§ Motion made, and Question proposed, That this House do now adjourn.— [Mr. Caplin.]
§ 6.2 pm
§ Sir Michael Spicer (West Worcestershire)
I am delighted that the Under-Secretary of State for Health, the hon. Member for Tottenham (Mr. Lammy), will respond to the debate. I confess that I would have been even more delighted if the Minister of State, Department of Health, the hon. Member for Redditch (Jacqui Smith), who has just left the Chamber, were responding because she knows Malvern very well. I first met the hon. Lady when she was a student at the Chase school in Malvern and I was addressing the sixth form. So great was my eloquence that she immediately rushed off and joined the Labour party.
Coming straight to the point, I have some questions for the Under-Secretary. First, do the Government still support the policy of developing community hospitals'? Secondly, following on from that, do the Government support the community hospitals of Malvern and Pershore? It is hard to exaggerate the importance that my constituents attach to both hospitals. Each hospital has served the surrounding area for around 100 years; each is an essential feature of the community; and each has provided a highly cost-effective service for the elderly and the dying, and above all, in recent years, those recuperating from treatment in the high-cost acute hospitals, particularly, this year, the new Worcestershire Royal hospital.
The great benefit that both community hospitals provide is that patients can recover close to their home and family at a cost that is far lower than that of the large acute hospitals. For that reason, residents of Malvern and Pershore and the surrounding villages have for many years cherished the hospitals and subscribed generously to their respective associations of friends. Each hospital, in different ways, is suddenly under threat. Malvern hospital has reached the point where it needs massive renovation and refurbishment. That has been anticipated for many years, which is why, for most of the period during which I have represented Malvern in Parliament, the hospital authorities have had a firm intention to rebuild the hospital. The previous hospital authority secured a site for precisely that purpose several years ago at Seaford court. In recent years, the plan for a new hospital has been analysed from every viewpoint, including the prospect that it might be subject to a private finance initiative.
Year after year has passed without a final decision being made. The current position is that South Worcestershire primary care trust has further postponed a decision until, it says, the summer. It is now essential that a decision to go ahead is made within the next month or so, otherwise the present hospital will fall into disrepair beyond redemption. My third question to the Minister is, therefore, what is to happen to Malvern hospital? What is its future? I hope that the Minister can provide some positive news.
Pressing as is the case for a new hospital in Malvern, a crisis point has been reached in Pershore, caused by the sudden announcement in the past few weeks by South Worcestershire primary care trust that it intends to close Pershore hospital in its present form and transfer 877 patients to 25 beds in a new, yet-to-be-completed residential home for the elderly at Heathlands. That plan has a number of unacceptable features. There are serious doubts about the suitability of a purpose-built home for the elderly for partial conversion into a hospital. At a basic level, it is not clear that special hospital beds will fit into the separate bedrooms as currently designed, nor that the present configuration of the ground floor, which has been designated as the hospital section, would allow for the proper movement of trolleys and patients.
Even if the necessary money could be found for the conversion, questions arise about the propriety of running a residential home above a hospital. For elderly people, the prospect of having to share an entrance with the hospital is likely to be distressing. The proposal flies in the face of the accepted need for more residential places for the elderly in the county to avoid bed blocking, particularly in the expensive acute hospital in Worcestershire. It is ironic that we should be discussing that immediately after the passage through Parliament of the Community Care (Delayed Discharges etc.) Bill. The proposal would mean losing 25 badly needed beds for elderly residents. Indeed, I understand that those rooms have already been assigned to specific people, who have even chosen the colour of their wallpaper. Their future is now in limbo, as is that of people suffering from dementia, who will have no place in Heathlands if the proposals go ahead.
It is all quite unsatisfactory. The idea of exchanging a purpose-built hospital with facilities for minor injury operations, day rooms and proper wards for a makeshift facility with inadequate parking, limited access for ambulances and no minor injury theatre makes no apparent sense at all. At best, the proposal is likely to be unstable. It is made in the context of the failure of South Worcestershire primary care trust, despite repeated assurances to me to the contrary, to honour its commitment to reopen the minor injuries unit at Pershore hospital, as it promised to do when it was temporarily closed because of staff shortages.
In Worcestershire, the word of the primary care trust is not considered to be its bond: put bluntly, my constituents do not trust the SWPCT. That is particularly so because of the reasons that the trust has given for making the move. It claims that that will help to address a deficit, which it says it inherited from the Worcester area health authority. There is a good deal of muddle about the size and nature of that deficit. For instance, was it inherited debt or is it recurring debt? That has not been fully established. What is the size of it? Is it 1 or 2 per cent. of the PCT's annual budget? That has not been properly established, either. My fourth question to the Minister is, what are the facts about the deficit and, if it exists at all, how can the Pershore hospital proposal solve it?
If the primary care trust carries out its proclaimed intent to sign a long-term contract with the Heart of England housing association, the owners of the residential home, it is difficult to foresee how any recurring savings would be made from exchanging a purpose-built hospital for one that is not purpose built. The servicing of 25 individual rooms. for example, must 878 be a much more expensive proposition than running purpose-designed wards. What will be the effect on the inherited deficit or on any recurring deficit?
§ Mr. Peter Luff (Mid-Worcestershire)
Can my hon. Friend confirm that if a capital revenue were to accrue to the South Worcestershire primary care trust arising from the sale of the current site of the Pershore hospital, it could not be used to pay off the deficit because it would be capital money, not revenue money? It would be in a separate pot, so it would not contribute to solving a deficit problem.
§ Sir Michael Spicer
That is an interesting question, and it is one of the reasons why it is important to sort out the deficit issue and establish whether it is a recurring current account deficit or whether it can properly be attributed on the balance sheet to the past and be treated as a capital amount. Those are important questions, and my hon. Friend pinpoints a significant aspect.
Part of the growing anger in Pershore stems from the nature of the consultation exercise now under way on behalf of the South Worcestershire primary care trust. The consultation exercise has been truncated to eight weeks. There have been no costings or time scales. It has failed to anticipate the obvious objections and problems. Surrounding villages whose residents look to Pershore hospital have not been consulted. I imagine that my hon. Friend has such villages in his constituency. Above all, the consultation has made no effort to consider the alternatives.
Untested assertions have been made at public meetings. and invariably no supportive evidence has been provided. For example, it has been argued that to rebuild the existing hospital using private finance would be unviable because planning permission would not be forthcoming to provide the land and scope for adequate parking and ancillary services. There is no evidence to suggest that the planning authority, Wychavon district council, would take such an outright negative position with respect to the height of the building or to the change of use of the land behind the present hospital.
