HC Deb 07 November 1996 vol 284 cc1409-20

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bates.]

6.46 pm
Mr. David Hinchliffe (Wakefield)

May I first of all welcome the fact that you in particular, Mr. Deputy Speaker, are in the Chair for the Adjournment debate tonight, because, although I appreciate that you will be totally neutral in chairing the debate, I want to express my personal appreciation for the work that you have done as a constituency Member on a number of the issues to which I shall refer tonight. I also express my personal appreciation to my hon. Friend the Member for Hemsworth (Mr. Trickett), who hopes to catch your eye. I am grateful for his support in staying behind to speak in this important debate.

It is customary at the outset of Adjournment debates to express appreciation for being granted the debate, and although I am most grateful for the opportunity to raise this subject, it is a matter of great concern to me that once again I find it necessary to have to draw the attention of the House to the considerable public disquiet over what is happening in the health service in the Wakefield metropolitan district.

When a similar Adjournment debate took place on 3 April this year, the hon. Member for Orpington (Mr. Horam), the Minister who is here again tonight, remarked that that was the seventh occasion in five months that I had raised the subject in the Chamber. I take no pleasure whatever in reminding him that this is the sixth separate Adjournment debate that I have had on health issues in Wakefield in my time in the House, and I have, as he knows, been forced to raise my concerns in numerous other debates and at Question Time, including Tuesday of this week.

I have found it necessary to speak so often because, throughout my time in the House, the health service in my area has appeared to be stumbling from one crisis to another, without strategy, direction or purpose. I make it clear that I do not blame in any way those dedicated people who are involved in the front-line services in the national health service in Wakefield. We are very fortunate to have in our area some of the best general practitioners, hospital consultants, doctors, nursing and ancillary staff. Most of them believe as strongly as I do in the basic principles of the NHS, but they are deeply demoralised by the consequences of Government health policy in Wakefield and the complete lack of any clear vision for the future.

Those people will have been as angry as I was to hear the Prime Minister say only this week that the service is now being properly managed". If the situation were not so serious, they would have laughed at his assertion that, as a result of this "proper management", money is being allocated to where it should go. Let met set out the background to the current merger proposals. The Minister knows as well as I do that the local health managers in Wakefield have, for some considerable time, faced an impossible situation in attempting to meet growing demands with resources that have not only failed to match that growth but been skewed by deliberate Government policy away from the areas of greatest need.

In previous debates, I have drawn attention to the fact that Wakefield health authority is the biggest loser in the whole of the Northern and Yorkshire region of the NHS as a consequence of the changed national funding formula being introduced in the current financial year, under which it is regarded as some £4.5 million overfunded.

According to a letter that I have received this week from the chair of the Wakefield health authority, Mrs. Ann Bolter, the health authority is facing a projected deficit of £2,225,000 based on the estimated expenditure for the year compared with budgets. I am told that the underlying projected deficit for the authority for 1996–97 is £1.7 million and that, in preparing the budget, the health authority agreed to overcommit resources by £3.3 million to cope with increasing demands and pressure from the trusts locally for more resources.

Therefore, there is a total over-commitment of £5 million and Mrs. Bolter states in her letter that the authority will have to look for further funding in 1997–98 in addition to identifying further savings from reduced management costs and the reconfiguration of services. I shall come to what is called the reconfiguration of services, but the Minister should be aware that overall funding is not the only problem.

The Prime Minister's assertion that money is being allocated to where it should go"—[Official Report, 5 November 1996: Vol. 284, c. 1031.] is particularly off target in Wakefield. Fundholding has created serious financial problems for the hospitals and a clear two-tier system of local treatment, to which I have referred on several occasions previously. I did a calculation in the last financial year based on the figures of fundholding surpluses supplied to me by the Wakefield health authority, which showed an interesting correlation between those surpluses in general practice and local hospital deficits. Therefore, the Wakefield health authority has an over-commitment of £5 million and the main provider hospital for my constituents and some of those of my hon. Friends who represent other constituencies in the Wakefield metropolitan district, Pinderfields, faced a deficit in the last financial year of £3.16 million.

