HC Deb 25 July 2000 vol 354 cc143-69WH

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. McNulty.]

10 am

Mr. Peter Luff (Mid-Worcestershire)

I am grateful to Madam Speaker for allowing us to debate a matter of exceptional importance to the people of Worcestershire. It is an unfortunate accident of history that Worcestershire has three acute hospitals. Modern medicine probably requires just one large hospital in a convenient location, probably near junction 5 of the M5, with a supporting network of well-resourced community hospitals. However, in reviewing that structure Worcestershire health authority was constrained by the political reality of where we are, and by money and clinical need.

For most of my constituents and me, our general hospital is the Worcester royal infirmary; for a small proportion of people in the north of my constituency, it is the Kidderminster hospital. Many people in the south of my constituency rely heavily on Evesham community hospital, and some people in the constituency of my hon. Friend the Member for West Worcestershire (Sir M. Spicer) use Pershore community hospital, so my concerns range from north to south. When the Alexandra hospital in Redditch provides us with specialist orthopaedic and urological services, my concerns will also spread from east to west—across the entire county.

Worcestershire health authority has faced difficult decisions on clinical and financial grounds, and I agree with its conclusion that a county the size of Worcestershire, located on the edge of Birmingham, cannot justify maintaining three acute hospitals with a full range of services. To do so would be clinically inappropriate and financially reckless, and it is genuinely in the best interests of all my constituents to move from three separate hospitals in three separate trusts to one acute hospital on two sites—Worcester and Redditch—and one redefined non-acute hospital in Kidderminster.

In this debate, I have no intention of pointing the finger of blame. The chairman of the Worcestershire health authority and the chairman of the Worcestershire Acute Hospitals NHS trust are doing a good job in difficult circumstances. I want simply to give the Government an opportunity to address the concerns that many people in Worcestershire feel are being brushed aside by some of their representatives. Sadly, there have been few convincing answers to many of the difficult questions that have been posed. As a result, my doubts have also increased.

Those questions have often, but not always, originated from the Kidderminster campaigners, whose anger is so deeply felt that they have even taken control of the district council. Their concern led to the publication of a new report, "Deficits before patients", which was produced by Professor Allyson Pollock and her colleagues at the health policy unit of University College London. I am one of those who believe the report to be flawed. Professor Pollock has her own clear—and perfectly honourable—agenda: to prevent increasing use of private finance in the health service. In other words, she is interested less in the future of Kidderminster hospital than undermining the private finance initiative that is building the new Worcester hospital. The health authority has published a damning critique, with which I have considerable sympathy, of "Deficits before patients". However, Professor Pollock has raised some very important questions, and the authority has been unable to reply to them to the complete satisfaction of anyone other than itself.

We must also recognise that, although mounting concern among GPs, local commentators and the general public outside Kidderminster increased after publication of Professor Pollock's report, it did not begin with it. Friends of mine who are GPs have told me for years that I was wrong to be so optimistic about bed numbers at Worcester. I did not dismiss their concerns, but I took the pragmatic view that it was better to try to improve what was on offer, rather than reject the new hospital because it was less than perfect. Moreover, I was assured by the old Worcester hospital trust that plans to increase bed numbers were flexible. Indeed, I want to thank both the new hospitals trust and the authority for building in flexibility through the establishment of a "winter pressures" facility of 56 beds at the existing Newtown branch. I shall return to the issue of bed numbers in due course.

As the strategy has been implemented, concern has focused on the implications for Kidderminster general hospital. However, concern is growing in the rest of the county that we are asking too much of the Worcester royal infirmary and the Alexandra hospital in Redditch in the transition period and the long term. I freely acknowledge that there are particularly harsh implications for many of the constituents of my hon. Friend the Member for Ludlow (Mr. Gill), who hopes to be able to voice his concerns later in the debate.

In these circumstances, it is a Member of Parliament's duty to obtain clear answers from the Government on the key questions. I had reached that conclusion and applied for the debate before a local newspaper, the Worcester Evening News, wrote in a brief front page editorial last Wednesday: How many more experts voicing such grave concerns will it take to halt this runaway health juggernaut? It is time for our MPs to take action.

I have my criticisms of the campaign that has been waged in the county against the health authority's strategy. Focusing on the wrong question—how to keep Kidderminster as a full general hospital—has diverted us from the debate that we should have had on whether the new pattern of services will be adequate. I hope that today's debate will be about the future, not the past—about how to make the authority's strategy work, not about seeking to undermine it. I hope that the Minister will reassure my constituents that all will be well, but I am not confident that she will be able to do so.