It is clear that car parking could be provided adjacent to the present site, which would allow the hospital to be rebuilt to an adequate size on the existing site. It is unacceptable that this alternative has not been considered as part of the proposals put forward by the PCT in the consultation process. For all those reasons, the suspicion remains that the current proposal is a smokescreen for closing the Pershore community hospital outright.
So my fifth question to the Minister is this: will he require the South Worcestershire primary care trust at least to consider alternative proposals to rebuild or refurbish Pershore hospital on its present site, or on any other appropriate local site, and in so doing, supply the public with proper costings, which it has not done to date? He at least owes it to the taxpayer, who is about to inject an additional £18 million next year into the bank account of the South Worcestershire primary care trust, to ask why that extra money is to coincide with a threat to the future of two hospitals for which it has direct responsibility.
My sixth and final question to the Minister is this: will he publish his understanding of how it is intended that the millions of pounds of taxpayers' money that will be 879 injected next year into the South Worcestershire primary care trust will be spent? It makes no sense whatever to my constituents that, on one hand, taxes are going up to pay for health, while on the other, hospitals are threatened with closure. If that pattern is repeating itself nationwide, he must be a very worried man. That would be further evidence of an emerging feature of the Government's policy on public services, in which more cash seems to go hand in hand with lower quality of service.
The Government have a responsibility to the nation to ensure that the money raised from income tax is not siphoned out into a morass of administration and wasted expenditure. That is precisely what seems to be happening in West Worcestershire, where the Minister must intervene at least to the extent of being able fully to answer the questions that I have put to him. Let me very briefly summarise those questions. First, does he support community hospitals in general, and in Malvern and Pershore in particular? Secondly, does he reject the notion that South Worcestershire PCT inherited a debt that justifies the proposed closure of the existing Pershore hospital? Thirdly, does he agree that the PCT should at least come up with options involving the continued existence of the hospital in Pershore, either on its present site or on another appropriate local site? Finally, is he satisfied with a situation in which closure of a community hospital is proposed when, at the same time, taxpayers are pouring millions of extra pounds into the area?
If the Minister cannot answer all those questions on the spot, I hope that he will at least write to me before the weekend.
§ Mr. Michael Foster (Worcester)
An opportunity to discuss the health economy in Worcestershire is always welcome and I congratulate the hon. Member for West Worcestershire (Sir Michael Spicer) on securing a debate on Pershore and Malvern hospitals. Although those hospitals do not serve Worcester directly, they have an impact on the south Worcestershire health economy, and I view Worcester as the capital of south Worcestershire, if I may put it that way.
The hon. Gentleman made a very important point about the role of community hospitals in providing care to support our acute hospital system in Worcestershire. Patients may go to the community hospital for observation before being admitted to the acute hospital, or not admitted, as the case may be. The community hospital also allows people to be discharged from the acute hospital into an area where an appropriate level of care can be given. As he said, that care is in a less intensive and therefore less costly form. The role of community hospitals, be they in Pershore, Malvern or Evesham in south Worcestershire, is very important to the Worcestershire health economy.
Delayed discharges from the acute trust are a problem. We have debated that issue in the Chamber previously and it is to be hoped that we made some progress on it earlier today. The issue flags up the question of Worcestershire's capacity to deal with the health needs of the county and south Worcestershire in particular.
That is why I welcome the opportunity to debate the future of Pershore and Malvern hospitals. These hospitals have a lower bed occupancy rate than the 880 acute trust, which gives the health economy a little bit more flexibility to operate creatively in seeing people move from acute hospitals to more appropriate forms of care. Bearing that in mind, however, I discovered earlier this year what I believe to be a form of discrimination against my constituents in Worcester and against people living in the northern part of the south Worcestershire area, in terms of how the relationship between community hospitals and the acute trust works. I shall give an example. If two patients—one from Pershore, the other from Worcester—were in an acute hospital but no longer needed acute care and were awaiting discharge, and two beds became available at the Pershore community hospital, the Pershore resident would pretty much automatically go to that hospital. The patient from Worcester, however, would not, even though it would be more appropriate to transfer that person to the Pershore environment. That is because the community hospitals serve the smaller towns and villages in south Worcestershire.
When I raised this issue with GPs from the local medical committee, they confirmed that that was indeed the case. My constituents are being discriminated against in terms of how the hospitals at Pershore. Malvern and Evesham currently work. Will the Minister look into this form of discrimination?
§ Mr. Luff
The hon. Gentleman is making an important point. I know, however, that, in the case of Evesham—on which I can speak with authority—the South Worcestershire primary care trust regards the hospital as the property, as it were, of the whole south Worcestershire health economy. It is certainly the trust's intention that people from all over south Worcestershire should be able to use it when they are discharged from an acute hospital. To be fair to the trust, it is taking this issue on board and dealing with it.
§ Mr. Foster
I can confirm that the South Worcestershire primary care trust is indeed taking this matter up. It has confirmed that the form of discrimination that I have just outlined can occur, and it is endeavouring to ensure that it is cut out, so that we can view south Worcestershire as a single health economy, rather than as distinct geographical locations. That is why I would like to ask the Minister to look into this matter.
This debate flags up the issue of whether Worcester as a city, and perhaps the northern part of the south Worcestershire area, should have some form of community hospital capacity. I put it on record that we in Worcester may have to campaign for a community hospital, so that we can get the type of care from which residents in the more rural parts of the county benefit, and from which those in the heart of Worcester currently do not.
§ Sir Michael Spicer
Surely that is the answer to the conundrum that the hon. Gentleman described at the beginning of his speech. He seemed to be implying that people were being prevented from going into hospitals in areas close to their families. Patients having their families close by as one of the advantages of such 881 hospitals; that is why they are called community hospitals. The answer to the hon. Gentleman's conundrum is surely to have one for Worcester as well.
§ Mr. Foster
I am most grateful to the hon. Gentleman for that intervention, because I was about to ask the Minister to support such a campaign for a community hospital in Worcester and to ask my colleagues from Worcestershire to do so as well, as there would be benefits not just for the residents of Worcester. There would also be knock-on effects for the more rural areas of the county.
