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19 Dec 2006 : Column 1294

It is difficult for established Government agencies to change such people’s lack of lifestyle opportunities, but a project in my constituency is doing just that. The Murray Hall community trust, funded by the safer stronger communities fund, has targeted the Tibbington estate in Tipton—the Tibby, as it is known locally—which historically has had high unemployment, low educational achievement and a family cycle of low aspiration and low achievement. It uses people from the estate—Jennifer Bryan, Janet Burbridge, Suzanne Cornick, Charlene Cotton and Stephen Walker—to act as mentors in the community to encourage people to go into training programmes and subsequently into jobs. The things for which it has recruited in the space of eight months include child care, construction, carpentry, flower arranging and, above all, family projects, in which families and children work together in schools on healthy eating programmes. So far, 78 adults have been recruited to training courses. I emphasise that those adults had rejected the educational process earlier in their lives, and this is their first taste of participating in formal training. Sixteen have gained qualifications to date, but the trust hopes to do more. By establishing a local community facility and analysing a local community problem, it hopes to build a business with considerable educational spin-offs.

Mr. Wills: I am interested in my hon. Friend’s comments because I have a similar experience in parts of my constituency. Does he agree that locally based centres for learning, such as the Penhill information and communications technology learning centre in my constituency, often achieve tremendous results with people who have never had learning opportunities before, because they are closest to the local communities?

Mr. Bailey: I agree entirely. This is a matter of people who have never felt comfortable with the delivery of public services being able to relate to local people and go to a familiar locality where they feel at ease and are confident enough to begin to engage with the educational process without feeling threatened by it, which they could never do when they were younger.

In the middle of Tipton, there is a large area of natural land called the Cracker. It is so called because it is where the crack—the effluent—from local foundries and companies was dumped for more than 100 years. It has just been developed as a green space and Tipton people like to tether their horses on it. Contrary to public perception, there is a high horse population in Tipton. It is almost entirely unregulated and often a nuisance, so much so that the local authority employed a horse ranger, which a national newspaper criticised a few years ago because it was inconceivable that such an urban area should need that service. However, it is necessary.

With the aid of business in the community, the Murray Hall community trust hopes to set up a stabling and horse management centre on that area, bringing in local people and, first, using it as a community facility for those who love their horses and want to keep them, and, secondly, developing an educational process on it which will enable people to learn about business practices, horse grooming, maintenance and care and so on, thereby allying a long-standing local cultural tradition with the educational process and opportunities that we
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need in the future. It is a clear demonstration of money being successfully invested in the community so that work is carried out with people who hitherto have been unable to engage in the educational process.

It is important that the Government recognise that investment in a local community must be followed by adequate monitoring and robust assessment procedures to justify more investment. If they look at what is taking place in one of the most deprived communities in my constituency, they will see that that is money well spent and that it will have a profound long-term impact. I ask the Minister to note that and take the thought away with him, and I look forward to further investment so that we do greater work in that local community in my constituency.

1.27 pm

Angela Browning (Tiverton and Honiton) (Con): I wish you, Mr. Speaker, and all members of staff of the House a very happy Christmas. I thought that I would put the festive greetings in at the beginning because last time I had a bit of a rant, and when I said “Happy Christmas” at the end, everybody burst out laughing. I am not sure why.

I want to raise one thing. On 8 November The Daily Telegraph carried a story as a result of information that the Conservatives had obtained under the Freedom of Information Act 2000 about proposed closures in small hospitals around the country. When I read the article I was surprised, because it listed the Mid Devon primary care trust in my constituency as one of the PCTs that was likely to suffer closures, in our hospital at Tiverton.

The Daily Telegraph said that the Secretary of State had drawn up maps with something that she called “hot spots” to ensure that closures did not occur in marginal Labour seats. There is no way my seat is a marginal Labour seat, I am pleased to say, but I kept the cutting. Although I was unaware of any proposed closures, lo and behold, in the past three weeks they have been announced, not only at the Tiverton hospital in what was the old Mid Devon PCT, but at the Honiton hospital, which serves a large catchment area of the east Devon part of my constituency.

It was obvious some time ago that the Government anticipated the closures, and the form that they have taken means that the minor injuries units at both hospitals are closed to the public between 11 pm and8 am. In addition, beds have been closed, albeit on a temporary basis until the end of next March.

