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Mike Penning (Hemel Hempstead) (Con):
May I say what a pleasure it is to follow my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes), who has done so much to defend the hospital in his constituency? I praise him for that. I cannot be as kind
to the Secretary of State for Health, whose speech some five hours ago was, frankly, complacent and patronising to my constituents and to constituents around the country who are so worried about health provision.
I am pleased to have fellow Hertfordshire MPs alongside me, not least my hon. Friends the Members for St. Albans (Anne Main) and for South-West Hertfordshire (Mr. Gauke). There is not time for them to speak in the debate so they have asked me to speak on behalf of their concerned constituents, too.
The Secretary of State knows full well how bad the crisis in south-west Hertfordshire is, because we have written to her several times, met her and explained the situation. That crisis is driven by deficits. The cuts and changes that are going on in south-west Hertfordshire are due not to reconfigurationthe new word that the Secretary of State has come up with to defend the cuts in services throughout the countrybut purely and simply to south-west Hertfordshires huge deficit problem.
There has been a debate for many years about the services that are to be provided in Hertfordshire, particularly in south-west Hertfordshire. That debate took place before the 1997 general election and has continued since. At a recent Prime Ministers Question Time, I said to the Prime Minister that I agreed that there had been huge investment in West Herts hospitals both before the general election of 1997 and since. Therefore, it is not the case that my part of Hertfordshire has Victorian hospitals that were built 150 years ago and are decrepit. It is not the case that we do not have a state-of-the-art birthing unitit is closed at present, and being used as offices. It is not the case that we do not have a cardiac unit at the Hemel Hempstead hospital; it is full most of the time. It is not the case that we do not have a stroke unit; that too is full most of the time. It is not the case that we do not have an intensive care unit; thatthe Secretary of State will be surprised to learnis full most of the time. It is not the case that we do not have an excellent accident and emergency centre; that, sadly, has recently been exceeding the four-hour waiting times as so many of our constituents need to go there for their treatment. It is not the case that we do not have or need a high dependency unit; that is closed at present, so it is not full. The maternity unit, which was built before the 1997 general election and closed immediately afterwards, is needed, and if it were used we would have a consultant-led maternity unit, but it is currently being used as office space.
Investing in your health was a wonderful catchphrase that was employed before the last general election. Those buzzwords referred to the reconfiguration, closure or movements of services in West Herts, and there was a huge debate about that. There was no consensus at all as to what should happen. The local residents in Hemel clearly did not want to lose their hospital and they voted against that in huge numbers. The people of Watford and the bottom part of south-west Herts did not want to lose Watford general hospital. The people of Welwyn and Hatfield had been promised a huge private finance initiative worth £500 million, so they were happy to lose their existing hospital if they got a new state-of-the-art hospital.
The promises and proposals before the last general election under Investing in your health were as follows: there would be a brand new PFI hospital in Welwyn and Hatfield and the Queen Elizabeth II hospital would go; the Watford general hospital would have a £350 million PFI project and would be built up; and Hemel would be downgradedalthough I had correspondence from the then Secretary of State and numerous Ministers saying that the accident and emergency unit would remain in Hemel and that the hospital site would be protected.
Let us explore what has happened since the general election, and since the Secretary of States decision to come down hard on trusts with funding problems. Those problems are purely to do with the funding formula that the Secretary of State has imposed on the trusts, and if she reads the Select Committee report on deficits she will learn that the Labour-dominated Committee agrees with that comment. Since the general election and the Secretary of States measure, a decision has been madewhich has nothing to do with clinical care or with greater efficiencies in the way that the health service is run locally, but which is purely to do with financial problemsto close the Hemel Hempstead hospital and to move its acute care services across to Watford, and the £350 million project will not take place, so they will be moved into portakabins. The people of St. Albans will have to travel past the Hemel hospital and all the way to Watford, if they are lucky, to get to the nearest accident and emergency unit. That is simply shameful.
That is frightening my constituents. The Secretary of State has been invited to the constituency time and again. When I was at this years Conservative party conference, I heard that the Secretary of State was going to come to Hemel. I was so proud; I wanted to show her the excellent hospital, the fantastic staff and the facilities that are about to be closed, and to try to convince her not to do that horrible thing to my constituency. However, when I arrived in Hemel I found that she was not going to visit the hospital; instead she was going to visit a social services department just up the road. A small demonstration of disabled people, mums with pushchairs and elderly people had gathered to express their concerns and to tell the Secretary of State what they were worried about. However, instead of coming through the front gate, the Secretary of State popped over the back fence and went through the back door, to be confronted by some elderly people with Zimmer frames running down the road. That is the sort of image that the Secretary of State left in my constituency.