I would also like to ask the Minister what I think are some pertinent questions, given the contribution made by the hon. Member for West Worcestershire. If the Minister does not have the answers to hand, perhaps he could write to me to put them on the record. There has been an increase in the rate of national insurance contributions, and the money raised by the Exchequer is to pay for improvements in the national health service. How much of that increase will go into the Worcestershire health economy? In particular, how much will the South Worcestershire primary care trust get as a result of the increase?
Will the Minister also make an estimate of the impact that there would have been on south Worcestershire—particularly on Pershore and Malvern hospitals—if national insurance contributions had not been increased? That is a relevant question to ask. Will the Minister also confirm which Members of Parliament from Worcestershire voted in favour of the increase in national insurance contributions—
§ Mr. Deputy Speaker (Sir Michael Lord)
Order. I must remind the hon. Gentleman that this is not his debate. It was initiated by another Member and its context is quite specific. He has not yet strayed too far from the future of Pershore and Malvern hospitals, which is the subject of the debate, and I should be grateful if he would stick to that.
§ Mr. Foster
Thank you, Mr. Deputy Speaker. I am inclined to get a little carried away when I try to protect the national health service in Worcestershire, whether that is Pershore or Malvern hospital.
Will the Minister make an assessment of what would happen to Pershore and Malvern hospitals if there were a 20 per cent. cut in the budget of the South Worcestershire primary care trust? That would have great relevance to my constituents arid those of the hon. Member for West Worcestershire. I support the call for clarification on the future of Pershore and Malvern hospitals, and I put on record again my intention to campaign for a community hospital facility for the heart of Worcester.
§ Mr. Peter Luff (Mid-Worcestershire)
It is a rare privilege to have such time in which to debate the health economy of Worcestershire. These debates are usually dominated by concerns about the north of the county, which are often expressed by the hon. Member for Wyre Forest (Dr. Taylor). It is good that the three hon.
882 Members who represent the south. Worcestershire health economy—that is rather an ugly phrase—are able to participate in a debate on the important question of the future of Pershore and Malvern hospitals and the implications and lessons of the consultation that is currently being conducted. I am specifically concerned with the consultation on Pershore hospital.
I congratulate my hon. Friend the Member for West Worcestershire (Sir Michael Spicer) on having the good luck to secure a debate on a subject that is important to his constituents. I shall not tread on his toes too much because Pershore hospital is firmly in his constituency, but he was kind enough to say that many of the villages to the north of Pershore look on that hospital as a health service that is valued and appreciated. Wyre Piddle parish council, especially, shares my hon. Friend's concerns about the inadequacy of the consultation. I have advised the parish council on how to contribute to the consultation but it remains deeply concerned.
I am glad, in most respects, that the hon. Member for Worcester (Mr. Foster) made his contribution and that he agrees that Worcester has a capacity problem. That is common ground between us. Ensuring that the Worcestershire health economy—I do not like the phrase but I shall use it—has an adequate capacity is an important challenge for us all. I agree that the solution to the problem is not closing community hospitals. Indeed, the solution might be to create community hospitals in addition to Pershore and Malvern.
I heard what the hon. Gentleman said about Worcester and I shall make a brief case for Droitwich in the north, although it is not strictly a matter for the debate, because that is short-changed by its community health care facilities. I know that the primary care trust, the town council and other bodies are considering how to improve the situation.
I was sorry that the hon. Gentleman adopted more of a party political approach towards the end of his remarks. He made a point that I shall briefly rebut. No one has ever talked about cutting public expenditure on the health services for Worcestershire, Pershore, Malvern or anywhere by 20 per cent. That is an invention of the hon. Gentleman—and other Labour Members—and a product of his febrile imagination. No one is considering that, and no one in their right mind would. I hope that he will stop making such a ridiculous allegation.
I want to address the consultation process on Pershore hospital and the precedent that it might set for the wider consultation on changes to health care provision that is being held throughout south Worcestershire. Consultation will be held on Evesham community hospital later in the year, and it is tremendously important to get those consultation processes right.
The point of my speech is to ask the Minister a central question. Is he satisfied that the consultation on Pershore community hospital is legal under section 11 of the Health and Social Care Act 2001? People in Worcestershire are seriously worried that the consultation could be open to legal challenge and that the primary care trust has not conducted it properly. That is not necessarily a criticism of the PCT, although its chairman is a leading supporter of the Labour party. I thought that he might have been aware of his own 883 Government's policy, but my views on his position are well known. However, there is a problem because of the deficit, which my hon. Friend the Member for West Worcestershire rightly mentioned often during his speech.
The South Worcestershire primary care trust had a small, inherited deficit, which has increased this year. The Government say that it must eradicate the deficit. I have asked parliamentary questions about the length of time that the Government will give the primary care trust to eradicate the deficit, and I found the answers a little frustrating. We know that the consultation on Pershore and the wider health care changes in South Worcestershire is driven by anxiety about the deficit.
The consultation on Evesham hospital is unlikely to be driven by the deficit. I believe that, for the reasons that the hon. Member for Worcester gave, the primary care trust genuinely supports Evesham hospital's continuation and wants it to flourish. However, that will doubtless involve a change in the pattern of service provision. Again, the consultation on Pershore will create the climate for that on Evesham hospital. We must therefore be satisfied that the Pershore consultation is being conducted properly.
Two documents apply to the debate. Malvern is not yet the subject of a document. They are entitled "Modernising Health Services in Pershore" and "Proposed changes to healthcare provision in South Worcestershire". Both are rather coy about the genuine reasons for the policies that they propose.
Let us consider the legality of the process. We held an interesting debate on 11 March in Westminster Hall during which the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), outlined the guidance in "Keeping the NHS local—a new direction of travel". I do not want to quote her out of context, and I shall therefore read the relevant paragraph. She said:The guidance has three core principles that will in future underpin everything that we do in this field. The first principle is that options for change should be developed with patients not for them, and that before we even start to formulate preferred options, we have a sense of sitting down right at the outset to design what services should look like—their essential features—and where they should be. In the NHS in the past, a preferred option would emerge and people were presented with it almost as a fait accompli.To me, the consultation on Pershore is an example of old-style NHS consultation. A "preferred option" has emerged and people are being are being presented with italmost as a fait accompli.The Under-Secretary went on:Consultation was sometimes simply the expiry of a period of time, people would do the first thing that they had thought of, and the process was not altered by the involvement of the public. The first underlying principle is that we develop proposals for change in consultation with local communities and that we start at the outset to think about what service redesign should look like.Later, she mentioned the legal basis for the framework guidance in section 11 of the Health and Social Care Act 2001. She said that itplaces a duty on the NHS to make arrangements to involve and consult the public in everything that it does. Under that new statutory framework, the NHS has a duty to involve the public in planning and developing services and in making decisions about how services will operate."—[Official Report, 11 March 2003; Vol. 401, c. 56–7WH.]884 She said more but I shall not detain hon. Members with an overlong quote.
