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26 Feb 2008 : Column 236WHcontinued
fleecing patients and their families
through high car park charges. Does my hon. Friend agree that if those hospitals were properly funded, they would not have to resort to funding shortfalls through such schemes?
Mr. Simpson: There is a problem. When my father was seriously ill a year ago, and I took my mother regularly to the Norfolk and Norwich university hospital NHS trust, the issue was not just about the financial aspect. Indeed, we MPs, as we know, are well paid, so with all our pay and allowances we can afford car parking charges, but many of my constituents cannot and most of the car parks are not large enough. The car parking aspect has been franchised out, but the Government must re-examine the problem, because I am sure that Norfolk is not the only area where it is an issue.
Mr. Fraser: It is funding shortfalls.
Mr. Simpson: The issue may be not just about funding but about the whole business of the car parking contracts. I am grateful to my hon. Friend for mentioning the issue.
Bed blocking has been much in the news, including the local news. The Eastern Daily Press ran a series of articles showing that there were bed-blocking crises at the Norfolk and Norwich University Hospital NHS
Trust and the Queen Elizabeth hospital in Kings Lynn. St. Michaels hospital, along with others, has offered a safety net. Sadly, however, bed blocking will remain a problem, and it must be addressed.
Following recent alerts at the Norfolk and Norwich University Hospital NHS Trust, the number of beds at St. Michaels hospital was increased from 24 to 26a clear demonstration of the need for community beds in Aylsham and in the county as a whole. Currently, St. Michaels hospital operates at 80 per cent.-plus capacity, and the effectiveness of the PCTs alternative intermediate care strategy ought to be measurable by specific endpoints that include a significant reduction to below 50 per cent. in admissions to St. Michaels hospital. As yet, the evidence is not available.
The PCT and the Aylsham care trust will provide intermediate care. The health campus project is insufficiently developed, and indeed, I do not think that most of us are clear about what the PCT means by a health campus. It has a warm feeling about it, invoking the idea of a multi-disciplined university campus, and it may well be the answer to the areas health care requirements. However, as yet, I have not seen sufficient details, and I suspect that one will have to pay the money up front in order to deliver such a campus and provide the health care that we want.
The Aylsham group has also been led to believe that there is a strong bid for the stroke unit to be developed in conjunction with the Norfolk and Norwich University Hospital NHS Trust, albeit with a greatly reduced number of beds24 instead of 40. That, once again, may mean pressure on the local community hospitals.
Home care has been trialled in west Norfolk, and it must work there, because that part of the county lacks community hospitals. The Minister will be only too well aware if he plots health care centres and community hospitals on a map of Norfolk, that owing to its sheer size, little in the way of a safety net exists to deal with any future health care crisis.
Based on the points that I and other people have made, the PCT should at the very least think about postponing its original closure date for St. Michaels hospital. The Minister should at the very least take an interest in the issue, and perhaps consult the PCT on whether it has enough financial resources to deal not only with that change, but with the impact of the Darzi review. I have been examining health care in Norfolk at the micro level, but I wonder whether the Minister mightto use the old music hall expressionshow an ankle and give us some indication of the outlines of the Darzi review. We heard some of it when the Prime Minister, being desperate to recover from the non-election, performed like a clapping seal a few months ago, and Lord Darzi had to rush through with some initial ideas.
In conclusion, the issue is important for my constituents and for myself, but it is not unique to my constituency. There are major challenges throughout Norfolk, and I should therefore be interested in the Ministers views.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Mid-Norfolk (Mr. Simpson) on securing this Adjournment debate about an issue that is important not only to his family but to his constituents and the local community.
The description of the dialogue, both in the hon. Gentlemans presentation today and in my briefing for the debate, is almost an example of best practice. He said that the process would not have happened without the overview and scrutiny committees referral, but that is the very reason why the Government gave local authorities for the first time the statutory right to comment on NHS reorganisation proposals locally and, if they were dissatisfied with the proposals, the right, as he knows, to refer them to the Secretary of State, who would then refer them to an independent review configuration panel. Although I agree that it is probably unlikely that those discussions would take place without the role of the overview and scrutiny committee, I hope that the hon. Gentleman agrees that the new role for local government in scrutinising NHS decisions, which can be uncomfortable and difficult, is right.
The hon. Gentleman, understandably, represents the views of the local community, which feels, also understandably, that it would like to preserve what it has. People are attached to the hospital, which they believe provides an excellent service. The hon. Gentleman referred to demographic change, so the issue is not just about the existing situation, but about projections of future need. The local community would like the hospital to be preserved in its current form.
I do not live in the area, so I am less able to comment than the local people who make those decisions and live there, but the vision is for a much wider range of community-based services. The hon. Gentleman rightly raised the question of what a wellness facility is. These days, we use all sorts of jargon in public services, which confuses people, but the principle of a wellness service is the recognition that the modern health servicethis is at the heart of Lord Darsis reviewis as much about preventing sickness and ill health as about intervening once somebody becomes very ill. That can be achieved through better health education, promotion, screening and so on, and by intervening early to prevent peoples health from deteriorating, which is particularly relevant to older people. Once they deteriorate, the danger is that it is difficult to get them back on their feet and living independently. The notion of a wellness approach is about prevention, early intervention and ensuring that people are aware of how best to stay healthy.
