| Previous Section | Index | Home Page |
14 July 2009 : Column 12WH—continued
I have been in constant communication with the Minister's predecessors. I have a letter from the Minister of State, Department of Health, the hon. Member for
Corby (Phil Hope), who said that the question is decided by the PCT, and I got a letter from the PCT saying that it is required by national regulations first to determine the rurality of the area as defined under the pharmacy regulations. Then there is a ludicrous passage in which the PCT just repeats what it is made to do by central Government regulations, and says:
"The regulations also clearly state that the fact that an area is classified as 'controlled' (ie not rural in character), or that a decision is taken to remove such a classification, does not necessarily mean that it is urban."
If you can understand that, Mrs. Humble, you are doing well.
Councillor Joyce Barrow has recently been elected the councillor for Morda, another village just outside Oswestry, which must be rural because it comes within Oswestry rural parish council, and it is likely to have its services removed. One of the excuses about Gobowen was that there are other services, such as a post office. However, the Government have removed the post office from Morda and there is really very little there. I have had a furious letter from the surgery saying that that will damage patient care. Will the Minister explain why the regulations were introduced? The PCT has said that it had no option but to implement them. [Interruption.] I should be grateful if the Minister would listen to me rather than to the hon. Member for Coventry, South (Mr. Cunningham).
It is causing real upset. Doctors tell me that it will damage patient care. I am all for freedom of choice. If someone wants to build a pharmacy, if they can compete, good for them, but why should we upset a system under which doctors have detailed knowledge of their patients and patients do not have to suffer the inconvenience of using a taxi or the infrequent bus service to go into town to get their medicines? I do not see any merit in what the Government are doing, and I would like to see things reviewed. I would like an answer from the Minister.
10.20 am
Daniel Kawczynski (Shrewsbury and Atcham) (Con): I congratulate my hon. Friend the Member for Ludlow (Mr. Dunne) on securing this important debate.
I pay tribute to the hard-working members of staff at the Royal Shrewsbury hospital-the doctors and nurses, the cleaning staff and all involved in providing care at that important health care facility in Shropshire. I pay tribute also to the chief executive and the chair of the Shrewsbury and Telford Hospital NHS Trust for their hard work, Mr. Taylor and Dr. Bamford respectively.
The most important thing that I want to get across in my truncated speech-we are running out of time-is that Shrewsbury is a border town. We live cheek by jowl with the Welsh community just across the border, which uses our hospital facilities. A political map of England will show that all the seats in that part of the country are held by Conservative or Liberal Democrat Members. Although I have repeatedly raised my concerns with Ministers on how English hospitals are losing out as a result of Welsh devolution, little progress has been made because the Government do not understand the grave consequences and are not prepared to act.
The Royal Shrewsbury hospital loses approximately £2 million a year because the Welsh Assembly has different ways of paying for treatment. That loss cannot be allowed to continue. I aim my remarks at my hon.
Friend the Member for Guildford (Anne Milton), the shadow Minister for Health, who will doubtless soon be making decisions on the matter. When we finally get a Conservative Government, I hope that there will be some redress, so that my constituents do not continue losing out.
Not only the financial aspects, but issues to do with drugs and waiting times concern me. One of the most emotional and fraught experiences that I have had as an MP is trying to secure live-saving drugs for my constituents; they are not entitled to them, whereas people who live just a few miles across the border in Wales that use my hospital are automatically allowed those drugs. I feel passionately about the United Kingdom, and I believe that we are one country. Allowing such a postcode lottery to continue is doing untold damage to the Union.
Lembit Öpik: I declare an interest in that the Royal Shrewsbury hospital saved my life on 13 April 1988, and the Gobowen hospital helped me to start walking again.
I challenge the hon. Gentleman: I believe that those Welsh patients provide a net contribution to the Royal Shrewsbury. If they went somewhere else-perhaps to Hereford or Aberystwyth-Shrewsbury might have to become smaller. He may criticise the benefits of devolution to my constituents, but I advise him to look at the figures again. On balance, the Royal Shrewsbury hospital gains a net benefit from my Montgomeryshire constituents going there for their health care.