Local people are witnessing a declining health service in Worcestershire. Yes, there is good news. There is a desperate need for a new hospital in Worcester. The current facilities are woefully inadequate and verging on the dangerous. The Castle street site, where the British Medical Association was founded, is a Georgian building, and Ronkswood is a series of prefabs, which are increasingly expensive to clean, heat and maintain.

People have been lobbying for a new hospital for 30 years, and at last it is being built by the Government—even if it is under Conservative policies that new Labour once reviled as the privatisation of the NHS—[Interruption.] There is no point in the hon. Member for Redditch (Jacqui Smith) laughing—that is a matter of fact and record. No party can gain great mileage in claiming the credit for the new hospital. The policy foundation was laid and the preparatory business casework was done by the previous Government—especially by the distinguished Worcester resident and former Secretary of State for Health, my right hon. Friend the Member for Charnwood (Mr. Dorrell). The Government rightly ate the words they used when in opposition and built—almost literally—on those secure foundations. The new hospital will be occupied late next year and will be fully operational by the late spring of 2002. It will be a joint achievement for which both parties can fairly take some credit.

However, there are several big buts. First, Worcestershire is right at the bottom of the funding tables for both health and social services—a crucial factor in the mounting deficit that has faced the health authority. That deficit undoubtedly brought forward the authority's strategic review, "Investing in Excellence". A healthier funding situation would have delayed that review for a few years, but that is all. I believe that the deficit is now cleared, but that does not make Worcestershire a cash-rich authority. The relative shortage of cash, especially for intermediate care, is a major factor in the problems facing the new hospital structure. Affordability was one of the main doubts raised by Professor Pollock's report. The health authority has put forward a pretty convincing argument that all is well, but doubts remain.

The new money that has come to the county seems to have been used to clear the historic deficit. Our funding situation remains less than robust—less robust than that of neighbouring Warwickshire, despite what must be a similar demographic and health profile. Will the Minister tell me whether the Government are still satisfied that Worcestershire can afford its new hospital? Is the authority's revenue stream sufficiently robust? Will there be money for new services and for an intermediate care strategy that works, or will all the cash go towards paying for the hospital?

Secondly, current resources at the Worcester royal infirmary—WRI—are seriously overstretched. In the county, the acute hospital beds are fully used. The local medical committee tells me that under the authority's plans bed numbers will be cut by 28 per cent. The authority and the trust produce a rather different figure, and I admit to being confused. The authority claims that the number of acute beds in the county stands at 1, 035, and will decline to 988—but if the winter pressures facility stays in place, the number will be 1, 044.

It is clear that Worcestershire hospitals are full to bursting now, at the height of what passes for an English summer. The WRI was closed to admissions on 17 July, and again on 19 July. On 17 July, Herefordshire and the Alexandra were closed too. Such closures happen regularly, yet there are no winter pressures in July. Last week, I received an e-mail from a Worcestershire resident, which read: I thought you should know that at 3.am on the morning of Wednesday the 5th July there were five medical patients for beds in the A&E at Ronkswood. (I know this for a fact for I was one of the patients). Eventually three beds were found in the day ward children's section, others I do not know. That this should happen during summer does not speak well of the future, and this without any patients from Kidderminster. I wish that my name be kept out of this, but I felt that you should know the facts.

A Worcestershire general practitioner told me at the weekend that there were effectively no elective medical beds at the Worcester royal infirmary. GPs can no longer refer patients in for a few days of tests; they must claim that their patients need emergency admission to obtain a medical bed. The local medical committee told me that only three years ago 1, 200 bed days on the surgical unit were filled with medical cases. In 1998, that figure was 1, 750, but in 1999 it was 3, 750. If that is not indicative of a serious bed shortage, I do not know what is.

A constituent wrote to me about out-patient appointments and stated: My eye appointment was made for 30th July, but this has now been put forward to 11th September, a whole month later. I have severe arthritis in my ankle too. An appointment was made for me on 30th July, but this has been changed to 20th October at the old hospital at Castle Street, a whole three months further away. We all know the deplorable state of the NHS, but these dreadful delays cause me considerable discomfort and pain, and to be further down the waiting list is hard to bear. Is there anything you can do to alleviate this situation please; the NHS was never intended to be as bad as this and steadily getting worse.

