HC Deb 03 December 1998 vol 321 cc1053-66 4.18 pm
The Secretary of State for Wales (Mr. Alun Michael)

With permission, Madam Speaker, I wish to make a statement on the future of the health service in Wales.

The national health service is one of Labour's proudest creations, especially in Wales. It is a tribute to the people who work in the NHS that it continues to give such a high standard of care and retains such public confidence. People want the NHS to be modernised and strengthened, rather than undermined or replaced.

I will not labour the point, but the NHS in Wales has not been given a fair chance in recent years and 18 years of damage cannot be repaired in 18 months. Lack of coherence in the long-term planning of the health service in Wales has frequently left clinicians, managers and officials trying to make the best of a bad job.

I saw that in my area, where the failure to develop an adequate 10-year plan in the early 1980s was compounded by a lunatic scheme to build a third district general hospital in the Cardiff area. The abandonment of that plan and subsequent piecemeal decisions have been bad for morale and for the aim of providing high-quality health care. I hope that today's statement will lay the foundations for a new partnership approach which strengthens the health service to create one NHS to serve the people of each community in Wales, replacing the two, three or four divided services in some areas.

Standing still is not an option for acute services. The Royal College of Surgeons generally wants specialist services to be centralised in fewer units. Instead of being forced to respond to clinical advice in a piecemeal and expensive way, trusts will be able to organise safe specialist services across different sites cost-effectively. A new, coherent pattern of trusts is needed to replace a situation in which many act as if they are mediaeval city states each competing with the other, rather than organisations which need to be partners with each other in providing health care.

Before we came to power, the then shadow Minister with responsibility for health in Wales pledged that we would cut the number of NHS trusts in order to direct resources away from administration and into patient care. The new configuration of trusts, which I am announcing today, follows 18 months of widespread consultation. May I pay tribute to my hon. Friend the Member for Bridgend (Mr. Griffiths) and the Under-Secretary of State for Wales, my hon. Friend the Member for Cardiff, Central (Mr. Jones) who played such a leading part in those consultations and discussions? Configuration is not an end in itself so I wish to spell out clearly the new shape and direction of the NHS in Wales and the way in which I expect board members and managers to carry out their work in future.

Unproductive competition and piecemeal changes in recent years have led many people to worry about the future of a specific hospital in their area. People rightly identify with "their" hospital and that is to be encouraged by the trusts, not seen as old-fashioned or irrelevant. I can reassure people in every part of Wales that the approach they want, reinforcing the hospitals and institutions they respect and depend upon, will be the way forward for the future.

Wherever possible, we have followed three principles. First, we want to bring together neighbouring trusts which provide acute services in order to eliminate competition, promote collaboration, reduce unnecessary duplication, tackle financial problems and attack waiting lists. Secondly, we want to combine community health and acute services to create a single health service for each area. That will allow clinicians in both sectors to collaborate in providing a seamless service to each patient. I expect that to be of particular benefit to the elderly. Thirdly, wherever possible, the new trust will share the same boundaries as unitary authorities to simplify relations with social services and within the new local health groups we are establishing.

Those principles will better provide for the co-ordination of care for each individual patient, whether on an acute ward or in a community hospital, a nursing home or at home. The changes will remove the problem of bed blocking and release resources for more urgent cases.

Those principles have won general support in Wales, but applying them can be difficult. The distribution of the population, the distribution of hospital services and the geography of Wales are all against us—otherwise it is straightforward! As a result, several themes came up consistently from the consultations. I wish to be absolutely clear on our response to these for the benefit of the public and for the benefit of planners and managers in the health service.

First, reconfiguration in itself must not stop anyone going to a local hospital. As at present, general practitioners will be able to refer patients where they believe it is in their clinical interests to do so. Secondly, mergers will not be takeovers, but the creation of a new partnership. Key services must not be moved to the larger hospital. Community and mental health services must not be ravaged for the benefit of acute services. No hospitals will close as a result of reconfiguration. If health services should change or a hospital should close, such events must occur for objective reasons, not as a result of reconfiguration.

Some people have asked for reconfiguration to be put off for a year or more. That is not an option. We have to keep the pre-election promise of cutting bureaucracy, and create health service structures that will enable the new Assembly to undertake its work of accountability. Reconfiguration is essential if trusts are to plan their services effectively, to deal with the mounting pressures upon them and to make real inroads into waiting lists and cope with current financial pressures.

