake and eat it. We are close to Christmas, and we do not want a major conflict, but our constituents are frightened. He cannot say that the Conservative party is scaremongering, because yesterday every GP’s surgery in a consortium under the Decorum primary care trust, which administers an area that I represent in part with my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke), signed a vote of no confidence in the trust. They are not convinced that their patients’ safety can be adhered to with the reconfiguration of acute services.
Unless the Minister can prove that every GP in my constituency is a Conservative—they may be, but we cannot assume it—he must accept that they are genuinely worried about the clinical care and treatment of their patients. With that in mind, I can bring the Minister up to date by letting him know that a judicial review of the way in which the consultation took place was launched today against the trust. It is not just a case of Conservatives demonstrating with banners. With my past, I have not been on the demonstrators’ side in many demonstrations. I have certainly been on the other side trying to prevent some of them, although I must stress that that was in Northern Ireland in the 1970s. However, people are not simply scaremongering, and it is demeaning for the Minister to indicate as much. People and GPs are worried.
I have a final point to which I should like the Minister to respond. Day in, day out, I receive anonymous e-mails and phone calls from members of staff in the NHS locally, telling me what is going on. They say to me, “Please, Mike, do not tell anybody that I am telling you this or giving you this document, because I will get the sack.”
Mr. Tyrie: Absolutely. We get that the whole time.
Mike Penning: It goes on every single day.
Like everybody in the House, I am an elected Member, and every member of the NHS has the right to be represented by their Member of Parliament. Will the Minister instruct every trust in the country not to threaten their staff with action if they speak to their MP? If any trust has included that threat in its contract with staff, it must be removed immediately. It is undemocratic, fundamentally wrong and an insult to the House.
Mr. Tyrie: Further to that, does not my hon. Friend think that it would be helpful if strategic health authority chief executives were permitted to represent their private concerns and those of their senior staff that their area is underfunded relative to the national cake? At the moment, they are debarred from participating in national debate. Would it not be helpful if the Minister could give strategic health authority chiefs an assurance about that as well?
Mike Penning:
My hon. Friend makes an important point, which I raised recently with the chief executive of my SHA at a public meeting. I said to him, “If you cannot guarantee the health care of my constituents—in other words, if you cannot do your
job because you are not being funded correctly—you should get on a platform and say so.” He said, “I am not allowed to do that. That is the job of the politicians. I have to do what I’m told.”
I know that the Minister is an honourable man, and I hope and pray that the Secretary of State is of similar ilk. In evidence to the Select Committee, she said that the NHS as a whole would be in balance by March 2007 and that she would take personal responsibility if that were not the case. Can we assume that she will resign if the NHS is not in balance by 2007?
5.1 pm
Dr. John Pugh (Southport) (LD): It has been an interesting, passionate and well informed debate. At one point, I thought that we should adjourn to Star Chamber Court, as that would suit the occasion better than Westminster Hall. The debate has shown the depth of the suspicion of Government intentions regarding the NHS and hon. Members’ laudable concerns about facilities in their constituencies.
There is a definite pattern in the critique arranged here against the Government, but the debate is about changes to medical and clinical practice. Medical science does indeed change and advance, and it informs medical practice. Undoubtedly, that has implications for medical service, as do people’s expectations of that service and the resources available. Those are all factors, but clinical auditing and learning and applying lessons and knowledge is, as we all agree, crucial.
Major advances have undoubtedly been made, and it would be churlish not to point to some of them. The treatment of chronic conditions has improved. I am thinking of improvements such as the expert patient programme, of which I was initially quite sceptical. I thought that people went to doctors because they were not experts and did not know what was wrong with them, but when it was explained to me that the programme was about long-term management and ownership of treatment, I accepted that it was very useful and kept patients from constantly needing to have recourse to the doctor.
Drug management is better than ever before, as are drugs. Specialist nurses are in the community and expertise is cascading out of the acute hospital and down to GP level where it is more accessible. Equally, I could point to advances in acute service and the treatment of acute conditions. There are more rapid interventions; we all know about our highly skilled ambulance service and how well kitted out they are to deal with almost any eventuality. More sophisticated interventions are available in hospitals—perhaps not in all, but in many—as well as less invasive interventions such as keyhole surgery. Procedures are done on an out-patient basis that might have led previously to a long hospital stay.
Progress has also been made in dealing with the natural hazards of life, such as maternity. Better pre-natal and post-natal care have shortened hospital stays; that certainly shows up in statistics. For conditions such as senility, supported living has reduced the need for institutional care. As always throughout history, though, many of the big effects, benefits and challenges to the therapeutic sector come from the public health sector. The modern demons of
obesity, drunkenness and smoking are fast replacing the ancient demons of poor sanitation and insufficient nutrition.
I think that the outline account that I have given of the development of medical services would generally be agreed with. I do not think that anybody will dispute it. More contentious are the conclusions that should be drawn from it. One contentious conclusion is that we need fewer hospitals, that we need hospitals to do less and that we need to centralise facilities. That is the Government subtext to this debate. It is ostensibly about medical development, but it is actually about rationalising clinical provision and reconfiguring service.
Mike Penning: Does that mean cuts?
Dr. Pugh: Yes. It normally does. It is not a political message that is easy to sell. Quite evidently from Members’ testimony here, it leads to massive protests, loss of political support for the Government—as is manifest in the polls—and public anxiety. The Government could conclude that they need to find a better way to put the message—to refine it and deliver it slightly better, because somehow or other, people are not getting the point. Perhaps we must be told that it is not about cost, even though we know the stories about deficits and we know how deficits influence decisions, and that it is not about politics, even though we know the stories about heat maps and how Ministers agonise about the political effects of what they do.
We know the Government’s story that it is not about fewer hospitals but about more community care, and we know that research has been published saying that that policy will save more lives. The Institute for Public Policy Research said that if super-hospitals provide most service, it will save something like 1,000 lives. Quite how it manufactured that figure I do not know, but it did. When stuck, the Government will even say, “Doctors want it.” Well, some doctors do. Sir Liam Donaldson said:
“Doctors need to take charge. Many of them privately see the need to make changes, but they feel intimidated when faced by the public waving placards.”
The Government could seek to refine its message. That is a strategy that they might wish to pursue, but I regard it as entirely doomed. It will not work; it is totally impossible, and it will not benefit them in the least at the end of the day. If the Minister is wise, he will be thinking of a better or alternative strategy.
Cost cannot be kept out of the equation. It was proposed recently that accident and emergency services should move out of my constituency. It did not happen—the medical people objected to it—but the people who proposed it were not go-ahead clinicians who saw a new way to deliver effective services. They were McKinsey & Company, the consultants who had been brought in for a few weeks to investigate how to save money.
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