The Minister has, I know, seen the letter sent to me and my hon. Friend the Member for Normanton (Mr. O'Brien) on 16 July by Dr. R. L. Smith, the medical secretary of the Wakefield local medical committee regarding the seriousness of the situation facing Pinderfields hospital in particular. I remind him that the letter stated: We can no longer deliver a 'safe' service for your constituents with the cake you give to the NHS. As the chair of the Wakefield health authority has admitted, what is termed a reconfiguration of services is seen as perhaps the only way of substantially addressing those serious problems. My particular concern is that the supposed public consultation process being undertaken on the proposed merger of the two acute trusts in Wakefield metropolitan district is fundamentally dishonest in not explaining to local people the real agenda of service reconfiguration that is being considered at present.

On Tuesday, during Health questions, the Minister referred to the fact that I was personally critical of the original establishment of three separate and competing third wave trusts within the Wakefield metropolitan district. I made it clear at the time that I believed that a health market would undermine strategic planning in health care and be wasteful of scarce resources. As the consultation document on the proposed merger makes clear, all my fears have, sadly, materialised and, if anything, the situation has become even worse than I originally envisaged.

The dishonesty of the consultation document relates to its avoidance of the key question of what the service reconfiguration will mean to my constituents and those of my hon. Friends representing the users of Pinderfields hospital, Wakefield, and Pontefract general infirmary. Page 8 of the consultation document states that the merger proposal and consultation processes do not relate to any proposal to relocate services across the district. It goes on to say such proposals would be the responsibility of Wakefield Health Authority to develop and consult upon. The Minister is well aware that, several weeks ago, the consultation process being undertaken by the two acute trusts concerned with the merger was stopped and passed to the health authority to continue. No one has offered me a formal explanation for that. The Minister did not answer the point on Tuesday when I questioned him at Question Time, but I expect a full explanation from him tonight.

Regardless of the reasons for that development, as the matter is now formally in the hands of the health authority, in accordance with what is said in the consultation document, my constituents and those of my hon. Friends and yourself, Mr. Deputy Speaker, now expect to be informed exactly what is proposed in relation to the relocation of services. The original excuse of this being a matter for the health authority will not wash, as the consultation process is now being handled by the health authority itself.

The Minister will recall that, in my contribution during the previous debate on the subject, in that of my hon. Friend the Member for Hemsworth and in meetings and in correspondence that my hon. Friends, including yourself, Mr. Deputy Speaker, and I have had with the Secretary of State, we have consistently pressed for a wider review of health care in Wakefield prior to any decision being made on a trust merger.

Our central criticism of the current proposal, apart from the attempt to camouflage a rationalisation agenda, is that it is a piecemeal, panic measure, designed temporarily to stem the tide of huge funding problems, which does not look any further at key questions of direct relevance to Wakefield's problems. It does not touch on the enormous implications of radical changes being introduced in the operation of general practice in our area, which will clearly impact upon acute provision, and it in no way anticipates the likely changes in primary and community care. The four Members of Parliament for the area were astonished to learn from the community trust's chief executive and chair that they had not even been consulted before the formulation of merger proposals by the two acute trusts.

Bearing in mind those points and the fact that the Wakefield health authority is now responsible for the remainder of the merger consultation process, I found it interesting, to say the least, to learn this week that, in the agenda for its monthly meeting, the Wakefield health authority was considering a paper proposing an urgent review of acute service provision within the district. The authority's report says: This work is likely to take at least six months to complete, and will be a completely separate exercise to the consultation process on Trust mergers… The process will enable a thorough consideration of strategic options for the future provision of acute services and in particular will take account of the drive towards a primary care led NHS. We are promised yet another so-called public consultation process in the summer of 1997.

The Minister must accept that proceeding with merger proposals prior to such a review of acute services is putting the cart before the horse in a highly irresponsible way. I suspect that key personnel at Wakefield health authority, some of whom I know reasonably well and respect, know that to be the case, but they have been told to get the merger out of the way by the Northern and Yorkshire region. That is not good enough, and the Minister knows it. I want him to give a clear undertaking to block further progress on the merger proposals, and to tie them in with the wider review of acute provision that will be held in the new year.