Section 11 of the 2001 Act, which should guide consultation on the future of services such as those at Pershore and Malvern, came into force from the beginning of the calendar year, but the guidance was published in February. The document is entitled "Strengthening Accountability". It includes a moving foreword by the Under-Secretary who will reply to the debate. It stated:To achieve our aim we will involve and consult patients and the public in how health services are planned and developed … Patient and public involvement is not an end in itself but a way of achieving three fundamental objectives: strengthened accountability to local communities; a health service that genuinely responds to patients and carers; and a sense of ownership and trust.The conduct of the Pershore consultation sets a worrying precedent for the wider consultation in south Worcestershire and the later consultation on Evesham. That sense of ownership and trust simply does not exist. There is genuine doubt about the underlying purpose.
The document does not mention the financial implications but we all know that they drive the consultation. Subsection 6 on page vii, entitled "Executive summary" states:The overall aim of Section 11 is to make sure patients and the public are involved and consulted from the very beginning of any process to develop health services or change how they operate. This will lead to patient-centred care and improvements in the patients' experience.On page 1, we read probably the most important single passage in the document, which leads me to raise the question of the legality of the process at Pershore. It states:Section 11 places a wider duty to involve and consult patients and the public … no: just when considering a proposal but in developing that proposal".I submit that the public have not been involved in developing that proposal. They are being presented with a fait accompli, or rather five separate ones that constitute the preferred policy of South Worcestershire PCT for Pershore hospital. That is very worrying. I genuinely believe that the Minister's fine words are being undermined by the nature of the consultation process at Pershore. The sense of ownership and trust that the Government rightly want to engender—the objectives are splendid and I do not disagree with them—is at risk as a result of how the process is being conducted.
On page 4 of the document, we read:Within the NHS, planning will be from the bottom up.PCTs (and relevant care trusts), as lead planners will be responsible for creating local plans which describe health and service improvements in their area. These will be developed using local clinicians' knowledge as well as patients and the public.Of course, the trouble is that what is being proposed at Pershore as well as in the wider consultation on the South Worcestershire PCT proposals for overall service provision in my constituency and those of my hon. Friend the Member for West Worcestershire and the hon. Member for Worcester constitutes not an improvement, but service reductions. We are consulting on service reductions at Pershore and across south Worcestershire's health economy.
885 I try to be a fair man, but I find that difficult to understand. The hon. Gentleman rightly raised the question of the 1 per cent. job-destroying tax introduced by the Chancellor, which comes into effect this week. The hon. Gentleman asked, "The money is coming into south Worcestershire, but where is it going?" I too ask where it is going, because we are consulting on service reductions. I fear that that proves to me that spending more money does not always produce better services. The question involves the quality of that spend, which is what worries me about south Worcestershire, and Pershore in particular. Is the money being spent well?
On page 7 of the document, there is a list. It states:Pressure to change services may come from any number of starting points—both negative and positive. Some examplesof why a consultation such as that at Pershore may need to be conducted areoutdated buildings and facilities; new standards … evidence of what works, workforce pressures",and so it goes on. There is no mention of deficits or of budgetary problems, but they are driving the process here, which is perhaps why the consultation is being conducted so urgently and so cack-handedly and why, worryingly, it appears to be contrary to the law of the land passed by this House of Commons only two years ago. We also read:The principles behind this should be:designing services with local populations, not for them;solutions developed for health communities rather than individual hospitals or organisations".That leads to my other point about the Pershore consultation in particular. We have two documents, entitled "Modernising Health Services in Pershore" and "Proposed Changes to Healthcare Provision in South Worcestershire". Members should study the fifth proposal of the second document, on community hospitals. They might expect to read about modernising health services in Pershore, but no. There is no cross-reference at all. The proposal talks entirely about the joint health and social services day rehabilitation unit at Evesham community hospital. The proposal is not to make changes, but to send the bill to the county council. The unit cannot be afforded any more, so the proposal is to send the bill to a hard-pressed county council that has already had to increase its council tax enormously just to stand still on service provision. Fat chance of that.
So, where is the joined-up government—I think that is the phrase—in relation to Pershore? I repeat: the document refers tosolutions developed for health communities rather than individual hospitals or organisations".Surely there should be one document, "Proposed Changes to Healthcare Provision in South Worcestershire", which would put Pershore in that broader context, but that has not been done. The consultation on Pershore's future is panicky and individual. I will not quote the legislation, as I am sure that the Minister knows what section 11 does, although I have it here if he wants it. It is clear that a duty is imposed on the PCT, which it is not meeting.
886 I am grateful for the opportunity to speak in this important debate, but I must begin to draw my remarks to a conclusion. The document on Pershore shows every sign of being cobbled together in a great hurry. As a cheap debating point, I note that "Monday 31th" March is an interesting date for a meeting, but the real, important point is that the consultation process ends so soon—in four weeks.
The other document hints at—indeed, if read carefully, makes more explicit—the reason for the Pershore consultation. It identifies three aims:To improve performance … To provide an equitable, safe service … To 'live' within our NHS budget, and remove the £5.7 million recurring deficit".That, of course, is the issue.
This document makes five proposals, three of which involve sending bills to the county council and two of which involve cutting services. I will not talk at length about this because it does not relate specifically to Pershore, but I consider the cut in the GP counselling services outrageous. It is a simple cost-driven measure with no obvious clinical logic. Although a reason is presented in the document, I do not accept it.
People in Droitwich Spa and Evesham have raised with me the proposal to abandon all pulmonary rehabilitation services in Malvern. I believe that those services are based in a Malvern hospital. The question was asked:What is happening to the pulmonary rehabilitation service in Malvern?The answer was:This is being reviewed separately within the PCT involving our Professional Executive Committee of GPs and Primary Care Professionals.We hear fine words about joined-up services, rather than solutions for individual services. Here is a service provided in Malvern and serving the whole of south Worcestershire—Worcester, Droitwich and Evesham—and here is a fudge. We are talking about not a separate review, but a proposal to remove the only pulmonary rehabilitation nurse serving south Worcestershire. Meanwhile, trusts north of that area are considering employing such nurses, because they recognise their value in reducing the number of emergency admissions.
