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I shall deal with some statistics and come to the core of the argument advanced by my hon. Friend the Member for Barnsley, West and Penistone. The HSE has reviewed the statistics quoted in the UCATT report, and its conclusion is that there is a significant underestimate of
enforcement action following fatalities. I welcome the fact that my hon. Friend did not go into statistics, because there are issues to consider about the methodology used, and the CCA might want to discuss them with the HSE. Let me be clear and give out the powerful message that the HSE enforces provisions robustly and takes any death at work very seriously. Its staff are committed to investigation and, where it is right, prosecution.
We must recognise, as the hon. Member for South-West Bedfordshire did, the difference between prosecution and conviction, which are different aspects of the process that we need to take cognisance of. Every workplace death is investigated unless there are very specific reasons for not doing so. The HSE always prosecutes if a death was the result of a breach of health and safety legislation, there is sufficient evidence and it is in the public interest to do so. That accords totally with the enforcement policy statement published by the Health and Safety Commission. Following that approach, the true picture in construction is that the HSE prosecutes about half of all fatalities, and about 80 per cent. of those prosecutions result in convictions. There is no question about there being insufficient resources or numbers of inspectors to investigate fatalities and to pursue consequent prosecutions. That will always be the highest operational priority for the HSE.
I recognise that time is running out, but I wish to pick up on a couple of points. There have been comments about the disparity in sentencing, about which we are deeply concerned. Indeed, the Sentencing Guidelines Council is planning to examine the guidelines for death at work cases as part of its ongoing work to produce guidelines for the new manslaughter offences that are to be debated later today. That is being done in England and Wales and will be conducted through the Scottish Executive for Scottish cases. I am sure that that will be of interest to my hon. Friends from Scotland.
On the summit proposal that my hon. Friend the Member for Barnsley, West and Penistone highlighted, there was a summit in 2001 and a follow-up summit in 2004. There is a view that it is probably too early to have another but, given the powerful arguments that he made today, we should keep under review when to have another summit. We are not rejecting the idea in principle; it is just a matter of whether enough time has passed before having another summit.
There are many cases in which it is difficult to prosecute, such as if the person involved is a domestic householder or a self-employed worker and nobody else is involved in the work activity, as in the tragic case in which a self-employed builder took his young child into the domestic property where he was working, which resulted in the young girl being killed. There are all sorts of issues to take into account. Our priority is that the HSE should prosecute, but prosecutions cannot always be seen through to the end, because of the nuances of individual cases.
Sometimes, of course, there is not a conviction. Witnesses may fail to appear, new evidence may emerge or the court may accept a plea, and all those things can result in non-prosecution. I hope that hon. Members recognise that in some parts of the process it is outwith the control of the HSE to pursue a prosecution to the bitter end. I reiterate that every death is a tragedy to the
individual and their family, and the HSEs priority is to ensure that it investigates those deaths fully.
I shall conclude at breakneck speed by saying that my hon. Friend the Member for Barnsley, West and Penistone highlighted the fact that an agenda is shared by the trade unions, the Government and the construction industry. I welcome the opportunities that he has given us to work in partnership, and I hope that we will continue to do so to raise the issue of deaths in the construction industry, which are unacceptable. It is not about international comparisons; it is about what we expect for our workers in our own industry in the 21st century.
Mr. Keith Simpson (Mid-Norfolk) (Con): It is a pleasure to serve under your authority, Dr. McCrea, I believe for the first time. I initiated this short debate because under the Norfolk primary care trust consultation documentthe consultation is taking place between 6 March and 5 June 2007St. Michaels hospital, Aylsham, in my constituency could close, along with two other community hospitals in Norfolk. That has caused widespread anger and dismay in Aylsham and the surrounding area, and those feelings are replicated elsewhere in Norfolk, where there are threatened cuts. My primary concern today is the standard of health care available to my constituents. I am not convinced that the alternative proposal of home health care will replace or enhance the facilities that will be cut at St. Michaels hospital.
