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4 July 2007 : Column 286WHcontinued
You cant close local hospitals. People would rather have slightly inferior services that are local.
To some extent, he has hit a raw and pertinent nerve in that comment. I know about the statistics on neonatal death, the shortage of paediatricians, the working time directives and the various pressures linked to that, the sophistication of first responders, the reduction in bed requirements, the cost of high-tech medicine and the preferences of the royal colleges. All of those factors are part of the debate. However, we Members of Parliament also know that communities want an easily accessible accident and emergency department, maternity care within reach and access problems addressed. In other words, there is a balance of consideration.
We are not calling for decisions to be made according to untutored populism or simple nostalgia, but we want an informed public debate and a democratically accountable decision made. Democratically accountable decisions can be toughI do not think that is an oxymoronbut people would prefer to make decisions, rather than to have decisions imposed on them.
Essentially, we want decision making in which clinical outcomes are tested and scrutinised. We also want transport links and patient journeys to be reviewed, financial arrangements to be fairly and transparently laid out and patients preferences to be clearly identified. Catastrophically for Sussex, there is no mechanism whereby that can be done and that is the essential point of this debate.
The Government are calling for a review by Dr. Darzi, as they think it will be a kind of solution, but it is not a sure solution. I have been involved in debates in this Chamber about recommendations made by Dr. Darzi for Teeside that led to internecine warfare between Labour Members. I believe that Conservatives are promoting the proposal that the ultimate decision-making body should be the NHS board supported by HealthWatch, making representations on behalf of patients.
My personal view is that that is simply not good enough for the people of Brighton, Eastbourne, Worthing, Haywards Heath, Lewes or Bognor Regis. Those people have a right to a decisive voice in how their local services are configured, along with the responsibilities that that involves. I really believe that if people had a voice, this and so many issues that do not get much further than debate would not come to this Chamber, but would be resolved democratically at a local level, and we would not have to debate reconfiguration time after time, in relation to area after area. However, for the moment, we are doomed to go on doing so for quite some time.
Tim Loughton (East Worthing and Shoreham) (Con): I congratulate my hon. Friend the Member for Arundel and South Downs (Nick Herbert) on initiating this important debate and welcome the Minister to her new position on the health team. This could be our first and last debate opposite each other.
I think that it is unprecedented for every single Member of Parliament for West Sussex to be present and to have taken part in a debate on this issue, apart from the hon. Member for Crawley (Laura Moffatt) who is rather straitjacketed by her position and is unable to do so. This is undoubtedly the largest single issue affecting every MP and every constituent in the whole of Sussex.
It is unfortunate that the three Members for the Brighton and Hove area who are not constrained by being on the Government payroll, but who are affected by these consultations have not come here to add their comments on behalf of their constituents.
My hon. Friend the Member for Arundel and South Downs made it absolutely clear that the whole consultation has been shambolic and is based on a shifting justification. There is now no serious financial basis for the consultation and it appears that the £37 million projected surplus over the next few year for West Sussex primary care trust will not be spent on the health of patients in West Sussex. I strongly echo my hon. Friends calls for the Secretary of State or some of his Ministers to visit our hospitals and see our patients who are under threat.
The hon. Member for Lewes (Norman Baker) reinforced the cross-party consensus of all the campaigns and, as he said, it is dangerous that these proposals are being put forward. My hon. Friend the Member for Worthing, West (Peter Bottomley) made it clear that the financial assumptions in the consultation are, in any case, seriously flawed. Every time we challenge the figures, we are not given a good response as to why such massive reorganisation is in the interests of our patients. Larger hospitals do not always make better hospitals, either from a clinical or financial point of view.
My hon. Friend the Member for Mid-Sussex (Mr. Soames) described the proposals as genuinely absurd and pointed out the proximity of Gatwick and the other pressures that exist in the densely populated county that West Sussex has become. My right hon. Friend the Member for Horsham (Mr. Maude) mentioned the downgrading of Crawley, in which the hon. Member for Crawley was herself complicit. When services were transferred to Redhill, the residents around Redhill may have cheered the extra capital investment. However, they are now finding that the extra pressures of numbers on that hospital means that they cannot get into their own hospital because it simply cannot cope. If West Sussex loses some of these services, I fear that the same thing will happen in Brighton. The infrastructure needs that we have in West Sussex are severe and we should ensure that the infrastructure is there before we commit to taking on extra house building and experience the population pressures that result from that.
