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31 Jan 2007 : Column 93WH—continued

10.39 am

Dr. Andrew Murrison (Westbury) (Con): Rarely have I seen such passion or, probably more importantly, consensus in Westminster Hall. The message from right hon. and hon. Members is pretty clear. I hope very much that the Minister is in listening mode and that he will not just trot our his pre-prepared speech, but comment on the many excellent points that have been made.

“Fit for the Future” sounds to me like another corny catchphrase, heralding another reorganisation driven by financial deficits and financial panic. It is not clear to me how the deficits in north-east London have arisen. I suspect that the reason, as in most parts of the UK, is an amalgam of poor financial husbandry, the rustication of the financial debt to other authorities and the funding formula.

Ministers are listening to those who suggest that the funding formula perhaps needs to be revised. They recently met a group from Plymouth, for example. I hope that Ministers will tell us how they will revise the funding formula to ensure in the long term that we are not faced with crippling deficits, which have such perverse and adverse effects on local health care economies and service provision.

The issue needs to be considered in the wider context of what is happening to district general hospitals throughout the country. We heard briefly from the hon. Member for Carshalton and Wallington (Tom Brake) about the Institute for Public Policy Research report. The significance of that report is that the IPPR is close to the Government. What it says about its perception of the need to reduce the number of district general hospitals is important, because Ministers tend to listen to the IPPR.

I think that the IPPR is wrong. The recent reports from the Department, authored by Professors Roger Boyle and Sir George Alberti, are perhaps also wide of the mark on how we should proceed with acute hospital delivery. Professors Alberti and Boyle argue that we perhaps need less A and E provision, with fewer A and E departments in the future, and that services should be concentrated in large tertiary centres. Professor Boyle in particular cites stroke and heart attack in that context. However, Professors Alberti and Boyle are not necessarily typical of doctors who work in either the primary or the secondary sector.

The British Association for Emergency Medicine takes a contrary view. Of the total number of cases that wander through the doors of A and E departments,
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97 per cent. have nothing to do with stroke and heart attack, which appear to be driving the agenda forward. We have been in touch with many casualty consultants and others, who are concerned that the general direction of travel on which the Government appear to have embarked will be to the detriment of the 97 per cent. of people who need easy and relatively rapid access to acute services. I hope that the Minister will take a more inclusive view when he consults those who work in the sector before doing anything that is irredeemable.

The changes in doctors’ working hours, such as those under the European working time directive, are also driving a great deal of what is happening in the secondary care sector. As an ex-junior doctor, I can reflect on the one-in-two rotas that I used to work and on whether that was a good thing to be doing. It did not seem to be so at the time, but we have nevertheless moved away from a culture of deep, profound commitment by junior doctors—working day in and day out, through the night, all the hours that God sends—towards more of a workaday approach to duties. That brings with it costs and benefits.

I would criticise the Government in their attitude to the SIMAP and Jaeger judgments by the European courts. We had hoped that the UK would secure a derogation for the specific way in which we tend to work in this country. Unfortunately, we did not do so, and that happened on the Government’s watch. Therefore, rotas have had to be redrawn and re-jigged. Often that results in smaller district general hospitals struggling to offer the same full range of acute services as in the past. In many cases, that has led to district general hospitals facing mergers or closures. We need to understand that.

We also need to understand that, paradoxically, there has not recently been a shift of services from the acute sector into primary and intermediate care—as we understand the Government would wish—but a shift in the other direction. We heard from the hon. Member for Leyton and Wanstead (Harry Cohen) that the changes in primary care had been fairly modest, despite the Government’s intentions. In fact, attendances at casualty departments in his borough and others have increased, so there has been a shift in the other direction. We have also heard that the recruitment of community nurses has been modest, which is certainly the case in my area, as it evidently is in the hon. Gentleman’s area.

