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14 July 2009 : Column 6WH—continued
The community has subsequently worked painstakingly with the PCT-particularly through the league of friends, which has been ably led by Mr. Peter Corfield as chairman, and the careful work of the two GP surgeries, led in this regard by Dr. Dorian Yahram and Dr. Graham Cook-to encourage the PCT to place the redevelopment of Ludlow community hospital at the top of its priority list. The hospital continues to work from a site that includes the listed administration block, which was formerly the Victorian poorhouse in the town. It is disparately set out on a constrained site, with buildings that were perhaps fit for purpose when they were constructed-in
some cases in Victorian times and in other cases in the 1950s and '60s. There is no doubt now in the PCT's mind that Ludlow is its top priority for redevelopment.
We received considerable encouragement from the West Midlands strategic health authority, whose chairman Elisabeth Buggins and then chief executive Cynthia Bower, who has, of course, moved on to dizzier heights in the Department of Health, visited the hospital at my invitation 18 months ago and endorsed the proposals put together by Shropshire County PCT for a redevelopment to take health care facilities into the 21st century. The PCT and local clinicians on the ground were encouraged to develop a vision that would provide an innovative plan for integrated health care services as envisaged under the White Paper, "Our health, our care, our say: a new direction for community services".
The plan that has been put together is innovative in a number of ways, not least in that it is built around co-location involving the two GP surgeries, both of which have their own constraints: one has no space at all-even its filing area is shared with a broom cupboard-and the other has also run out of capacity. They will be co-located with the hospital. A site has been identified and work has gone so far as to include the inevitable, as it is these days, bat survey to ensure that the development of the site does not disturb the resident bat population in the fine line of oak trees that borders the site. That illustrates the extent to which plans are well advanced. We had been given every encouragement by the PCT to believe that that was something that it wished to proceed with, and there had been every suggestion by the SHA that it was the SHA's top priority project for a community hospital redevelopment in the west midlands. I was under the impression that those plans-the outline business case-had been presented by the SHA to the Department of Health. It seems as though the Department decided to put the onus on the SHA to take things forward.
The primary source of funding for the proposal, which has not been costed to the last quote at this point, because it was an outline business case, was a £30 million scheme. A sum of £30 million for a community the size of Ludlow was quite a big ask, and we in the community were somewhat concerned about where the funding would come from. We were therefore greatly relieved when the then Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), made an announcement in the House on 5 July 2006. The Hansard reference is volume 448, columns 816 to 832. In her statement on community hospitals, she announced the establishment of the community hospital redevelopment fund. She said that a £750 million fund would be available over a five-year period. If I may, I shall quote from her speech, because it has come to light that the prospects of using that fund, not only for the community of Ludlow but for the county's PCT and the SHA overall, appear to have been stymied by the fund having been terminated, although that word has not yet been used by a Minister. I am looking to this Minister to give us some reassurance on the fund's precise status. In her speech announcing the fund, the then Secretary of State said that the Government would make available
"up to £150 million of capital...in each of the next five years, starting this year-a total of up to £750 million-for the development of a new generation of community hospitals and services."-[Official Report, 5 July 2006; Vol. 448, c. 816.]
That speech was given in 2006, so the words "starting this year" suggested that there might be some spending in 2006-07 and that there would certainly be some in 2007-08. We are now in the middle of 2009, and we had a reasonable expectation that some of the money, which had been specifically set aside from the Department's capital budgets, would now be available.
In a parliamentary question in December 2008, I asked how much of the money had been spent, and I received a written answer saying that £248.1 million had been committed by the end of 2008-18 months after the scheme had been announced. Again, that gave those of us in Ludlow who were concerned about the issue some comfort that money was being allocated and spent, and there was evidence in the answer that I received that buildings were starting to come out of the ground all around the country.