Reconfiguration must not be just a question of merging organisations or drawing lines on a map. I am prepared to take time to explain the reasons behind each decision and to demonstrate that I have listened to people's concerns. For that reason, I have prepared a much fuller statement explaining my decisions which will be sent to trusts, health authorities, community health councils, local authorities, trade unions and the press. I am placing a copy on the Board this afternoon for every hon. Member with a Welsh constituency and for representatives of the Conservative party. I will also send a letter to trust chairs to pass on to staff to allay concerns.

I have approved the establishment of eight new trusts on 1 April 1999, but I wish first to refer to two areas where I am not going ahead with the proposals on the basis on which consultation took place. I do not intend to agree to a merger of the Powys Health Care NHS trust with Ceredigion and Mid Wales NHS trust. On each of the visits I made to Powys during my period as a shadow Health Minister for Wales, I was impressed by the degree of local unity, which was reinforced by GPs and nurses during my recent visit to Newtown hospital and by views expressed by local MPs, Labour party members, trade unions, and local councillors as well as the trust itself.

The decision leaves challenges for the Powys trust, and I shall insist that it delivers on the assurances given to the Under-Secretary of State for Wales, my hon. Friend the Member for Cardiff, Central, that the benefits and savings of reconfiguration can be delivered without the need for a merger. I hope that local Members and others will support the board in delivering on those commitments.

I am very much aware of the isolation of Ceredigion's acute services, but those problems would be hidden in a combined trust. I therefore expect the development of close collaboration between Ceredigion and acute services in other trusts. I shall in the near future discuss those issues personally with representatives of the Ceredigion trust and other local representatives.

In Cardiff and the Vale of Glamorgan, the proposal to split the Llandough hospital from community services now managed by Llandough NHS trust is entirely opposed to the principle of creating a single health service for each area. The way forward for Cardiff and the Vale of Glamorgan is the creation of a single integrated trust for the area—excluding Velindre, because of its specialist nature. However, immediately to create one trust would involve an operation of far greater complexity than any of the other mergers.

I have, therefore, reluctantly accepted that a two-stage process is necessary. It is important to give certainty to staff and management by setting a clear time scale for both stages. I intend to merge the University Hospital trust with the Llandough trust—including the community element—and to combine Cardiff Community trust with the University dental hospital. There will be speedy consultation on the proposal, but I am confident that it meets most of the objections to the previous proposal. My intention is that the merger will proceed on 1 April 1999. As soon as possible, I shall make a further announcement on the second stage.

The new NHS trusts to which I am giving the go-ahead are: North West Wales NHS trust; Conwy and Denbighshire NHS trust; North East Wales NHS trust; Carmarthenshire NHS trust; Swansea NHS trust; Bro Morgannwg NHS trust; Pontypridd and Rhondda NHS trust; and Gwent Healthcare NHS trust.

I intend to take a personal interest in the way in which the changes are made, and I will strengthen the role of community health councils which, with local authorities and local health groups, will help to create an effective and inclusive structure for the NHS in Wales.

Major benefits are available, for example, by bringing the Gwent health authority's three trusts together. Moreover, the merger in Gwent—unlike the merger in Cardiff—can be achieved immediately, as it is a far less complex operation. I am convinced that the future of Nevill Hall hospital is secure because of its key strategic position, but appreciate the fears that have been expressed in north Gwent.

I am requiring the new trust to state clearly how the pattern of services will be developed across hospitals in Gwent. Local authorities, hon. Members, and community health councils and the new local health groups will have a chance to comment, and I hope that that transparency will ensure that the reconfiguration is seen as a new partnership in Gwent and not as a takeover of one hospital by another.

The same principles will be emphasised with every one of the new trusts. We are interested not only in the pattern of services, but in the nature of management and the way in which services are delivered. For example, I have more reason than most people to understand the local importance of Llandudno hospital, which is where, after an operation in 1950, I left my tonsils. Community links and expectations might suggest that Llandudno hospital should be linked to Ysbyty Gwynedd, but doing so would fail to provide the critical mass of acute services in north-west Wales that are essential to effective local care.

