Mr. Bradshaw: I shall endeavour to respond to as many of the points made in this good and constructive debate as I can in the short time that has been left to me. I hope that hon. Members will understand if I am not able to respond to their points, and I shall endeavour to write to them where that is the case. [Interruption.] The hon. Member for Hemel Hempstead (Mike Penning) said from a sedentary position that I should not have spoken for so long earlier, but he may recall that I was extremely generous in taking interventions. That was why my introductory comments took so long. I should warn him that, as a result, I do not intend to take any interventions in my summing up.
My hon. Friend the Member for Walthamstow (Mr. Gerrard) made an interesting speech about the transformation of the health service that he has witnessed in his area over the past few years. He made a specific point about osteoporosis and the quality and outcomes frameworkQOF. It might help if I were to inform him that general practitioners are rewarded for improving particular clinical services, including those in connection with osteoporosis, by not only the QOF, but the enhanced services. This year, the enhanced services have already been rewarding GPs for the work that they done on osteoporosis. The rewarding has been to the tune of £50 million on five clinical directly enhanced services including osteoporosis. Thus, some of the progress that he would like to see has already been made. He also asked when the National Institute for Health and Clinical Excellence consultation on the changes to the QOF process would be published, and I am advised that we intend to publish that by the end of October.
The hon. Member for Banbury (Tony Baldry), who is no longer in his place, asked why there was a reason to have a health centre in his areawe dealt with that in some detail at the timeand why Oxfordshires primary care trust did not seek to have more centres. It is perfectly within its rights to seek to have more centres.
In contradiction to what was said by the hon. Member for Wellingborough (Mr. Bone), I am informed that Northamptonshires authority still intends to procure four new GP-led health centresone before Christmas, another before March next year and two more thereafter. We have stressed all along that primary care trusts are perfectly free to decide the pattern of health care provision in their areas.
My hon. Friend the Member for Stroud (Mr. Drew) highlighted the fact that Gloucestershire PCT was one of a small number of PCTs that, according to the latest figures, had not yet progressed very well, if at all, on extended hours. I am happy to be able to inform him, again via Hansard, because he is no longer in his place, that Gloucestershire has rapidly caught up, that 34 out of its 84 practices have extended opening hours and that the PCT is confident that it will achieve the 50 per cent. target next monthtwo months ahead of schedule.
My hon. Friend the Member for Dartford (Dr. Stoate) and the hon. Member for Wyre Forest (Dr. Taylor) both did a sterling job of standing up for GPs. In every speech that the Secretary of State and I make, we emphasise the incredibly valuable work that GPs do and the contribution that they make. I have defended today, as I do regularly, the contract that we brought in. I said in my opening remarks that it was vital that GPs were rewarded properly, because they had not been in the past, which was why we had such a problem with recruitment and retention. That is not to say that we will not have disagreements and, earlier this year, we had such a disagreement about the introduction of GP-led health centres with the BMA leadership. My hon. Friend was on our side of that disagreement and, as he rightly said, had discussions with his local GPs who are now involved in the delivery of one of those health centres in his area. We will praise primary care and the work of GPs when that praise is due. The vast majority of GPs do a fantastic job, but it is also the role of Government to try to improve things and to get better value for money out of the contract on behalf of the taxpayer.
In response to the questions that the hon. Member for Wyre Forest posed about urgent and out-of-hours care, I welcomeas he doesthe changes in his area. Just because the service is being provided by a Suffolk co-operative does not mean that it will necessarily be substandard. The hon. Member for South Cambridgeshire praised Devon Doctors, a doctors co-operative from my area that happily and successfully runs the out-of-hours service in Devon and has expanded its tentacles all over the place. I hope that the new service will be an improvement on the last one in the constituency of the hon. Member for Wyre Forest. As I am sure he will have noticed, we said in the next stage review that we will
consider options to improve and simplify access for the public to urgent healthcare by exploring the introduction of a single three-digit number in addition to the emergency services number 999.
The hon. Member for North Norfolk (Norman Lamb) asked why there was such a variation in the performance on extended hours so far. We are not sure, but there may be several reasons for that. Some PCTs may have been a bit slow off the mark. In some areas where local medical committees are more powerful, they may be holding out for a better deal. It may be some time before they hit the target. In the case of Liverpool, the low offering is due
to practices not meeting the core DES criteria. The PCT in Liverpool is working hard to achieve compliance and some practices were working for DES before signing up. The PCT says that it is confident of achieving at least 50 per cent. by the end of the year, which is what the Government expect of it.
The hon. Gentleman also asked me about comments in Pulse. I apologise if I am not such an avid reader of the GP press as Opposition spokesmen, but I am informed that the quotation to which he referred was a misquotation. The official concerned actually said that PCTs have a choice in contracting with their practices through a local contract or by using the national direct enhanced service. However, PCTs must ensure that local contracts meet core minimum standards. They can then build on those to expand and enhance the services.