Hon. Members can imagine our surprise, therefore, when Shropshire County PCT received a letter from West Midlands SHA on 1 May, stating:
"Andy Stubbing, Head of Capital and Revenue Investment Branches at the Department of Health, has said that 'the Treasury is unlikely to agree further releases of funding for this programme.' Instead SHAs will have to apply for funding through PFI schemes"-
private finance initiative schemes. That came as a bit of a bombshell to us: although we could look at PFI schemes, and a great deal of work is going on to consider LIFT-local improvement finance trust-and Express LIFT, as well as other schemes that the Department is encouraging, we were under the impression that the community hospital redevelopment fund was there precisely to fund the sort of projects that we had proposed with the blessing of the NHS hierarchy.
I raised the issue with the present Secretary of State during the Second Reading of the Health Bill on 8 June, which was his first working day in office. I did not therefore expect him to give me an instant answer, and he admitted that he could not do so, but he did agree to write to me. True to his word, he did so, which was helpful-or it appeared to be. Just before I received the Secretary of State's letter, I received another from the Minister of State, Department of Health, the hon. Member for Lincoln (Gillian Merron). In her letter, which is dated 22 June, she said:
"I can however assure you that there are no plans to remove funding from the Community Hospital Programme."
Being a relatively new Member, I took the view that a letter from a Minister of State saying that there were no plans to remove funding from the programme was quite a positive indication that there had perhaps been some mistake. The Minister of State's letter appeared directly to contradict what the SHA had told the PCT, and that appeared to be good news.
I then received the Secretary of State's letter, which is dated 22 and 23 June-I am not quite sure when it was sent. He made two points that are of interest. First, he referred to his predecessor's original announcement, saying:
"The £750 million was assumed to be required across a period of five years or so, spanning the CSR 2007 years, 2008-09, 2009-10 and 2010-11, and subsequent years for which"
"has yet to receive an indication of capital resources from HMT"-
Her Majesty's Treasury. That is a slightly different way of describing what his predecessor had described as a £750 million programme starting in 2005-06. The current
Secretary of State is suggesting that the programme is meant to run from 2008-09, whereas we know from his predecessor's answer in Hansard that the money was already committed in 2007-08. The current Secretary of State is trying to introduce a bit of wriggle room to suggest that the programme is being backdated, rather than front-loaded, which is what was apparent from what had been said before.
The second thing that the Secretary of State said in his letter is also important:
"HMT approval for additional funding would be unlikely because of the current pressures on the Department's capital settlement. However, that does not necessarily mean that 'no more funds would be made available'"-
that is a quote from my letter to the Secretary of State-
"but that future access to the funds would be determined by HMT."
There you have it. On 22 June, one Minister says that there are no plans to remove funding from the community hospital programme. Then, probably on 23 June, her boss says that future access to the funds will be determined by the Treasury. Either we have a community hospital redevelopment fund that has funding or we do not. The Minister would do the country a service if he could clarify whether there is any money in the pot and, if so, whether we can have access to it. If not, let us come clean and establish that there is no money, and those of us who are working hard to come up with schemes to improve health facilities in our constituencies can focus on that.
The Minister of State, Department of Health (Mr. Mike O'Brien): Will the hon. Gentleman confirm that the penultimate sentence in the letter from my right hon. Friend the Secretary of State says:
"However, that does not necessarily mean that 'no more funds would be made available', but that future access to the funds would be determined by HMT"?
In other words, there is funding, but there needs to be HMT approval for it. The hon. Gentleman is making a mystery of something that seems very straightforward.
Mr. Dunne: I am grateful to the Minister for paying attention to what I was saying-that is precisely the sentence that I have just read out to him. Two years ago, the Secretary of State's predecessor said that £750 million was available and that the capital would be spent at the rate of up to £150 million a year
"in each of the next five years, starting this year".-[Official Report, 5 July 2006; Vol. 448, c. 816.]
That is where the problem lies: one Secretary of State has said that money is available, while a subsequent Secretary of State has said, "No, there isn't."
I had actually brought my remarks to a close. I look forward to the Minister picking up this issue in his winding-up speech.