At the end of last year, a prominent local consultant wrote to me stating: I watch the NHS lurch further into crisis. To massage the statistics we are asked to remove wisdom teeth, insert grommets and remove lumps and bumps. Money is poured into the waiting list initiatives whilst individuals wait even longer for coronary artery bypass, cancer treatment and joint replacements.

That leads me to my third point. It is often said that the structure of Worcestershire's hospitals will always be affected by its proximity to Birmingham, but the waiting periods for treatment there, especially for coronary surgery, are also growing with potentially tragic consequences. I have at least one constituent who was forced to spend his life's savings to avoid waiting months for coronary surgery and risk dying while he waited. Two others are in the same position—waiting, worrying and not knowing what to do. Meanwhile, one of them has seen a family friend rushed into hospital to deal with his snoring problem.

To score hospital beds outside Worcestershire against our total is hardly encouraging. Other beds seem to be under pretty intense pressure also. To be fair, the Government have at least been reasonably frank that there is a problem. Recently published figures on waiting lists are given on the Government's annual report website "In Your Area" facility, which states: There are 9, 788 people waiting for in-patients operations in your area, compared with 9, 625 at the same time in 1997. There are 986 people on out-patient waiting lists locally, compared with 581 people in March 1988 (the first year the figures were collected). So we see a local health service under huge pressure with mounting waiting lists, full hospitals and collapsing morale. Those of us who live in the county have friends and neighbours who work in the county's hospitals. The demoralising effect of the current conditions cannot be overstated. Many now fear that they will lose their jobs under the restructuring and are actively looking to leave the area. Kidderminster staff have been hit particularly, but I know that staff at the WRI are similarly gloomy.

I have already made it clear that I remain a supporter of the basic Worcestershire health authority strategy. However, a general may have a perfect strategy to win a battle, but it will work only if the logistic support is also spot on. Logistic support for the health authority strategy seems flawed in two crucial respects: the transitional phase was not properly planned and the resources to support new hospitals are likely to prove inadequate.

I shall deal with the transitional phase first. Clinical services have collapsed or are on the verge of collapsing at Kidderminster. That is what the health authority means in the leaflet, "Changes to Your Hospital Services", which it sends to all Worcestershire residents and which states: The timing of the changes has become more crucial because of Kidderminster Consultants' concerns that some services cannot be safely sustained throughout another Winter. In short this is because there may not be the appropriate number of doctors or nurses to provide adequate clinical cover for acute in-patients. That has resulted in a rushed programme of change to the old buildings with hundreds of thousands of pounds being spent on interim arrangements at Worcester. Whoever is to blame for that, it is not the current trust management. In the regrettable circumstances they face, their plans have inevitability about them. That does not make the position more sensible, but it is part of a well—established pattern in the NHS.

Writing in The Spectator in the early 1990s, hospital and prison doctor Theodore Dalrymple stated that his hospital was so deeply engaged in its Expenditure Maximization Programme that it hardly has time any more for patients. For example, two of our ward blocks, less than architecturally distinguished, I admit, but serviceable nonetheless, were recently redecorated and refurbished. This unaccustomed expenditure on hitherto neglected buildings could only presage demolition, as anyone who has worked in the National Health Service will acknowledge: and so it transpired. No sooner, give or take a month—had the painters and plumbers departed than the bulldozers moved in. This is a phenomenon I have seen several times in the course of my career: refurbishment as a prelude to extinction. Once it happened to an entire hospital in which I worked. It is of course a great comfort to know that all the activity of the decorators and demolishers alike, counts toward the gross domestic product and, Dalrymple might have added, to the Government's figures for investment in the national health service.

In Worcester, Dalrymple's law is at work: refurbishment, improvement and significant investment in a hospital that will close within a year or so of the work's completion. Refurbishment is a prelude to extinction for both the Castle Street and Ronkswood sites. Despite the investment, my constituents will still face problems with overcrowding this winter. Patients from Kidderminster who go to Castle Street will be treated in some of the country's oldest hospital buildings, rather than in a relatively modern hospital in their hometown. Specific safety concerns have also been raised.

The die is cast: I accept the clinical arguments for moving services to Worcester, but my support for that strategy was always conditional on the understanding that my constituents, from villages such as Hartlebury, would be forced to go to Worcester for hospital treatment only when the new hospital was finished and was offering better services. I feel betrayed, because they will now be forced to seek treatment in decayed, overcrowded and—some doctors believe—unsafe conditions at the old Worcester facilities.