Daniel Kawczynski: I do not want to get engaged in cross-border parliamentary warfare, but if the hon. Gentleman speaks to the chief executive of the Royal Shrewsbury, as I have done, he will discover that the hospital has lost out. Of course we welcome Welsh patients coming across the border to use our hospital's facilities, but the Welsh Assembly must start paying the same for medication as English authorities. That is what leads to the losses in English hospitals.
We pay too much for car parking at our hospital. We have to pay £2 to leave our cars at the Royal Shrewsbury. When my daughter was being born there, I remember thinking that I would have to leave the labour ward and rush out to fill the meter, because parking tickets expire at midnight and one has to buy another ticket. We are the fourth-wealthiest economy in the world, yet we are charging people to leave their motor vehicles. Many come, not as I did for the birth of my daughter, for a relatively short period, but for much longer, as they have relatives with long-term illnesses at the hospital. For people on limited incomes, paying £2 a day is bad.
I remember that the windows of the maternity ward at the Royal Shrewsbury hospital have to be sealed for security reasons. It was sweltering when my daughter was born, but the hospital did not have air conditioning or fans. I hope that the Minister will do everything possible to ensure that the maternity services at the hospital have better ventilation or air conditioning, so that people have a more conducive atmosphere.
The league of friends at Royal Shrewsbury hospital is a group of volunteers that raise hundreds of thousands of pounds every year for the hospital. It runs tea and coffee shops, sells goods and runs events throughout Shropshire to raise funds to buy vital equipment. That equipment should be provided by the state through taxation, but as a result of the lack of Government
funding, the league of friends, a local charity, is increasingly burdened with having to find ever more money. I ran the London marathon a few years ago. It nearly killed me, but I raised £9,000 for the league of friends. Should I be re-elected, I may do it again because of the tremendous benefits that the group is able to give the hospital.
My constituents in Shrewsbury have raised aspects of the problem of long-term care for the elderly, as did my hon. Friends the Members for Ludlow and for North Shropshire (Mr. Paterson). For many of my constituents, it is the biggest health care issue. Many of my constituents have had to sell their relatives' homes in order to pay for their care. The BBC website says this morning that the Government are considering asking people in England to take out care insurance to pay for long-term care in their old age.
The question of long-term care is hugely important to my constituents. There are many senior citizens in Shrewsbury. We have an above-average population of senior citizens, and they are looking to this Government, or to the next Conservative Government, for some form of answer. It is unacceptable that people who have been thrifty and have saved should have to sell their assets and their homes to pay for long-term care.
I end by trying to indicate to the Minister the passion that everyone feels about health care services in Shropshire. We want a fair deal, and I look forward to hearing the Minister's response.
10.28 am
Lembit Öpik (Montgomeryshire) (LD): I am aware of the time, Mrs. Humble. I have delegations arriving here from Welshpool, so I hope that the Minister will forgive me, on condition that I do not ask him any questions, if I leave a little early.
As has been said, my constituency neighbours Shropshire, and my Montgomeryshire constituents depend heavily on the health care services of the Royal Shrewsbury hospital and, particularly, the Gobowen hospital. I cannot praise enough the efforts of the staff at those facilities, not least because of my experience there. I also praise the efforts of Tom Taylor in putting into order accounts and finances that have gone dreadfully wrong.
I wish to add two further observations. First, it seems that the most effective way to provide the care that my constituents need is for the district general hospital in north Shrewsbury to do what only it can, but to allow convalescence in the other four hospitals-at Llanidloes, Newtown, Machynlleth and Welshpool. Bed spaces are cheaper there and a collective approach could make a huge difference.
Secondly, technology should enable us to do outreach work much more creatively and extensively. By using modern technology, some sophisticated diagnosis and treatment could once again be devolved back to those smaller hospitals. That, too, would reduce the pressure on the Royal Shrewsbury hospital. I have no doubt that technology will make a difference, but it would be better if we did that strategically.