We must get the right balance of prevention and early intervention services in the hon. Gentlemans community and ensure that there are some beds, which is indeed part of the plan. Those beds might not be in the existing hospital environment, but there is a commitment to develop a nursing home-type provision in the community. That seems to me a better outcome for health care provision in Aylsham than the current position. The cynicism and scepticism among residents and professionals may be because they have not yet seen a tangible vision of what the alternative will look like. In defence of the primary care trust, it seems to me that it is trying to develop that vision in partnership with the local community rather than simply impose on it a managers know best or professionals know best approach.
From all the information I have, from both the hon. Gentlemans contribution and my briefing for the debate, I think that what is happening is what we would want to happen in communities where change is essential. We want engagement between the health bodies and local communities, and we want the local authority, Members
of Parliament and local residents to be involved to try to come up with a solution in the best interests of the relevant community.
The hon. Gentleman asked about resources. It is important to point out that if the PCT can emerge from the process with a credible, sensible vision, which will improve health care and be more up to date, modern and responsive to the needs of the community, and if it puts a credible and robust bid to the strategic health authority, demonstrating improved outcomes for patients, of course resources will be available. There are resources both regionally and nationallySHAs can seek resources from the Department of Healthto support the reorganisation and reconfiguration of services. The hon. Gentleman says that has not yet happened, so resource problems are not preventing progress. We need a clear vision about a new range of health services that best meet the needs of the Aylsham community.
I will be happy to meet the hon. Gentleman at a later stage if he is dissatisfied with the outcome of the engagement and consultation process. I urge him to show a little leadership in the local communityI am not saying that he is not already doing so, because I have no reason to believe thatand to say that, although not all change is good, if there can be change that leads to a better range of services, focused on prevention, early intervention and ensuring that older people do not deteriorate and need acute hospital care, it will be in the interests of all families in Aylsham. The hon. Gentleman was right about the impact on the work force and on professionals, recruitment and so on, but the changes mean that a different mix of professionalsdoctors, community nurses and social care staffwill need to work together to ensure that there is a shift to prevention and early intervention.
I understand that it was originally feared that, under the proposals, the five existing beds would be removed and not replaced, but from what the PCT has said, it seems that as well as an NHS campus with integrated services and a shift from acute to primary health care, there will also be guaranteed protection of at least five beds in any new organisation of services. I ask the hon. Gentleman to see the proposals as a major opportunity, not as a threat. He must consider the range of services currently provided and the consequences for patient care in Aylsham and surrounding areas, and whether the proposed changes would lead to better outcomes in the long term. It is easy to hang on to the status quo and, understandably, people are emotionally attached to existing services. They are not necessarily persuaded of the need for change until it is clear to them what the change will be and whether it will lead to improvement or to the diminution or undermining of existing services.
The hon. Member for South-West Norfolk (Mr. Fraser) made an important contribution, but it is difficult to see
how he can argue that we should seek maximum devolution for managers and professionals on the front line and minimal Government interferencehis party supported the foundation hospital model on the whole, for exampleand then ask the Government to intervene in individual hospitals where he feels the car parking charges are excessive. Although it is acceptable for hospitals to charge for car parking, and there is no law or rule to prevent them from doing so, they certainly should not abuse that right by charging extortionate amounts. The test of reasonableness should be applied to decisions on the matter.
As a Member of Parliament, the hon. Gentleman has the right to make strong statements and representations if it can be demonstrated that the charging regime is either extortionate or disproportionate. I do not know the details of the case that he mentioned, so I cannot make a definitive comment, but charges should be proportionate and reasonable.
Mr. Fraser: I am enormously grateful to the Minister for giving way, given that this is not my debate. Does he accept that because of budget balancing issues hospitals are put under undue pressure over parking charges?
Mr. Lewis: I have great respect for the hon. Gentleman, whom I met for the first time over dinner last nightI am not going to show him my ankle during the debate, by the waybut I do not believe that is the case. The NHS has had unprecedented resources in the past eight or nine years, including in Norfolk, and there will be a continued increase in resources over the next three years as part of the comprehensive spending review settlement, so even if it is true that parking charges are extortionate and disproportionate, I do not accept that it is necessary. If the high charges are for resource reasons, why are they not happening in hospitals throughout the country, and why are there such different approaches to charging? There has been unprecedented sustained investment in the NHS, so although car parking charging is perfectly acceptable under current rules, we expect proportionality and fairness.
I say to the hon. Member for Mid-Norfolk that I hope that the PCTs engagement with the local community leads to a clear vision about how a shift in health services can be provided, with maximum local support, which leads demonstrably to an improved range of services, particularly for older people. I urge him to consider the fact that moving towards prevention and early intervention is, on the whole, in the interests of maintaining the independence of older people. My ankle will not be shown in the debate, but my door will remain open to the hon. Gentleman as the process evolves in case he wishes to discuss it further with me.