Mrs. Joan Humble (in the Chair): Order. Three hon. Gentlemen are seeking to catch my eye. I advise them that I hope to call the Front-Bench spokespeople at 10.30 am. If hon. Members take that into account in their contributions, I hope to be able to fit everyone in.
10.8 am
Mr. Owen Paterson (North Shropshire) (Con): It is pleasure to serve under you, Mrs. Humble, and I will be as brief as I can.
I congratulate my hon. Friend the Member for Ludlow (Mr. Dunne) on securing the debate. As he said, this is the second such debate-there really is a sense of déjà vu and continuity. At the time of the previous debate, we went to see the then Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), for a private meeting. We actually congratulated her on parts of her White Paper and pressed her-this was confirmed in letters-to stick to the proposals on community health. We strongly supported those proposals. Indeed, I led a march through Whitchurch while my hon. Friend was marching around his constituency on behalf of community hospitals.
Let me give one example of what we are talking about. Some 75 per cent. of diabetic patients in Shropshire are treated by GPs, while 75 per cent. of diabetic patients in Birmingham are treated in district general hospitals. Our doctors reckon that there would probably be about a 20 per cent. saving if their GP practices could be enhanced with more facilities.
The Government came up with a White Paper, and I do not want to embarrass the Minister, but the then Secretary of State made the following useful statement:
"community facilities that are needed for the long term must not be lost in response to short-term budgetary pressures. So we will expect primary care trusts to reconsider such proposals against the principles of the White Paper."-[Official Report, 30 January 2006; Vol. 442, c. 24.]
We were assured at the time that funds would be there for such community projects.
There has been expansion of GP practice facilities in Market Drayton, and I have been heavily involved in the expansion at Oswestry, which is going ahead. I should like the Minister's assurance that the funds that PCTs were assured of, for the GP practice extensions, will continue. I am not asking for any more money; those moneys were promised. I want to name two practices in particular. I took doctors from the Ellesmere and Wem practices to see the present Minister for Regional Economic Development and Co-ordination when she was a Health Minister, and she made all the right noises about community care. Three years further on I should like assurances that the funds are there for the PCT.
With respect to Ellesmere, the White Paper called for collaboration with the local authority. Before it was dissolved into the new unitary authority, the outgoing North Shropshire district council bought the ground. The population in my constituency is expanding, and, as my hon. Friend the Member for Ludlow has said, ageing, so I should like to know that the funds set aside at the time of the White Paper are available for the extensions. I think 18 practices across Shropshire have been allocated priority, but the two that I would pick out would be Ellesmere and Wem.
Will the Minister confirm how the NHS funding formula works? My hon. Friend touched on it, but as I see things there is a lag in Shropshire. We have an increasing population, because of people moving in, but it is also an ageing population, and I should like an explanation of the notion of distance from target. I
understand that that is about an amount that an area is deemed to warrant, under a formula, but does not yet receive, on the understanding that the target figure is to be worked towards, over the years. For counties such as Shropshire the delay in reaching that fair-share allocation can represent a significant current shortfall. Combined with particular financial pressures in commissioning services, given the elderly population that I mentioned, in a large and thinly populated rural area, that can cause the PCT problems. I reiterate that I am not asking for more money-the moneys I am talking about have been allocated, but there seems to be a drag in the system.
To cheer the Minister up I shall move to some good news, which is that I am happy to have the jewel in the crown of Shropshire health care in my constituency. That is the Robert Jones and Agnes Hunt orthopaedic hospital, which is a shining example of how health care can be provided. I was chomping through my drearily healthy breakfast about a year ago when I saw a list of hospitals that had been rated by the Healthcare Commission. I was not surprised, but delighted, to see that the orthopaedic hospital came top, with a score of 92 out of 100, on a range of scores. It had a higher score than any other trust nationally on four questions, and it was the top scorer in six out of eight headline categories across the west midlands. The key thing is that it has got its costs down by about 10 per cent. in the past couple of years. Above all it has zero MRSA-there is no MRSA there, despite an enormous increase in its activity. It employs 1,200 people and £80 million goes to the local economy; it is the biggest organisation near Oswestry. It is a very successful organisation, and is critical for the local area.