Finally, I thank Tom Taylor for bringing things into order at the Royal Shrewsbury hospital. Unquestionably, his leadership has turned around by 180° the dreadful
situation that his predecessor had left to fester. The hospital is a cross-border lifeline for my constituents, and I thank its staff and leadership for all that they do. I hope that, collectively, we can create a cohesive strategy embodying the work of the small, local hospitals and using modern technology to improve their reach and to save funds and lives.
10.30 am
Greg Mulholland (Leeds, North-West) (LD): I congratulate the hon. Member for Ludlow (Mr. Dunne), a former Work and Pensions Committee colleague, on securing this important debate. I have enjoyed listening to the description of the issues in his constituency and the constituencies of other Shropshire Members. I know Ludlow reasonably well: my wife lived there for some years when a child and my brother-in-law Josh was born there, which presumably explains why he is a Manchester United fan-I never quite worked that out. However, it is a wonderful part of the country and one that I am always pleased to visit.
The case laid out by the hon. Gentleman and other hon. Members demonstrates the stark contrast between Ministers' rhetoric and the reality of the NHS in the 21st century. The rhetoric is about localism, but in reality we have the most over-centralised health service in the world. I am afraid that that is an issue for us all. Few MPs have a community hospital in their constituency, but I am one of them-the excellent Wharfedale hospital-and very few of those MPs have not had to spend considerable time supporting those facilities, and often campaigning against cuts, service reductions and, on too many occasions, the threat of closure.
The hon. Gentleman alluded to a 2006 statement made by the former Secretary of State for Health, the right hon. Member for Leicester, West (Ms Hewitt), and the commitment to dedicate £750 million to community hospitals. Three years on, however, not even half that has been invested in those important health facilities. That is of real concern to communities in Shropshire and in Yorkshire, and up and down the country. I shall read some of the words accompanying the announcement. The 2006 statement said:
"Developments in medical technology are making it possible to provide far more care in local communities, closer to where people live".
Is that how people perceive the health service? I say not.
"Services could include in-patient and out-patient facilities, diagnostic tests, specialist clinics, minor surgery, health and social care services for people with long term conditions, dentistry, rehabilitation and palliative care... we expect to see a strategic shift in how the NHS provides care, with a reduction of funding to support the provision of more convenient services in local communities."-[Official Report, 5 July 2006; Vol. 448, c. 816-17.]
Those warm words simply do not represent the experiences of people throughout the country, which is that many services that could be provided more locally are not. They have to travel increasingly large distances. In my constituency, people have to travel the 11 miles from Otley to the large hospitals in Leeds such as Leeds general infirmary and St. James's university hospital.
In more rural constituencies, such as those of the hon. Gentleman and my hon. Friend the Member for Montgomeryshire (Lembit Öpik), some people regularly have to travel large distances to access important services
that are often an hour and a half's drive away. That simply is not acceptable. We should be trying to make as many services as possible accessible locally.
I wish to make another important point that comes up every time we debate local health services. The modern NHS is not accountable. It takes marches of thousands of people in the streets of our towns and MPs organising petitions, protests and public meetings to get any sort of accountability in local health services. Whatever Ministers or civil servants say, local health managers are not accountable to local people. They are accountable in this bizarre chain to strategic health authorities, which, as we all know, are not only enormously wasteful, but the puppets of the Secretary of State. They oversee a wide area and ensure that his bidding on general policy is done in local areas. That is entirely inappropriate and wasteful.
What should be a people's health service has fallen into the hands of managers who do not see themselves as accountable. I have seen many examples in the health service in my constituency of a paternalist attitude. The managers say, "We know best. We know what our priorities are. We will deliver them and make decisions with little or no consultation." When there is consultation, it is usually inadequate and often simply a fig leaf, enabling them to rubber-stamp a decision already made.
