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That this House takes note of European Union Documents No. 14490/07 and Addenda 1 and 2, draft Directive on the conditions of entry and residence of third country nationals for the purpose of highly qualified employment, and No. 14491/07 and Addenda 1 and 2, draft Directive on a single application procedure for a single permit for third country nationals to reside and work in the territory of a Member State and on a common set of rights for third country nationals legally residing in a Member State; and supports the Governments intention not to opt in to these Directives. [Mr. Michael Foster.]
Mr. Peter Bone (Wellingborough) (Con): Mr. Speaker, with your permission I would like to present the petition of residents of the Croyland ward of Wellingborough and surrounding areas. It deals with a roadwell, I should rather say a series of potholes and craters with a little bit of tarmac in betweenin the constituency. The petition has been signed by more than 200 residents, including people who work at the local ambulance station. It reads:
The Humble Petition of residents of Croyland ward of Wellingborough and surrounding areas,
That The Kingsway, a road in Wellingborough, is in disrepair, speed humps are severely damaged and the footpath is in a deplorable state.
Wherefore your Petitioners pray that your Honourable House urges the Secretary of State for Communities and Local Government to liaise with Northamptonshire County Council to provide, a) a complete resurfacing of the road and footpath, b) the removal of all speed humps and c) a revision of traffic calming measures including the installation of chicanes and a Vehicle Activated Speed Sign.
And your Petitioners, as in duty bound, will ever pray, &c.
Mr. James Gray (North Wiltshire) (Con): I am glad to have the opportunity of an Adjournment debate, even at this late hour, on a subject of huge concern in my constituencya matter that has angered the population of Chippenham and the surrounding area more than almost any other issue that I can remember in my 11 years representing them in this place. That culminated in an angry public meeting in Chippenham town hall a week ago on Saturday, attended by 300 people, some of whom were very upset. They were upset about the fact that Chippenham hospitalwhich serves a town of 40,000 people that is soon to grow to 50,000 peoplewas to be cut from 43 medical beds to 10 medical beds. That would not resemble a hospital as we normally think of it, and it is questionable whether it would have been sustainable in the long term from an economic or a medical standpoint.
The anger of the local people is well understood, particularly as the proposal comes after various other cuts in the hospital, including the closure of the overnight minor injuries unit, the withdrawal of day care for geriatrics, and the fact that the hospital stopped using the cardiac machine that cost £23,000, which was recently raised by popular subscription. All that was done over last autumn. The final blow was the proposed reduction in beds from 43 to 10.
At oral questions this afternoon, the Minister was able to announce to the House something that has since been confirmed in a press release: the number of beds at Chippenham hospital would be reduced to 20 rather than to 10. Without being immodest, I should like to think that the timing of that decision may not have been uncoincidental with the occurrence of this Adjournment debate and oral questions today, but perhaps it was for other reasons. There has been a change of heart by the primary care trust, which was adamant on the subject at a stormy meeting only two weeks ago.
The chairman and chief executive of the PCT are decent enough people, but were carrying out the will of the Government and were adamant that the hospital would go down to 10 beds. I am glad that in the subsequent two weeks they have seen reason and realised that 10 beds is not sustainable and that 20 is a more reasonable number. A deal has been done with the Royal United hospital in Bath, which will have 10 beds at Chippenham. That is an eminently healthy development. It is still not enough; 20 beds is half the present number, and it is difficult to assess whether that is sustainable.
The news removes some of the passion from the debate. I welcome it and I look forward to hearing what the Minister has to say later about that deal. I hope that it may be possible to extend that 10-bed deal to a better arrangement for Chippenham hospital. The development comes about as a result of the Pathways for Change consultation. As a result of the proposals in that document, a petition with 25,000 signatures was delivered to Parliament. There were huge public
meetings and outcry everywhere, but that outcry was nothing by comparison with what has happened to the hospital since.