Small hospitals, serving sparsely populated rural communities, which is what I have in my Tiverton and Honiton seat, rely very much on local services. In particular, I want to consider the implications of the closure of minor injuries units. It is important to flag up why that has happened. As a result of Government policy, what were six primary care trusts have been brought together as a pan-Devon primary care trust. Collectively, by the end of the current financial year they must claw back some £7.6 million. As we all know, according to the bizarre formula that the Government apply to the NHS, if PCTs overspend they must recoup not just the amount overspent but twice that amount, thus making cuts even deeper than they would otherwise have been.

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The two hospitals also serve local general practices, in that GPs often make referrals to them. If my constituents could not have access to the minor injuries units at night, they would be forced to go to the casualty department in Exeter, quite some distance away. Obviously, in some cases they would depend on an ambulance service. Devon PCT tells me that the minor injuries units are little used at night, but a father from Tiverton wrote to me:

from the local minor injuries unit—

What worried that father was that if the unit closed—as it now has—the delay involved in taking the child to the larger casualty unit a long way away could have a devastating effect.

Even if we accept that minor injuries units have less throughput at night than during the daylight hours, we must ask what the consequences of closure will be for the patients who present there. It worries me that although the closures were flagged up in The Daily Telegraph on 8 November, there has been no proper consultation. There are no contingency plans to deal with the possible knock-on effects on the general hospital, on the ambulance service or on referrals through NHS Direct. It looks as if the decision was made in order to tick some boxes and save some money.

I have some sympathy for those who must administer the health service and balance the books accordingto the formula that they are required to employ. However, the people of whom no account seems to have been taken are patients—and, for that matter, professionals. One might have expected the doctors who service the hospital at least to have been consulted, but that has not happened. I was told by a GP in my constituency this morning that a meeting had been called for tonight, long after the closure of the units.

Apparently, a bizarre process will now operate when people turn up at Honiton hospital after 11 pm thinking that they can receive treatment at the minor injuries unit, as may happen. A nurse—and there is sometimes only one trained nurse—will have to come to the casualty department from one of the wards, fill in a form stating that he or she has received the patient, and then redirect the patient elsewhere with the form. Nurses on night duty, particularly those on medical wards, are kept pretty busy. The proposal to divert them to perform an administrative function and, if a patient has a serious problem, to cope with that as well, shows a lack of forethought and also a lack of knowledge of what goes on in a hospital, especially at night.

Seven beds have been closed at Honiton hospital. Beds in small hospitals, particularly during the winter months, are an important facility for elderly people with respiratory problems. Respiratory problems can develop quickly and turn into something serious very quickly, so getting those people into hospital beds is very important. However, no thought seems to have been given to the fact that we are approaching the months of the year in which demand due to flu, or just among the elderly, is likely to increase rather than decreasing.

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When I spoke to someone at the hospital this morning, I was told that yesterday it had discharged two patients, and both beds were filled within half an hour. It is not that there are empty beds sitting about, or that there is a lack of demand even now. The fact is that none of these matters seem to have been discussed or considered from the point of view of patients.

The closure of hospital beds usually means a reduction in staff, especially nursing staff. I am told by the nurses’ union representative that there has been no consultation with professional staff about the impact on nurses. I always understood that employers had a statutory obligation to consult union representatives, and to take account of the views of professional staff. On so many counts, the way in which information has come into the public domain suggests that these decisions were made with only one purpose: to reduce the budget by cutting services—we are told—at the end of the financial year, which means the end of March. Meanwhile, none of the procedures that might have been expected to take place have taken place.

Let us consider what has happened to the health service in recent years. I picked up, literally at random, a couple of the documents that have arrived on my desk, most of them from the Government. In 2002 we all received copies of “Delivering the NHS Plan”. Paragraph 5.9 states

I do not think any of us would disagree with that, but if it is part of the national health service plan, what has happened to that plan?

I know from raising matters with Ministers that they often pray in aid the idea that “It’s the trusts out there that must make the day-to-day decisions. Nothing to do with us, guv; we provide the money, they decide what to spend it on.” That is all well and good, but we know that the trusts are not free to make the decisions that they want to make at local level. They must constantly work within a framework in which finances are controlled from the centre, and all the boxes that must be ticked if financial penalties are to be avoided are imposed from the centre. There is no real freedom of choice for trusts, or for the professionals managing local services in our NHS hospitals around the country. Everything is predicated on the priorities of the centre, despite the fine words in the documents that we find on our desks every day.

