HC Deb 13 July 2000 vol 353 cc1266-74

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

1.15 am
Mrs. Virginia Bottomley (South-West Surrey)

I had intended to say how grateful I was to Madam Speaker for choosing me for an Adjournment debate that should have taken place at 7 pm on Thursday. It is now 1.15 am. Although I am still grateful to Madam Speaker—I shall miss her greatly when she steps down—you will understand, Mr. Deputy Speaker, that 1.15 am is rather different from 7 o'clock in the evening.

I wish to speak on a subject of the most profound and serious concern to my constituency. In my 16 years in the House, I cannot recall an occasion on which I have had more letters containing greater depth, detail, responsible argument and increasing anger. They are about the complex consultation exercise that the health authority has introduced, most of which will take place over the summer recess. This is almost my last opportunity to raise the issue in the House before then.

I wish to discuss the future of community nursing, mental health services and the provision of care in West Surrey as well as in north and mid-Hampshire. Much of the complex detail has not been thought through or carefully argued, but the proposal is that there should be no community beds in the hospitals in Farnham, a town serving more than 40,000 people, and Haslemere, the town with the highest elderly population in Surrey whose hospital also serves people from Sussex and Hampshire. It is suggested that there should be a temporary reprieve for Milford hospital, an isolated hospital far from a local community and with no available transport services.

The proposals have been made following the Government's election and less than two years after the health authority came forward with plans, after careful and detailed deliberation and debate, that at Farnham there certainly would be a 42-bed community hospital, a stroke rehabilitation unit and a day hospital. At that time, the health authority chairman and the other members of the team gave their word that those plans would settle the future of Farnham hospital. I have just looked at the trust's publication for the plans for the health service in that area for 1999–2000. It, too, reasserts the commitment to Farnham hospital and its future.

I issued a leaflet shortly before Christmas to confirm with the trust that the plans for the hospital would still proceed, and I was given the affirmation that they would. I make my points with strong feeling, because I worked extremely hard—for well over 100 hours—with the people across the area to lower their expectations. People need to understand that change is necessary and that the patterns of the past cannot continue in the future. I had the absolute assurance that the plans would go ahead and, after much pressure and persuasion, people were prepared to accept the project for a 42-bed hospital which is now apparently to be abandoned.

Such a level of betrayal has profoundly affronted people across the Waverley area and West Surrey. That is particularly so because the community hospitals in the north of the area—in Weybridge, Woking and elsewhere—are to be saved. Worse than that, in the Hampshire health authority across the border, the Fleet hospital will continue to have community beds.

I wish to quote Dr. Raw, one of the most distinguished and long-standing general practitioners in Farnham. He is not given to militant language, but he said that the Farnham doctors are horrified at the failure of the authorities to build a proper community hospital for a town of 38,000 people with a larger catchment area and a significant elderly population, when other new facilities are springing up all over the country. Such a building requires a range of hospital facilities, including day care and beds for both the elderly and General Practitioner use. Mary Neville of West street, Farnham, said It is so ridiculous to think that care in the home will take the place of rehabilitation beds in the hospital when we all know that Social Services are totally understaffed and underfunded. The fact that somehow we are all going to be packed into Frimley or the Royal Surrey, when necessary, when they are already filled to bursting is totally unrealistic. They did at least confess that they had reneged on their agreement on The Right Balance, but to tell us that it is a privilege to have a Community hospital in a town of this size, rather than a right, took some swallowing. Some years ago we had five hospitals and now we will have one "bedless care centre", illustrating the pathetic state of the NHS and the insensitivity of the Health Authorities to the needs of an ageing and growing population. In the Haslemere area, Dr. Taylor—an extremely distinguished senior partner—explains: Haslemere will lose the opportunity to be treated in a high quality community hospital environment greatly respected and originally paid for by the local community. This type of care cannot be found in a nursing home, which lacks specialist nursing and support of pathology, x-ray and in-house services such as physiotherapy, occupational therapy and dietetics. I have been overwhelmed by letters, and I can only apologise to my constituents that it is not possible for me to do justice to the great number who have spoken to me.

There have been a series of meetings in Farnham and Haslemere. Only with reluctance did the health authority chairman attend. However, he came and, I hope, was taken aback by what he heard. The letters that I have received show that people do not believe that the health authority was responsive, listening or behaving in the way we are now told it should in terms of partnership and trying to regain public confidence in the health service.