The crucial aspect of the Malvern service is that it serves the whole county, and allows a reduction in the number of emergency admissions in winter. Many emergency admissions are caused by respiratory diseases, but the trust is thinking of sacking the nurse in order to deal with its budgetary problem and ending a service whose users are understandably worried. This is not just a Malvern problem; it is a south Worcestershire problem.
Other proposals will reach the Minister's desk—proposals relating to Worcestershire, but extending beyond Pershore and Malvern—in the coming weeks and months. There will be further consultation. If the pressure on Pershore and Malvern and the whole south Worcestershire economy is to be relieved, the trust must be given a longer time in which to pay off its deficit. If it is forced to pay it off in a single year, there will be cuts and a loss of confidence in the process whereby the future of health services in my constituency and that of my hon. Friend the Member for West Worcestershire is 887 dealt with and consulted on. I urge the Minister to reflect on whether the consultation should be halted and begun again, in accordance with the law.
§ The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)
I congratulate the hon. Member for West Worcestershire (Sir Michael Spicer) on securing the debate. I know of his interest in health matters in his constituency, and of his long association with Malvern hospital. I also congratulate my hon. Friend the Member for Worcester (Mr. Foster) and the hon. Member for Mid-Worcestershire (Mr. Lull) on their speeches, and on their commitment to the hospitals in their area. I shall try to answer the questions asked by, in particular, the hon. Member for West Worcestershire and my hon. Friend the Member for Worcester, but if I cannot manage that this evening I shall write to them both in due course.
The proposals for community health services in West Worcestershire are complex. Three public consultations are being undertaken by South Worcestershire primary care trust. As all the proposals are out to public consultation, I hope that the hon. Gentleman will understand that I cannot comment on the details. However, I am willing to outline the context. Let me answer two of the hon. Gentleman's questions immediately. The Government are committed to community hospitals, and that includes those in Pershore and Malvern.
South Worcestershire primary care trust came into being on 1 April 2002. It has a population of approximately 280,000 across the south of Worcestershire. The geographical area stretches from Broadway in the east to Tenbury Wells in the west and from Worcester city and Droitwich in the north to Upton-on-Severn in the south. It manages community hospitals with a total of 132 beds—Evesham, Malvern, Tenbury Wells and Pershore hospitals.
The NHS plan outlines a series of challenges designed to deliver a 21st-century health service that puts the needs of each patient as the focal point of the system. South Worcestershire PCT, like all other NHS organisations, will benefit from the massive investment being made by the Government over the next three years. The resources available to the PCT will have increased by £59 million from the level in 2002–03, an overall increase of nearly 30 per cent. The hon. Member for Mid-Worcestershire raised the issue of the deficit, but that increase of £59 million, or nearly 30 per cent., will be a tremendous contribution from the Government to dealing with that problem. That is an indication of the Government's commitment to the area's health economy.
§ Mr. Lammy
It will go into the health economy and an overall package of services, and that will be clear to the hon. Gentleman's constituents. I will come to some of the proposals for the area later in my speech. He should tread lightly in that area, as it is Conservative Front Benchers who propose a 20 per cent. cut.
§ Mr. Luff
The Minister must understand that that is simply untrue. There is no parliamentary turn of phrase 888 that I can find to describe what he has just said, but there is an unattractive word with three letters that I cannot use in the Chamber. What he has just said is not true and I challenge him to produce a single quotation that justifies that preposterous and outrageous claim, because it has no basis in truth. I hope that I have made myself clear.
§ Mr. Lammy
That is a matter for the hon. Gentleman and his Front Benchers. The Opposition's policy is well known, in the Ho use and in the country. I am not attempting to be partisan on what is an important issue to his constituents and to the Government. The investment is going in, but there is a historic deficit and cuts would make the situation worse. It is right that I, as the Minister responsible, make the Government's position clear and that the hon. Gentleman's constituents understand the dividing line on the issue.
The set of challenges in the NHS plan, combined with unprecedented growth in investment over three years, gives South Worcestershire PCT the opportunity to plan for change and to deliver the principles of public sector reform—devolved, responsive, flexible services with choice for the people who use the NHS. In South Worcestershire, that planning has just been completed via the PCT's local delivery plan. The LDP matches investment over the three years to the challenges set out in the NHS plan to meet service demand needs overall, in particular for emergency and planned care. Overall, South Worcestershire has had a significant share of the resources and has planned sufficient capacity to deliver all targets.
§ Sir Michael Spicer
That is all rhetoric and political stuff that is not answering the questions that we asked. We accept that taxpayers' money will be spent in the area, but we want to know how it will be spent and how it can be that we now have worse services and two hospitals in my constituency under threat of closure. The Minister must address those precise questions, instead of giving us all that rhetoric that has been written for him by someone else.
§ Mr. Lammy
I hope that the hon. Gentleman will forgive me, but this is not rhetoric. I am setting out the position in his trust area. I am only three minutes into my contribution, and I hope that I will be able to move on and deal with some of the issues raised in the debate. However, people waiting for surgery and in-patient and out-patient appointments have seen the targets met, as have those waiting for emergency services. Now, 90 per cent. of people wait no longer than four hours, and tremendous progress has been made, in his constituency and elsewhere. It is unacceptable to suggest that services have somehow not improved. They are improving. They are getting better, and the money is going in. I need to repeat that.
If the hon. Gentleman is not happy with what I have said, he can take matter up in the usual way. Indeed, the hon. Member for Mid-Worcestershire mentioned section 11 and the duty of overview and scrutiny, and the normal way in which hon. Members and local people can take such matters up. Those are the normal mechanisms, and the hon. Member for West Worcestershire is free to use them if he is not satisfied with what is happening in his local health economy.
889 As I said, in South Worcestershire this planning has just been completed via the PCT's local delivery plan. That matches investment over these years to the challenges set out in the NHS plan to meet service demand needs overall and, in particular, for emergency and planned care. Overall, South Worcestershire has had a significant share of the resources and has planned sufficient capacity to deliver all targets. The strategic issue is to achieve the right balance between primary, community, secondary and social care.
That is particularly important in relation to maximising the benefits of having a new, private finance initiative, state-of-the-art acute hospital, and developing appropriate community-based services to enable people to be treated and cared for in the community, as far as possible.