In addition there is charity work, which I think is rare in the NHS-I should declare an interest for my involvement in the Institute of Orthopaedics. That has led to the building of the Leopold Muller centre. A couple of weeks ago I went round the Torch centre, which probably has the most sophisticated gait laboratory in western Europe, which deals with the treatment of children with acute spina bifida or muscular dystrophy. That is at the crossing point of medicine, mechanical engineering and physics. I do not entirely understand it, but I enormously admire the work that is done there. An application has been made for national designation for muscular dystrophy services, and I wonder whether the Minister can clarify when that may come through.
The trust has cleared its debts and is now pressing on to foundation status; that goes back to my meeting with the right hon. Member for Leicester, West. I hope that it will happen in the next 12 months. The process has been dragging on.
What seems to be the sticking point is the fact that there are probably only four top orthopaedic hospitals in the country that can do revision operations; they rework operations that may have gone wrong or may not have been quite so skilfully done in other hospitals. That is immensely complex and difficult work. About 1,000 such operations a year are done there. Only the Nuffield orthopaedic centre in Oxford, the Royal orthopaedic hospital at the Woodlands in Birmingham, the Royal National orthopaedic hospital at Stanmore in
London, and Wrightington hospital, which happens to be in the Secretary of State's patch, can carry out such operations.
There is haggling about the tariff. It was increased last year, but the operations are so complex and difficult that there is still a problem, and that might be a block in the quest for foundation status. What are the Minister's proposals on that? It would, bluntly, be humiliating for the country if those operations had to be conducted abroad, which might be an option if the hospital could not afford to carry on doing them. It is the cutting edge of medicine. As before, I am not asking for more money. The trust has saved the NHS substantial sums by efficiency gains. We just ask that the correct sums should be paid for a quite small number of very difficult operations. I am very much in favour of foundation status. The orthopaedic hospital is a classic example of a smaller operation with a really tight team and a tremendous team spirit throughout the place, which really delivers.
In the past I have felt that there has been a bit of prejudice in the west midlands authorities against that world-class operation, tucked away in the north-west of the west midlands. I met an Australian on an aeroplane once-I shall not bore hon. Members by doing the accent-who said, "I have been to this amazing hospital; it's entirely surrounded by sheep." It is isolated, but it delivers the care that it does partly because that is the attraction for the people who work there. There has been a sea change. I pay tribute to Elisabeth Buggins, the chairman of the strategic health authority, who has been to the hospital a couple of times and understands its value. She supports its drive for foundation status. However, I should like an answer on the vexed question of the tariffs for revision operations. The orthopaedic hospital has a sports injury service. Three consultants work on sports injuries. What links does the Minister have with his colleagues working on the Olympics, with a view to making sure that the hospital could benefit from that?
To move on, rapidly, from good news to bad news, a ludicrous vexed area is the nonsense of redesignating the status of GP practices that can dispense medicines. The Shawbury practice raised that with me last summer. I do not see why the Government have brought in the new regulations, which are wholly damaging and negative. We saw them off in Shawbury, thanks to a spirited campaign. I probably had more letters about that last summer than about anything else. Sadly, the issue has moved on to Gobowen, a large village a couple of miles outside Oswestry. I had many letters from furious constituents who are used to going to the GP and getting their medicines at the same time. The pharmacists there have local knowledge and access to medical records. The system is wholly beneficial. However, under the new regulations, if another company puts in a bid for a pharmacy, and if the designation of the area is considered and the rurality is withdrawn, the doctors' surgery can no longer dispense. In Gobowen the utter nonsense of the situation is that the company that put in the bid does not yet plan to build a pharmacy. That is a wholly negative development and it is nonsense. It is all to do with the designation of rurality.
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