At least the proper transport arrangements are likely to be in place, to convey friends and relations who do not have cars to the three sites. In that respect, the authority and the trust have listened to local concerns, which is good. The interim arrangements are still unsatisfactory, but I cannot change them now. I can try to ensure that the new hospital structure at Worcester and Redditch will be as good as possible, but I have my doubts. The new hospital is, if anything, ahead of schedule. Occupation is likely to begin in little over a year and will be complete by summer 2002. There is not much time to get it right.

I want to look at four specifics about the new structure: safety, staffing, beds and intermediate care. Many of my constituents will continue to use Kidderminster. Indeed, most of those who use Kidderminster now will continue to do so, and only two categories will not—acute in-patients and real emergencies, many of which will be treated at the proposed ambulatory care and diagnostic centre. My hon. Friend the Member for Bromsgrove (Miss Kirkbride) will discuss the implications of that, if she catches your eye later, Mr. Deputy Speaker. We should be aware that there is much local speculation that, despite the miracles of telemedicine, the protocols and arrangements for the new unit will be rejected on safety grounds. If that happens, there will be no emergency service of any substance at Kidderminster, which will be further downgraded, and there will be more pressure on Worcester.

My second specific concern relates to staffing levels. My hon. Friend the Member for West Worcestershire wanted to raise this issue in our debate, but, sadly, he has been detained by his work on the Treasury Committee, scrutinising the Chancellor's expenditure statement from last week. He sends his apologies. My hon. Friend wants to be associated with our concerns on this issue. The Pollock report revealed that the detailed business plan for the new hospital at Worcester envisages a 17 per cent. reduction in the number of nurses. If more patients are being treated—albeit in fewer beds—can that be right? I am happy that there will be more intensive therapy unit and high dependency beds at the new hospital, with more operating theatres and support services—it promises to be a fine hospital, in many respects—but is it right that there should be fewer nurses? If so, why?

There is the critical issue of bed numbers. How many beds will there be in Worcestershire, after the opening of the new Worcester hospital? That is a key question for local doctors, but they cannot get a straight answer. I also failed to get a straight answer from the Government, and that was one of the factors in my decision to apply for this debate, although my experience of getting replies from the Department of Health on almost anything is, to say the least, discouraging. I asked a priority written question, which was due for answer on 12 June. Last week—more than a month later—I was still waiting. I asked: how many acute hospital beds there are per 1,000 of local populations in each health authority area of England and Wales; and how many such beds there will be in the Worcestershire health authority area per 1,000 of population after the complete implementation of the authority's Investing in Excellence strategy. The Minister for Public Health replied on 20 July: The important issue for the health service in Worcestershire is the number of patients who need to be treated and the appropriateness of their care. In line with this, the current estimate is that following hospital reorganisation there will be approximately 1,400 acute and community based beds available across Worcestershire. The Minister goes on to talk about the national beds inquiry, set up to review assumptions about the demand for in-patient care: The consultation, which was completed on 15 May, focused on how health services, and specifically hospital beds, should be developed over the next 10-20 years. The aim of the consultation is to enable us to get the right number of the right sort of beds in the right places. Our response to the consultation will be published in the summer.—[Official Report, 20 July 2000; Vol. 354, c. 275W.] There were detailed figures on the status quo, as I requested, but none for the future. That made it impossible for me to make the comparisons that I and the people of the county want to make. If the Government are committed to ensuring that there are more beds in the whole care system, why are they, apparently, planning to cut bed numbers in my county? Why did the Minister lump together all kinds of acute and community beds in her reply, when I asked about acute beds? Why could she provide only a current estimate for a hospital that is already being built, under the private finance initiative? I suppose that I should be reassured to know that the consultation's aim is to get the right number of the right sort of beds in the right places. I would hardly expect it to be to get the wrong number of the wrong sort of beds in the wrong places. However, if that is the aim, why are the Government pressing ahead with a commitment to reduce bed numbers in my county, when their own consultation may show that to be woefully inadequate?

There is growing evidence that historic trends in bed usage may be changing. Years of decline may be coming to an end, as day-case surgery and less intrusive methods reduce the demand for overnight stays. Indeed, as the elderly make increased demands on health care, we may need more beds in our hospitals rather than fewer. The old line that no hospital has ever been built with too few beds may no longer be true.

I therefore expect, either in the Minister's reply or in a subsequent letter, a clear indication of how many acute beds there are in the county now, and how many there will be after the full implementation of the strategy. I want those figures on a strictly comparable basis. The Government may want to give the figures for all beds, from intensive care to community, but I want them separated out in detail according to official Department of Health criteria on a comparable basis between what we have now and what we shall have in future.