Llandudno will stay with Ysbyty Gwynedd, but the way in which it provides its services must respect local expectations in Llandudno and the surrounding area. I am therefore requiring Gwynedd Hospital NHS trust to consult Glan Clwyd District General Hospital NHS trust and other local partners, including the local authority and local health group, and report back to me on how those matters can be reconciled.

Mechanisms such as the one that I have proposed are the way in which we can ensure that there is proper co-operation in the best interests of local areas, in which the principles I have stated are inevitably in conflict with each other.

Similarly, the merger of the Llanelli Dinefwr and Carmarthen trusts is intended to improve patient care across the county. However, I understand also the fears in the Llanelli area and the strength of support for a hospital that local people have supported enormously strongly over many years.

I am determined that reconfiguration will not lead to the closure or downgrading of Prince Philip hospital. The hospital will not lose its accident and emergency unit or its magnetic resonance imaging scanner. I am requiring the new trust to state how it will meet those requirements, and the views of local hon. Members and other local partners will be sought to ensure that our intention becomes a reality.

Finally, I am aware of the concern that changes in patient flows as a result of creating a single new trust could damage services in Swansea. I shall hold Iecyhd Morgannwg health authority to its pledge not to allow patient flows to change because of reconfiguration. My officials will have the clear task of working with health authorities and the new trusts in as transparent a way as possible towards an improved style and quality of management in the new structures directed entirely at providing better patient care and respecting the needs of local communities.

It is central to the role of the new trusts that they should make themselves accessible to their communities and engage them in their decision making and planning, as our NHS White Paper requires. That is the only way in which to reassure communities about the impact of reconfiguration and to reap the benefit of better patient care that the changes are intended to achieve.

Mr. Nigel Evans (Ribble Valley)

I welcome the right hon. Gentleman to his post. I believe that this is his first statement as Secretary of State for Wales. I am grateful to him for giving me a copy of his statement earlier this afternoon so that I had an opportunity to read it. He may have other matters to divert his attention these days, particularly the battle with the hon. Member for Cardiff, West (Mr. Morgan), and his hopes to be parachuted into a position in the Welsh Assembly, but I hope that he will be able to get his head out of the clouds for long enough to give sufficient attention to those issues that need it, including the national health service.

We fully appreciate the fact that the health service in Wales needs special extra attention. The consultation document "Better Health, Better Wales" mentions on page 5 that health service provision and the health of people in Wales is poorer than in England and the rest of the European Community. There is no reason why that should be allowed to continue.

I applaud the work of the nurses, doctors and support services in the hospitals in Wales. They do a superb job and deserve our recognition, not just today but every day.

The people of Wales will want to know how the reconfiguration of trusts will improve services. Will it reduce waiting lists and waiting times? I am sure that the Secretary of State saw the Western Mail on 12 November, which said that more people were waiting 12 months and 18 months for operations in Wales. That is unacceptable and we need to ensure great improvements. Many people believe that there is more fiddling with waiting list figures than Stephane Grappelli has ever seen. The Western Mail article features the comments of Jan Williams, the chairman of the confederation, who welcomes extra money to tackle waiting lists, but believes that sustained improvements will need increased funding on a recurring basis. Can we have assurances that we shall get such continued extra money for the health service?

I am concerned about the comments of Dr. Dewi Evans of Singleton and Morriston hospitals on the scandal of youngsters having to wait for operations in certain specialties in Wales. Will the reconfiguration of the trusts ensure an improvement in the health service, particularly for our young people?

The Government have talked about the reconfiguration resulting in savings. Initially a figure of £10 million was mentioned, although that has changed to £7 million recently. Those who work in the NHS have grave suspicions that the savings cannot come simply from the reconfiguration and that the extra money will come from front-line services. We are concerned that if the savings cannot be made as the Secretary of State has outlined, he will have to turn his attention elsewhere in the NHS to secure them. We want to ensure that the front-line services are improved, not damaged, by the changes.

The Secretary of State has also said that he has not acted on all the recommendations initially, with particular reference to Powys and Ceredigion, which I applaud. When I was in Powys, I too listened to the concerns of many members of the public—the people who are on the receiving end of the health service in Wales. People were worried that the acute service would completely swamp the community-based treatment that they received. I am delighted that the right hon. Gentleman has listened to their concerns.