All that comes as a great disappointment, as the Government went out of their way to seek to reassure us about the future of community hospitals. They said in their rather fetchingly entitled consultation paper Our Health, Our Care, Our Say that
we are clear that community facilities should not be lost in response to short-term budgetary pressures,
Primary Care Trusts that are considering closing community facilities should now review that in the light of the clear strategy that we have spelled out in the White Paper.
In a debate on 30 January 2006, the then Secretary of State reassured me that Avon, Gloucestershire and Wiltshire should think again about its strategy to close or cut community hospitals. We took some encouragement from that. We like to take encouragement from what the Government tell us. Imagine our surprise when, despite that, Malmesbury was effectively closed, and Westbury, Trowbridge, Melksham and Devizes hospitals were closed and huge cuts were made elsewhere in hospital provision across the area.
Despite the Governments assurances on community facilities, why is all this happening? I had a written parliamentary question last week that may help to explain. The Minister admitted last week that one of the worst funded primary care trusts in England is that in Wiltshire. We in Wiltshire get £1,155 per head per annum for health carecompared with £1,182 in neighbouring Hampshire, £1,425 in Northumberland and £1,416 in London. Why should Wiltshire get £300 per head less than Northumberland? What on earth would justify thatother than the fact that Northumberland, of course, is entirely represented by Labour Members of Parliament, while Wiltshire, I am glad to say, is entirely represented by Conservative ones?
To put the whole thing into context, I should say that before all this started Wiltshire community hospitals had a total of 173 beds, spread across the hospitals that I mentioned. The Pathways for Change document proposed that the number should be cut to 7424 beds in Marlborough, 20 in Melksham and 30 in Chippenham. However, Melksham closed and Warminster got its 20 beds. Then, with no consultation at all, it was proposed that the number for Chippenham would be cut from 43 down to 10or now, 20.
Dr. Andrew Murrison (Westbury) (Con): One of the things that my hon. Friends constituents and mine are concerned about is maternity services. Has he seen the recent Healthcare Commission report, which commended both Chippenham and Trowbridge maternity units? Does he share my exasperation that the primary care trust that we unfortunately have in Wiltshire seems selective in the evidence that it uses to back up its position? It appears to ignore things such as the Healthcare Commissions assertion that smaller is better when it comes to maternity services.
My hon. Friend is right, and I am grateful to him for staying so late in the evening to support me in this Adjournment debate. The fact is that maternity services, for example, are delivered better in small units
than in big ones. Although I welcome the fact that our maternity unit in Chippenham is being maintained, I very much regret that many of the others around Wiltshire have gone, such as the one in Malmesbury, for examplealso in my constituency and for which we campaigned hard. My hon. Friend is absolutely right. The mere facts that we are keeping our maternity unit in Chippenham, which the Minister will no doubt raise in a moment, and that we have a 20-bed specialist stroke unit in Chippenham, do not excuse the fact that all those other facilities around the county have been abolished.
The fact is that we will end up with 30 per cent. of the community beds that we had before all this started, and that seems altogether retrograde. We are a large rural area. There are first-class hospitals in Bath and Swindon, although criticisms can be made of them. However, those hospitals are remote from my and my hon. Friends constituents in rural Wiltshire. We need community hospitals, particularly to deal effectively with those needing intermediate and geriatric care.
In replying, the Minister may well say that I am looking at things in an old-fashioned way and that we do not just need community hospitals because now there are community teams. Of course, we all welcome the notion that if people can be cared for at home, they should be. That is a good thing; no one wants to lock people up in hospitals if that can be avoided. However, if the community teams are to work properly, the hospital beds should be kept open until the teams are working. Incidentally, community teams are not working 24/7, as was promised; there is, as yet, no night-time care in the area.
If the Minister came to the House and said, The Chippenham hospital beds are empty week after week, and we are paying a lot of money to keep them, we would all say, Fineclose them down. We have no problem at all, as the community teams are great. However, the fact is that the community beds are fuller than ever. Currently, they are 96 per cent. occupied over the winter. Most people stay in them for 30 days, and some for 40 days. The Great Western hospital intermediate care unit has closed, which means that the patients have to go to Chippenham instead. Six wards in the Royal United hospital in Bath are currently closed because of the norovirus and there are terrible MRSA problems there too; there are constant red alerts all winter. All the people have to come to Chippenham, especially those requiring geriatric or intermediate care.
