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Laura Moffatt (Crawley) (Lab): Probably no other subject strikes as much terror in the hearts of Members as learning that there is to be a review of acute services in their area. I live in a constituency where that has happened and I want to share some of the experiences of the people of Crawley, and to tell Members that there is life after reconfiguration and there are excellent services to be hadif Members are prepared to be open-minded about what these services are about.
We in this House are in a privileged position, in that we have access to information that our constituents would love to have. We have a responsibility to share that knowledge so that our constituents can understand what the drivers for a review of services are. I was very interested to hear the hon. Member for North-East Bedfordshire (Alistair Burt) argue that pre-1997, the then Labour Opposition were preventing the reconfiguration and modernisation of the health service. I wish that the then Conservative Government had taken the bull by the horns, realised that Crawley hospital was in desperate trouble and addressed the issues of underfunding, accreditation and the hospitals general decline. They have now been properly addressed, and in sharing such experiences I want to show that the interests of our constituents must come first.
I completely understand that, as I said, such reviews strike terror in our hearts, but our constituents interests must of course be firmly at the heart of our efforts. We have had review after review in my local area. I have heard many Members say, I am in favour of modernising, reconfiguring and providing a better service, but most are thinking, But dont do it in my patch, if you dont mind, because I dont want the hassle of dealing with the consequences. Unless Members are mature enough to tackle this issue, which has emerged time and again in contribution after contribution, the way in which politicians will be perceived will be a worry. We have a responsibility to understand the clinical drivers behind the proposed changes, even though we might not like them or want to accept them.
Tim Farron (Westmorland and Lonsdale) (LD): The hon. Lady is right to say that hon. Members should consider all the issues when a review of acute services is taking place. One size does not fit all. In my constituency, the Westmorland general hospital faces closure of its heart unit because of the acute services review. There are clinical arguments for that, but there are also strong arguments for providing emergency services close to where people live. There is no point in having an all-bells-and-whistles centre of excellence an hour away from where someone lives, so that they die before reaching that fantastic centre.
Laura Moffatt: I hope that the hon. Gentleman has his press release already written, and I am glad that he had the opportunity to mention his local difficulty. We have a responsibility to understand the implications of the times that ambulances need to get to patients. We no longer pick people up off the road and run to the front door of the nearest hospital. All the factors are important in determining whether people live or die, and that is the reality behind many of the reconfigurations.
I have heard many claims that if a certain local facility is closed people will die before they reach one that is further away. Hon. Members need to think carefully and do their homework before they make such statements, either in their constituencies or in the House, because there is no evidence to support such views. There is evidence of the effect of 24-hour consultant cover and of a cardiac unit that regularly performs angioplasty and can do one immediately a
patient is admitted. There is also evidence of the benefits of surgeons getting practice by regularly performing a range of surgeries for the 500,000 people in an area. That is where the evidence lies and we have a responsibility to ensure that we convey that information to our constituents.
The hon. Member for South Cambridgeshire (Mr. Lansley) said that he was not opposed to progress in acute services. If that is so, we all have a responsibility to consider each individual reconfiguration and take a view on it, as difficult as that may be. I bear the scars of having a majority of 37 for that very reason. I worked in the NHS for 25 years before entering the House and I knew that things were not right with the health service and my local hospital. I knew that it had difficulties that needed to be addressed, but which had not been addressed for many years.
I was one of the first Members of Parliament to face a review of acute services, which puts paid to the lierecently put to me by local journaliststhat only Conservative Members are having to go through that. That is absolute nonsense. The reviews are taking place where they are needed.
Tim Loughton (East Worthing and Shoreham) (Con): The hon. Lady is right to say that she was one of the first to face an acute services review, but does she agree that it was because of the privilege of her position as a Labour MP and her relationship with the Secretary of State that, to save her own hide, she was able to get the inevitable decision deferred until after a general election?
Laura Moffatt: I have had that put to me by several Members of Parliament and it is just a smokescreen for their refusal to get involved in reconfiguration. They do not attempt to understand the issues or communicate them to their constituents. In the midst of the review in Crawley in 2005, I did have to face a general election, and the fact that I am a Member of Parliament now puts paid to that argument.
It is easy to take the populist view. I have watched Members of Parliament on local television saying, Oh, isnt it awful, isnt it dreadful? They do not want to listen to the real arguments. They just want to say that the problem is all about money so that they can survive whatever might happen. I urge Members to think more carefully about what they are doing because, in the future, we will have to answer for all our actions. Often, if we do not do what we think is right at the time, it will come back to haunt us later. I hope that Members will think about that carefully.
We have undergone a reconfiguration in Crawley. Of course I did not like it or want it to happen. Of course I kept pressing the Secretary of State about it. I have pages and pages that show the action that I took to try to make people understand how difficult the decision was. I am not ashamed of that. I am aware that the people of Crawley would understand that these are difficult decisions and that one has to keep arguing to get the best deal for ones own communityas I did. But inevitably, because of the overwhelming clinical arguments in support of reconfiguration, the major
accident and emergency department was consolidated Crawley was never a major accident centreat East Surrey hospital.