Yesterday, a statement was made on the millennium bug problem. The right hon. Gentleman did not mention it today, but as the changes in the health service will take place in 1999—exactly when the millennium bug might affect hospitals that have not taken proper action—will he assure us that the problem will continue to be treated as a priority? The Audit Commission reported earlier this year that the treatment of the problem in the NHS was extremely patchy.

Will the right hon. Gentleman assure the House that people who live in rural areas will continue to receive the community services on which they have come to rely? He will appreciate that those people do not have adequate public transport to go to larger hospitals many miles away.

Will the Secretary of State reassure us that, in the reconfiguration, waiting list lengths will be tackled? I understand what he says about the geographical problem in Wales, but we must not allow those hospitals that he says will not be closed to be generally downgraded; the reconfiguration must not be used as an excuse to downgrade services. Will he assure us that there will be no downgrading of provision in, for example, the Nevill Hall hospital, which he mentioned?

The right hon. Gentleman referred to Swansea. That is where I grew up and where my family live, so I have particular reason to attend to what happens to the hospitals there. I remember that, when the emergency service in Singleton hospital was threatened with closure, there was an almighty outcry, even though extra provision was being made elsewhere. Will he guarantee that, even with the flows of patients between various hospitals in the area, that service will not be damaged?

If the Government paid as much attention to the real doctors in Wales as they do to their spin doctors—on whom they spend twice as much money as the Conservative Government did—the services would be much better in Wales. The right hon. Gentleman knows that there will be elections in Wales next year. Many people will wonder why, as it is only a few months until the Assembly takes responsibility for the health service in Wales, he did not delay his decisions on the reconfiguration and let the Assembly take them. The Assembly may want to look again at what he has announced today and make further changes, and that could be extremely expensive. He should remember that, in the elections to the Assembly, the Government will be judged not on their words, but on their deeds.

Mr. Michael

There was a good deal of knockabout in that contribution. The hon. Gentleman has a cheek to talk about parachutes. I have represented a Welsh constituency for 11 years and, before 1 took up other responsibilities, I spent four years as shadow Health Minister for Wales. I have been immersed in the politics of the Labour party and Wales for more than 30 years, but he had to go to Ribble Valley to win a seat in the House. I take it that he left his parachute outside the Chamber before he came in and had the cheek, as someone who represents an English constituency, to talk about the health service in Wales.

I suppose that we should take his contribution as a belated apology for the damage that the Conservative party did over 18 years to the health service in Wales. His recognition of the importance of nurses is also belated. I speak for all Labour Members in saying that we value the nurses, doctors and the other health service staff who have a variety of functions; they all contribute enormously to the quality of health care.

It is important that we do not become frozen in immobility because of the Assembly. I believe that the leader of Plaid Cymru, the right hon. Member for Caernarfon (Mr. Wigley), agrees with that. We must lay down foundations and make sure that structures are in place so that the Assembly will be able to call the health service to account, to examine the management of the health service and to look at the outcomes and the outputs that are important to the people whom we represent.

The proposals will help to reduce waiting lists and waiting times, and the hon. Member for Ribble Valley (Mr. Evans) should recognise that waiting lists dropped by 1,700 last month. The Under-Secretary of State for Wales, my hon. Friend the Member for Cardiff, Central, will have more to say next week to embarrass the hon. Gentleman further. The separation of elective and emergency work within the new trusts will help to tackle waiting lists.

The hon. Member for Ribble Valley was worried about the extent of savings, but the Pembroke-Derwen merger made continuing savings of £750,000 per annum—well above the estimates given of resultant savings. We can have some confidence in the estimates. I will talk to people who have concerns about achieving the savings and about the way in which they are fed back into health care. The hon. Gentleman seems to get most of his information from the Western Mail, and I can tell him that I will listen to those who work in the health service, including the representatives of Unison. They have genuine concerns about these matters—they do not want to score points in this Chamber.

The hon. Member wanted to know about the millennium bug. He must have been scraping the bottom of the barrel for something to say at that point. Yes, the changes will take place on 1 April 1999, and we are making sure that the millennium bug will not damage the emergency services and health services generally in Wales. We give priority to that matter. I have been a member of the Cabinet Committee that is emphasising the need for every organisation to be aware of the issue. If new IT systems are needed as part of the reconfiguration, they will be millennium compliant.