When the Government decided to abolish those primary care trusts and group them together, South West Peninsula strategic health authority invited consultation, which ended in March this year. The consultation document talks of “working closely with partners” and others to ensure integrated services, and providing “appropriate clinical leadership.” When I asked the chief executive of Devon primary care trust what clinical advice he had received or taken in deciding to make changes and cuts, I was assured that there were clinicians on the PCT’s board. The clinicians who were out in the field delivering the service were clearly not part of the consultation.

John Bercow: Is not an additional problem a lack of co-ordination and a ready preference for unproductive ping-pong between the different agencies responsible
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for the delivery of public services? Has my hon.Friend encountered in her constituency—as I have in mine—parents of children with statements of special educational needs and an entitlement to speech therapy who find that they cannot enforce that entitlementon primary care trusts that are reneging on theirduties?

Angela Browning: My hon. Friend is absolutely right, and I know that he takes a special interest in the subject. The only advice I would give him is that if something has been written into a statement of special educational needs and it has been signed by the parent and the due authority, it is a legal document and there is recourse to ensure that it is enforced. I encourage Members to ensure that when statements of special educational needs are signed they are enforced, and if people are reluctant to act on them, to take matters a step further. I am informed by some local authorities that when people reach the point in the process when they threaten legal action, they more often than not settle out of court. That is not how the process should be, and it is a dire process for parents to have to go through, particularly if they are not supported. However, if that is what it takes, the answer is to cut to the chase, and to get to that point as quickly as possible. That is my philosophy.

My hon. Friend alluded to an issue that I have already identified: joined-up government. I am sick of hearing and reading language to do with partnerships, consultations and working together—documents on such matters cross our desks all the time—when that is not what is happening in practice. My constituents have certainly experienced that in the past two or three weeks.

What is important is the people at the sharp end. The new patient and public involvement—PPI—forums, which the Government themselves set up, have written about the closures that I have described. They were not consulted. They wrote to the primary care trust to say that the cuts had been made too soon—that it has come straight in and made the cuts—but although we would expect them to have been consulted, they were not consulted.

Across the piece, we face a winter with services cut and professional members of staff—nursing staff and doctors—uncertain about what “temporary” means when they are told that the measures will be temporary. It is not said that the service will be re-established at the end of March, but it is stated that the closures are meant to be temporary. However, there is no guarantee of what that actually means.

The Government have had much to say about the NHS and all the people who do such a fantastic job in it and who built it up, but the Government are now knocking it down piece by piece. Patients, and the people who live in my constituency and in other parts of the country, deserve better.

Royal Assent

Madam Deputy Speaker (Sylvia Heal): I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified her Royal Assent to the following Acts:

Consolidated Fund Act 2006

Investment Exchanges and Clearing Houses Act 2006

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Christmas Adjournment

Question again proposed, That this House do now adjourn.

1.43 pm

Mrs. Ann Cryer (Keighley) (Lab): I wish you, Madam Deputy Speaker, and Mr. Heal a very happy Christmas, and I extend the season’s greetings to all Members and all servants of the House.

The local government pension scheme is close to the hearts of many of my constituents, and because I want to be certain to get what I have to say about it absolutely right I shall be very dull and read out my speech.

Previous difficulties regarding the well-being of the individual local government pension schemes were in large part due to employers of all political complexions, but particularly Tories, taking “contribution holidays”. In many cases, those pension contribution holidays meant that for long periods—10 years or more in some instances—many local government employers paid little or nothing into their local pension fund. Those contribution holidays, together with the downturn in the markets several years ago, have directly led to the fund deficits that have caused problems in recent times. The local government pension scheme needs to be improved and brought into line with other public service pension schemes, not downgraded to the extent that employees pay more for a worse scheme to pay for their employers’ past mistakes, while their employers share neither the responsibility nor the pain of remedying matters.

The employers and the recognised trade unions are currently engaged in detailed negotiations and they need to be allowed a reasonable period of time to reach agreement on the terms of any revised scheme. If those negotiations fail to lead to an agreement being reached, the Government will need to amend the current draft regulations so that the trade unions can consult their membership on revised proposals that they have at least a possibility of being able to recommend.

Mr. Fraser Kemp (Houghton and Washington, East) (Lab): On employer contribution, does my hon. Friend agree that one of the added pressures on many local authorities that fought hard to protect jobs and to keep them in-house is the additional burden that they have to carry in respect of single status?

Mrs. Cryer: I agree with my hon. Friend.

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