Gradual change is being taker forward locally through a series of modernisation compacts between primary and secondary care, the implementation of first-class clinical governance systems, and the identification and delivery of improvements to clinical and service quality.
The PCT instigated a series of service reviews in November. The reviews lasted several months, and involved consultation meetings. Every general practitioner in Worcestershire was invited to those meetings, so that they could gain a degree of ownership of the reviews and the evolving proposals arising from them.
The PCT board met in February 2003 to receive a report on the service reviews and a consultation was proposed entitled, "Improving GP and Community Services in Malvern". In March, the board met and agreed to further consultations. One is entitled "Modernising Health Services in Pershore", and the other is called "Proposed Changes to Health Care Provision in South Worcestershire".
Agreement was also given to a series of public meetings to support the consultation process, with the community health council agreeing to host the meetings and feed back their conclusions. The meetings have started and are ongoing.
The consultation for South Worcestershire as a whole outlines proposals covering occupational therapy, GP-attached social workers, GP practice-based counselling services, sexual health, and the day rehabilitation services of community hospitals. The consultation on Pershore covers the options for the redevelopment of Pershore health centre and the expansion of Abbotswood medical centre. It also considers the provision of minor injury services, the community dental service, and a new community hospital of up to 25 NHS beds at the Heathlands development as a re-provision of Pershore hospital. The consultation covers substantive matters and it is hoped the investment that has gone into the local area will be spent wisely on those substantive matters to meet the point raised by the hon. Member for Mid-Worcestershire. The final consultation on better GP services and community healthcare for Malvern plans to bring the existing services of Malvern health centre and Court road surgery together, on one site and under one roof.
890 Without prejudice to the final outcome of those consultations, it is worth stating some of the public commitments made by the PCT in the context of the reconfigurations. That is particularly pertinent given some of what has been said, which, at least on my advice, is not the basis on which the consultations are being conducted. For Pershore hospital, the PCT gave in its public consultation a clear indication that it is seeking to retain a local hospital. The PCT also confirms that any new hospital would continue to provide the majority of services, with the possible exception that some of those services would be provided in a primary care setting. In addition, the latest proposals signify that overall bed numbers would in fact increase.
§ Sir Michael Spicer
Does the Minister really accept that a few beds in a purpose-built residential home that is pretty well completed is an acceptable definition of a hospital? If he does—I hope that he does not—what are the implications for the future of the residential home and, indeed, for the beds that will be lost?
§ Mr. Lammy
I have said that I do not want to prejudice the final outcome of the consultations, but I am advised that the staff are working in inadequate conditions and that patients deserve a more modern inpatient facility. The PCT wants the service to continue in the town, but the existing site is too small. The people of Pershore should have modern health care facilities, and these proposals mean that each patient would have a single en-suite room instead of the existing Nightingale multi-bedded ward.
§ Sir Michael Spicer
Yes, we have another half an hour.
When the Minister says that the existing site would not be big enough to rebuild a hospital on it, that is surely a prejudicial statement in itself. The fact is that there is plenty of room, subject to planning permission. The supposition is that planning permission would not be given, but that supposition is not accurate. He is trying not to prejudice the consultation process, but that does not tally with some of his comments—for example, defining a hospital as something inside a residential home, saying that we are going to keep a hospital, and saying that there is no room on the existing site. Of course, it has all been given to him by the PCT or by whoever wrote his speech—I do not blame him personally—but he must understand that he is prejudicing his own position by making those very assertive remarks. That is precisely what the PCT is doing, and precisely why I introduced this debate on the Floor of the House.
§ Sir Michael Spicer
That is exactly the point that I am trying to raise. As my hon. Friend the Member for Mid- 891 Worcestershire (Mr. Lull) and I have said, the problem is that the way in which the proposition has been couched allows for no alternatives. It has been asserted during the consultation process that the size of the existing site is insufficient. They have gone from one particular—
It being Seven o'clock, the motion for the Adjournment of the House lapsed, without Question put.
Motion made, and Question proposed, That this House do now adjourn.— [Mr. Caplin.]
§ Sir Michael Spicer
We have raised this issue precisely because of what has been said and because the consultation is flawed—possibly legally flawed. The problem with this debate is that one suspects that the Minister's speech has been written by the people who have already put the matter out to consultation. Those are the people against whom we are making various comments, hoping to hear some objective advice from the Minister.
I do not expect the Minister to answer without having thought the matter through with his advisers, but the least I expect of him is that he take on board the central point that the consultation process is flawed, perhaps legally. I hope that he will look into that and come back to us on why no options have been offered and why the money is going up but the quality of service at the hospital is going down.
§ Mr. Lammy
I am advised that there is genuine commitment to a community hospital in Pershore. That is the subject of consultation. It cannot be right that we should conduct that consultation among ourselves in the Chamber. That consultation should take place in the local community. The Government are committed to that consultation, and in January we introduced the section 11 powers, under the Health and Social Care Act 2001, to bring into being the overview and scrutiny committee. That was opposed by the Opposition, but the consultation is taking place.
§ Mr. Michael Foster
Earlier this year, I attended a meeting at which the chairman and chief executive of the South Worcestershire primary care trust gave a briefing on the proposals. I left the room believing that there was a genuine intention to keep the services at Pershore, and a genuine commitment to Pershore community hospital. I entered the room immediately after the hon. Member for West Worcestershire (Sir Michael Spicer) left. He had had a similar briefing from the same people.
§ Mr. Lammy
I ought to make some progress. As I was saying, we cannot conduct the consultation in this Chamber; it should be conducted locally. The Government gave overview and scrutiny powers to the community that the hon. Member for West Worcestershire represents so that people could take ownership of decisions. I ask the hon. Gentleman 892 whether he has met his strategic health authority to convey his views. I have heard Opposition Members talk about the challenges of centralisation and localisation. The Government are localising the health service through the establishment of primary care trusts and overview and scrutiny committees, and are delegating downwards and shifting the balance of power, yet not even two months into a consultation, I am being asked to intervene on what is clearly a local issue.