Mrs. Green of Brambletonn avenue, Farnham, said: The attitude of the platform, despite declaring that they were there to listen, indicated that the audience was wasting its time because the Health Authority knew best and the plan to close the beds was the only way forward. The local feeling has been inflamed by successive comments from the Government, suggesting that the direction of travel is one that is sympathetic to the concerns of local people. The Secretary of State, in his new health network speech of 6 June, referred to the national plan: an unfortunately chosen name, following George Brown's national plan. The right hon. Gentleman said that the audit will confirm that older people are currently poorly served by the lack of intermediate care beds, with up to a fifth of hospital beds occupied by patients who could be getting better care elsewhere. That is the case in Farnham and Haslemere, and local people are up in arms.

Recently, an Audit Commission report confirmed the need for the facilities that are currently available at Farnham and Haslemere. Of course intermediate care is a sensible idea, and we should care for people in the community wherever possible. But, as with mental health services, there is a need for some beds and some community beds. The idea that nursing homes can pick up the strain, with their fragmented provision and without the integrated care pathway and the coherent care given by nurses in the community hospital who have a close working relationship with GPs, is ridiculous. It would lead to enormous pressure on GPs.

There is already tremendous difficulty in finding nursing home places and this has been exacerbated by deliberate policies from the Government. In my area, under this Government, we have seen a severe deterioration in services. I am afraid that the Government are not given to openness in information, but I pay a warm tribute to the Library. Time and again, I ask either the health authority or Ministers for information that they are simply not prepared to give. Somehow, miraculously, the Library seems able to find it.

Let us discuss equity. One person in eight has been waiting for in-patient treatment in West Surrey. In the Prime Minister's area of Durham, the figure is one in a hundred. I do not think that that represents equity and neither do my constituents. I have always regarded the number of people waiting for more than a year as the absolute test for an adequate health service. I say that partly because, when I was a Health Minister, the number waiting for one year went from 200,000 to 4,000. I wish that I had eliminated the waiting list altogether. Since the election, the percentage waiting more than a year has doubled in West Surrey. The number of finished consultant episodes went up by 0.8 per cent. in my area and by 5 per cent. in Durham. The number of district nurses and health visitors per thousand of population rose in Durham and fell in West Surrey.

Behind those figures lies the fact that the Government have taken steps further to distort the funding formula, so the gap between West Surrey and Durham is now £115 a head. The Government have top-sliced more and allowed less to come out in the distribution so that they can fund projects such as the £12 million census on the NHS, which was met with derision by health staff and members of the public. That sum would have covered the £7 million that my health authority has been told that it needs to find.

Dr. Taylor commented that the £583 per capita payment for people in West Surrey is due to fall further to £570. There are 632,000 people in West Surrey, so if the payment falls by that £13 a head, the amount raised will be £8.2 million, which would also cover the £7 million needed by the health authority. However one looks at the figures, there is a postcode lottery for health care funding.

The Minister will say that there are many prosperous people in my constituency, and that is true, but there are many impoverished people, and they live in a high cost area. I fail to understand why somebody living on social security in an area such as mine should have a much worse service than somebody living on income support in the Prime Minister's constituency. Mrs. Daphne White, of Long Garden place in Farnham, put it well when she said that the people of Farnham are devastated by this news, but we realise that the Government are not concerned about the people living and paying astronomical taxes in this country. The last thing they are concerned about is their welfare. I am afraid that local people feel very bitter indeed.

After I had spoken to the Secretary of State and many other Ministers, and said that in three years there had been no ministerial visit to West Surrey and that I did not believe that that indicated proper stewardship of the health service, the Under-Secretary finally arrived. Her visit coincided with the opening of a side ward at the accident and emergency unit. I thought that she would like to know what the situation was in June at the A and E unit at the Royal Surrey County hospital.

Mr. Groves wrote to me to say that on 28 and 29 June he spent 34 hours in the A and E unit: 10 hours on a hard stretcher and 24 hours on a bed. While he was there, he was told that at one particular time some 20 patients were on stretchers outside the A and E ward. There was no flu epidemic and it was not winter.

We have an excellent general practitioner in Haslemere, Dr. Ridsdill Smith, who says that the casualty department at the Royal Surrey County hospital is under such pressure that patients are routinely left on trolleys overnight or, more recently, on allocated chairs. Besides the increased risk of bedsores and the danger of leaving cardiac patients in casualty, there is the sheer depravity of 50 ill people sharing one loo and shower. The hospital is undergoing a bed crisis in midsummer. There is no capacity to decrease chair and trolley numbers, let alone community beds.

There has been a rearguard action to try to pretend that the Royal Surrey has problems of its own. My hon. Friend the Member for Guildford (Mr. St. Aubyn) has spoken eloquently about the hospital's excellence, strength and efficiency. It is under huge pressure to control its financial difficulties, which are caused by a formula that gives the region, which consists of a dispersed rural area as well as town centres, so savage steps have been taken.