I also want the Minister to give me a detailed explanation of the reasons for the resignation last week of Mr. Roy Cusworth, the chair of the Pinderfields trust. I wrote to the chair of the Northern and Yorkshire region. Mr. John Greetham, asking for an explanation. His reply of 1 November states: Roy Cusworth did not offer his resignation but decided for personal and business reasons that he did not wish to offer himself for re-appointment. I believe that Mr. Cusworth was forced to resign, and we have a right to know why. The Minister must understand that the removal of the chair of the trust in that way has created considerable tensions at Pinderfields hospital. The consultants at that hospital met on Monday night, and have advised me through the chair of the hospital medical committee, Mr. Oliver Fenton, of their serious concern about yet another upheaval at Pinderfields, the purpose of which no one can understand. As the Minister will probably know, representatives of the Pinderfields consultants are to see the chief executive of the Northern and Yorkshire region next week to seek urgent reassurances on the position of Pinderfields, especially in the context of the proposed merger.

I know that you, Mr. Deputy Speaker, have serious anxieties about the future of Pontefract general infirmary if the merger goes through. I share your concerns and determination to defend the interests of the users of that hospital. In the light of recent events, I have fears for the future of Pinderfields.

Following the transfer of regional neurosurgery provision from Pinderfields to Leeds, I strongly fear that it will lose other regional specialisms, such as plastic burns and spinal injuries. It is common knowledge that certain senior consultants at Pinderfields are being head-hunted by the Leeds trusts, and that St. James's, with a deficit of £8 million, and Leeds general infirmary, with a deficit of £7 million, are desperate for the additional revenue that further regional specialisms would attract.

Clearly, the situation in Leeds and the outcome of the recent health review have an important bearing on health provision, especially regional specialisms, in other parts of west Yorkshire. I fear that, particularly since the demise of the Yorkshire regional health authority, there has been little, if any, attempt to interfere with the operation of naked market forces and the obvious ambitions of the Leeds trusts. I assume that that approach has the Government's blessing, but the logical consequence will be the reduction of Pinderfields hospital and Pontefract general infirmary to the status of cottage hospitals, as all the key specialisms would be concentrated in Leeds.

A merged acute trust in Wakefield may offer a much-needed short-term financial fix, but without the wider strategic review for which my hon. Friends and I have persistently pressed, the future direction of health care in Wakefield metropolitan district will be uncertain, leaving our services wide open to predators. The health authority recognised that fact, and the acute review proposed this week makes obvious sense, but beyond keeping the lid on things until the general election, it makes no sense for regional officials to insist on the separation of this process from the merger debate. I hope that the Minister has listened carefully to the points that I have made, and that he will respond positively to them.

7.4 pm

Mr. Jon Trickett (Hemsworth)

I wish to associate myself with the remarks that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) made about you, Mr. Deputy Speaker, and about the high quality of the staff—clinicians and managers—employed in the health service in the Wakefield area.

Until recently, I was a publicly elected representative in a major city—Leeds. I was closely involved with the Leeds health service for a considerable time. We had two relatively robust general hospitals, albeit within a flawed health care structure. Since being elected to represent Hemsworth, I have been dismayed to discover the fragile state of the health service in our district.

My constituents come within the catchment areas of Pontefract and Pinderfields hospitals. I can therefore express an overall view of the services provided right across the district. The NHS provision in the area suffers from a series of structural problems, which, taken together, produce a service in serious crisis. In no particular order, I shall identify seven structural problems.

First, the continued underfunding of the service in our area has been compounded by the recent changes to the funding formula. That means that our district is to lose several millions of pounds a year, and is certainly the worst loser in the region. Secondly, there is a lack of recognition in the funding formula of the problems that arise from trying to apply a uniform health service across such a heterogeneous set of communities as there is in our district.

The third structural problem is the acute fragmentation—almost a disintegration—of the health institutions in our district. There is clear evidence of a breakdown of confidence between the health providers: the two acute trusts and the community health trust. As Members of Parliament for the district, my hon. Friends and I have been informed of the extraordinary allegations that have been made by people in one or other of those organisations against their colleagues.