The hon. Member asked about rural areas, and I have recognised the need for flexibility. That is precisely the reason for the decision in Powys, and why I have recognised that the situation in Ceredigion is difficult, but must be addressed. Problems of rurality, sparsity, mountains and other matters cause problems in the provision of services in virtually every part of Wales. That is one of the issues that we are trying to address through the flexibility provided by the reconfiguration. I am glad that the hon. Gentleman noticed the geographical problems of Wales. I am not sure how long it took him to come to that conclusion.

I emphasised in the statement the answers to a number of questions that the hon. Member for Ribble Valley asked, such as the future of Nevill Hall, which I said should not be downgraded. I made it clear that in each of the trusts, there should be no asset-stripping of one hospital by another or any undermining of confidence, so that services are available where people need them. The ability to maintain those local services and different centres of provision will be strengthened, not weakened, by the way in which we have undertaken the reconfiguration. I can assure the hon. Gentleman that it is all good news and that he can leave the Chamber cheering at the news that he has been given.

Mr. Win Griffiths (Bridgend)

First, I pay tribute to the civil servants in the Welsh Office, and to the managers, medical staff and others at all levels in the health service in Wales for the immense efforts that they have put into the reconfiguration process, which has been incredibly important. It is estimated that it will save between £7 million and £10 million by the end of this Parliament. Given the small adjustments that have been made in individual proposals, will there be any effect on those savings? My trust was confident that it could do better in savings terms than the figures in the proposals.

It is very important that we get the message across that permanent savings from administration will go directly to patient care. Will my right hon. Friend confirm and underline that the future of hospital and community services in the health service in Wales will, in the near future, lie in the hands of local health groups, doctors, nurses, midwives and local authority representatives, who will have the job of seeing how hospital services fit into the new health service in Wales?

Mr. Michael

I join my hon. Friend in paying tribute to those people who are going through a difficult process, and who worked closely with him during his period as the Minister with responsibility for health in Wales. I repeat my tribute to my hon. Friend for the hard work that he undertook in difficult circumstances. It is always more difficult to start when one is clearing up a mess than if one is starting from a strong position. Frankly, the former is where we found ourselves 18 months ago.

I am confident that the adjustments will not cause a problem in relation to savings. In Powys, the health authority has given the assurance that the necessary savings can be effected in ways that it is happy to achieve itself. I am certain that the dismemberment of the Llandough trust in order to put it back together again in a couple of years as part of stage 2 would have been an expensive way of doing a job badly. I am confident that the savings will not be any lower as a result of the decisions on Cardiff and the Vale of Glamorgan.

We will look specifically at Ceredigion in light of our decision, but I hope that my intention can be carried through and that we can strengthen partnership and co-operation between Ceredigion and other trusts to make sure that difficulties are not caused. I underline the point that savings are to be diverted back into health care, and I am sure that all my hon. Friends want to see that happen.

Finally, I can give my hon. Friend the answer he is looking for in relation to community services. It is very important that there is a proper balance between hospital and community services, which must be integrated and complementary. My hon. Friend is right to stress that the future is in the hands of local health groups, which will bring a new degree of accountability at the most local level. That matches the developments that will take place in the coming year, when the overall strategic accountability will be in the hands of the new elected Assembly for Wales.

Mr. Lembit öpik (Montgomeryshire)

May I offer the Secretary of State and his Minister my profound gratitude and that of my hon. Friend the Member for Brecon and Radnorshire (Mr. Livsey) and the people of Powys at today's decision? The people of Powys have worked so hard to protect the continued existence of Powys health trust, and have won a common-sense victory today. Does the right hon. Gentleman recognise that this will be regarded as an indication that, for once at least, Ministers have been willing to listen to the concerns of the public and to act accordingly—something that is extremely welcome? That will bring great cause for celebration to the professionals working in health trusts in Powys.

Does the Secretary of State agree that while this decision may not please everyone in Wales, few in Powys will be disappointed? Does he agree that it was somewhat mean-spirited of the hon. Member for Ribble Valley (Mr. Evans) to seek the negatives and to make irrelevant party political points at a time when it is important for us to recognise that the decisions have been altered according to the consultation process that involved effort on both sides? That process has led ultimately to a pleasing result in terms of the modification of the plans.

The Secretary of State mentioned the need for Powys to achieve savings, and that has been mentioned on a number of occasions. Will he accept my assurance that I and my hon. Friend the Member for Brecon and Radnorshire will honour the commitment to work with Powys health trust to ensure that those savings are found—recognising, none the less, that the process presents us with a further challenge that we must not avoid?