We cannot have the Government saying that they will increase provision in the community and close down acute services, without their first planning for those improvements. Those improvements must be up and running before we start contemplating closures in the acute sector. So far, we have seen very little indeed in the way of improvements, and I was interested to hear the hon. Gentleman’s reflections about his borough.

The Secretary of State for Health said last week that she wanted GPs to do more and for more to be done in the community. That is all well and good, but she also said that she felt that GPs’ salaries needed to be restrained or capped. As I know very well, GPs’ remuneration has escalated under this Government. I am sure that GPs are grateful for that. However, I am not sure that it is terribly edifying for the Health
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Secretary, having supervised that, to say that the Government will have to cap those salaries, particularly if she is saying that GPs must do more.

The Government cannot have it both ways. In general, I would support incentivising primary care to do more and to take more of the burden from the acute sector, because that is what patients want. However, the Government cannot do that on the one hand, but on the other say, “Ah, but we’re going to expect GPs to do more for less”. Things do not work that way and the Minister should know that very well. Ministers need to be clear about the precise direction in which they intend the change to go.

We have spoken a little about consultation, mainly in relation to elected representatives. I have been horrified by what I have heard about the attitude of local health care managers in that respect. However, we should also consider the consultation process in the round. Up and down the country, many consultations are little more than a sham or a tick-box exercise. That is deeply worrying and encourages a culture of cynicism among consultees, who feel that they are not properly listened to, which I suspect is true in the case that we are debating.

The health overview and scrutiny committee and the independent reconfiguration panel process has been mentioned briefly, as have its shortcomings. However, as the hon. Member for Carshalton and Wallington pointed out, the process is important in that there appears to be a democratic deficit. There is indeed a democratic deficit: the Secretary of State is unwilling to assume responsibility for what is happening in the health service for which she is responsible. Time and again, the message that we hear from the Ministers is, “This really has nothing to with us—it’s down to local decision making”. Under the current circumstances that is a sham. I hope very much that the Minister will grip what is happening in north-east London and assume responsibility for it.

10.49 am

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I am tempted to say that we are all agreed, but that is not my role in this debate, which must have felt like déjà vu for you, Mr. Cook, given some of your recent experiences with your local health service.

I congratulate my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) on securing this debate, which has been a powerful one. Hon. Members on both sides of the House have made passionate and clear cases about why they feel so strongly about the issues that affect their local communities. In the relatively short period available, I shall try to do justice to the points made. I cannot say that I agree with everything that has been said, but I am sensitive to the fact that many of the concerns expressed have been reasonable and legitimate. I shall try to respond in that spirit.

First, I shall deal gently with the hon. Member for Westbury (Dr. Murrison). He cannot play such games. Tory policy on the national health service is in favour of total operational independence at local level, as stated by the Leader of the Opposition and the shadow Secretary of State for Health. Yet now the hon. Gentleman says that he wants Ministers sat in offices in Westminster and Whitehall to interfere in every
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difficult, controversial and contentious local issue and to take whatever action suits him at the time. That position is entirely incoherent and disingenuous.

Dr. Murrison: Will the Minister give way?

Mr. Lewis: No. The hon. Gentleman talks about looking at the funding formula, but what he means is moving away from a funding formula based on health inequality to redirecting resources to more affluent areas. We will not do that, because that is the policy of the Conservative party, which, furthermore, has voted against every additional investment in the national health service proposed by the Government since 1997. I shall take no lectures from the Conservative Front-Bench spokesman—I emphasise, “Front Bench”—on overall health policy.

The essential difficulty about the arguments is as follows. Hon. Members say in all debates on the health service that they acknowledge the need for change. They say that they acknowledge the comments made, the papers released and the policies developed by people such as Professors Alberti and Boyle—all of which say that more and more treatment needs to take place closer to people’s homes in the community and in primary care settings. Hon. Members acknowledge that that direction of travel is good for patients and reflects many patients’ aspirations and preferences in a modern world. Alongside that, however, hon. Members say that they want the status quo to prevail. They must accept that there is an element of contradiction in that position.