§ Mr. Luff
The Minister has been generous in giving way and as there are 26 minutes remaining, there will be a few more opportunities. I think he does not understand that the consultations are being held because of directions from the Government about the rate at which deficit should be repaid. It is not a localising issue but a centralising one: the Government are telling the primary care trust what to do through the strategic health authority. I realise that this is a legal matter and that the Minister may want to think about it, but will he at least promise to write to me about the legality of the consultation? The Pershore document asks:The existing Pershore cottage hospital is loved by local people why must it relocate?The question about relocation has been prejudged, completely contrary to section 11 of the Act to which the Minister rightly referred. There is a real issue in relation to the legality of a consultation that is being conducted only so that the PCT can meet the Government's targets. I urge the Minister to look into that and not to dismiss the real concern that I have expressed, which is not partisan but genuine.
§ Mr. Lammy
This is not the right Chamber in which to raise issues of legality. There are chambers of a different nature where they can be taken up. My understanding is that consultation is taking place and that we should at least allow it to finish before prejudging the outcome or the manner in which it was conducted.
Without prejudicing the final outcome of the consultations, it is worth stating some of the public commitments made by the PCT and their context. The PCT wants to retain a local hospital, and has made it clear publicly that it hopes that a consultation process relating to a new Malvern community hospital will be developed during the summer. The PCT recognises that the local community is becoming frustrated by the length of time that the process has taken. I accept the point that the hon. Member for West Worcestershire made about that.
The PCT is committed to the future of the two hospitals and will develop plans in accordance with the outcome of the public consultation. Several other local public consultations are currently under way on the provision of community services in south Worcestershire.
As I said, I am unable to comment in detail on the proposals while the consultation is going on.
§ Sir Michael Spicer
The hon. Member for Worcester (Mr. Foster) said that he had attended a meeting after which he and I had been assured that hospital services would be maintained in Pershore, although I must confess that that was not exactly what was said to me. 893 In that context, does the Minister think that, in general terms, it is suitable for residential homes to be partially converted to so-called hospitals? That is being proposed elsewhere, so it must have turned up on his desk as a general issue. Is it a good way forward?
§ Mr. Lammy
That depends on several things, including community-based provision in primary care and the needs of older people. As the hon. Gentleman knows, many older people do not want to be in residential homes; they want to stay in the community. In different health economies, depending on the demography of the area, there may be a move in that direction. It will also depend on consultation and on the other services that are needed to support older people or people who require residential care.
There is no one-size-fits-all answer to the hon. Gentleman's question. Our national health service employs 1.2 million people. Every year, 13 million people receive emergency care alone. There can be no one-size-fits-all solution in such a complex health economy in one of the western world's major democracies. The question is complicated and the answer is determined by local variations. Clinicians and managers in local communities throughout the country are trying to do their best for local people to deliver the kind of health service that we want.
As I have stated, I cannot comment on the proposals in detail, but, clearly, the first stage is to get involved with the public consultation itself. As the hon. Member for Mid-Worcestershire said, section 11 of the Health and Social Care Act 2001 puts a new duty on the NHS to make arrangements to involve and consult the public in planning the services for which it is responsible. The Department has just published "Strengthening Accountability"—policy and practice guidance to support the NHS in meeting the requirements of that duty.
South Worcestershire PCT will be aware of its duties in that regard, and it will have been further advised on its consultation processes by the West Midlands South strategic health authority. The PCT is holding a number of consultation meetings. My hon. Friend the Member for Worcester has suggested that some of those meetings have taken place, and hon. Members have had a chance to go to them. If hon. Members feel strongly, I would encourage them, the public or stakeholders to attend those meetings and get their views across. I encourage them to raise such issues with the local authority, which now has a nexus in the overview and scrutiny committees, and with the strategic health authority, which clearly has an interest.
There is also the opportunity to submit written views to the PCT during the consultation period. I repeat that this Adjournment debate is being held during the consultation period, which has only been running for a few weeks.
The Health and Social Care Act 2001 has also given new powers to local authority overview and scrutiny committees to review and scrutinise the planning, operation and development of health services, thus ensuring that the democratically elected representatives of local people with responsibility for their well-being have proper influence over the NHS. Those powers came into force on 1 January.
894 The hon. Member for Mid-Worcestershire mentioned my words in the preface to "Strengthening Accountability". Even though I have a self-interest, I am very proud of that preface—proud of its substance and proud of the fact that the Labour Government have given local people the powers and accountability that they did not have before. I encourage hon. Members, even though they voted against that legislation, to use those powers to raise such issues as they see fit, and to do so locally, with their local stakeholders at local meetings with local people. That arena, not Whitehall, must be the right one in which to do that.
§ Sir Michael Spicer
We certainly try to use those meetings to do so. I have certainly attended a public meeting on the consultation process. The point that we are making is that people have no option. The outcome is a fait accompli, and people are told, "This is what we are going to do." I should have thought that the first point of consultation is to be given some figures, but we are given no figures, time scales or facts; nor are we given any options. I assure the Minister that I have personally attended one of those public meetings, and the process is pretty well pointless because the whole thing is tied up before people get there.
§ Mr. Lammy
I hear the sentiment with which the hon. Gentleman makes that suggestion, but there are clearly differences of opinion about the nature of the consultation. I hope that he will forgive me—I do not want to be facetious—but he says that the outcome is a fait accompli, which does not fit with a process that is still continuing. Something cannot have come to an end if it is still going on. This is about consultation and getting involved, and it is about doing so to the best effect, as hon. Members seek to do on behalf of their constituents across the country.
To facilitate health scrutiny, the Act places three key obligations on the NHS: to provide information to overview and scrutiny committees; to consult on the substantial variation and development of services; and to provide for senior NHS officials to attend meetings to explain their decisions. On top of that, the committees have a specific right to refer the proposals to the Secretary of State if they consider that public involvement has been inadequate or that the proposal is flawed. The arrangements exist. Although they exist at some distance from the consultation period, the arrangements are available if there are local remedies. That must be right in what is, after all, a national health service.
Public interest is highest when proposals are made to reconfigure services. That is why we have also set up the independent reconfiguration panel. The panel will tackle complex and sensitive contested reconfigurations, referring in particular to "Strengthening Accountability" and "Keeping the NHS local—a new direction of travel". It will consider how the process of involving and consulting patients and the public was carried out to ensure that involvement has been an inclusive process.
The panel—made up of key stakeholders, a third of whom will be patient representatives—will provide authoritative advice to the Secretary of State on any proposed NHS service reconfigurations or significant service change that he asks it to consider. I should like 895 to clarify at this point that it is for the Secretary of State to ask the panel to consider a case. Overview and scrutiny committees have a power to refer decisions to the Secretary of State, and he will then decide whether to seek further advice. Only those contested proposals in which it is clear that all other options have been exhausted are likely to be referred to the panel for detailed consideration. The panel is very much the final option.