Fourthly, that fragmentation has been seriously exacerbated by the effects of the internal market. There is evidence of what can only be regarded as irresponsible poaching by each of the trusts from the others, and by trusts outside the district. More serious still is the impact of the extension of GP fundholding in the Wakefield district, to a point where every practice is part of the fundholding system, thereby achieving twice the national average level of GP fundholding. The impact of that extension of fundholding is not yet fully understood, but it is already having a serious effect on the acute trusts.

In my constituency, at least two practices have constructed, without proper planning, what can only be described as mini-hospitals, which are taking services away from the existing acute trusts. It is widely believed that services are being purchased by GP fundholders in our district from hospitals as far away as Manchester and Glasgow. I have been informed of patients being sent by taxi to hospitals in Manchester for minor ophthalmic operations. I have been told of one patient who was taken by taxi to Manchester airport and flown to Glasgow for a relatively minor operation that was paid for by a local GP fundholder.

The fifth problem is that the health service in the area suffers to a degree from regional imbalances. The presence of big neighbours, such as Leeds, inevitably causes problems for smaller hospital trusts. The sixth problem is the general morale in the district, which, as in the rest of the country, is now poor. Hospital trusts are suffering from major problems of recruitment and retention of key staff.

The seventh problem is the lack of leadership among those who have been appointed to give directions to the health service in our area. In Pinderfields, both the chief executive and, now, the chair of the trust appear to have been removed without adequate public explanation, arid with no private explanation to any of us who represent the area. I am led to believe by a senior individual in the Pontefract region that the chair of the trust there is likely to be reappointed only for a single year. Can anyone—such as the Minister—explain why such action is being taken? Why was the Pinderfields chair removed recently, and why was the chief executive removed? We have been given no explanations about that, or about why the unusual procedure of establishing a single-year appointment has apparently been adopted.

My exposition of those seven structural problems may not constitute a comprehensive description of all the difficulties facing our area's health service, and not everyone may share my analysis; but it is clear that nearly everyone who is interested in the health service in our area believes that the service faces serious difficulties. Anyone who doubts that should read this week's edition of The Independent on Sunday, which draws attention to the extraordinary fact that a whole ward of nurses has been privatised. It is understood that this is the first time that nursing for a whole ward has been put out to tender. That must be regarded as a step towards privatisation of the health service, either by stealth or, possibly, by incompetence.

The answer from those responsible for the health service in the area has been wholly inadequate. They have been unequal to the task, tackling only one symptom of the problem rather than the multiple causes. To suggest that we can solve all the problems to which I have alluded, and others as well, simply by merging two acute trusts is a grotesquely inadequate response that fails to recognise the scale of the crisis. Indeed, such a response does not address one of the structural problems that I have described. It disappoints by its lack of ambition; it was also badly bungled, and the manner in which it was executed was arguably illegal, or at least outside the law. If it was not illegal, it was certainly unethical.

How could anyone seriously believe that the public consultation could be conducted properly and transparently by individuals who not only were the authors of the merger proposals but were actively advocating the cause of the merger during that consultation—and, moreover, appeared likely to benefit from the merger? No one could have confidence in a public consultation exercise undertaken in such a way.

Particularly extraordinary is the fact that, when the views of local residents and health care users were supposedly being obtained at public meetings, members of the project team did not merely attend those meetings to provide information but advocated the proposals—and then commented on and participated in a debate that was taking place, supposedly, among health care users. Even more extraordinary, they then proceeded to vote.

At a meeting in Upton, in my constituency, an extraordinary event took place. Every member of the public who was present voted against the merger; every one of the seven votes in favour came from one of those who had been brought along by, or were apparently connected in some way with, the project team who had been charged with consulting the public. It is bizarre, surely, that one of the principal architects of the proposal for a merger, a senior executive on one of the trusts and a member of the board, was actually found to be voting in favour of a merger about which he was supposedly consulting the public.

Will the Minister now tell the House why the public consultation exercise was aborted—why it was handed over to the district health authority, and removed from the project team? I have received no explanation; indeed, I have received no information that such a change has taken place. I understand that no other local Member of Parliament has been told that a new round of public consultation has been taking place. I consider that a fundamental error. Perhaps it will be explored in other places.