I accept the argument that a proper intermediate care strategy is crucial for the new structure, and that the availability of community step-up and step-down beds is a key component of that. However, I do not want all those beds lumped together. We must know how many hospital beds and how many community beds there are now and how many there will be. These concerns are widely shared in Worcestershire. That is why the chamber of commerce has written to the chief executive of the health authority to say: Members are concerned that the number of beds within the new County structure may not reflect the provision that may be recommended at the conclusion of the national beds inquiry and it will not then be easy or perhaps possible to meet those recommendations.

The questions that flow from this are far from theoretical. A Worcestershire general practitioner wrote to me last week to say: Even as I write this letter, I have been told of a 92-year-old lady who was discharged from Ronkswood hospital at 5.00 am this morning, back to her nursing home having spent all night in casualty, and died just as the ambulance arrived back at the home. The Coroner of course, has been informed. Earlier in the same letter, he said: I would appreciate your clarifying with someone at the Department of Health, that in the case of a patient dying whilst waiting for treatment at Worcester Royal Infirmary, who would be held responsible? I hope that the Minister will be able to reply to that point at the end of this debate.

Finally, I shall turn to the question of intermediate care, which is, perhaps, the most important of all. The health authority says that up to 38 per cent. of individuals in acute hospital beds in the county could be cared for elsewhere. Other estimates are a good deal lower—as low as 8 per cent. with more accurate criteria. There is bed blocking in Worcestershire, but there is considerable dispute between the health authority and the county social services department about its true extent.

Frankly, I do not understand where the buck stops on intermediate care, and I hope that the Minister can tell me. The primary care groups, the health authority, the acute trust, the community trust, the social services department and the private care home sector all have a role to play. I believe that the health authority is in the lead. However, it is cash strapped, the social services department has seriously overspent on children's services and is seeking to save money on care for the elderly, and the care homes are in crisis as a result of Government policies and are closing fast. The seriousness of the financial situation in the county social services department cannot be overstated. Always the poor relation compared with similar authorities—never mind with Birmingham—the county now faces a deepening crisis following a serious overspend on children's care.

Councillor Carol Warren, the Labour leader of the council, stated in a recent letter to the Minister of State, Department of Health: Worcestershire County Council is asking that the government make extra funds available in 2001/2002 for [investment in family support and preventative services for vulnerable children and children in need] through Quality Protects and that further funds be made available in future years. In 2000/2001 there is a projected overspend of £2.1 million on Children Looked After. This overspend has sent shock waves through the local health care community.

Local doctors are receiving letters from the county council saying: You are likely also to see a change in our recommended care plans with more children returning more quickly to the care of their families. We will need your help and support to achieve this. In other words, there will be more work for the hard-pressed GPs of Worcestershire, and probably cuts in the care budget for the elderly too. Intermediate care is not even working smoothly now. The Worcestershire association of carers has recently written to the chief executive of the Worcestershire Community and Mental Health NHS trust to say: As an Association we are very concerned by the number of carers who have been contacting our offices with major worries about the apparent lack of proper assessment and care planning prior to discharge from hospital and transfer to nursing homes, intermediate care or home. The discharge procedures for patients who have mental health problems, Alzheimer's and general frailty have to be properly thought through in conjunction with the needs of their carers. We are aware that the new hospital development and relocation of various services may well necessitate large numbers of discharges at the same time. This could prove catastrophic to patients and carers if sufficient time and resources are not made available for proper assessments and care plans to be carried out.

At least the community hospitals look secure. I should like to put on record my deep appreciation for the sympathy and understanding shown by the health authority to the community hospital sector and, above all, to Evesham in my constituency. Those hospitals, together with Kidderminster, will play a crucial role in supporting the new hospital structure of the county. They too will have to accept change as they adapt, but their future is rightly secure.

On the broader picture, the intermediate care strategy for the county seems to be emerging almost by accident. There will be no such beds for the major and growing town of Droitwich Spa. What are family and friends from that town supposed to do when their loved ones are discharged from Worcester or Redditch? Will Worcester doctors happily jump in their cars to visit patients miles away in intermediate care beds, recently and rather arbitrarily situated at, I believe, Callow End, when they have overflowing surgeries and home visits to make in Worcester?