The number of beds has declined by 12 per cent., from 350 to 307 since the Government have been in power. There was a slight reduction before they came to office. In addition, the number of beds to which patients can be discharged has been further reduced by 25, so the overall number of beds available in the Royal Surrey area has gone from 472 to 404—that is, 68 fewer beds, or a 14 per cent. reduction. That is why it is intolerable for people to be told that they may lose the community beds that are available for their use.

Let me make some points clear. I am not opposed to intermediate care, but it cannot cope with the unmet demand that we now face, let alone the extra demand from an ageing population. Intermediate care on the scale proposed is totally untried and untested.

I am not opposed to the health staff. Indeed, I have the highest praise and admiration for the nurses, doctors and other health staff. It is their distress, which has been communicated to me with great intensity over the past two years, that led me to see the Secretary of State privately before Christmas and to raise the matter repeatedly in the House. I remain deeply unhappy that the Government seem so extraordinarily insensitive to these matters.

The Godwin unit at Haslemere is a rehabilitation unit for young disabled people. I opened it myself. It was a rehabilitation project near the town, offering the quality of care and attention that was considered the most suitable. People there are being told that they might have an interim move to Milford, before moving on to an acute hospital.

Why are people so angry? They are angry because services have deteriorated to an unacceptable level while the Government have distorted the funding formula. They are angry because the Government's rhetoric implies that there has never been money like it in the NHS and the problems are over. They are angry because, two years ago, they were given assurances by the health authority that, yes, there would be difficulties in service provision, but the towns of Farnham and Haslemere would have their community beds. People are angry because they have no confidence that the health authority will act honourably, listen to their concerns and provide the local community with a service of which they can be proud.

This may be my last opportunity before the end of the consultation period to raise the matter in the House. I very much hope that the Minister will listen carefully and will be able to give people some encouragement. We are told that for the next three years, there will be an additional 6 per cent. above inflation for the NHS. The Hampshire health authority has taken those figures into account in its proposals. For no reason known to anybody, the Surrey health authority has chosen to disregard those proposals.

Since the previous plan, has the need for care changed? No. Has the financial position changed? No—except that we are told that there is more money coming through. It would be absolutely wrong to commit a long-term act of vandalism in the health infrastructure in West Surrey for reasons of short-term economic constraint.

1.33 am
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I congratulate the right hon. Member for South-West Surrey (Mrs. Bottomley) on securing tonight's debate about the future of Farnham and Haslemere hospitals. I hope that she will not mind my mentioning that the Prime Minister's constituency is Sedgefield.

My ministerial colleagues and I are fully aware of the concerns about health services in West Surrey. Indeed, we have debated them in the House on many occasions. The historical context is clear, but it is obviously not one that the right hon. Lady seems ready to accept. I shall deal with that a little later.

I admit to being surprised to read the title of tonight's debate on the Order Paper. As the right hon. Lady knows, and as she mentioned in some detail, current proposals on the future of Farnham and Haslemere hospitals are subject to full, public, statutory consultation. That is set out in West Surrey health authority's "Sustainable NHS Strategy" consultation document. Consultation commenced in May of this year, and will not close until September. The usual consultation period is three months; in the case of West Surrey, it will be almost four months.

The right hon. Lady knows perfectly well that if, following consultation, the local community health council objects to the health authority's final proposals, the matters will be referred to Ministers. Until then, we must remain impartial and not be seen to be influencing any decision. We must not, and I will not, prejudge the outcome of any local consultation.

At times, I find it tiring that some Members of the House constantly run down local services and refuse to accept any form of change, but it is encouraging that others take the time to acknowledge progress. The right hon. Lady said that change is necessary. However, it is interesting that there were no substantial or contentious changes in West Surrey between 1989 and 1995. On the consultation, it is important to put it on record that we want local people to have an input on shaping services in the area.

Mrs. Bottomley

Will the Minister give way?

Ms Stuart

May I please continue?

That is why I established an independent advisory panel made up of a cross-section of local people that will help to advise the health authority on the future strategic direction of NHS services in the area.

Mrs. Bottomley

Will the Minister give way?

Ms Stuart

Just for once, I would like the case on West Surrey to be listened to. It would be helpful if we both listened.

Mrs. Bottomley

Will the Minister give way?

Ms Stuart

This is the one and only time that I shall give way.

Mrs. Bottomley

The Minister should be better prepared. There have been major changes at Farnham and Haslemere and maternity services and surgery were lost at both hospitals. On both occasions, I tried to lead the local community to accept those substantial changes and there have been many other alterations, including similar ones at Milford. The assurance was given that community beds would be retained. The Minister's remarks are not accurate.

Ms Stuart

I will not revisit old ground. I want to put on record the coherent, rational case and I should be grateful if, just for once, it was listened to.