Public consultation about the merger has produced overwhelming hostility from the people of the area. Other than those with vested interests in the outcome of the proposal, no significant represented body or elected individual throughout the Wakefield district—as far as I am aware—has been found to favour it. The proposal was cooked up behind closed doors, and no one has yet made an admission to Members of Parliament representing the district about who first came up with the idea.

What we do know about the mystery is that primary care providers were certainly not consulted at the time. Surely it is outrageous that the community health trust in particular—on which the merger will have a direct bearing—was not consulted when the proposal was being drafted. It is also apparent from first-hand accounts given to me—and others—by local general practitioners that they were not consulted, either. Moreover, we know that the district health authority was not directly involved in the drafting of the proposal. Finally, it appears that the consultants were not involved in the conceptual stages, either individually or as a body.

Who sponsored the original suggestion, if it was not the clinicians and those responsible for the direct provision of care? It seems that the whole train of events was concocted by Department of Health officials, whose primary motivations were financial and administrative rather than clinical. There is also evidence that those same administrators had been conducting discussions with developers about a private finance initiative in relation to the district hospitals, concurrently with preparations to seek the trust merger. Indeed, one of the chairs of the hospital trusts let the cat out of the bag to local Members of Parliament when he informed us that a named private sector developer—we know the name—had requested that the discussions about the PFI in the Wakefield area in relation to the hospitals be put on ice until the proposal had been agreed.

The Secretary of State had suggested to the district Members of Parliament that he would judge any merger proposal on the basis of improvement in clinical care; yet we know that the basis of the merger document about which we are now being consulted was financial and administrative rather than clinical. Indeed, the whole thrust of the document is based on non-clinical considerations. It could not be otherwise, given the way in which the merger proposal itself originated.

Hon. Members will search the document in vain for any detailed proposal about clinical changes. A reading of the document, taken together with discussions with practising hospital clinicians, leads to the conclusion that the reconfiguration of clinical services that is implied—hut not made explicit—in the merger document will be revealed only subsequent to any decision to merge. That is clearly putting the cart before the horse. Changes in the structure of the NHS should follow clinical change, not vice versa.

A reconfiguration of the services is inevitable if a merger takes place, as we all know; yet the public have no idea what the new configuration will look like. Notwithstanding that, they are still being required to express their views during the current flawed public consultation exercise.

Although those who manage the health service in the district have not been prepared to come clean about the new configuration, I think that it is possible to guess its likely shape. In the absence of evidence to the contrary, here is my own educated guess about the likely shape of the health service in the district within a few years, given that the merger proceeds and assuming the continuation of the financing regime of the current Conservative Government.

I guess that a single privately owned acute hospital—possibly on neither of the two existing sites, and clearly geographically and clinically remote from the communities that I represent—will have emerged. Statutory ratios will have changed, and the terms and conditions of staff employment contracts will have been renegotiated. Indeed, secret discussions with the trade unions are already taking place on those matters.

The clinical services will have been transferred—sometimes out of the district entirely—and frequently devolved to fundholding practices. Already existing tensions with other health providers will be exacerbated and the community health trust's future will be placed in jeopardy. Heaven knows what will happen in the case of statutory duties of care that are owed to certain vulnerable groups. I understand that, in some cases, those duties have already been transferred out of the district to other providers.

That is not the right outcome for our district. I do not accept that the current modus operandi in relation to the consultations is valid in determining the district's needs. What is required is a halt to the merger proposal until such time as a major review, of the type described by my hon. Friend, takes into account both health needs and the district's institutional structures, dealing with, among other points, the seven problems that I outlined.

I hope that the Minister will deal with our request for an overall review and, even at this late stage, put on ice the merger discussions until we can identify the long-term future of health care, which all our citizens would dearly love to be of the best.

7.20 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam)

I am glad to have the opportunity to respond to the hon. Member for Wakefield (Mr. Hinchliffe). I congratulate him on again securing time to debate a subject that is linked to health services in Wakefield—in this case, the proposed merger between Pinderfields hospital and Pontefract general infirrnary trusts. He said that this is the sixth time during this Parliament that he has raised a Wakefield health services matter in an Adjournment debate. Indeed, it is better than that. It is the fourth time since January 1995, which must be a record. I also note the interest of the hon. Member for Hemsworth (Mr. Trickett) in the subject. I associate myself with the tribute that the hon. Member for Wakefield paid to the front-line staff in Wakefield, who, I have every evidence, do a first-class job on behalf of the people in the Wakefield region.