Richard Adams, the Conservative prospective parliamentary candidate for Worcester, put it very well in a letter to me at the weekend. He said that he joined me in supporting the aims of Investing in Excellence, but added I am receiving ever increasing numbers of enquiries about the transitional period and ultimate bed numbers. Some assurances are needed to quell fears, but in Worcester at present we only hear claim and counterclaim from opposing factions. Many people are very worried, and that should not be the case.

The people of Worcestershire need the Minister to answer some specific questions. First, is the new PFI hospital at Worcester genuinely affordable for cash-strapped Worcestershire health authority? Secondly, will there be fewer nurses in Worcestershire's acute hospitals after these changes? Thirdly, on a strictly comparable basis using Department of Health classifications, how many acute beds are there now and how many will there be in the county after these changes? Fourthly, is the Minister satisfied with the safety of the Castle street site in the interim period? Fifthly, is the Minister satisfied with the safety of the proposed ambulatory care and diagnostic centre at Kidderminster? Finally, is the Minister satisfied that a sufficiently robust intermediate care strategy will be put in place to support the new arrangements?

I make one final request to the Minister. Please can we have no further structural changes in Worcestershire's health care system before 2003, after the new Worcester hospital is up and running? Please do not transfer the primary care groups to primary care trusts; just leave things alone while all the arrangements for the new hospital settle down. Health care in Worcestershire is going through almost traumatic change as it is. Please do not make matters worse by changing the bureaucratic goalposts, too.

I remain an optimist. The new hospital structure can work. Confidence in the new structure can be rebuilt, but the Minister must seize this opportunity to start that process and to give some specific assurances. If there is one issue that I would emphasise, it is intermediate care. If the new hospital structure is to work, that is the key. I hope that the Minister will use it to unlock the door to a new and robust confidence in Worcestershire on the future structure of hospital services in the county.

10.27 am
Mr. Michael J. Foster (Worcester)

The structure of hospital services has been the subject of much debate in Worcestershire. Since May 1997, questions have been raised in the House and there have been Adjournment debates about changes in the county. I am pleased that the hon. Member for Mid-Worcestershire (Mr. Luff) has secured another opportunity not only to debate these changes but to highlight the Government's success in delivering improved health care in the county and once again to show that Labour is delivering its pre-election promise to build a new hospital in Worcester.

The debate should be about reassuring people in Worcestershire, not fuelling fears about the changes that are planned. However, causing unnecessary fear is a consequence of playing out the debate in the media. Headlines such as "I fear for our health" in the Worcester Evening News last Thursday and the demand of the hon. Member for Mid-Worcestershire that Ministers should be put on the spot show clearly how the debate can become party political. Comments to the newspaper claiming that lives will be at risk hardly show a mature response to a debate that has increased in temperature of late.

I am always mindful of the words of a non-practising GP, who said: I think that there is a role for politicians in regulating the National Health Service, and deciding what we should get out of the service, but they should then allow managers and doctors to do what they are trained to do, which is to manage the service and treat patients. I hope that all hon. Members support that view. I see the hon. Member for Bromsgrove (Miss Kirkbride) shaking her head. Did that indicate dissent?

Mr. Luff

No, Something different.

Mr. Foster

Without doubt, changes to the current structure of the hospital services were always likely when, back in 1996, the annual health report stated: Now is a good time to undertake a strategic review of health services in Worcestershire. Before 1996, nobody had looked holistically at Worcestershire's health services. The report went on to say that such a review will require collaboration between units and sectors. Interestingly, it went further: This requires a degree of co-operation, which may be undermined by competition created by the Internal Market.

Worcestershire health authority then produced a strategy for public consultation called "Investing in Excellence". It acknowledged that changes would need to be made at Kidderminster hospital to provide safe, high-quality health care in the most appropriate location and—importantly—to address any areas where population size, number of operations performed or medical staffing problems could pose a risk to patients. The county's Members of Parliament responded to the consultation document, which outlined a range of options, with the health authorities' preference being known. The responses are interesting, given the comments made recently to the press and in today's debate.

I have a copy of a letter dated 8 May 1998 from the hon. Member for Mid-Worcestershire to the chief executive of the health authority. It said: I hope to write to you again before the close of the consultation after a meeting I am attending in Evesham with the local GPs. I can confirm that within my constituency there is overwhelming support for the Health Authority's strategy and I, therefore, write to endorse it. [Interruption.] I am not disputing that.

Mr. Luff

The hon. Gentleman may need to rewrite his speech, because he clearly thought that I would make a different speech from the one that I actually made. I repeat my strong support for the health authority's strategy; it is the detail that worries me.