Jon Cruddas rose—

Mr. Lewis: I shall give way to my hon. Friend in a minute; let me develop my argument.

For example, during this debate, hon. Members have talked about the need to invest in primary care and access to transport for their constituents. They are absolutely right to say that it would be nonsense to make changes to acute NHS care in any locality without investing properly in community services and primary health. They are also right to say that it would be nonsense not to consider the very real transport and access problems that constituents experience as services are reconfigured. However, it is unfair to suggest that, if changes were made in any locality, those issues would not be considered holistically, as part of the changes.

Jon Cruddas: I take the Minister’s point, but does he not accept that there is a certain uniqueness to the geographical area that we are discussing? Not only is an increase of 311,000 anticipated in the population of north-east London, but the Government anticipate an extra 750,000 people in east London and across the Thames Gateway in the next 10 years. No one is arguing for the status quo; given those empirical realities, we are all arguing for extra capacity.

Mr. Lewis: I have great respect for my hon. Friend’s work in his constituency, particularly in dealing with the far-right elements that are dividing his community. I agree entirely that any decision made in the context of the reorganisation must take proper and full account not only of the current population but of the direction of travel of population growth. Any failure to do so would be nonsense.


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Mr. Duncan Smith: Will the Minister give way?

Mr. Lewis: I shall not give way any more; I have to—

Mr. Duncan Smith: I want to intervene only very briefly; this is important. I know the Minister has little time, but I wish that those on our two Front Benches had not spoken. I have two points to make. First, the Thames Gateway programme talked about 1,000 extra acute beds; it did not say that there would be investment only in primary care. Secondly, we are told endlessly at the meetings that, yes, the PCTs say that there will be more investment, but only when the money is withdrawn from the acute trusts. We are looking way down the road before we even get that facility.

Mr. Lewis: All I say to the right hon. Gentleman is that the future population growth in those communities matters. I would certainly be extremely concerned at any suggestion that young people do not get ill.

To reassure my hon. Friend the Member for Dagenham (Jon Cruddas), I do not think that anybody is saying that Whipps Cross hospital is bad. There is no evidence to prove that: the hospital would not have received a £2.8 million investment in emergency and urgent care, nor a £3.4 million investment in an endoscopy unit only last year if there had been a genuine belief that it was, as a matter of course, a bad hospital. There is no suggestion that that is the case.

Other hon. Members, including the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith), have talked about the review of London health needs across the piece and the importance of integrating that into the review. They asked why the review was taking place separately. I have two things to say about that. First, it is not for me to instruct NHS London on what it ought to do. Secondly, when NHS London receives the proposals and has to make a decision on whether to consult on them—for that process would be about to take place—it must consider the consequences of going ahead with that consultation outside the overall review of health services in the London area. It is for NHS London to make the judgment on whether that would be an ill-advised direction of travel, but it certainly has a responsibility to take full account of that issue when it receives recommendations and before it decides whether it would be appropriate to allow a stand-alone consultation to go ahead.

Mike Gapes: I ask the Minister to get from the London region a copy of its letter to me and ask it why such a letter was sent. It is clear from that letter that it has a pre-conceived approach and will go ahead regardless.

Mr. Lewis: I shall make sure that I familiarise myself with that letter.


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I say to hon. Members, particularly the right hon. Member for Chingford and Woodford Green, that I do not think that it helps or is appropriate to cast aspersions on the integrity of officials in the local NHS. The right hon. Gentleman may disagree with their judgment. On occasions, he may not be satisfied with their performance, but it is entirely inappropriate to cast aspersions on the integrity of those people, many of whom are genuinely trying to do their best for local patients and the local health economy.