More broadly, there will be debates and concerns in other parts of Wales, especially about the financial savings that must be found. Does the Secretary of State agree none the less that the Powys decision should be regarded as an example of what can be done when parties listen and work together—[Interruption.]—when the public are genuinely consulted and, perhaps most importantly, when the public interest is put above party political concerns, in this case leading to the maintenance of a health service that is loved by the people of Powys and highly respected by all those who have cause to use it?

Mr. Michael

I welcome the hon. Gentleman's remarks. To those Conservative Members who mocked some of his points, let me say that I welcome his reasonable approach. This is the new politics: to disagree when there are things to disagree about, but to agree when we can agree. In particular, I would stress the importance of one thing that he said: it is a matter of integrity that he acknowledged the fact that there are difficult decisions for Powys Health Care trust to take in order to make the savings that will be necessary for it to deliver on its promises.

I have heard Labour party and trade union voices arguing in the same direction as the hon. Gentleman and the hon. Member for Brecon and Radnorshire (Mr. Livsey). I look to Members of Parliament, local authorities, trade union representatives and others to help to deliver on the promises that have been made. I am convinced that, with a reasonable and co-operative approach, we can achieve an outcome that is satisfactory for everybody.

Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. I have given some leeway to Front Benchers and to the former Health Minister in Wales, but I now appeal for shorter questions and answers, as we have other important business to cover.

Mr. Alan Williams (Swansea, West)

I accept entirely the logic of the proposals for Swansea, which reflect the consultation that was held in the area. Is my right hon. Friend aware that the new trust will start with an enormous problem, with the overhanging shadow of the £8 million debt that Morriston will bring? If the new trust is not to start in an atmosphere of cutting and holding back on developments, we must deal with the debt. Recognising that it should not have been built up in the first place, will he consider writing it off?

Mr. Michael

There are proposals to deal with the problem to some extent. A recovery programme is being set up, and my right hon. Friend makes a reasonable point when he says that the debt should not have been built up in the first place. The reconfiguration will help the process, but I recognise that the problem to which he alludes is extremely difficult. We will be conscious of it when we consider how the new trust is to develop its work.

Mr. Cynog Dafis (Ceredigion)

There is widespread cynicism in Wales about the reconfiguration exercise. People think that it has more to do with a pre-election undertaking than with actual need and the provision of a more efficient health care system. There will be widespread dismay at the failure to take the opportunities for improvements in health care delivery in mid-Wales— especially in relation to the integration of services—that were carefully described in the consultation process.

Will the Secretary of State guarantee that the development of services and of clinical excellence that has taken place in Ceredigion, and particularly in Bronglais general hospital, will be able to continue? Does he accept that accessibility is also vital, and that the royal colleges need to—and are in fact beginning to—understand that? May I warn him that any diminution in the status of Bronglais hospital in Aberystwyth or reduction in its range of services and specialties would evoke a furious public reaction in the area, compared with which what we have witnessed in Powys would pale into insignificance?

Mr. Michael

I agree that there is widespread cynicism in Wales. That is precisely why, when I took up my post, I delayed the announcement of the reconfiguration in order to examine the proposals and ensure that I would not be announcing something that I could not put my hand on my heart and say would improve patient care. That is my objective in today's announcement. That is precisely why the announcement is about not only lines on the map, but the way in which the new arrangements will be put into practice.

I would have hoped that the way in which I made the announcement would have set some of the hon. Gentleman's doubts to rest. He asks whether I can guarantee that the development of clinical excellence in Bronglais will continue. The whole point of the way in which I referred to Bronglais and services in Ceredigion is that I recognise that there is a specific problem there. That problem would not have been helped at all by simply merging it with another set of problems at Powys Health Care trust: that would have been running away from the problem.

I fully intend to address the problem, and I will be quite happy to talk to the hon. Gentleman and to listen to any constructive suggestions about the future of the health service in his area. The reference to co-operation and partnership with other adjoining trusts is precisely about trying to find a formula that will protect the future of Bronglais.

I understand the hon. Gentleman's point about accessibility. It is not an easy situation to protect, but I am determined to do so, and I look forward to working with him, with those who work in the trusts and with other interested parties in the area. It is not my intention that there should be any diminution in the standard of care available.