Mr. Foster

I hope that the hon. Gentleman will let me pursue my point a little further before intervening in an ill-tempered manner. He went on to say: This letter is to record my strong support for the elements of the review outlined in the document— we agree on this— I specifically note that the County Council commissioned its own independent analysis of the document which has also supported the review strategy. That is a strong endorsement of the strategy. On 11 May 1998, the hon. Gentleman wrote to the chief executive again to reaffirm my strong support.

Mr. Luff

May I ask where the hon. Gentleman got those letters? They are matters of public record, but no one has ever shared any of the hon. Gentleman's letters with me. I do not exactly regard this as a breach of confidence, but I am slightly surprised that someone has given him the letters.

Mr. Foster

The letters were part of the public consultation relating to the "Investing in Excellence" document, and the hon. Gentleman should know that. In his speech this morning, he said that his approval was always "conditional". However, in his letter of 11 May 1998, he said: Please therefore accept this letter as an unqualified approval for the plans put forward by the Health Authority.

Why is the hon. Gentleman suddenly so concerned that lives will be at risk? Is it because of the interim changes that will be made in September? Those changes will be made on the back of medical advice received by the acute trust board. Clinical working groups were set up to consider all the aspects of the changes planned under "Investing in Excellence" to ensure that the highest possible quality of patient care is available throughout and that particular attention is paid to specialties and clinical areas demonstrating clinical fragility. Many hon. Members in this Chamber have already heard that explanation. Indeed, the hon. Member for Mid-Worcestershire met the acute trust chairman for a briefing on the changes.

Mr. Christopher Gill (Ludlow)

On the question of putting lives at risk, the hon. Gentleman may be interested in a letter from the Worcestershire division of the British Medical Association, which says: Unless plans are revised we fear there will be unnecessary deaths in the western half of the County and immense problems over acute admissions throughout the area from 2001. That letter is dated 23 June this year.

Mr. Foster

I am under no illusions; I know that the medical profession has concerns and I shall deal with those later.

The clinical working groups reached some chilling conclusions. They suggested that the changes in Worcestershire be made sooner rather than later. The medical director at Kidderminster said: my own view is that the moves should take place this year rather than waiting for next year or beyond, since uncertainty is the most destructive element in the running of any service or organisation and we are likely to lose a large number of key staff if this continues for any longer. It is also my view that general medicine and surgery should move shortly after Orthopaedics.

A letter to the acute trust board following a meeting of Kidderminster consultants says: The consensus of clinical opinion was that retaining acute inpatient services at Kidderminster over the winter period of 2000 presented significant clinical risks and the ability to maintain a quality service would be difficult. As the hon. Member for Mid-Worcestershire knows and as I appreciate, the reasons for the transitional changes are medical, medical, medical. I accept that change and uncertainty require careful explanation to allay the build-up of unnecessary fears. Without doubt, the so-called Pollock report has added to those fears. The briefing of the report's conclusions to the press before the health authority saw them was a deliberate act.

The Pollock report casts doubts on the capacity of Worcestershire's acute trusts to cope with the reconfigured health service. The focus is on bed numbers, but they are not the sole determinant of good health care. The report claims that when the new hospital is open, bed numbers will fall to a level that poses risks to patients. Reassurances have been given about bed numbers. I shall deal with the statistics mentioned by the hon. Member for Mid-Worcestershire as I understand them.

There are 1,035 utilised acute hospital beds in Worcestershire at present. During the transitional period—from September 2000 until the opening of the new hospital—there will be an increase to 1, 041. When the new hospital opens there will be 988 acute beds but, significantly, there will be 56 extra beds available at the Newtown site in Worcester to cope with winter pressures and high demand. That provides a total of 1, 044 beds. The chairman of the acute trust made it clear that he has no intention of giving up the extra 56 beds until he is convinced that the lower number is sufficient to cope. If extra beds were needed, there is room available at Newtown and at the Alexandra hospital in Redditch for potential expansion. I received a letter from the acute trust, which makes it clear that, after the hon. Member for Mid-Worcestershire met its chairman, he was largely reassured about bed numbers.

As a result of the Pollock report, the BMA and the local medical committee actively questioned the strategy set out in "Investing in Excellence". Some doctors publicly questioned the changes, as the hon. Member for Ludlow (Mr. Gill) pointed out, and some have demanded an independent review. They argued that the initial public consultation was "suspect". The fact that it was subject to judicial reviews not once, but three times, seems to have escaped them. The health authority was vindicated three times. Just what is the local medical committee thinking—

Mr. Luff


Mr. Foster

I should like to make further progress.