In January, RUH in Bath ended up sending patients to local private hospitals to try to meet the Governments 18-week target. Last week in Chippenham, local managers inquired as to whether it would be possible to take the Cameron ward in the hospital out of mothballs. It has been mothballed ever since the Government closed it down, but the managers asked whether it could be brought out again because the beds were needed so badly. When they found that they could not do that for economic reasons, they inquired whether the day rooms at the end of the open wards could possibly have beds in them, because they were short of beds. Against that background, they are apparently cutting the number of beds from an inadequate 43 to 20.
The neighbourhood teams are very far from the promised 24/7 service. We have heard of several cases where a patient has been told not to expect a visit for toileting assistance but either to wear incontinence pads and wait for someone to arrive, or to have a catheter inserted... As a very experienced nurse, I am becoming appalled and almost ashamed to be part of that profession.
What about the dignity of life? We are closing hospital beds in Chippenham, where people can be properly looked after, and sending them home and suggesting that they should either wear incontinence pads or have a catheter inserted until the nurse turns up. That will not do. People demand the proper human care that they have had over the years. The cuts, even to 20 beds in Chippenham hospital, are unrealistic and inhumane.
We look to the Minister for three things. First, will he please explain why the people of Wiltshire have £300 less a year spent on them than, for example, the people of Northumberland? The county is among the worst funded in England. What will we do about that? It is a question for the long term and the Minister should answer it.
Secondly, surely the Minister accepts that there is a place for community hospitals such as Chippenham. Will not he continue the negotiations that the PCT has had with, for example, the RUH in Bath, and maintain the movement that got the number of beds increased from 10 to 20? Let us try to get the figure back to 30 if we can.
Thirdly, I hope that the Minister can give a hint about the next question, even if he cannot answer it. The PCT applied for some £17 million to redevelop the old hospital, which had been the Victorian workhouse, but the Government did not like some aspects of the application and asked the PCT to renew it. It has now done that. It would therefore be interesting to receive a hint from the Minister about whether that application for £17 million to redevelop the hospital might meet the Governments approval. That would give new life and hope to the community around Chippenham hospital.
The people of Chippenhamand throughout North Wiltshire, because the hospital serves the whole of my constituency, not only the town of Chippenhamdeserve a fully functional hospital. They demand that the Government give them it.
The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate the hon. Member for North Wiltshire (Mr. Gray) on securing the debate and I appreciate his comments. I would like to take the opportunity to pay tribute to all NHS staff in Chippenham and North Wiltshire for their hard work and dedication.
I hope, in the time that is left, to reassure the hon. Gentleman, and, through him, his constituents, that the proposed changes to NHS provision in Wiltshire have been developed after extensive consultation and approved by democratically elected local councillors, and are not about cost-cutting. On the contrary, funding is increasing, and I will deal with that later.
The proposed changes will lead to better clinical care for the people of Wiltshire, and Chippenham hospital has a good future.
The proposals of Wiltshire primary care trust for Chippenham hospitalthe Reforming Community Services programmewere developed after two years of extensive consultation. The board of the PCT agreed the programme in January last year, and it was considered in March 2007 by the county councils overview and scrutiny committee. The council is dominated by the Conservative party. As the hon. Gentleman knows, overview and scrutiny committees are composed of local councillors.
To increase democratic oversight of NHS decisions, the Government made it a requirement that such committees should consider any reorganisation of local health provision. If they have concerns about those proposals, they have the power to refer them to the Secretary of Stateand my right hon. Friend has made it clear since he took on his role that in such circumstances, he would automatically refer the matter to the independent reconfiguration panel. That has happened in several cases in which recommendations have been overturned. As the hon. Gentleman will know, Wiltshire county councils overview and scrutiny committee did not refer the proposals to the Secretary of State, but supported the Reforming Community Services programme.