Those were difficult decisions for us all. However, that is not the end of the story by any means and the work does not stop there. Remaining engaged and getting the best out of local services is our responsibility. Because of all the issues that I outlined to the House earlier in relation to accreditation and making sure that we were serving the public in the best way that we could, it was important to make sure that our local GPs had control of our local hospital. Crawley hospital has been reborn. It has had £20 million of investment. I am a member of the local league of friends and this Monday we toured our new urgent treatment centre. We have stepped up the service in Crawley from a walk-in centre to an urgent treatment centre. That is going to open fully on 5 March. It took a lot of hard work to make sure that that happened. The local GPs have the hospital in their control and they are filling it with all sorts of services. We have a new stroke unit, a renal unit, a chronic disease management centre and services that the hospital never saw the like of before. The community can see that there is a point in supporting local services.
The real issue that I wanted to raise today is that if any Member thinks that this change is going to end, frankly I think that they are being ridiculous. No matter what we say in the House, or how many times we speak to try to defend a local service, change within the NHS is inevitable. I predict that in 10 years time PCTs will not exist. I firmly believe that there will be single budgets. Local authoritythe county authority or however the local government is set upand health money will be in a single budget, to address the needs of local communities. We have made a start on that in Crawley already. We are keen for social enterprise to apply and to have that single pot of money. If somebody could fall over because their carpet needs replacing or get cold because they need their heating repaired, that budget will be able to address those issues and the needs of our local communities.
We will probably look back at Hansard and think what a strange, old-fashioned debate this was, because in many ways the model that is being defended on many sides simply will not exist. I hope that it will not, because it has stifled development in the health service for many years. A holistic approach is needed, certainly in relation to elderly care, mental health care and many of the chronic diseases from which people suffer. Some 17 million people in the country suffer from chronic diseases and they need their care local to home. That is why what happens following reconfiguration is essential in making sure that those services are in place. That is precisely what we have been doing in Crawley.
I know and understand that these matters are difficultthere is no question about thatbut there are opportunities to be had following reconfiguration. I urge hon. Members to examine plans seriously and, rather than just taking an oppositionist view, to attempt to understand that this is not just about money. Of course money is an aspect of the process, and of course there is an impact on budgets. My acute trust is the most indebted trust in the country and is trying to get itself back into order. Despite that, it is still developing services and delivering a much better
service that it did 10 years ago. It is still able to move forward with new services and to develop community services. It is working in a way that is meaningful to my constituents.
It was interesting to hear my hon. Friend the Member for Dartford (Dr. Stoate) talking about consolidation. I will finish with a statement made by the Royal College of Physicians and the Royal College of General Practitioners:
Service provision should move away from the needs of organisations to the needs of patients
The Colleges believe that specialists and generalists working in strong collaborative arrangements offer a major and unrivalled opportunity to improve the quality and safety of patient care and to reduce health inequalities.
Mr. Nigel Evans (Ribble Valley) (Con): There was one aspect of the speech made by the hon. Member for Crawley (Laura Moffatt) with which I agreed implicitly: we hear people saying that we must modernise the national health service, but not their bit of it. I was struck by the fact that that was almost a fly-on-the-wall statement about the Cabinet. Clearly, some members of the Cabinet want modernisation and efficiency savings in some parts of the country, but not if that affects their services. It is amazing that they are saying one thing in Cabinet, yet something completely different to their constituents. That cannot be right. There must be consistency. As I said to the shadow Health Secretary, there was such a thing as collective responsibility at one time. People who are part of a decision should stand by it, rather than taking to the picket lines in complete opposition to policies that come forth from decisions made directly in Cabinet.
I agreed with everything said by my hon. Friend the Member for North-East Bedfordshire (Alistair Burt). We sat together on the Government Benches between 1992 and 1997 and heard what the then Opposition were saying to us. Our opposition to many of the things that are happening in the health service today is far more measured, far more sensible and put in a calmer tonealthough we are still angry and frustrated about what is happeningthan that of the then Opposition. There was a lot of shroud waving from Labour Members between 1992 and 1997. We are seeing things happening in the health service in our patches that we do not like, so if we were to show restraint by not standing up in the Commons to expose deficiencies, we would not be doing our duty.
Although the Government think that the changes that are being made will make the situation betterwe are yet to see whether that will be the casea lot of people working in the health service are worried about those changes. The hon. Member for Pendle (Mr. Prentice) raised that matter during todays Prime Ministers questions, so, as a neighbour of his, I will raise the same issue and ask the Minister to address it in his winding-up speech.