The Minister knows that there have been widespread demonstrations against proposed cuts in community hospitals not only in Norfolk but elsewhere in England. People rightly suspect that the cuts have more to do with overcoming PCT deficits than meeting new health care demands. He will be only too well aware that his ministerial colleagues the Parliamentary Secretary to the Treasury, the Minister without Portfolio and the Under-Secretary of State for Health have publicly protested about proposed cuts in their constituencies. I do not think that that ever happened under previous Governments, and it stretches ministerial responsibility almost to breaking point.
In Norfolk, there have been widespread protest meetings, petitions and demonstrations against the proposed cuts. That is not the consequence of some out-of-date sense of nostalgia. Local people, including health professionals, value their community hospitals and are unconvinced that alternative health care delivery is a substitute. I have received thousands of letters of protest and petitions, and I have spoken to both health professionals who work at St. Michaels hospital and local general practitioners, and all are united in that view. I have not received one letter, e-mail or verbal representation that favours the proposed cuts or supports the view that an alternative home health care system would be a good substitute.
One of the problems is that people in Norfolk have very little confidence in the PCT. The Minister is probably aware that the current chairman of the PCT, Miss Sheila Childerhouse, was an independent councillor on Breckland district council. She lost her council seat to a candidate who supported the campaign to stop the hospital closure. That says something about local feeling.
The Minister should also be aware that my constituents are pretty well convinced that the consultation exercise that is now being carried out is, in the words of one health professional, a sham, and that the decision to close St. Michaels has already been reached. In the consultation document, St. Michaels is flagged up as a hospital that may closeI believe that will close is the view of most of my constituents.
The idea of closing community hospitals flies in the face of what was said in a letter dated 15 March that I received from the Ministers departmental colleague,
the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton):
We are committed to empowering citizens to give them more confidence and more opportunities to influence public services in ways that are relevant and meaningful to them, and in ways that will make a real difference to services.
As the Minister knows, many of the problems that we face in Norfolk are a direct consequence of the continual reorganisation of PCTs that has taken place over the past six years. Reorganisation has been incredibly costly, and it has undermined professional morale and public confidence. The Minister will be aware that Norfolk PCT has an annual budget of £900 million but debts of £47 millionit is one of the most indebted PCTs in the country. That is a direct consequence of poor financial management in the past, the impact of Government NHS reforms and, of course, historic debt. Removing the deficit is one of the drivers behind the PCTs proposals, and I accept the fact that it is not the only driverthere is, of course, a genuine desire to improve health carebut the consequence is the likely closure of St. Michaels hospital.
The strategic health authority set the PCT a target to cut the deficit of £47 million by £23 million by the end of March this year, and to clear all the debts by March 2008. I understand that at present the PCT has been able to cut only £3 million. How does the Minister think that it can reduce the deficit? Even if the deficit is reduced, what guarantee is there that it will not be repeated, given the fact that only three years ago, under the previous PCT reorganisation, PCTs Norfolk-wide had debts of nearly £30 million?
It is also relevant to bear it in mind that the Government are urging that alternative health care be provided in the community as a consequence of closing community hospitals. The Times stated yesterday:
A key target in the Governments health reformsto have thousands of community nurses treating the most seriously ill patients outside hospitalhas been missed,
and that less than 50 per cent. of the required number of nurses are in place. Can the Minister assure me that we will not have a further reorganisation of the PCTs in the lifetime of this Parliament?
My constituents and most Norfolk MPs, regardless of political party, are frustrated that responsibility and accountability for health care in Norfolk are passed around between the Department of Health, the strategic health authority and the PCTit is like pass the parcel. It is incredibly difficult to get a grip on responsibility. Ministers say that they have devolved budgets and responsibility downwards, eventually to the PCT, yet it is obvious that PCTs are constrained and often lack the kind of professionalism that is required. The result is that my constituents suffer.