I listened to the concerns of the hon. Member for Wakefield and his case in favour of halting the trust merger consultation. He may be trying, however, to link two separate issues: the management of the acute trusts at Pontefract and Pinderfields and delivery of services. The proposal under discussion in Wakefield and in Pontefract is to merge two trusts or, to be more exact, to dissolve two trusts and create a new one. That proposal is to change the management structure of national health service trusts in Wakefield. It is not, I repeat, a proposal to change services.

I am told that the proposal has strong clinical involvement, and there is said to be clinical support for it. Separately, Wakefield health authority has recently announced that it will shortly reconsider its health strategy and will hold separate public consultation at the appropriate time next year.

Mr. Hinchliffe

The Minister has listened to my explanation, and to that of my hon. Friend the Member for Hemsworth (Mr. Trickett), of the acute financial difficulties facing health care providers in Wakefield. Does he accept that it is a complete waste of scarce public resources to have, yet again, a public consultation, when that consultation will deal with exactly the issues about which we are concerned in the current consultation on merger?

Mr. Horam

That is a matter for the local health authority. Clearly I am in the position, in effect, of an independent person waiting to adjudicate on these matters, when and if they come to me.

Mr. Hinchliffe

I apologise for intervening again.

My intelligence on this issue is that Wakefield health authority will be happy to conduct the public consultation on the merger alongside this wider review, but it has been prevented from having the review of acute services by the regional executive of the NHS. Common sense would suggest that the health authority would want to do that, so the Government are stepping in to prevent it from proceeding in that direction.

Mr. Horam

That is not my information, which is, as the hon. Gentleman knows, that a separate consultation is taking place on the merger and that, recently—certainly well after the consultation on the merger began—the health authority said that it wished to reconsider the acute side of its health strategy. That is the chronological order in which things have happened. Therefore, it would be strange for the health authority to merge the two things, having separated them to begin with. I am surprised at what the hon. Gentleman says.

Mr. Trickett

Will the Minister give way?

Mr. Horam

The hon. Gentleman will know that this is the debate of the hon. Member for Wakefield, and I want to continue a little further.

Separately, as I have said, Wakefield health authority has recently announced that it will shortly reconsider the acute side of its health strategy consultation and will hold separate public consultation at the appropriate time next year. If I can come to the point raised by the hon. Members for Hemsworth and for Wakefield, it is set out in law that the Secretary of State for Health is required to consult on proposals to establish a new NHS trust. The: trust project team asked for local views with the intention of passing them to the Secretary of State. The process began in July and lasted until 22 October. It was soon realised, however, that more was needed to fulfil statutory consultation requirements. That is why the health authority decided to extend the consultation.

The health authority was asked to consult on behalf of the Secretary of State and the consultation period was therefore extended. That has meant that consultation will take longer than it might otherwise have done. The extra consultation period, however, will not be wasted. All the views expressed during both consultation periods will be passed to the NHS executive and, ultimately, to Ministers. The extension has also allowed more time for local people to advance their views—in fact, it has almost doubled the time, as I told the hon. Member for Wakefield earlier this week at Question Time.

After the consultation period has ended in January, the decision whether to merge the two trusts will be taken by Ministers. As I have emphasised, at this stage we must take an independent view of all the proposals that are referred to us. Many factors need to be taken into account when considering such a proposal. We will consider carefully both the adequacy of the consultation process and local people's views, which the hon. Member for Wakefield has stressed are so important. We will also consider the likely impact on the effectiveness, efficiency and accessibility of the potential creation of a new trust. Accessibility was referred to particularly by the hon. Member for Hemsworth, whose constituency adjoins Wakefield.

Any potential economies of scale will have to be balanced against any possible loss of patient choice. Ministers are rightly enjoined to take into account that mixture of considerations when considering the results of consultation. Until all the facts are before us, clearly we cannot comment, beyond saying that we will take it all into the account.