My hon. Friend the Member for Wealden (Charles Hendry) rightly pointed out the cynicism that accompanies these consultations and the fear that decisions have already been made. He certainly made a good point about travel times and the complications for problem pregnancies that could lead to very real dangers for the mothers involved. My hon. Friend the Member for Eastbourne (Mr. Waterson) pointed out that it is ordinary people who have set up these campaigns of resistance. He mentioned the four options that people had in Eastbourne. We did not even have four options; we were restricted to three. There seems to be a commonality of missing options between the different consultations.
My hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb) challenged the financial savings and the statement that the deficits will not exist in a few years time. My hon. Friend the Member for Chichester (Mr. Tyrie), who has led the campaign to save St. Richards from the front with great skill and aplomb, asked who is taking these decisions. Is it just managers who are doing the Governments bidding and a case of the managers
who wear the Governments clothes having no clothesto use the analogy of the Emperor.
The document that was produced last week and started the debate is flawed. It was nine months late and did not have a fourth option, which we were promised would consider the possibility of keeping two main hospitals in West Sussex with at least accident and emergency and maternity departments or the status quo. The representations made by Members of Parliament, councillors, patients and constituents to the PCT asked for that option, which was ignored with breathtaking arrogance by the PCT. We wrote a letter that was signed by every Conservative Member in West Sussex and by every leader, mayor and chairman of every council in West Sussex and most Opposition leaders. The letter pointed out that the consultation was flawed and asked for it to be suspended until the fourth option was restored. Arrogantly, the PCT completely and utterly disregarded the letter when, interestingly, most of the non-executive directors of the PCT sent their apologies when the vital decisions were being made.
Henry Smith, the leader of West Sussex council, has made the county councils view absolutely clear. He says
This is a bleak picture of the future for health services in West Sussex, and the County Council rejects it totally.
It is no surprise that we have such strong campaigns to save St. Richards, the Princess Royal in Haywards Heath and Worthing and Southlands hospitals. It is crazy that we are looking to downgrade hospitals in a county the size of West Sussex, which has 750,000 people and special needs for elderly people, in particular; some 4.6 per cent of the population of Worthing is over the age of 85such people have additional needs.
I believe that, last week, the Brighton hospital had been on divert for nine days running simply because it could not cope with the pressure of patients arriving in ambulances. Regularly, there are ambulance queues outside that hospital, and it is a nightmare travelling to it. Yet the Royal Sussex county hospital in Brighton will be the major beneficiary of the downgrading of West Sussex hospitals, particularly the Worthing and Princess Royal hospitals. Despite the excellent efforts and hard work of the Brighton hospitals managers and staff, it is struggling under the pressure of work. Can it make sense to apply further pressure?
Last year, some 63,000 people went to the accident and emergency department in Worthing, of which a large number were admitted to hospital. They did not need just a plaster; they needed serious attention. How can Brighton and Hove cope with those extra 63,000 people? It is also interesting that Worthing hospital will this year deliver some 3,000 births, and most of the increase is from mothers from Brighton and Hove having their babies delivered there.
Worthing and Southlands hospital, the Princess Royal hospital and St. Richards hospital, in Chichester, are good, cost-effective, and, as has been mentioned, well-liked hospitals. If it aint bust, dont fix it, particularly given that we do not have a clue what will be put in its place. And neither do we know the displacement costs of the extra community activity that we have been promised. It is death by a thousands cuts! It is dishonest and unfair, particularly on the 3,200 staff at Worthing and Southlands hospital, and on those at other hospitals, over whose jobs there has been uncertainty in recent
years. That is bad for local businesses, as the chairman of the South East England Development Agency said when he came to Worthing. Furthermore, it is bad for patients, staff and the NHS in Sussex. The fit for the future consultation document, which started all of this, is not fit for the future of our constituents. It is said that Sussex people wont be druv. Well, we will not be druv; we will fight for the future of our hospitals. I hope that the Minister listens.
