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As the hon. Gentleman knows, we have recently published a series of reports from the clinical directorsthe tsarson, for instance, accident and emergency medicine, heart attacks and stroke. He will also be aware that, because of the rapid changes taking place in medicine, we now have an opportunity to ensure that some of those assessment and diagnostic services to which he refers can be provided even more conveniently than in a local district hospitalfor
example, in a walk-in centre, a GP centre or an urgent care centrebut also that some of the more specialist services need to be provided in specialist centres with enough patients to ensure that the doctors and other staff there can provide the best possible care. However, as I recently saw at Harrogate district hospitalone of the two best hospitals in the country, according to the Healthcare Commissionit is very possible for a small hospital that has made itself the focal point for a wider network of care to provide outstanding services to patients within its community.
Mr. David Winnick (Walsall, North) (Lab): My right hon. Friends visit to the Manor hospital in Walsall was very welcome. Apart from the reduction in waiting times, was she shown the extensive building plans, the largest development of the hospital since it was built in the 19th century, which was the subject of an Adjournment debate of mine last June to which the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis) replied? As I say, I am pleased that she did visit.
Ms Hewitt: My hon. Friend has been rock solid in his support for Manor hospital and the trust, and the substantial investment programme for the new hospital, which is so badly needed on the Manor hospital site. I congratulate the staff at Manor hospital and the local primary care trust. It will be one of the first hospitals in the country to ensure that for almost every patient with almost every condition there will be a maximum of 18 weeksand far less than that, for many of thembetween GP referral and hospital operation by the end of this year, one year earlier than we pledged in our manifesto. That kind of excellent, fast, safe care was never delivered in hospitals around the country under the Conservative party. It is now being delivered, thanks to the investment and reforms that we are making.
Mr. Humfrey Malins (Woking) (Con): The Secretary of State will be aware that in Surrey the accident and emergency provision at St. Peters hospital and at the Royal Surrey county hospital are under threat. My hon. Friends take the view, as I do, that this will be deeply damaging. Is the Secretary of State worried that although the proposals have been floated since last year, the promised consultation document did not come out at Christmas, in January or in March, as we were led to believe, and is now promised for some time in June? Can the right hon. Lady guarantee that this suspense for the people of Surrey will not be dragged out much longer? It is a great burden for them at present.
I understand the uncertainty that is inevitably caused when the local NHS considers how best to improve services. As I have just said to the hon. Member for Surrey Heath (Michael Gove), there will be a consultation on specific proposals in relation to hospital and other services in Surrey, and the commitment is that that will start in the summer. The important thing is to ensure that the proposals are right and clinically based, and now that the NHS is back in balance and the NHS in the hon. Gentlemans part of the country has made such enormous progress in getting on top of the financial problems that have
arisen, I hope that he and his constituents will accept that the changes proposed will be driven by the need to improve clinical outcomes for patients, not the need to balance the books.
Mrs. Sharon Hodgson (Gateshead, East and Washington, West) (Lab): Will my right hon. Friend join me in welcoming the action taken by my local hospital, the Queen Elizabeth hospital in Gateshead, which is another of the 13 early adopter sites? That will ensure that the 18-week target is hit by this Decemberone year early, as she said in reply to my hon. Friend the Member for Walsall, North (Mr. Winnick).
Ms Hewitt: I am grateful to my hon. Friend for giving me the opportunity to thank and congratulate the staff at that Gateshead hospital and others. Eighteen hospitals will expect to achieve that 18-week target one year ahead of time by the end of this year. Staff at Gateshead, Walsall and other hospitals are reorganising services. For instance, in the case of orthopaedic patients at Walsall, the staff found that it was taking 200 hours of staff time, much of it administrative, to take a patient from initial receipt of the GP referral through to the hip replacement or other operation. By reorganising the way in which they workednot by putting in more moneythey reduced that to just 30 hours, enabling them to transform the lives of between six and seven people in the time they had previously taken to treat just one. That is the kind of improvement that we are seeing, thanks to NHS staff.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Is the Secretary of State aware of a document called Squaring the Triangle, which is intended to be the basis for the reconfiguration of acute hospital services in west Surrey? It says:
Current Department of Health and Strategic Health Authority guidance suggests that to be viable, a full A&E Department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people. On this basis only two full A&E Departments (rather than the existing three) will be viable for the West Surrey population in the future.