If the Secretary of State wants to deny that, she can rise at the Dispatch Box. She does not do so because it is true; that is exactly what happened. Instead of her coming along there armed with platitudes and saying, This is all about better care for your constituents and for south-west Hertfordshire, it should be acknowledged that what is happening is all about the fact that there is not the money. I know that that is true, because when I approached my trusts medical director at a recent public meeting and said, Would you make these
changes and cuts if it werent for the deficits? he said, Of course I wouldnt, Mr. Penning. That man is a professional; he is not going to lie to me or mislead me. These cuts and changes are being made because we are not getting a fair deal. The Secretary of States constituency gets £400 per head more than mine. When giving evidence to the Health Committee, she said that the reason
Mike Penning: No. The Secretary of State had plenty of chances to intervene earlier. I now have only a minute and a half left, and to be honest I do not want to listen to her waffle. At the end of the day, the situation is clear: we in Hemel Hempstead and west Herts get £400 less per head than people in the Secretary of States constituency. Her answer to that was that we are healthier. If someone is run down by a car, it does not matter how healthy they arethey need an A and E.
Mr. Stephen O'Brien (Eddisbury) (Con): It is a great pleasure to follow my hon. Friend the Member for Hemel Hempstead (Mike Penning), who gave one of his most modest and quiet speeches and pulled his punches today. I hope that the Secretary of State realises just how lucky she was to hear only that much of the argument.
We have had a very good debate, in Opposition time, on the vital issue of what our constituents demand of their NHS, not what this Government are hellbent on imposing. We remain deeply concerned that this Labour Governments basic reconfiguration of acute hospital services remains rooted in their desperate scramble to mitigate an NHS cash crisis of their own incompetent makinga problem that will intensify when the European working time directive comes into forcerather than in meeting the needs of the English public.
Let us be clear: as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said in his authoritative, measured and responsible opening speech, we are not opposed to change. Indeed, far from standing in the way of changebe it changes to primary angioplasty or stroke services, or reconfiguration itselfour challenge to the Government is that they are arguing for change without producing the clinical, health-based evidence to inform it. Todays reconfiguration is their emergency response to financial pressures of their own making and to the anticipated effects of the European working time directive.
Where was the evidence? What was the Governments response? Not a scrap of evidence was forthcoming from the Secretary of State in a speech that, sadly for the House, has not improved on its umpteenth outing. Before we get the usual rant from the Minister, during which he reaches back and bypasses a complete decade in which Labours hands have been on the tiller of the NHS, I hope that he will, for once, debate the real and substantive issues raised about our NHS today.
We heard just yesterday the latest deficit figures. Almost a third of Englands hospital trusts and almost half its primary care trusts are forecast to be in deficit at the end of this financial year. The gross deficit is forecast to be slightly larger than last yearthe cash crisis has not been solvedand Ministers are seeking to create a slush fund by plundering training and other budgets and cutting services. Many organisations are simply pushing costs into the next financial year by putting off orders and payments until April, or by rationing treatment.
At the beginning of this month, a BBC survey found that a quarter of all PCTs in England are asking patients to wait longer for hospital treatment, and all of us are contending with cuts to front-line patient services in our constituencies, be they podiatry, maternity and physiotherapy services, or occupational and speech therapy services. People do not have to take just the Oppositions word for it. At the beginning of chapter four of its Delivering High-Quality Surgical Services for the Future document, the Royal College of Surgeons has identified the drivers for reconfiguration. It states:
The reconfiguration of services must have a sound clinical and evidence base. Financial and managerial expediency must not be primary drivers for reconfiguration.
The problem is compounded by the imminent enactment of the European working time directive. The Secretary of State tries from time to time to blamecan you believe it, Mr. Deputy Speaker?the last Conservative Government for poorly negotiating the directive. However, it was case law modifications to the directive, brought about by the SIMAP and Jaegar rulings in 2002 and 2003 respectively, that made it so damaging. It is this Government who have failed to address those issues and continue to drag their feet and bury their head in the sand at the same time, which is some achievement. Lord Hunt, who was recently reappointed, was responsible for this area back in 2004 and he said on the record that if the European working time directive proved to be difficult to implement, he would consider putting off the next round of implementation from 2009 to 2012. I hope that the Minister will respondhe seems to be taking some adviceand tell us whether the Government are considering that delay in the light of the problems that have now been clearly identified.
We have heard about the need to configure services to the geography of a locality, be that in West Sussex, as we heard in a series of powerful interventions from my hon. Friend the Member for Chichester (Mr. Tyrie); in Lancashire, as we heard in the powerful speech by my hon. Friend the Member for Ribble Valley (Mr. Evans); or in Surrey, on whose behalf my hon. Friends the Members for Spelthorne (Mr. Wilshire) and for South-West Surrey (Mr. Hunt) both made clear cases. There are many rural areas that need to rely on those same arguments.
David Lewis, consultant at the threatenedfor financial reasons, of courseemergency department in Ipswich, has summarised the whole debate. He wrote to my right hon. Friend the Member for Witney (Mr. Cameron) on 5 December, identifying the fact that the Governments problem is that they are seeking to reconfigure services to suit just 3 per cent. of
patientsthose who need the specialist super-centres. They should not shut down the accident and emergency units needed by the other 97 per cent. Mr. Lewis asks:
what will happen to the 97 per cent. of patients without Ischaemic Stroke
Those specific patients may benefit from the longer journey but who is going to sort them from the multitude of others with similar symptoms and signs. These patients do not have their diagnosis written on their forehead when the paramedics arrive. Making these diagnoses is often difficult and requires good quality doctors in local Emergency Departments with local back up of core services in that hospital.