§ Sir Michael Spicer
This is an interesting and helpful passage in the Minister's speech. As I understand it, he is saying that the Secretary of State can call a matter in if he does not think that all options have been assessed properly and consulted upon. The Secretary of State can take his own position, and this is a useful precursor to that process.
§ Mr. Lammy
The hon. Gentleman will have heard me set out the course that is available to hon. Members and their constituents in such circumstances. On personal involvement, I have also made it clear that I am advised that consultations are taking place, and the hon. Gentleman takes no issue with that. Let that consultation take its due course. Clearly, other hon. Members and their constituents who have taken an interest in the matter see a difference in what is occurring. It is accepted that there is a deficit in the community, and the Government are doing all that they can to assist with allocations not just in the hon. Gentleman's area but right across the country. Record allocations of above the rate of inflation have been made to PCTs to assist in that endeavour. We are also supporting local people.
I have set out—yes, partly in legalese—what is available should things go wrong. However, despite all that has been said about the services, the PCTs are seeking to retain and enhance them. Given the money going in and the consultation that is at its midway point, the hon. Gentleman's conclusions may be a little premature.
§ Sir Michael Spicer
The advice that the Minister is giving the House is extremely interesting. If all options have not been considered in the consultation, that would provide a case for the Secretary of State to call a matter in. The law that the Minister has set down is that all options have to be considered, and certainly at the final phase. Is he saying that, if all options were not considered, that would be a serious matter and cause for the Secretary of State to call a matter in?
§ Mr. Lammy
I have set those arrangements out very clearly. Things are moving on at a pace in the hon. Gentleman's area, and I encourage him to support the health community's endeavours. I know, from Hansard and other sources, that the hon. Gentleman is committed to Malvern hospital and his local community. He will know that it is possible to jump to conclusions and to raise fears before the results of a consultation are complete. I ask him to engage in the process, to support the Government and to work closely with my hon. Friend the Member for Worcester.
§ Mr. Foster
I am conscious that we are running out of time, so I thank my hon. Friend for giving way. Does he 896 think that constituents, interest groups and communities have options for the future of Pershore and Malvern hospitals which they think are suitable? Will he urge them to make those options public and to include them in the consultation process while it is still ongoing, so that they can be duly considered and any recourse to the Secretary of State becomes a long stop that is not appropriate to this particular consultation?
§ Mr. Lammy
Absolutely. I say unequivocally that people should be involved in the process and support what is, at the end of the day, devolution in the NHS. It cannot be right that the buck stops with Whitehall. As a Minister, I am a moderniser in that respect. I want decisions to be made locally, not here. I certainly support my hon. Friend in that endeavour.
§ Mr. Luff
I am trespassing on the hon. Gentleman's generosity, and I am grateful to him for giving way. I agree with much c f what he is saying now, so we are ending on a note of consensus, which is marvellous. How can my constituents engage with one service at Malvern, the pulmonary rehabilitation service, about which the document says:This is being reviewed separately within the PCT"?I appreciate that the Minister may not want to answer now, and I did not do very well with my last request for a letter, but perhaps he could advise me on how that aspect of the public consultation on services at Malvern is being conducted when that service is being reviewed separately within the PCT. That seems to fall short of the very high standards that the Minister is rightly setting.
§ Mr. Lammy
As I have indicated, where there is a substantial change under section 11, there is a duty to consult through overview and scrutiny. I advise the hon. Gentleman to return to his community with "Strengthening Accountability", which includes my preface, and to take the matter up with them. The thrust of my remarks has been that these decisions must be made locally.
§ Sir Michael Spicer
The Minister has been extremely generous and rather charming in the last parts of his speech, so I feel bad about pressing him on another point.
The Minister was pressed by the hon. Member for Worcester to say that we should all become deeply engaged in this process of consultation, and we are. Our problem, which I suspect the Minister and the Secretary of State may share, is that we have not been given alternatives with which we can engage. We have been offered just one option, so we can only say yes or no. If the Minister is suggesting that we should be offered alternatives through the consultation process, will he please let that be known to the PCT? That would be an important step forward, and it would certainly solve many of our problems.
Secondly, will the Minister make it clear that if those options do not exist or are not presented during the consultation, that will be cause for the Secretary of State to call the matter in?
§ Mr. Lammy
The hon. Member has been here for some time, and is seeking to draw me into the detail of 897 the process, but as a new and diligent Minister, it is important that I am not drawn into that detail. The consultation is under way and the hon. Gentleman, as I have encouraged him to do, should be in close contact with his PCT—I know that he is. What I have said about the process is on the record in Hansard and is available in the Department's documents on patient and public involvement in health.
Finally, as the Minister responsible for patient and public involvement in health, I want to say that we are spending more funds on this issue than ever before in the history of the NHS. Whether it is patient advice and liaison services in our local hospitals, the patients forums that will be at the heart of our local communities, or section 11 of the 2001 Act, which makes provision for overview and scrutiny committees, we are spending more funds because we believe in democratic accountability and want it to be at the heart of our NHS. I repeat that I am proud that the Government have moved in that direction. It would be wrong for me to undermine that democratic and local decision making from the Dispatch Box.
Finally, I mentioned the Government's document "Keeping the NHS local," which states that hospital services need to change if we are to continue to meet patients' needs and improve access to local services. Biggest is not always best—we recognise that patients 898 want more, not fewer, local services. Our approach is based on three core principles that all health organisations embarking on service change must now follow. The first principle is about developing options with people, not for them, building on the new legal framework for patient and public involvement in health, which I have set out. The second is about exploiting the opportunities for service redesign and developing new ways of working to keep services local, sometimes keeping people in their homes rather than in a residential care setting. The third is about taking a whole systems view, with different health and social care organisations in a locality working together in a mutually supportive way.
I expect the PCT to take account of the various forms of guidance available, and I hope that the hon. Member for West Worcestershire is ultimately reassured that a decision will be made in the right manner in the coming months. I recommend that the hon. Gentleman continue to press his views and concerns with the PCT, as well as with the strategic health authority, to ensure that proper scrutiny is undertaken, and that massive investment in health care in south Worcestershire under the Government brings about real changes in people's experience of the NHS.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes past Seven o'clock.