Ms Hewitt: As I have said, there are as yet no settled proposals for service improvements in west Surreyor, indeed, in east Surrey. As the hon. Gentleman will be aware from Professor Sir George Albertis recent report on emergency medicine, there is already a very wide range of different kinds of A and E departments, from those providing the full range of trauma centres down to those providing [ Interruption . ]
There is already a very wide range of services provided by different A and E departments. I hope that the hon. Member for South Cambridgeshire (Mr. Lansley) would be as focused as we are on
ensuring that A and E services give the best possible care to every patient, whether they need it locally, much closer to home, or in a specialist centre, possibly slightly further away, in order to save their lives.
Mr. Lansley: The Secretary of State is not answering the question. I am focusing on both specialisation and access, and quality of services includes the issue of access. Will she answer the question? Does she endorse or reject the reference to Department of Health guidance? If this is acted on in west Surrey, the implication is that an A and E department will shut. If it were to be acted upon in the north-west of England, where there is one type 1 A and E department to every 207,000 people, half the A and E departments in that region would have to shut. Why do not we not see that happening in the north-west of England, when my colleagues in Surrey see their A and E departments threatened, apparently on the basis of Department of Health guidance?
Ms Hewitt: I think that we can all see the next Conservative party campaign coming, with the misleading propaganda that we have come to expect from it on health. The hon. Gentleman completely misses the point that different A and E departments will offer different sorts of services. For the most specialist services, including stroke services, about which I know he has a long-standing concern, a larger population is required to ensure that specialist staff are available 24 hours a day, seven days a week to deal with the patients who need that care. Different A and E departments will provide a different range of services. That will be one of the key themes of the guidelines and proposals on urgent and emergency care that the Department will publish shortly.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I suspect that this answer is a direct response to my hon. Friends persistence on the matter, Mr. Speaker. Central Lancashire primary care trust has agreed with Lancashire Teaching Hospitals NHS Foundation Trust that CATS services will be provided at the trusts hospitals, including Chorley and South Ribble hospital.
Mr. Hoyle: I thank the Minister for reaffirming the position. He could possibly go as far as congratulating the primary care trust on listening to the people of Chorley, because the decision is ground-breaking. It ensures not only that no private company will operate CATS in Chorley but that the services will be run and funded by the NHS and based at the local hospital. That is good news for Chorley. Does my hon. Friend agree?
I congratulate my hon. Friend on the points that he has been making for some time about this issue. The consequence of the PCTs decision is that patients in my hon. Friends constituency and in neighbouring constituencies will get the choice that
they deserve, and any unacceptable waiting times for particular treatments will be slashed. In many areas, that requires a contribution from the independent sector. However, the PCT in Chorley has shown that where the NHS believes that it can do the job and achieve the outcome, it is chosen as a suitable provider. Most importantly, waiting lists and times in my hon. Friends constituency will be reduced.
Mr. Gordon Prentice (Pendle) (Lab): The first wave of independent sector treatment centres was paid 11 per cent. more than NHS organisations for carrying out exactly the same operations. What is the uplift? How much more will private sector, not NHS, CATS be paid for carrying out precisely the same operations in future?
Mr. Lewis: In the context of the first wave and incentives, the issue was creating a position whereby we could ensure that, in communities where waiting lists and times were unacceptableand should be unacceptable to the NHSthe independent sector could build its capacity and help the NHS treat those patients as quickly as possible. Whatever debate there may be about the specific amount of the incentive, that was why it was required at that stage in the process.
The Minister of State, Department of Health (Andy Burnham): We are committed to community hospitals when they represent the best solutions for local communities. To support that, we have set up a five-year £750 million programme to promote the development of community hospitals and services. To date, we have allocated around £100 million to 14 different schemes. Decisions are outstanding on a further 18 schemes.
Ms Butler: Bringing community care and health care closer to individuals will have a profound effect on their lives, ensuring that people live longer and healthier lives. The PCTs have a vital role to play in that. Will my hon. Friend join me in condemning the Lib-Dem council in Brentalso known as the Fib-Dem council
Andy Burnham: It is tempting to do as my hon. Friend asks, and I would like to, Mr. Speaker. However, perhaps I shall simply say that I agree with her that patients support the move to provide more and extended services in the heart of communities, including those in London. That comes through time and again in all the consultations that the Department has carried out.
Richard Younger-Ross (Teignbridge) (LD):
Does the Minister agree that minor injury units are an essential part of community hospitals but that the services provided are often cut, as are the hours of opening?