The hon. Gentleman asked what role QOF was playing in reducing health inequalities. Research by the national primary care research centre in Manchester shows that the performance of practices in deprived and disadvantaged areas has significantly improved since the introduction of QOF, and that practices in those areas achieve as well as other practices. I agree with the hon. Gentleman that more can be done, which is exactly why the agreement this year will end the prevalence adjustment that disadvantages practices with the highest number of patients with certain diseases. That adjustment will end completely in 2010, when practices will be rewarded on true prevalence, not adjusted prevalence.
The hon. Gentleman also asked how long it would take to phase out the minimum practice income guarantee. That depends on what level of uplift the Doctors and Dentists Review Body, the independent pay review body, recommends for primary care. For arguments sake, if it recommended a 2 per cent. uplift this year, and that was repeated in subsequent years, it would take five years to phase out the MPIG completely, apart from a small rump of practices that would need some level of protection. I am also informed that if there were a 2 per cent. uplift this year, it should reduce the amount of protection moneys paid by about 50 per cent. nationally in the first year, so that would be a big step forward. We will continue to work with the BMA to secure year-on-year progress.
The hon. Gentleman also asked what role GP-led health centres will play in helping to address health inequalities. They will play a role through the additional and enhanced services that many of them will offer and the community-based services with which they will be co-located. His own, in Norwich, will be providing sexual health services, and I am sure that that is something that he will welcome.
Mr. David Evennett (Bexleyheath and Crayford) (Con): Bexley borough is a great place in which to live and to work. It has many good and positive attributes, including its location, the many open spaces and places of interest, excellent schools and facilities and a good Conservative council led by Councillor Teresa ONeill. However, there are a number of local concerns, and among the major concerns is the issue of health care in the borough. I am therefore grateful for the opportunity to raise some of the concerns about health care in Bexley in the debate.
I am delighted that my hon. Friend the Member for Bromley and Chislehurst (Robert Neill)my long-term personal friend as well as my neighbour and colleagueis in his place this evening. I am also grateful that the hon. Member for Erith and Thamesmead (John Austin), a fellow MP for Bexley borough, is with us for this important debate. Thirdly, I am delighted that my hon. Friend the Member for Hornchurch (James Brokenshire), who is the Conservative parliamentary candidate for the constituency of Old Bexley and Sidcup, is here to listen to the debate, too.
My hon. Friend the Member for Hornchurch has already been very active in our area on this and other issues. His positive contributions to the debate locally have been welcome, in marked contrast to those of some of the Labour parliamentary candidates, who still seem to be rather wedded to spin and inaccuracy and do not seem to take on board the concerns and views of the people of the boroughparticularly the views of constituents in Bexleyheath and Crayford and in Old Bexley and Sidcup.
The Minister is a fair and reasonable man, and I hope that he will take on board the concerns felt across my borough. We do not feel that the Government are taking seriously residents views, wants and needs about health care at this time.
We accept that there has been increased taxation and increased spending on health. There has been some considerable local improvement, as we know, across London. The Government are to be commended for what has been achieved. However, Bexley residents are concerned that there is a regrettable planned programme of downgrades and cuts to our local NHS. I hope that the Minister will listen to our heartfelt pleas and will take on board the concerns, and I hope that he will go back to the Department and act accordingly.
It is, of course, particularly opportune that we are holding this debate on a day when the Healthcare Commission report is published showing that in London service quality has declined. Is it any wonder that Bexley residents are concerned about their health care?
I turn, first, to Queen Marys hospital, Sidcup, in the south of our borough and the proposals made under A Picture of Health. Over the past year, residents from Bexley and the surrounding boroughs have been campaigning vigorously against the closure of the accident and emergency, maternity and childrens departments at Queen Marys hospital, Sidcup. The campaign has been
ably led by Bexley councillors Sharon Massey and David Hurt. Those of us who live in the area and represent the local community believe that those services are vital to local people. There has been considerable concern about the hospitals future should the proposed changes go ahead. There is a real fear that if the changes are implemented, the long-term prognosis for Queen Marys Sidcup will be decline.
John Austin (Erith and Thamesmead) (Lab): The hon. Gentleman has referred to accident and emergency departments, but he will know that the plans under A Picture of Health provide for a 24-hour urgent care centre to cover all but the major emergency, blue-light casualty services. In the unfortunate event that he were to suffer a stroke or have a cardiac arrest, would he rather go to the hospital that is nearest, or to the one with the full diagnostic facilities that might save his life?
Mr. Evennett: The hon. Gentleman will have to wait and listen to the rest of my speech, but the most important point is that Queen Marys hospital has a fully active accident and emergency department. Of course we accept that people would want to get the best treatment that the major hospitals specialising in treatment for heart and stroke problems offer, but we are talking about something in between, and the present services are greater than what would be provided if the proposals go ahead. That is the crucial point and, although I have a lot of respect for him, the hon. Gentleman is trying to be rather too clever by half on this matter.