I understand that the hon. Member for Wakefield believes that the consultation on a proposed trust merger is already, in effect, a fait accompli. I assure him that that is absolutely not true. We have a statutory responsibility to consult publicly. Ministers need sufficient information to be able to judge the proposed merger for the value it may or may not have, and the adequacy of the consultation process that has taken place.

The hon. Gentleman referred to the "resignation" of the chairman of the Pinderfields trust, Mr. Roy Cusworth. It is more accurate to say that his period of office as trust chairman ended on 31 October, as the hon. Gentleman knows. Mr. Cusworth did not seek renewal of his appointment. He has, as the hon. Gentleman knows, other business commitments to pursue.

It should be said on Mr. Cusworth's behalf that he leaves behind an able acting chairman and a trust that has recruited 25 new consultants since 1993. The trust has transformed the quality of its treatment for elderly people and has developed a centre for enhanced eye surgery, and Pinderfields and Pontefract hospitals are already co-operating with Dewsbury district hospital to provide an integrated clinical haematology service locally and for a wider population. That is a considerable achievement under Mr. Cusworth's chairmanship, and we should give him due credit for that.

At Health questions earlier this week, the hon. Gentleman and I talked about the "Cook" test, after the right hon. Member for Livingston (Mr. Cook). The test was: will organisational change lead to better service? I have no doubt that it has led to better services in Wakefield.

The hon. Member for Hemsworth criticised the agency nurses who had possibly been brought to man a ward, but surely he agrees that it is a flexible way of manning a new ward when an extra ward is needed. We are talking about an extra facility for elderly people so that the local trust can manage resources effectively during the coming winter and have additional facilities available for elderly people. We are talking about additional facilities. Surely the hon. Gentleman is not against that.

I recognise that Pinderfields hospital trust is facing a complex set of interdependent issues. The ultimate goal is to ensure that sustainable high-quality and cost-effective clinical services are provided in modern facilities. Although the consultation on the proposed merger of the two trusts and, separately, the configuration of health services will take time, those processes should ensure that whatever solution emerges is based on informed debate among the public and the professions.

The hon. Member for Wakefield suggested that the merger proposals should be stopped or combined with a review of health services in Wakefield. In view of his great knowledge of and interest in the matter, he will recall that not long ago Wakefield health authority undertook a detailed consultation on its five-year health strategy. In fact, it was in 1994, and the health strategy was published as recently as March last year. The document covers the needs of everyone in the Wakefield metropolitan district council area. More than 1,000 copies of the full document were issued locally and regionally. A further 125,000 copies of the summary were printed, most of which were issued through the free press. The remainder were handed out at various local events throughout the district.

Representatives of Wakefield health authority also spoke about the strategy to a large number of local groups, as well as holding meetings with the three local national health service trusts and the two community health councils in Wakefield and Pontefract. Those meetings certainly included one with local Members of Parliament. It is worth stressing that Wakefield's health strategy discussed how health services in Wakefield will be shaped over the next five years. It also examined the need for a strategic shift to primary care. Local general practitioners were closely involved in the process.

We are talking about a considered, strategic examination of the health needs of the people of Wakefield. Nevertheless, the health authority plans to revisit and review that part of its health strategy relating to acute health services. I welcome the fact that the hon. Gentleman said that it was sensible to do that. There are plans to take that forward in the near future. The process is likely to take about six months, and I am assured that it will involve detailed discussions with clinicians and general practitioners and active participation by the two community health councils. Public consultation will follow later in 1997. Judging by the number of debates that we have had—and your own interest, Mr. Deputy Speaker—I have no doubt that local Members of Parliament will be fully and actively involved in the process.

I am grateful for having had this opportunity to respond to the debate. We share the determination of the hon. Member for Wakefield to ensure that high-quality treatment and care continue to be available to people in the Wakefield area. I am absolutely sure that Wakefield health authority, as well as the trusts in the Wakefield and Pontefract area, shares that commitment. Whether a merger of the two trusts in Wakefield will assist in that process is a matter on which I shall keep an open mind until the statutory consultation is completed in January, and the results are known.

Question put and agreed to.

Adjourned accordingly at twenty-eight minutes to Eight o'clock.