Mr. Denzil Davies (Llanelli)

Is my right hon. Friend aware that there will be considerable anger in Llanelli at the decision to abolish the Llanelli Dinefwr hospital trust and that the anger will be compounded by the fact that the decision was taken by a Labour Secretary of State? Is he further aware that there will be widespread cynicism about the consultation process, because all groups in my constituency—health professionals and others—were totally opposed to the Welsh Office plans? Is he finally aware that all his fine words about not downgrading hospitals will carry little credibility because there is real concern, as a result of the decision that he has taken, that Prince Philip hospital in Llanelli will be downgraded and we will lose our medical services?

Mr. Michael

I know and understand my right hon. Friend's passion for the health services in his area. I hope that he will help to ensure that nobody pursues the approach of either cynicism or promoting the belief that there is any threat to Prince Philip hospital. I have made it clear that that is not the basis on which the reconfiguration is proceeding. I have been absolutely explicit—I hope that he will pass my words on to those of his constituents who have expressed concerns—about the requirement on the trust, the board and officials at the Welsh Office to ensure that none of the dangers that he fears will come about.

I understand the fears and cynicism that have arisen from the way in which health service decisions have been taken over the past 20 years. Many of us have had worries about our local services. The whole point of making my statement in a clear and considered way, measuring each word, is to ensure that the changes that I have to accept as necessary to concentrate on health care are implemented in such a way that high-quality care is provided, but with a proper regard for factors such as the affection of people in Llanelli for their own hospital. I hope that that offers the reassurance that my right hon. Friend seeks.

Mr. Rhodri Morgan (Cardiff, West)

I agree with 80 per cent. of the statement, but I want to ask my right hon. Friend about the two-stage reorganisation of the trusts in Cardiff and the Vale of Glamorgan. We heard enough about two-stage reorganisation yesterday to last us a lifetime, although I understand that today's announcement does not involve any grouse moors or the resignation of any Tory Front-Bench spokesmen, however popular that might be in Wales.

How long does my right hon. Friend expect the period to be between the completion of stage one reform, with the two mergers that he has announced today, and the ultimate merger of the two newly merged trusts into one mega-trust covering the whole of Cardiff and the Vale of Glamorgan? How high will morale be among the top management, the clinicians and everybody working in the health service in the Cardiff and Vale of Glamorgan area when they work for two organisations with such a limited shelf life?

Mr. Michael

I accept that a two-stage reform is not ideal, but nothing else was on the cards from the beginning of the consultation, as my hon. Friend knows. I hope that not only will we have no grouse moors, but no grouses at the end of the process. I have made our direction clear, following much uncertainty in the health service in Cardiff and the Vale of Glamorgan. People suspected that we would have stage one and that stage two would never happen. I am determined that we shall have a short first phase, leading to the completion of the job as soon as possible. I will consult further on how quickly that can be done, so that a time scale can be produced that gives some certainty to clinicians and staff in the area.

It is only fair to point out that the complexities in the area, of which my hon. Friend is aware, include the moving of the accident and emergency unit from Cardiff Royal infirmary to the University hospital of Wales and a variety of other movements in the acute services in the area. We do not intend to dismember the Llandough hospital from community services, thus producing a mish-mash and pretending that that is a second stage towards a single trust. Instead, we will merge existing arrangements in a manageable first stage, which will quickly lead to a sensible second stage and the degree of certainty that my hon. Friend rightly suggests should be achieved.

Mr. Don Touhig (Islwyn)

I welcome my right hon. Friend's statement as far as Gwent is concerned, because I believe that the single trust is the proper solution. However, I know that my hon. Friends have some concerns about that and I am sure that they will express them to him. Will he confirm that his decision will provide us with an opportunity in Gwent to shift resources from bureaucracy to patient care and how does he intend to ensure that that happens?

Mr. Michael

My hon. Friend is right: the purpose is to shift resources from bureaucracy into patient care by having only one level of bureaucracy and ensuring that services are available to people in appropriate and convenient locations. We wish to strengthen services in the northern half of Gwent, about which there has been some concern, and we want to ensure the safety and long-term security of Nevill Hall hospital. I am certain that the reconfiguration can achieve the improvement in patient care in Gwent for which my hon. Friend hopes.