Will he ensure that community hospitals are adequately funded to ensure a consistency of service for minor injury units and look into standardising those services in order to ensure that when people go to such units, they know what services they are going to get?
Andy Burnham: The hon. Gentleman makes an important point. Minor injury units are an important part of the 10 community hospital schemes that I announced recently. I agree that PCTs should take a view locally on where those schemes can help to fill an identifiable need. That is precisely the sort of scheme that we want. In looking further at the range of schemes recently approved, I found that many are very innovative and are offering new kinds of services to communities that have often had poor to patchy general practice in the past. It is all about bringing better and extended services to communities that have not benefited from such services in the past.
Mr. Kevin Barron (Rother Valley) (Lab): May I thank my hon. Friend for his recent announcement about the building of a new primary care centre in Rotherham? Does he accept that that will not only provide patient services seven days a week, but will have further benefits to services in the acute sector? Does he also agree that those reconfigured services in the NHS are improving the level of service to patients and should be welcomed by everyone and not cried against by Opposition Members every time we attempt to improve patient services?
Andy Burnham: The points that my right hon. Friend makes about the links between pressure on accident and emergency departments and acute hospitals generally are extremely well made. The scheme that we recently put forward and approved in his constituency includes a walk-in centre and a minor injuries unit. It also includes access to diagnostic facilities, dietary services, physiotherapy and audiology, so it truly provides a step forward for my right hon. Friends community. He is absolutely right that the beauty and benefit of those schemes is that they can take the pressure off local acute hospitals and give patients another option rather than trekking into accident and emergency as the only available option for treatment.
The Minister of State, Department of Health (Ms Rosie Winterton): We have made a commitment to eliminate within two years the use of adult psychiatric wards for children younger than 16. My officials are writing to strategic health authorities informing them that if a child younger than 16 is placed on an adult psychiatric ward, it should be reported directly to the Department so that we can take appropriate action.
Mr. Swayne: Given that the Governments own commissioner, Professor Sir Al Aynsley-Green, has said that children who go into adult wards for treatment come out in a worse state than when they went in, will she guarantee that the current provisions in the Mental Health Bill that require age-appropriate treatment settings will remain unamended?
Ms Winterton: No, I will not. One of the problems with the House of Lords amendments to the Mental Health Bill is that, in certain circumstances, they restrict the ability of clinicians to treat 16 or 17-year-olds, for example, who might be better placed on an adult ward. That imposes quite a straitjacket in terms of the clinicians ability to place people. There is also the issue of emergency treatment and the Lords amendments create further problems in that respect. However, as I said, we are certainly committed to ensuring within two years that children younger than 16 are not treated on adult wards.
Dr. Doug Naysmith (Bristol, North-West) (Lab/Co-op): As my right hon. Friend is aware, during recent consideration of the Lords amendments to the Mental Health Bill, a number of interesting suggestions and proposals were made. Will she give me a guarantee that she will consider them very carefully?
Ms Winterton: My hon. Friend is right to say that this is an extremely important issue. I know that he is concerned about it, and he has raised the matter with me separately. As I have said, the problem with the House of Lords amendments is that they would create a clinical and legal straitjacket, but that is not to say that important issues have not been raised, and I am sure that we shall discuss them in Committee.
Mr. James Gray (North Wiltshire) (Con): My constituent, Miss Fiona Gale of Sherston, having been treated in an adult mental health care ward and abused in various ways while she was there, was then discharged against her wishes. Tragically, she committed suicide in front of a train in my constituency shortly afterwards. The coroner agreed that she should have been treated in a separate childrens ward and that there should have been a halfway house between the completion of her treatment and her discharge into the community. I welcome what the Minister has said about under-16s; will she also consider what I have said about the provision of a halfway house?
Ms Winterton: It is absolutely tragic to hear about such cases. The hon. Gentleman mentioned that the child had been discharged against her will, and that obviously should not happen if a child is still in need of psychiatric help. The hon. Gentleman will be aware of changes made to the Mental Health Bill in the House of Lords that we are seeking to overturn, but one of the provisions that we are seeking to introduce is supervised community treatment. That would enable someone to be discharged but to remain under the care of health care professionals.
Charlotte Atkins (Staffordshire, Moorlands) (Lab): What evidence is there that primary care trusts and mental health trusts are discharging their duty of care to the under-18s who need mental health treatment? What proportion of under-18s have access to early intervention provision, which has proved highly successful in treating psychosis among people of that young age group?
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