As I have said many times, we inherited a health service that spent more locally than it was allocated. Even our generous funding increases—West Surrey health authority received £401 million for this year, which is a cash increase of some £30.7 million—were not enough to enable the health authority to meet its statutory duty to balance its books on a recurring basis. I put it on record that the funding per weighted head in West Surrey is £706. The national average is £688. For County Durham, the figure is £674. Although base funding per head in West Surrey is £633, weighted funding is above the national average. That must be accepted. This is not a matter of debate, but a matter of fact.

The health authority has stated that the aims of phase 2 are to achieve stability and to ensure that services in the area build on best practice and are fit for the 21st century. The services are about providing more care closer to people's homes, in either expanded health centres or local care centres. The intention is that the new primary care trusts will provide or co-ordinate all primary, community and a range of other services for local people. Local people will have access to modern, up-to-date facilities and be treated with the latest technology. The health authority plans a network of care to prevent unnecessary admissions to hospital and to ensure that patients are discharged as soon as their treatment is completed.

Positive progress has been made in West Surrey, despite the problems of neglect that we inherited. We cannot ignore the fact that the NHS had too few doctors and too few nurses. Three quarters of accident and emergency departments needed modernisation. The NHS was crying out for the biggest building programme in its history, but was stuck with a party content to spend funds on consultancy fees rather than construction fees. NHS debts, which were being built up year on year, amounted to £450 million. The right hon. Lady's own health authority, West Surrey, managed to build up a deficit of £18 million. Average real-terms growth over the full 18 years of Conservative government amounted to just 3 per cent.

After 18 years of neglect, we have started to put that right with the largest hospital building programme in the history of the NHS. There are 5,000 more nurse training places and more than 10,000 extra qualified nurses already working in the NHS. The number of doctors has risen by nearly 5,000. By 2005, we will have increased the number of medical school places by more than 1,000—the biggest increase in a generation.

I could go on. However, all this seems to have passed by the right hon. Member for South-West Surrey. We have heard again how, according to the Opposition, the Government are failing people in West Surrey, but that is not the case. Four million pounds has been invested in health-care facilities and community hospital services, £300,000 has been invested to open a 16-bed medical admissions unit at Royal Surrey County hospital, and Frimley Park hospital has received £525,000 for new X-ray and information technology equipment.

As part of our £20 million boost for revolutionary on-the-spot booking systems, both Ashford and St Peter's and Frimley Park, in conjunction with local primary care groups, have been chosen for pilot projects. Doctors will now be able to book dates for operations at times that suit patients. Two new primary-care walk-in centres have opened, serving Weybridge and Woking. These are new services, responding to the needs of the population and to changed life styles.

Surrey Hampshire Borders NHS trust is to receive a brand new trailer to further improve its breast screening services, and replacement ultrasound facilities have been provided. NHS Direct has proved a huge success. The right hon. Lady has described it as peripheral and frivolous, but nearly 12,000 people have called it in West Surrey. The calls were taken by Surrey Oaklands NHS trust.

Again, I could go on, but I sometimes fear that that serves no purpose. My son once said to me, "The fact that I can hear does not mean I am listening." I sometimes feel much the same here.

The positive steps that I have described show not only that West Surrey is able to offer its community modern services, but that the Government are prepared to match their plans for the NHS with extra investment in local services. Those services have been improved only thanks to the Government's commitment to modernising the NHS—a commitment that the Conservative party did its best to destroy.

I strongly believe that, in West Surrey and across the service, there are the courage and conviction to make changes—to face up to the needs of the population but also to respond to technological changes and changes in the way in which services are delivered. It is a tragedy that the only people who do not have the same courage are Opposition Members.

Let me say a little more about the independent panel. It is important to us for local consensus to be achieved: that is why the normal consultation process is supplemented by the panel's work. In some areas, I have seen it working to reach a genuine local consensus involving all stakeholders from different parties. I know that in West Surrey other political parties are engaging in constructive debates, asking what the best option is when choices must be made. That is what we are trying to achieve, and I am sorry that the right hon. Lady does not agree with me.

We have presented a coherent strategy to address the problems that have been allowed to build up. We are not prepared to let any authority fail to meet its statutory duty to live within its means. Modernisation means a reconfiguration of services, but always in the interests of the local population. The fact that we disagree with others does not mean that we are wrong. We are consulting local people, and have shown our commitment by investing extra funds.

I know that I keep returning to this, but the weighted per-head figure in the right hon. Lady's area is £706, which is well above the national average. Any accusation that we are starving the area of funds simply does not make sense.

I hope that all the politicians in the area will engage in constructive dialogue—I know that some already do—and will have the courage to face up to what change means.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to Two o'clock.