It is not up to me to second-guess what was on the minds of the hon. Gentlemans colleagues on Wiltshire county council, but I cannot believe that they would have approved the programme if they thought that it would not be for the benefit of their constituents, or would be about cost cutting. The main driver for any local health service reorganisation has to be clinically led, and the central focus must be the best outcome for patients. That is not about saving money, but about investing in services fit for the 21st century.
Let me deal with funding in Wiltshire more generally. Wiltshire PCTs funding allocation has increased from £341.1 million in 2003-04 to £539.6 million this year. Next year funding will increase further, to £569.1 milliona 66 per cent. increase since 2003-04. Whereas a few years ago some primary care trusts were a long way from their fair funding targetWiltshire may have been one of thoseno primary care trust in the country, apart from Northamptonshire, is now more than 3.5 per cent. away from its target. Just to correct the hon. Gentleman about Northumberland, it is not represented in the House only by Labour MPs; rather, I understand that there are two Labour MPs, one Conservative MP and one Liberal Democrat MP. Those funding figures mean that funding per head in Wiltshire has increased in just five years from less than £800 to more than £1,200. That is, in any sense of the term, a massive increase.
I do not think that Wiltshire councillors would have approved proposals that they thought would lead to worse clinical outcomes for patients, either. Having looked into health provision in the county and future need, the PCT concluded that there was an oversupply of general medical beds at Chippenham hospital, which currently has 73 beds. Wiltshire PCT was proposing to reduce the number of medical beds to 10,
as the hon. Gentleman mentioned, but has now reconsidered that. The PCT has been in discussions for some time with the Royal hospital in Bath, apparently about the possibility of devolving some of the acute beds from Bath to Chippenham, and, to allow for the possible relocation of services from the Royal Bath to Chippenham, has adjusted that figure up to 20. There are no plans to reduce the size of the stroke unit at the hospital, and the maternity unit, which has also be referred to, will in fact be expanded. Taken in all, those changes will mean that Chippenham hospital will still have a total of 54 beds.
According to the PCT, one of the reasons for the reduction in the number of general medical beds is that it has been determined to reduce what is called delayed discharge, where patients are ready to go home, but the support to enable them to do so is not in place. Wiltshire PCT has already cut delayed discharge by half. I hope that we would all congratulate it, and Wiltshire county council, on achieving that. As I am sure the hon. Gentleman would accept, delayed discharge is bad for patients and bad for the taxpayer.
The second reason for the reduction in general medical beds is that the PCT has been investing in neighbourhood nursing teams, which have been gradually introduced since November last year. Existing teams provide cover to those in Chippenham, Calne, Corsham and Box, and last month another team was set up covering Malmesbury and the surrounding area. The teams comprise 52 nurses and 22 physiotherapists or occupational therapists in total, and serve a population of 18,000 people aged over 65. In January the teams saw 350 new patients. It is worth noting that fewer than 300 new patients were admitted to the general in-patient beds in Chippenham hospital during the same period.
On a recent visit to Wiltshire, I had the opportunity to visit the nursing team in Calne, in the constituency of the right hon. and learned Member for Devizes (Mr. Ancram). I accompanied one of district nurses on a visit and saw at first hand how valued the service that the team provides to the local community is.
As the hon. Member for North Wiltshire acknowledged in his speech, people want to be treated at home where possible, or as close to home as possible. However, the development of community support should not mean that the days of the community hospital are numbered. The general devolving of servicesthe devolving of services out of acute hospitals, as I hope they will be devolved out of Bath to Chippenham, and out of Chippenham to peoples homesis the direction of travel that is supported in, I think, all parts of the House.
The Government still have a massive commitment to the redevelopment and modernisation of our community hospitals, involving a £750 million programme over this spending review period. Our region in the south-west is already a major beneficiary of the community hospitals programme. It has received £58 million, which is more than a quarter of the total of £190 million allocated so far. That money is supporting major refurbishments in Yate, Minehead, South Bristol, Keynsham Park and Dursley, and at the Moreton and Bourton hospitals in the north Cotswolds.
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