The Minister of State, Department of Health (Dawn Primarolo): I congratulate the hon. Member for Arundel and South Downs (Nick Herbert) on securing this very important debate and on his new position on his partys Front Bench. I hope that hon. Members who have spoken will forgive me if I do not refer directly to them in the short time available. Clearly, there are issues of great significance here that affect not only his constituents, but those of all hon. Members who have spoken.
Issues raised by Members are always of great concern. Potential change can provoke very strong reactions, and striving to further improve services for local people can involve such proposals for change. That can be uncomfortable for many at first. We must ensure that while acknowledging the difficulties and tensions involved, we do not lose sight of the ultimate goals of the NHS at a local level when it introduces proposals to improve services. All Members want to improve clinical outcomes in our communities, which sometimes means making difficult choices. When we talk about reorganisation and improvement, we are talking about saving more lives, providing better and safer services, getting the best clinical outcomes for our communities and consulting with the relevant people.
The hon. Member for Arundel and South Downs is quite right: this is not about finance or saving money; it must be about providing safe, high-quality care. Changes are being proposed to reflect and respond to what the public are telling their local NHS. They want more convenient and appropriate services available at times and in places more convenient to them. The NHS must respond to a variety of drivers for change and ensure that it keeps up with changes in services. Those changes are not imposed by the Government, but are proposals for improvements made by the local NHS, based on local knowledge, experience and clinical expertise. When developing proposals, such vast consultation processes, which are necessary, must involve everyone fully, particularly, in this case, clinicians. Regardless of what hon. Members say, that is what has happened in this case.
The overwhelming clinical case for change has been made by independent experts, such as Sir George Alberti, the national director for emergency access. However, I recognise what the hon. Member for Worthing, West (Peter Bottomley) said when he quoted other views and referred me to other clinicians. Of course, people have very strong views. We are trying to determine locally how to produce the best outcomes and services and how to ensure that our constituents have the best chances, in terms of convenience and emergency care.
Peter Bottomley:
On a point of order, Mr. Conway. Is it in order for the Minister to quote Sir George Alberti, who, at a meeting with Sussex MPs, said that
he would fight for two major hospitals in West Sussex, but then went back on thatfor balance, I should say both?
Derek Conway (in the Chair): The hon. Gentleman has made his point, but the Minister was not out of order.
Dawn Primarolo: I am saddened by the hon. Gentlemans intervention and his aggressive pose in this debate. I have tried genuinely to listen very carefully to all the points that have been made. Any proposals for change that are a matter for the local NHS must, as is clear from today, have a message about the importance of making services relevant to local needs. Public consultation with all interested parties and stakeholders must take place in an informed and constructive way.
As the hon. Member for Mid-Sussex (Mr. Soames) said clearly, the proposals have now been put forward and are based on local priorities, but now is the time for local people to have their say. Those proposals and that consultation, when it closes, will bring forward results and outcomes for discussion in public in the autumn. All of the complex proposals for Sussex need to be developed in partnership with a wide variety of people, including doctors, nurses, other health professionals, local authorities, voluntary groups and local people and patients.
Norman Baker: Will the Minister give way?
Dawn Primarolo: No, I shall not give way. I have been very generous and this is a very complicated debate. In a very short period, I am trying to give a steer on how I intend to take the matter forward. The future of the proposals and the development of the service in the area are in local hands. The consultation and serious debate need to take place now and must deal with points raised by the hon. Member for Arundel and South Downs. I take note also of the specific points made by the hon. Member for Chichester (Mr. Tyrie).
Mr. Tyrie: Will the Minister undertake to supply in detail written definitions of urgent care centres and weighted criteria on the basis of which the decision will be taken?
Dawn Primarolo: I intend to look at every single point made today, including those of the hon. Gentleman, and to respond appropriately. I have listened carefully to the debate. I know the strength of feeling that hon. Members have clearly and effectively expressed today. However, I find it a little odd that, in a debate in which Opposition Members have spoken about defending their current hospitals, the right hon. Member for Horsham (Mr. Maude) made a bid for another hospital, with no regard to the possible impact on hospitals such as the Princess Royal. We need to think carefully about this matter and take it forward with consultation in order to reach the right conclusions for those who live in the area.
