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“The service is so overcrowded that the gangways are blocked. This is dangerous and breaks safety regulations. (from a member of FGW staff) ... I have to leave work 20 minutes earlier to get a train that serves Thatcham.”
That does not sound a great inconvenience, but if it is added up over a week, a month or even a year, it is an enormous inconvenience. Another says:
“The new...service is taking significantly longer (10 minutes more in the morning and around half an hour in the afternoon”.
“Since moving to Newbury in September in part to be closer to train services into London and better train/bus connections to Heathrow I have found the local service to be overcrowded, uncomfortable and local rail staff rude and high-handed. As a consequence”—
I really hope that the Minister responsible gets this important point—
“I am now driving into London and the airport more often than travel by train”.
Last week we heard that Newbury had one of the most congested school runs in the country. I have been struck by how many parents and children have contacted me to give me their experience. One mother says:
“My daughter attends St. Bart’s School in Newbury. She commutes every morning by train from Hungerford.
Since the changes to the morning train timetable, my daughter has to literally run to school,”—
“to avoid being late.”
“The changing of the trains has dramatically affected me getting to school every morning. I have to travel from Kintbury to Newbury every morning and have no other choice because of my parents being market traders. The train leaving Kintbury at 8.18 every morning, and me having to be in school by 8.40, causes great issues.”
I will not burden the House much longer because I want to allow other hon. Members to speak. I am indebted to the Vodafone intranet. Vodafone is for the moment the largest employer in my constituency. The Atomic Weapons Establishment at Aldermaston is fast catching it up, but 3,500 employees of Vodafone work in Newbury. It has done a trawl via its intranet to see the effect that the timetable changes are having on one company. I was struck by a debate that my hon. Friend the Member for Reading, East (Mr. Wilson) initiated recently on transport infrastructure in the Thames Valley. He pointed out that Hewlett Packard was moving out of Reading due to pressure from its employees about the amount of time that it takes for them to get to work. I quote a couple of Vodafone employees. One says:
“Needless to say, I went out and bought a car and now drive to London, which is cheaper and I can come home to Newbury at whatever time I like.”
Another describes his commuting experience over the last couple of weeks:
“I was sitting in a seat where three people face each other and we actually had people standing between myself and the passenger opposite ... One woman got very distressed and claustrophobic and started screaming and shouting but there was nothing anyone could do, as you couldn’t move an inch.”
Finally, a great many people raised the issue of bicycles. As one said, if we are to have an integrated transport system, we need to make provision for bicycles. He thought that the sooner the Adelante trains are gone, the better, because there is not enough room for bicycles on them.
There is a major social dimension to this matter. Research in the US—ground-breaking research by Professor Puttnam, culminating in his book “Bowling Alone”—showed that for every 10 more minutes that people spend commuting, 10 per cent. less time is spent
on community activities, social events, sports clubs, other voluntary work and even family gatherings. It is a major issue, not just one for rail users. It affects car users, who are stuck in greater congestion. We talk about general well-being and this is a real health issue. People are more stressed at work, it affects the economy and it affects communities.
I finish with one more quote. Alec Mellor sent me an e-mail, in which he referred to his “sum of displeasure today” as
“2 hrs standing up on top of a 10hr working day. This cannot be the quality of my life for 5 days a week. I cannot do any work on the trains any more, cannot read and am seething for the entire durations.”
5.41 pm
Sarah Teather (Brent, East) (LD): I wish to raise two pressing constituency issues today. The first is about the financial crisis in Brent’s health service, which threatens to have a massive impact on patients and a devastating knock-on effect on local services provided by the council and voluntary groups.
In Brent as in other areas, we have watched with horror as reports of the health savings necessary have escalated from £6 million to a projected £53 million over two years. We were initially told that Brent’s teaching primary care trust had a good reputation for balancing its books and that, unlike other primary care trusts in London, it finished each financial year in budget. However, the impact of top-slicing—not once, but twice—and then the failure to meet the initial savings plan, followed by a closer look at the books by the turnaround team and some incomprehensible budgeting, brought us to the extraordinary level of debt that is now reported.
No immediate solution appears to be in sight. The PCT expects to achieve only £14 million of savings by the end of this financial year, leaving a further£13 million that will be annually recurring. In a drastic attempt to resolve this crisis, countless services are set to be slashed, countless more costs shunted on to the council, and all without any eye to long-term planning or even the Government’s own national preventive health agenda.
The list of clinics set to be axed includes the Roberts Court clinic, Perrin Road, College Road, Helena Road, Hay Lane, Stag Lane, Mortimer Road, Neasden and the Wembley walk-in centre. Fifteen district nurses will go, children’s health services will be slashed and rehabilitation beds at Willesden community hospital shut. Services for young people with learning disabilities will be renegotiated, smoking cessation advisers cut and cuts imposed to services in the mental health arena that the mental health trust has said are impossible to achieve.