The board of A Picture of Health was set up to review services in south-east London. It has decided that the Queen Elizabeth hospital in Woolwich, the Princess Royal hospital in Farnborough and Lewisham hospital should retain their accident and emergency services, while Queen Marys hospital should lose them. Many residents are concerned that closure of those services at Queen Marys would mean that some patients would have to travel much further to obtain treatment.
Transport is a very important issue in our area. Accessibility for treatment, consultation and visitors is all important, and we all know that transport links in south-east London are not good. It is unacceptable to say that the alternatives are only 5 or 7 miles away, as the impact would be felt more by those in our community who are already disadvantagedthe elderly, mothers with young children and people without cars. Those are the key issues.
Robert Neill (Bromley and Chislehurst) (Con): I congratulate my hon. Friend on securing this debate on a very important issue. May I add my support to his observations on behalf of those residents in that part of my constituency of Bromley that adjoins his area, as they also use the services at Queen Marys hospital? He may be aware that I carried out a survey of 9,000 of my constituents who are affected and there was not a single response in support of the proposals, not least because not one of the four options included keeping A and E on the Queen Marys site. That stokes up real concerns that the part of the site not covered by private finance arrangements may eventually be disposed of.
In March this year, more than 1,500 people attended a march against the proposals that was organised by local Conservatives. I presented a representative of the
A Picture of Health board with a petition containing more than 8,500 signatures, including those of children, parents, doctors, nurses and other professionals from the health service. I believe that that demonstrates the strength of feeling among local people about the A Picture of Health plans, and their desire to retain vital services at Queen Marys hospital. As my hon. Friend the Member for Bromley and Chislehurst said, residents of Greenwich and Bromley joined Greenwich residents in the rally.
It would be devastating for local people, if Queen Marys Hospital in Sidcup is downgraded to a borough hospital, and it loses its emergency services, including A&E, childrens and maternity department, under A Picture of Health proposals...I am deeply disappointed by these proposals and will do everything I can to help the residents of Bexley in their battle to keep the important services provided by Queen Marys. I have already stated that I will give evidence if the Government refers the case to the independent reconfiguration panel.
The consultation was confusing with A Picture of Health and Healthcare for London running concurrently. In our opinion the views of the public were not taken into consideration and the outcome seemed predetermined.
James Brokenshire (Hornchurch) (Con): My hon. Friend is making some powerful points. I was at Queen Marys hospital yesterday and I was impressed by the professionalism of the staff and the real care, focus and attention that was given to patients. There were some very high standards.
My hon. Friend has mentioned his concern about pre-determination and the fact that the views of local residents were not properly taken into account. Does he share my concern and that of other residents that the decisions appear to have been made on the grounds of finance and the existence of PFI hospitals in the vicinity rather than what is best for health care in the borough and in the interests of local residents?
My concern is whether the other hospitals will be able to meet the need if we close A and E at Queen Marys. In December last year the Princess Royal hospital in Farnborough had to turn away patients as it was unable to cope with the high demand. Three ambulances were diverted to Queen Marys for three hours because of the influx of patients on 18 December 2007.
There was an increase of about 32 per cent. in the number of A and E attendances at Queen Elizabeth hospital in Woolwich between 2001-02 and 2007-08. So I seriously believe that neither hospital could cope with the additional attendees that the closure of QM at Sidcup would cause.
In 1988 I campaigned vigorously for part of my then constituency of Erith and Crayford to be included in the maternity services catchment area of Queen Marys hospital because constituents were having to travel a
long way for the services that they needed. We were fortunate in that campaign. The Government and the health authority listened, and the campaign was successful. Residents of Crayford were included in that catchment area. I fear that we are now looking at a retrograde step of closing maternity services at Queen Marys, and other areas of Bexley will experience the same problems as my constituents had in the 1980s.
Many constituents from Bexley and Sidcup have contacted my office to praise maternity services at the hospital, which are provided by hard-working doctors and nurses and other staff. The unit has an extremely good record. Again, capacity at other hospitals in south-east London is a concern. While more home births are being promotedwhich is good for those who want itthere will be issues for those who prefer hospital care and delivery. I understand that nationally in 2007, 42 per cent. of NHS trusts providing maternity services had to turn away women in labour because they were full. This is a worry that we will have in our area too.
I know that the Princess Royal hospital had to divert patients from its maternity unit in March due to high activity and capacity issues. These are real concerns. I hope that the Minister will appreciate that we are closing facilities in Queen Marys hospital in Sidcup when other hospitals are not able to cope. Yet the experts say that those hospitals could cope.
The plans for Maternity services in both Primary and Secondary care do not seem robust. Bexley will be left with a midwife-led birthing unit at QMH with no Consultant backup on the premises.