Labour and their Think Tank (Comfortably situated in London and never more than a few miles from their local well funded Emergency dept) forget about the conditions which will do worse by spending an extra 20-40 mins in the back of an ambulance, eg...cardiac arrhythmia...meningococcal sepsis in children...pulmonary embolism...pelvic fractures.
Also what will happen to all the other patients we deal with who do not need specialist centres...Broken arms and legs in children...overdoses...gastroenteritis.
What is actually needed is a realistic assessment of what are the core requirements of a local Emergency Department...By all means lets invest more in super-centres but not at the expense of the only real safety net left in the NHSthe local Emergency Department. Dont expect minor injury centres or emergency care practitioners to take up the slack. We were told this when the GPs stopped being on call for their patients. Local services would apparently take overthis has not happened and there has been a rise in Emergency Department attendances.
When my right hon. Friend the Member for East Hampshire (Mr. Mates) argues, in a comprehensive speech, for the retention of acute and other NHS services in his area, the Government should listen. My hon. Friend the Member for Mid-Sussex (Mr. Soames), in a superb speech, pointed out that the massive public support that has been engendered in his area rejects the proposals by the Government, the Department and the local NHS. The options are simply a change too far on top of a rash of changes that have been suffered locally. The Government should listen, because the removal of full accident and emergency services from the Princess Royal hospital in Haywards Heath is not acceptable, and it is not what Dr. Alberti wrote.
There was intervention upon intervention on the Secretary of State demanding to know how the consultations were anything but a sham when the Government are intent on proceeding with their reconfiguration plans anyway. The powerful consultations that have been taking place up and down the country and that clearly show disagreement with the Government and the Department have had no effect.
As my hon. Friend the Member for North-East Bedfordshire (Alistair Burt) said, in a speech of great impact, this has taken place against the background of the Government putting in place what Labour ranted against before 1997. The funding formula, especially for county areasnot least in Cheshire, as in
Bedfordshiremust be reviewed to establish a new, fair basis. Otherwise, it exacerbates the real financial pressures leading to the non-clinically driven reconfiguration.
My hon. Friend the Member for South-West Surrey made a strong case and gave the Government the opportunity, if only they would listen, to do the right thing for the people of Surrey, but I fear that they will not listen and that the wrong thing will then proceed. We will continue to argue and not be in any way deterred, as was clear from the powerful speeches of my hon. Friends the Members for Enfield, Southgate (Mr. Burrowes) and for Hemel Hempstead.
The hon. Member for North Norfolk (Norman Lamb) reinforced many of the powerful arguments made by my hon. Friend the Member for South Cambridgeshire. He failed, however, to give credit to the healthwatch initiative that we have put out as policy, which includes local authority involvementthe very thing that he argues forand the enhancement of the oversight and scrutiny committees. He should find reading those policies profitable, especially when they are contrasted with what the Government have been doing. The Government have sought, once more, to quash the patient and public voice. LINkslocal involvement networkshave been widely discredited, and yet the Government are pushing ahead with them.
We have also heard from Labour Members, all trying to justify changes to acute services and the health service in their constituencies as reconfigurations on anything other than financial grounds, or grounds related to the European working time directive and staffing issues.
We heard from the hon. Members for Kingswood (Roger Berry), for Crawley (Laura Moffatt), for Dudley, North (Mr. Austin), for Dartford (Dr. Stoate), for Staffordshire, Moorlands (Charlotte Atkins) and for Stockton, North (Frank Cook), but they did not convince. However, the hon. Member for Hartlepool (Mr. Wright), in a dignified and courageous critique of his own Government, which confirmed the complaint about sham consultation that we all make, showed how the promise that was made by the Prime Minister at the time of the election to keep the University hospital of Hartlepool has not been honoured. I believe that the hon. Gentlemans interpretation of the IRP, and not the alternative that was offered during the course of the debate, is the one to be supported.
It is perhaps no surprise that we heard this week that 84 per cent.more than five in sixof the senior civil servants in the Department that is led by the Secretary of State do not believe that it is well managed. That compares with 49 per cent. in the civil service as a whole. Uncannily, three years ago, when the Secretary of State was at the Department of Trade and Industry, only 17 per cent. of officials in the DTI thought that
our leaders make the right decisions for the long term
our leaders are effective in facing up to difficult issues.
There is a clear, stark example of poor policy: the Staffordshire ambulance service, which has been put in the departure lounge. I hope that the Government will at last listen and that the Staffordshire ambulance service will not be reduced in quality in order to meet the demands of the West Midlands service.
We have seen Ministers and Cabinet Ministers running around seeking to defy their own Government policy. That may be collective hypocrisy, rather than collective responsibility, but I hope that at last they will now listen in order to make reconfiguration respond to the demands of patients, rather than simply acting as an emergency outlet for their financial mismanagement.
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