Perhaps most damaging are the smallest cuts of all—those to the voluntary sector, such as grants to citizens advice bureaux to provide outreach workersin GP surgeries. Those posts almost certainly did more to cut the consultation time with GPs than any other single thing that the PCT could possibly have done. Grants to bereavement counselling and carers groups have also been cut as they are not seen to be core NHS activities. That is the whole point, is it not? Working with the most vulnerable members of our society is not core to anybody’s business, which is why those people always fall through the net.
The long-term impact will take some time to assess, as the PCT renegotiates every section 31 agreement with the council, arbitrarily assigning previous joint working as social care rather than health care, thereby shunting the costs on to the council and leaving people whose care was provided free previously to find that they are subject to means-testing and that they might be unable to afford or receive the care that they expect.
The local council has no idea of how much NHS debt it must absorb. Early discussions suggested a figure of possibly up to £21 million, but the PCT’s debt has doubled since then. The PCT in Brent is in financial meltdown. Little or no communication is coming from the organisation, and it is impossible for the council to plan its long-term care provision. The PCT already owes the council about £10 million, because it has failed to pay for joint work that was previously agreed going back to 2004. Of course, it is not just the local authority that must pick up the cost of such cost shunting. Many voluntary sector groups will find themselves at the forefront of providing services for people who have otherwise been refused them.
Perhaps the most frustrating aspect is that, as the hon. Member for Uxbridge (Mr. Randall) said earlier, given all that crisis debt management, there is no long-term planning and no sense of incorporating even the Government’s plans for preventive health. Many of the cuts will fall on essential health and social care outreach programmes, on community rehabilitation posts and on family planning, sexual health, drugs and alcohol services, as well as on help and advice for smokers or the obese—the very work that ensures that people do not need to go into hospital in the first place. If those programmes are scrapped, the burden on acute NHS services will increase, not decrease. That is idiotic—it is short-term planning—and it will not resolve anything for the long-term health of peoplein Brent. The voluntary sector—Brent carers centre, Brent Mencap, Age Concern Brent and Elders Voice—believes that those cuts will have a devastating impact on the most vulnerable members of Brent’s population.
It beggars belief that financial management was so incompetent that that situation was allowed to arisein the first place; but having found that it has arisen, surely, it is ridiculous to expect the PCT to cut £53 million-worth of services in two years—or, in practice, in rather less than two years, because the cuts have been found part way through a financial year. The PCT’s total budget is £400 million, so a substantial proportion of its annual budget is involved
In Brent, it is not just the PCT that is in financial meltdown; the North West London Hospitals NHS Trust also faces a deficit of about £30 million, with a projected cumulative deficit of £67 million. Those figures are quoted from The Guardian, because the figures that come from the North West London Hospitals NHS trust are rather contradictory. A variety of figures are floating around, just as with the PCT, so it is difficult for local people to understand what the implications are for them.
All patients and staff know is that the long-planned reorganisation of services across hospitals in north-west London—something that may or may not have a clinical basis—now seems to be obscured by financial crisis. Frankly, like everyone else in Brent, I do not believe a word that I am being told by hospital managers about what they are trying to do or why they are trying to do it. That is a very sad state of affairs, and it is time that everyone paid a little more attention to communication and transparency, given that the implications will be huge for everyone concerned.
Very briefly, I should like to refer to the changes to legal aid, which are of considerable concern to many hon. Members. The issue was raised today in departmental questions, and it has been raised with me extensively by constituency organisations, such as the citizens advice bureau, the community law centre, Brent private tenants rights group and the refugee legal centre—and many interested individual constituents. Their concern is that a fixed fee, regardless of the complexities of the case, will dissuade lawyers from taking on the more complicated cases. Such cases will inevitably take longer in a borough such as mine, with very many vulnerable people, often with very complex needs, who frequently do not speak English as a first language. My concern is that vulnerable people, who need legal aid most, will find themselves unable to obtain it.
The new fee system will have a particular impact on immigration cases. I will finish with an example of a constituent who I fear may find himself in difficulty. Let us call him Mr. A. He is an Iraqi. His problems are due to a failure of the Home Office to apply its own undisclosed policies to grant refugee status or exceptional leave to remain to certain categories of asylum seekers from Iraq. Following litigation in which the policies were finally disclosed, the Home Office now accepts that decisions to refuse leave to people who should have been granted it need to be reversed. There are potentially large numbers of applicants who have been asked to apply to the Home Office again, saying why they feel that their cases were unfairly treated.
Under the proposed graduated fee system, legal representatives would end up bearing the cost of such Home Office maladministration. They would have been deprived of an early resolution fee as a result of the Home Office’s failure to apply its own policy in the first place. There is no provision for representatives to be paid for reviewing old cases, but that work would have to be done to remedy what the High Court termed
“the series of errors which amounted to conspicuous unfairness on the part of the Home Office”.
The failings of one Department have created a financial hole for those people who need their appeals funded. That is being passed on to legal providers, who will be forced to withdraw their services from clients. The original Home Office failing still has not been rectified.