Andrew Gwynne (Denton and Reddish) (Lab): First, I draw hon. Members attention to my entry in the Register of Members Interests. I am pleased that we are having this debate, and it is a pleasure to see you in the Chair, Mr. Marshall. I thank the Speaker for affording me the opportunity to discuss this issue at this important time. There is always a case to be made for debating the peace process, and this topic comes up frequently in parliamentary debates. I am sure that it will not have escaped the Governments notice that so many Members on both sides of the House display interest in and commitment to this foreign policy issue, and I am pleased that it remains high on the Governments agenda.
The debate is particularly timely, and I hope that it will refocus attention on the positive developments that are being made following the Annapolis conference. This year got off to a difficult start with the deterioration of the situation in Gaza and the dramatic increase in the number of rocket and mortar attacks being fired into Israel. I will return to that distressing situation a little later. First, I remind the House that, despite the unwelcome developments in Gaza, there have been plenty of good-will gestures and confidence-building measures from both President Abbas and Prime Minister Olmert in an effort to sustain the Annapolis momentum and to ensure that dialogue between both sides continues.
Since Annapolis, Olmert and Abbas have had bi-monthly meetings, and Palestinian and Israeli negotiators have continued to sit and talk through the difficult issues on the table in order to realise the objective of reaching final status talks by the end of 2008. I shall return to some of those developments later. First, I shall discuss my experiences of the conflict, drawing on my trip to the region with the Labour Friends of Israel in September. During that visit, my parliamentary colleagues and I spent time in Jerusalem, Tel Aviv and Ramallah. We held extensive meetings with Israeli and Palestinian parliamentarians, academics, opinion formers and Government Ministers. When talking to that wide range of people, the complexities involved in achieving the two-state solution for which we hope were obvious at all times.
The trip took place as early discussions about Annapolis were being considered, and the common message that we got from everyone whom we met was that it was time to acttime to return to the road map and to seize an opportunity for lasting peace. It was obvious why so many felt that way. The deplorable daily suffering of Israelis and Palestinians was making life too hard for too many people, and the impetus was clearly there to seek a sustainable, two-state solution, with both parties living side by side in peace and security. However, despite the renewed efforts made towards peace at the end of 2007, tensions between the parties have been rising in 2008 amid increased violence and casualties.
In January, there was a dramatic increase in mortar and rocket attacks fired from Gaza into Israel, causing several serious injuries, including to an eight-year-old Israeli boy, who lost a leg in a Qassam rocket attack on 9 February. A woman was killed in a suicide bomb attack in Dimona on 4 Februarythe first suicide attack in Israel for nearly a year. The upsurge in violent attacks on Israel has resulted in mounting pressure on the Israeli Government to take action. As a result,
Israel has implemented a number of measures to counter the barrages, and the Israel Defence Forces have launched several incursions into Gaza in the past six weeks, with the intention of targeting militant cells responsible for the rocket attacks. As part of that, Israel closed border crossings into Gaza between 17 and 22 January, and imposed electricity and other fuel restrictions to curb rocket production.
Neither the incursions nor the restrictions have proven effective in stopping the rockets. In the past few weeks, hundreds of Israelis have marched in protest to Jerusalem and Tel Aviv to demonstrate against their Governments inability to put an end to the Qassam attacks. In the wake of those events, it is all the more important that we sustain momentum in the peace process, and I urge the UK Government to ensure that it remains at the forefront of their international agenda.
Mr. James Clappison (Hertsmere) (Con): I congratulate the hon. Gentleman on securing the debate, and I am listening carefully to the powerful case that he is making. Does he agree that the situation for Israeli citizens that he has so movingly described is absolutely intolerable, and that the rocket attacks have continued every day since Hamas took control of Gaza? Should not the international community share some responsibility for holding Hamas to account for causing or permitting those rocket attacks, which are simply intolerable for people in Israel?
Andrew Gwynne: I agree entirely. When we went there in September, we saw the effect on ordinary people living in the towns around the Gaza strip in Israel proper. They are experiencing the barrages on a daily basis, and it is quite intolerable. If they were my constituents in this country, I would demand that my Government did something about it. As a member of the international community, the British Government ought to do all that they can to stop the rocket attacks and to secure daily life for ordinary Israelis who live close to the Gaza strip.
In the wake of such events, it is all the more important that we should sustain the momentum in the peace process. We should actively work to build on the achievements of Annapolis. At the conference, the Israelis and Palestinians committed to meeting their obligations as laid out in the first stage of the re-launched road map, and pledged to agree on final status issues by the end of 2008. General James Jones was appointed as US middle east envoy to monitor the situation and to help Israelis and Palestinians to live up to those commitments. We also welcome the work of our former Prime Minister, Tony Blair, who, as the Quartet envoy, has the difficult task of Palestinian institution-building. We met Mr. Blair when we were out there in September, and he was motivated to try to make the most of Annapolis and to engage the international community fully in this challenge. Some of the fruits of his labour are already being realised.
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