My hon. Friend the Member for Walthamstow (Mr. Gerrard) made some important points. He talked about the knock-on effects on neighbouring hospitals in the context of any London-wide review and the effect of doing things separately from that. He talked about the apparent resentment of MPs’ involvement. Well, I give a clear message to any NHS leader or manager anywhere in the country: engagement with MPs is a priority, although it is not the final part of the process. MPs are democratically elected and represent their local populations and communities for good or bad. They have every right to be those taken most seriously when such decisions are made. That is not the same as saying that hon. Members have the right of veto, which might sometimes lead to anarchy. However, any suggestion that MPs should not be one of the first groups to be consulted is unacceptable.

I nearly called the hon. Member for Ilford, North (Mr. Scott) my hon. Friend. I cannot do so yet, although I am sure that he will see the light one day. He talked about the gentleman from Barratt Homes and his medical expertise. It is a bit rich for the Conservative party to slag off business people sitting on public service boards for being business people, given that it completely transformed the management and accountability of public services and placed business people on boards purely because they were business people—whether they knew about anything else did not seem to matter. That policy was ideologically driven.

However, the hon. Gentleman was good enough to congratulate the Government on Queen’s hospital. I am a bit disappointed that my hon. Friends did not talk positively about the massive investment in that hospital. I say gently to my hon. Friend the Member for Ilford, South (Mike Gapes) that, yes, the hospital has teething problems, but he and we should be very proud of the Government’s £261 million investment. I am also delighted that my hon. Friend the Member for Leyton and Wanstead is a passionate advocate of PFI schemes and the Government’s choice agenda in the national health service. That is a revelation, but I promise not to tell anybody.

The hon. Member for Carshalton and Wallington (Tom Brake) talked about not opposing change for the sake of it. He has clearly not read “Focus” leaflets these days; all the literature is about opposing any politically expedient change. There will be balance in the NHS by the end of the financial year, so the hon. Gentleman is wrong about that.


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Northampton Travellers Site

11 am

Ms Sally Keeble (Northampton, North) (Lab): I am grateful to have secured this Adjournment debate, as it provides an opportunity to get my serious concerns about the Northampton Travellers site on the public record and also to get some reassurances from the Minister about how the matter will be progressed. Although the debate will refer to sites in general, the refurbishment of one particular site was part of a national programme of the Department for Communities and Local Government, which is why it is appropriate to bring it to the attention of the House and the Minister.

I am grateful to the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Sheffield, Heeley (Meg Munn), who is also Minister for Women and Equality, for the time she provided to talk through the matter with me, and also to officials of the Government office for the east midlands for their time and subsequent actions.

The matter at hand is the Ecton Lane Travellers site and the use of public funds for refurbishing it. The site has 32 utility blocks, which are small brick units with a kitchenette, shower room and toilet. The infrastructure of the site is poor, and the utility blocks themselves are in desperate condition. They are not the kind of facility that is appropriate in this day and age. Frankly, a total rebuild would have been better, but, failing that, refurbishment was desperately needed.

The application for the refurbishment grant was approved in 2005. The Government provided £366,899, and Northampton borough council was to provide £125,000. A company called Westgate managed the site and was involved in drawing up the funding application and then delivering the contract. The contract specifies internal and external improvements to the utility blocks, and also some site improvements and repairs, which were later specified as fencing around the site and floodlighting.

Concerns about the project were first raised with me last spring by a member of staff at the Northamptonshire county Travellers unit, who contacted me because several Travellers’ relatives have settled in my constituency. I should make it clear right at the start that the concerns that were raised with me, and on which I shall focus, involve the delivery of the refurbishment scheme. Separate concerns about the procurement of the contract have been investigated by PricewaterhouseCoopers. I can understand why people would be concerned about the procurement, but those issues were not raised with me, and they have not been the subject of my letters and representations. I ask my hon. Friend to note that my concerns do not involve procurement, and I shall not deal with it in this debate.

My first visit to the site after the matter was raised with me was last May. I spent a couple of hours going from block to block to see the work that had been completed and to talk to the residents, who were concerned and agitated about what had been happening on the site. I then put in a detailed report to Northampton borough council and left the matter for three months to provide time for remedial work to be undertaken.


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