There are campaigns throughout the country not only on community hospitals, but on other important health facilities and health centres. It takes such people power to bring any kind of accountability. When will the Government address that clear democratic deficit? If they did so, they would not have to listen time and again to MPs complaining that even we find it difficult to influence decisions on behalf of our constituents, except through such petitions, marches and protests.
The Liberal Democrats will enter the next election with a policy to replace PCTs with partially elected health boards. We can debate whether that is a good idea, but it acknowledges a problem that cannot be ignored and needs policy solutions. We have put one on the table to be discussed: involve local people in decisions so that they can kick out, through elections, hospital trust managers making unpopular decisions and PCT bosses making unpopular local strategic decisions. Without that accountability, all the warm words about localism and accountability are not only just words, but rather insulting to the many people who take part in marches and sign petitions.
The sad reality is that the health service is unaccountable and desperately over-centralised, and does not respond to the needs and demands of local people. Until that changes we cannot make the best use of the energy of our health professionals and managers who are passionate about the care that they provide. Health services are so tightly controlled from Whitehall and the Departments. That must change if we are ever to give the NHS back to the communities, where health service decisions should be made.
10.39 am
Anne Milton (Guildford) (Con):
I congratulate my hon. Friend the Member for Ludlow (Mr. Dunne) on securing this debate. He has clearly spent a lot of time participating in marches around his constituency. He talked about 4,000 people marching in protest at the threats to Bridgenorth hospital, and he mentioned Bishops
Castle community hospital. It was encouraging to hear him talk in such glowing terms about the community effort that has gone into the design of not only services but buildings. Clearly, a lesson in best practice can be learned about designing services that are responsive to local people's needs and that make people feel that the NHS is responding to their concerns.
My hon. Friend mentioned Ludlow community hospital and the closure of the mental health ward. As a shadow spokesman with responsibilities for mental health, I caution against the loss of mental health beds. The closure of such beds has resulted in a rise in the prison population. Whether people are in prison or in mental health hospitals, they must receive the care and services that they need.
My hon. Friend told a very frustrating story about how the hospital and the local people were encouraged to redevelop services. Both the PCT and the strategic health authority described Ludlow as a top priority. Mention was made of the community hospital redevelopment fund. Despite the Minister's intervention, I am still not clear whether or not the fund is there. That shows the confusion about some of the Government's announcements. The Minister shakes his head. Either we are all being very dim or he is not paying attention, and I suggest that it is the latter.
Mr. Mike O'Brien: Will the hon. Lady give way?
Anne Milton: The Minister will have a chance to address the points when he replies to the debate. [Interruption.] Okay, I will give way.
Mr. O'Brien: I should be grateful if the hon. Lady did not make personal asides and then stop me from intervening, because it is discourteous. As I have said already, the fund is available, and it needs the consent of both the Department of Health and the Treasury. It is very simple and straightforward, and there is nothing obscure about it.
Anne Milton: I certainly did not mean any discourtesy to the Minister. I was driven by frustration over the lack of clarity. By implication, I do not think that we are all being very dim either. None the less, we need more clarity. The Minister has not explained why the money is not being spent at the rate at which it was originally intended to be spent.
As for community hospitals, I certainly have one in my constituency. Cranleigh village hospital is extremely important. I am often unconvinced by both the modelling and the drivers of such hospitals, which relate, I am convinced, to short-term budgetary pressures, rather than to clinical improvements. The Government's White Paper, "Our health, our care, our say: a new direction for community services" made it absolutely clear that decisions should be made on the basis of improving clinical outcomes. Yet, all too often, the drivers are the financial pressures.
My hon. Friend the Member for Ludlow also raised the issue of financial deficits and the yo-yoing between PCTs and acute trusts. That is confusing not only for local people but for the trusts, and we need to have some clarity about where those deficits lie. In my PCT, I have had considerable difficulty discovering why, with a 5.2 per cent. increase in funding, the PCT has to save £60 million. I cannot make sense of the figures.
| Next Section | Index | Home Page |