I know that the issue is of considerable concern to many Members and I hope that Ministers will listen to the representations that have been made today, both in this Adjournment debate and in Question Time. They are forcing through the changes without the necessary consultation. If we lose the experts who provide legal aid in the profession, they cannot be brought back into
the system quickly. That could have a serious long-term effect on the most vulnerable members of our society, who must have access to justice in this country.
I wish you and all the staff in the House a happy Christmas, Mr. Deputy Speaker.
5.52 pm
Greg Clark (Tunbridge Wells) (Con): I add my good wishes to you, Mr. Deputy Speaker, to hon. Members and to the staff who support us in the House. I would like to use the opportunity of this Adjournment debate and the presence of the Minister on the Front Bench to reflect on perhaps the most important issue that has dominated my constituents’ thoughts on policy—and I suspect those of many others—over the past year: our local NHS. In doing so, I do not expect that 2007 will be any different. Indeed, the issues that have troubled my constituents over the past year look set to continue to dominate their lives going forward. In thinking about the NHS locally, my constituents do not share the Secretary of State’s view that this has been the “best year ever” for the NHS—rather the reverse. Across the board in our health economy, we have seen cuts, question marks over long-planned initiatives and a level of uncertainty that is troubling to those of us who depend on the national health service for our livelihoods or for the sake of our health.
In my constituency, we have been waiting for a new hospital for many years. There are two hospitals that serve the constituency. One of them, in Pembury, consists of a workhouse that was built in the 1890s. I suggest that there are very few examples in the country of workhouses that are still being used as NHS hospitals. The main workhouse is supplemented by wooden huts—again, something unbelievable in 2006. The other principal hospital, the Kent and Sussex hospital, is in a congested part of my constituency, in the heart of town. Even though it is a 20th-century hospital, its facilities are out of date. For example, it has mixed-sex wards at a time when patients expect the privacy and dignity of single-sex wards.
I place on record my gratitude and admiration for the staff in the NHS in my constituency, who work in conditions that are at times intolerable and manage to deliver a standard of health care that is extremely proficient and compares well with other parts of the country. They do so because they have a vocation to provide the best health care that can be available. We owe it to them, as well as to my constituents, that they should be able to operate in the type of facilities that other constituencies take for granted.
We have been waiting for many years for a new private finance initiative hospital to replace those facilities. We received some good news today: the Maidstone and Tunbridge Wells NHS Trust has felt able to appoint a preferred bidder for the new hospital. That bidder, Equion, will develop its exciting plans further. It should be a state-of-the-art hospital, in which 100 per cent. of the rooms will be single ones. That will address the privacy issue at a stroke and will make a major contribution to infection control. The hospital will be a beacon for the NHS and will represent best practice around the world.
Over the past year, there has been delay after delay in the original decision to build the hospital. It should have been well on the way to being built by now. We
were expecting a preferred bidder to be appointed in February, but various Department of Health and Treasury reviews put that further and further back. The final decision will now be taken in March 2007 bythe Treasury and the Department of Health, based on the financial situation locally and nationally.
The case for the new Pembury hospital is overwhelming. No one could deny that the team in the local trust has put together the best possible bid and case, or that it had addressed all the questions before it. Any fair-minded person would recognise that it is time to build that hospital, and to get on with building it quickly. I urge the Deputy Leader of the House to take back to his colleagues in government the strong feelings of everyone in not just Tunbridge Wells, but west Kent and East Sussex, that we need this hospital now. As time goes by, we know that construction costs are liable to increase, so time is precious.
It is not just the PFI hospital that troubles us. Unfortunately, a series of cutbacks and proposed cutbacks were announced during the past year, and decisions will be taken during the months ahead. Let us consider some of those. Antenatal classes might not be considered the most pressing need in our health service when it is cash-strapped, but the provision of parentcraft classes to new parents is of significance to first-time parents, who are understandably worried about what lies in store and have no experience of looking after a new child. They benefit from the practical help given by midwives and other health professionals on how to cope with labour and childbirth. More than that, antenatal classes provide an important transition into the early weeks and months of a child’s life. Ministerial statements over recent months have told us how important the early years are to the development of a child, so increasing the anxiety and stress on parents at that time is unforgivable.
It is also important that we have established social networks, in which new parents can meet each other and give each other support, outside state provision. That is an important means of self-help, and the provision of antenatal classes is important to that. I gather from the managers of the local NHS trust that the trouble is that the new funding formula does not include a specified element for antenatal classes, so at a time when the trust needs to recover its deficit, it is easy to cut such services.
Another threat to the provision of childbirth services that is proposed by the local primary care trust is a cut of up to one third in the health visitor service. The proposal aims to focus health visits on new mothers who are perceived to be at risk. I am concerned about that, because it is difficult to know in advance whether a mother, especially a first-time one, is likely to experience post-natal depression. We know that post-natal depression strikes people down very unexpectedly, and the visit of a health professional shortly after birth can be crucial in protecting the health of the mother and her new baby. I am very concerned that the proposals may jeopardise the future health of my constituents. I am aware that the Government nationally are reviewing the provision of health visitor services, and it would be appropriate if, in different parts of the country, we benefited from the conclusions of that review before we took any decisions that might be precipitous.
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