So far, my constituents have not been impressed by the PCTs consultation process. At a public meeting held in Aylsham on 23 April, the chairman of the PCT and a senior official were unable to answer some obvious and straightforward questions concerning the future of the hospital, alternative health care provision, redundancies among staff and, given that the
constituency is a rural one, the ensuing transport problems. In proposing the closure of St. Michaels and other hospitals in Norfolk, the PCT hopes to make financial savings, hopes to reduce redundant bed capacity, hopes to concentrate facilities and resources on fewer sites and hopes to meet the Governments policy of providing health care to people in their homes. I emphasise the word hopes, because so far I have seen little evidence that it will be able to achieve that. Perhaps the Minister will be able to convince me that it will.
Let me remind the Minister of the important services that are currently being delivered at St. Michaels hospital. They include physiotherapy, incontinence clinic, occupational therapy, occupational health, chiropody, speech therapy, womens health, falls clinic, Parkinsons clinic, splint clinic, dietician, Dr. Woodhouse clinic Dr. Woodhouse is a Norfolk and Norwich University hospital consultant for the elderlyand a district rehabilitation centre consisting of 24 operational bed spaces and six spare bed spaces for emergencies. I know from talking to local health professionals, particularly local GPs, that those services make up a critical mass that provides total health cover 24 hours a day, seven days a week, which, in their considered opinion, health care teams cannot and will not provide.
Many of my constituents have given me examples where elderly relatives stayed at St. Michaels hospital for post-operative recovery. Under the PCT proposals, local doctors have told me that many of those patients would have to be taken directly home without a stay at St. Michaels. If they were to have a relapse, they would find themselves back at the Norfolk and Norwich University hospital, which already has considerable pressure on beds and facilities.
When and if St. Michaels closes, many of my constituents will have to travel to alternative health care centres at Dereham, Holt or Norwich. The Minister may not have travelled in Norfolk, but as I live eight miles west of Aylsham in the market town of Reepham, I can assure him that, to say the least, public transport is not good. The proposed changes to St. Michaels will create major transport problems, particularly for the elderly, and for the journey times of mobile health teams.
The closure of St. Michaels hospital flies in the face of the Governments aim to enhance community health centres. Localism is an important matter for all political parties in relation to not only health care, but many other delivery systems that central Government were expected to provide in the past. None of the proposed changes takes into account the profile of Norfolks population, let alone the projected population profile. Norfolk primary care trust provides services to a population of more than 700,000. It is an ageing population, and more than one fifth of people are over 65 years old, which is approximately 150,000 people. By 2020, the elderly population of the area will rise to 200,000, which is a quarter of Norfolks population. Currently, 30.9 per cent. of Aylshams population is already over 60 years old, which is above average for Norfolk.
The elderly often require many kinds of intense health care, and if St. Michaels hospital, Aylsham and at least two other community hospitals are closed, I suspect that in five or 10 years time, this Government
or a future Government would want to provide the kind of community facilities that exist now in Aylsham. Such facilities would probably be brought back to Aylsham or near to Aylsham. The Government and the PCT have not taken the age profile of the area into account. Furthermore, within the next 10 years, under local government proposals, Norfolk is likely to have an extra 70,000 houses, which will mean a population increase.
In conclusion, I will ask the Minister a number of questionsI contacted his office to inform him of the questions, because I knew that it would be helpful if he had them in advance. Local people are unconvinced that the proposed home care teams will provide a credible alternative to what St. Michaels currently offers. What is his Departments assessment of Norfolk PCTs proposed plan? When St. Michaels closes, how will the 24-hour services that are currently met, in large part, by the provision at St. Michaels be met by mobile health teams? If patients have to go for treatment in Dereham, Holt and Norwich, what transport facilities will be provided by the PCT or the strategic health authority in addition to those available to individual families, either by using public transport or their own cars? If St. Michaels closes, what are the estimated financial savings over five years?