I believe in localism, and that services should be as close as possible to where the public are. I have previously raised the reconfiguration of the primary care trusts in the Chamber. Although people in Longridge were receiving all their services in Preston, all of a sudden they were asked to get a chunk of their secondary provision in east Lancashire, although they do not live anywhere near there. I am sure that the Minister knows Ribble Valley and is thus aware of how difficult it is for people from Longridge to go to Accrington or Burnleythey do not know that area. We want local provision. Locally, there is Longridge community hospital, which the Longridge GPs rightly use, and Clitheroe community hospital, a tremendous community facility. We want those to thrive and to be used, and I praise the staff who work in the health service in my patch.
All of us will have received letters from constituents about problems and deficiencies of service. If it is proven that the service was well below what the public expect, provided that the problems are properly investigated and corrected, we can have no difficulty with that, but attempts to cover up deficiencies are completely wrong. To address the Ministers point, I am sure that all of us in the Chamber will know of examples of excellence in our own patch, but there are other matters that we need to address properly.
The major point that I want to make is about the clinical assessment, treat and supportor CATSproject under way at the Royal Preston hospital. On 25 January, the Lancashire Evening Post had the headline, Hundreds of NHS jobs face axe. The hon. Member for Pendle talked about a private company providing some of the care normally offered directly by the national health service in the fields of general surgery, rheumatology, urology, gynaecology, ear, nose and throat, and orthopaedics. Those services will be provided by a South African company called Netcare. When I have held surgeries in Booths in FulwoodBooths is opposite the Royal Preston hospitalmany people have come up to me and said, Were really concerned about the CATS scheme coming into our area. They believe that it will result in job losses in the area, and that hospitals in Preston and Chorley could lose as much as £16 million in income because of money being diverted to Netcare. That could result in 360 NHS jobs being lost.
I hope that the Minister can address that point, which has also been made by the hon. Members for Chorley (Mr. Hoyle) and for Pendle. I hope that he will answer a question that a constituent asked me: what if Netcare brings nursing care with it from South Africa, which is where the company originates? Will the Minister give an assurance that if the medical assistance is in any way, shape or form South African, he will look carefully to make sure that none of that medical care could be better used in South Africa, particularly given the HIV/AIDS pandemic that the country faces? I know that the Government have a policy on that, and I hope that he will consider the matter carefully.
I received a letter from a local councillor, Mrs. McManus, who asks a few questions about the change in Preston. She asks what will happen if there
is, as expected, a severe drop in income, leading to a reduction in services at the Royal Preston hospital, and she asks about a
reduction of surgical experience for Junior/newly qualified staff. The type of operations to be undertaken by Netcare are the type that Doctors cut their teeth on before moving on to the big stuff.
Can the private company match the diversity of Diagnostic equipment available at the hospital?
She asks how much experience the doctors working for Netcare will have, and we need to know that. The hon. Member for Pendle raised an interesting point earlier about the fact that there seems to be a lot of secrecy about the way in which the system will be financed. The figures cannot be made generally available. Will extra money be made available, or will the money be taken directly from the Royal Preston hospitals budget?
I am sure that the Minister understands that Members from his own party are deeply concerned, as am I, to ensure the best provision for people who live in the Preston area. We want to ensure that we are not pouring one pool of money into another, but that total provision will instead be increased, and we want to ensure that the care provided at the Royal Preston hospital, which is excellent in the main, will not be damaged.
I wish to conclude with an issue that has already been raised. Clearly, if we can keep people out of hospital to begin with, that is a good thing. I am sure that we all have constituents who have been told by their GP that they need a certain drug that will keep them out of hospital and keep them alive longer. If the National Institute for Health and Clinical Excellence has not adjudicated on that drug, it is for the local primary care trust to determine whether it should be made available. One of my constituents, Keith Ditchfield, has acute renal cancer, and has to pay £3,000 a month of his own money for his drugs. He goes to Germany, as he does not have to pay VAT thereif the drug was available here, he would have to pay VATand pays £3,000 a month for a drug that many experts believe is useful because it keeps him alive and gives him a better quality of life. Why has that drug not been made generally available?
The Minister will know about Velcade, which has been made available in Scotland, but not in England. Some drugs are made available by some PCTs, but not by others, even though they help to keep people out of hospital. I urge the Minister to address the postcode lottery. Why can we not reintroduce a national health service in which people, irrespective of where they live, are treated according to need, and nothing else? If a drug is effective for patients in Scotland, it is effective for patients in England, so cost should not be the reason why people are not given the drugs that they need.
When we had the worlds favourite health service, everybody was treated equally irrespective of where they lived. Everybody pays taxes, and we all pay an extra 1 per cent. in national insurance to pay for the health service. Everybody, irrespective of where they live, should receive the same care and treatment from a national health service.
Roger Berry (Kingswood) (Lab): It is a pleasure to have the opportunity to speak in the debate. Most of my contribution is critical of the Opposition motion, but I agree with the final clause, which calls for
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