Mr. Philip Hollobone (Kettering) (Con): I thank Mr. Speaker for granting permission for this important debate and I welcome the newly appointed Minister to her post. She will respond to the debate in due course, but I want to leave her in no doubt whatever about the strength of feeling among staff at the local tax offices in Kettering, which is shared by local residents. They are outraged at the proposed closure of Ketterings tax offices. Those offices have many loyal and dedicated staff who have provided an excellent service to the people of the borough of Kettering and further afield in north Northamptonshire over many years.
I had the privilege, perhaps unusually for a Conservative Member of Parliament, of joining the staff on their picket line on 31 January, such was the strength of local feeling. I had the privilege to present on their behalf a petition to the House on 26 February, with more than 400 signatories protesting at the closure plans. I also attended a meeting in Her Majestys Treasury on 10 May with officials including Mr. Michael Hanson and Mr. Brian Redford. I now have the privilege of opening this important debate.
In the main tax office in Kettering, there are 78 staff in total. Fifty-nine of them, or 75 per cent. of the work force, are female. Of those 59 women, 32 are part-timers, which is 54 per cent. In total, part-time staff in the Kettering tax office comprise 42 per cent. of the work force. Closure of the office would not only be a bitter blow to the local economy; it would very badly affect, in a totally unfair way, female employees. If Her Majestys Treasury has not already conducted an assessment of the inequality as regards the effects on male and female employees of the planned closure, I very much hope that it will do so in short order.
Kettering and north Northamptonshire are a part of the country that will probably have, in the next 15 to 25 years, one of the fastest rates of growth for houses, population and jobs of anywhere in the United Kingdom. According to the Governments own plans, in north Northamptonshire, which includes Kettering, Wellingborough, Corby and east Northamptonshire, there will be an additional 53,200 houses by 2021, of which 13,100 will be built in Kettering borough. Also according to the Governments own plans, an additional 43,100 jobs are needed in the local economy. North Northamptonshire needs from Her Majestys Treasury a vote of confidence that those plans will be successful and that the tax advice needs of all the new small and large businesses that are to be created in the local economy will have their own dedicated tax office nearby. It seems absurd that at a time when the Government are pushing through those housing expansion plans, they are in effect giving a vote of no confidence in the local economy by threatening to withdraw Ketterings own tax office.
The staff are rightly outraged, because they are being told that they will be relocated to Northampton or Leicester, but it simply will not be possible for many of the staff to be relocated to those locations. As I said, many of them are female and, because of their child care responsibilities, work part-time. Many will have to give up their jobs at a time when the number of people
unemployed in north Northamptonshire is approaching the number unemployed in 1997. Indeed, in the constituency of my hon. Friend the Member for Wellingborough (Mr. Bone), the number unemployed now exceeds that in 1997.
Mr. Peter Bone (Wellingborough) (Con): I am grateful to my hon. Friend for securing this exceptionally important debate. What he knows but perhaps the Minister does not is that my local tax office in Wellingborough is due to close as well, leaving no tax office in north Northamptonshire and adding to the number of people unemployed in Wellingborough.
Mr. Hollobone: That is an excellent point. I believe that some 170 staff are employed both in Wellingborough and in Kettering. The sensible thing for Her Majestys Treasury to do would be to combine those offices at the present Cytringan house location in Kettering, rather than relocating staff from Kettering and Wellingborough to Northampton. The reason for that is that north Northamptonshire is a major growth area, and people, businesses and individuals simply will not want to travel to Northampton to obtain expert tax advice.
Northampton is about 16 miles from Kettering, which does not sound a long way, but between the two towns is the A43 road, which I have to tell the Minister is the most dangerous and congested road in the whole county of Northamptonshire. At peak times in the morning and evening, it is like a linear car park from Kettering to Northampton. The travel time will be more than an hour. That is significant because in the meeting at the Treasury on 10 May to which I was invited, Mr. Brian Redford, the senior Treasury official there, said:
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