Meeting health care needs is an expensive business. Governments must continually look at how health care is delivered, and rightly so. There are continuing changes in developments in medicine and in the kind of total package that can be delivered. There must be an assessment of how populations change in an areasome areas effectively lose population while others experience population growth. I accept all those factors, but in 10 years of being an MP I have never known so much deep anger and resentment about proposed closures not only in my constituency, but across Norfolk.
This is not just a question of nostalgia, although that is important. The hospital has received much financial support from voluntary organisations in Aylsham. It was originally a workhouse and then became a war memorial hospital. There has been a lot of local investment in the hospital, but the bottom line is that any changes in health care must, as a minimum, provide the same level of health care as my constituents have now. Any changes should, of course, aim to provide much better health care, and my fear is that, as a consequence of Norfolk PCTs proposals, my constituents in the Aylsham area will receive a reduced level of health care. I hope that the Minister will answer some of my questions.
The Minister of State, Department of Health (Andy Burnham): I congratulate the hon. Member for Mid-Norfolk (Mr. Simpson) on securing the debate. I have no doubts in accepting that this is a matter of great significance to his constituents and I also accept that there is a lot of local attachment and investment in this particular health facility. I accept all of those points and assure him that I appreciate the strength of feeling that he represents.
As the hon. Gentleman acknowledged, these matters are subject to local consultation and as we speak the consultation is a live process. It is not a get-out to say
that the issue is essentially one for local discussion and decision making, and at this point is not a matter for ministerial intervention. I hope that he balances that comment with the further remarks that I will make. If I can, I will also answer the questions put to me.
The hon. Gentleman questioned whether I had often travelled in Norfolk and I assure him that I vividly remember a family holiday to Cromer in the early 1980sit would be difficult to forget that particular experience. I have also spent many happy afternoons at Carrow Road when following Everton football club, so I have travelled considerably in the area covered by his constituency.
Let us put the debate in context. I know that people allege that Ministers, the Department and, more broadly, the Government are interested in change for changes sake and think that it is good to continually inflict gratuitous change on the system. That is not at all the case. It is self-evidently true that medicine and medical practice continues to change, and the health service and its facilities must keep up with changes in medicine and science. If it does not, it will be left behind and will not provide the best for patients.
Recently, new technology and the latest drugs and treatments can provide faster, safer treatments and faster recovery and greatly reduce the time that people need to stay in hospital, all of which are positive developments. The NHS today and the service that it can provide are different from the services that were first envisaged when the old NHS infrastructure was developed. For example, 10 years ago it would have been common to spend 10 weeks in hospital to recover from a total hip replacement. Now, supported by community staff, most patients can expect to be home within five daysgive or take a few days. That example shows that the more we improve the speed with which we can help patients rehabilitate and the more we support patients and get them active, the less the need for in-patient beds and hospital-based services. Although that process of change can be difficult, it should not necessarily be claimed that it is not progress. In my view, it is indeed progress.
The hon. Gentleman asked whether the situation has more to do with deficits. We announced details yesterday of the spending plans of each primary care trust. In the last financial year, Norfolk PCT had a budget of £839,900,000, which will rise to £932,400,000 this financial year. I hope he would agree that that is a significant increase in resources for his local community. As departmental officials tell me, it is very rarely the case that a hospital reconfiguration delivers savings straight away, if that is the intention, in order to address immediate financial problems.
From the work that Sir Ian Carruthers has done within the Department on hospital reconfiguration, and looking across the country, scheme by scheme, he said that, in the vast majority of cases, if not all of them, the schemes were aimed at making better use of resources and providing better services to patients; they were not driven by financial considerations. I hope that the hon. Gentleman will accept that although some of the decisions might be difficult and might be asking people to accept changes to services that they have long known, PCT management and staff need to be supported in making those difficult and often challenging decisions in their local communities.
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