Mr. Paul Flynn (Newport, West)

I thank my right hon. Friend for his statement and I agree that the best solution is to concentrate the strengths of the services into a single trust. All the alternatives would have meant that administrators would have been appointed unnecessarily, and bureaucracy would have been doubled or even trebled at the expense of patient care by doctors and nurses. Given what my right hon. Friend said about the problems in the north of the county, may I remind him that the area of Wales with the worst health record is a ward in Newport? The solution will help all parts of Gwent to save money and enjoy a stronger health service.

Mr. Michael

I am grateful to my hon. Friend for those remarks. He is right to suggest that we should focus on seeking to improve health care where it is worst, including wards in his constituency and areas in north Gwent. The purpose of the reforms is to ensure that everyone, wherever they live, has access to high-quality health care from acute and community services and from the complementary services of local authorities.

Mr. Alan W. Williams (East Carmarthen and Dinefwr)

I wish to express my disappointment with the statement as it affects my constituency. The policy of forced mergers of trusts that my right hon. Friend has inherited from his predecessor and my hon. Friend the Member for Bridgend (Mr. Griffiths) is mistaken, because mergers should be voluntary. What reassurance can my right hon. Friend provide for my constituents and people in Llanelli that services will be available in both areas and will not be affected by rationalisation?

Mr. Michael

I can understand my hon. Friend's disappointment, but I am not sure about the concept of voluntary mergers because that might mean leaving the management of trusts that may have been established on an unsatisfactory basis to choose whether to merge. The overriding consideration must be the need to provide the best quality of patient care, as I know my hon. Friend agrees. I am happy to give the reassurance he seeks that the quality and choice of care in his part of the new county area will not be downgraded, and I shall remind those who will run the trusts of the need to ensure that there is no asset stripping of one hospital for another. That applies equally to both sides of the combined trust.

Mr. Llew Smith (Blaenau Gwent)

While I welcome my right hon. Friend's commitment to Nevill Hall hospital, people in Blaenau Gwent will still be angry about the statement. My right hon. Friend quoted the Royal College of Surgeons, but if he had quoted the local authorities, such as Blaenau Gwent, Monmouthshire and, even, Newport he would have found opposition to a single trust for the county of Gwent. The vast majority of general practitioners in Gwent are also opposed. The community of Blaenau Gwent has some of the worst health problems in the United Kingdom, including heart and respiratory disease and cancers, and the people are terrified that they will again have an authority that will be unable to relate to and respond to their health problems.

Mr. Michael

I understand the concerns that my hon. Friend presents on behalf of his constituents. I accept that different voices have different views, but I mentioned the Royal College of Surgeons because it has argued for larger concentrations of acute services, which can cause problems for more localised services, unless they are a part of a combination. I have proceeded with the interests of his constituents and the services at Nevill Hall hospital in mind. I accept my hon. Friend's concerns for his local area, but I believe that the creation of the local health groups and a stronger voice for community health councils will be a way in which to achieve our intentions. I am happy to discuss with my hon. Friend and his colleagues the changes to community health councils, because they will be important to our scheme.

Mr. Huw Edwards (Monmouth)

I remind my right hon. Friend that, when the previous Government introduced the trust system, they included no consultation whatever. The Government should take some credit for having a consultation process on this occasion. My right hon. Friend will know that I campaigned with my hon. Friend the Member for Blaenau Gwent (Mr. Smith) for a separate trust for north Gwent and I must express the disappointment of campaigners that my right hon. Friend has decided not to implement that. Will he give us an assurance that Nevill Hall hospital will be maintained as a district general hospital, that there will be no drift of resources to south Gwent and that the Government's commitment to combat social inequalities in health will work specifically in the interests of the people of north Gwent?

Mr. Michael

I am happy to give those assurances. Nevill Hall will continue as a district general hospital. As I indicated earlier, there must not be an exercise in asset stripping. My hon. Friend is right to point out that there was no consultation when the previous group of trusts was created, but we have listened, and I would be more likely to share the concerns expressed by some of his constituents if the trusts were to be of the type set up by the previous Government. We have made it clear that the trusts must be totally different, and must involve partnership and co-operation. They must provide an integrated health service in which there is no question of hospitals or acute services winning over community services, but, instead, complementing each other. I shall be happy to work through those issues with my hon. Friend and his colleagues as time goes by.

Back to