Further delay in implementing "Investing in Excellence" will heighten the uncertainty for patients and staff and increase the risk associated with clinical fragility. Can the LMC justify further delays when faced with the hard medical facts presented by clinical—[Interruption.]

Mr. Deputy Speaker (Mr. Frank Cook)

Order. Hon. Members in this Chamber have a reputation for listening carefully to debate. The conduct of argument across the Chamber should be put to one side. Can we please continue with the debate in a proper parliamentary fashion?

Mr. Foster

Thank you, Mr. Deputy Speaker.

Can the local medical committee justify further delays when faced with the hard medical facts presented by the trust's clinical working group? Its action demonstrates the forces of conservatism that hold back our public services.

I was pleased to see all six primary care groups sign up to and support changes to health services in Worcestershire. They signed a joint letter to all general practitioners to tell them so. It says: We ask you not to give credence to this biased and cynical attack on plans but instead to continue to work with the majority of us who want to see a new modern health service providing the highest standards of care for our patients.

The debate is not about genuine concerns over health issues alone because some people use health as a political football. I regret that, but it is no surprise in view of the debate surrounding the history of Worcester's new hospital. The people of Worcester have been promised a new hospital for more than 40 years. The hon. Member for Mid-Worcestershire knows all about the false dawns and empty promises that were made. For example, in what I assume to have been a planted parliamentary question on 23 March 1993, he was told by the then Secretary of State: I know that he will be pleased, as I was, to learn that the West Midlands regional health authority has agreed a capital scheme for his district general hospital in Worcester, that it will not be affected by the capital moratorium and that work on it will start soon. [Official Report, 23 March 1993;Vol. 221, c. 753.] Nothing happened. Prior to the general election, the Tories claimed that Labour would scrap plans to build a new hospital. The then Chief Secretary to the Treasury said: If Labour came to power they would bring the whole PFI scheme to an end. You could say goodbye to a new hospital. Events have shown how wrong the Tories were. The new hospital is well under construction, perhaps even ahead of schedule—concrete evidence of Labour delivering in Worcester.

I have doubts about the motives for calling this debate. However, I believe that Labour can be seen to be delivering when a new hospital is being built. The hon. Gentleman previously supported the health authority, at a time when it was planning fewer beds than now. He and I know that genuine care is being taken over the number of beds, to allay fears expressed in the press. Similarly, my hon. Friend the Member for Wyre Forest (Mr. Lock) has called resolutely for clarification of the number of beds that will be made available: I believe that clarification has been given.

The true measure of what is happening in Worcestershire needs to be aired publicly. The so-called killer facts are as follows. Since 31 March 1998, waiting lists have fallen by more than 2, 200, or 19 per cent. That is a creditable performance, but the critics will say that it has happened at the expense of other areas.

Let us consider other areas of health care. Elective activity for the same period has increased by more than 6, 100, or 13 per cent., emergency activity by more than 600, or 1 per cent. and out-patient activity by more than 29, 200, or 8 per cent. Since September 1997, the number of nurses has increased by 144, or 5 per cent. and there are now 10 more doctors and four more consultants.

What is behind such improvements? Without doubt, the extra cash that the Government have made available is fundamental to them. Each year of this Government has brought the health authority true increases in cash, including an extra £26.3 million this year. This investment has enabled all three accident and emergency units in the county to be modernised. In addition, special assistance funding of £4.5 million has been made available for the reconfiguration and restructuring of services. For example, some of it has enabled extra paramedics to be trained, ready to begin in September this year, in time for the transitional arrangements.

The doctors, nurses and support staff who have delivered those improvements deserve our thanks and praise in debates such as this. I am pleased to go on record as offering them both. Indeed, those same staff may now be asking what would happen if the Tory spending cuts guarantee were to bite in the county. Reductions of £144 million in Worcestershire are bound to have an adverse impact on health care there, as well as on our schools and the police.

Is it not strange that we did not hear about those cuts from the hon. Member for Mid-Worcestershire, or hear him congratulate the Government on securing extra funding, which will result in his constituents as well as mine being treated more quickly—something that I imagined he would wish to welcome publicly?

Mr. Luff

Will the hon. Gentleman give way?

Mr. Foster

No. I have said that I will not give way.

In my view, those in the county who are fuelling fears about the health service are playing a dangerous game. It is a political trap that I know the Conservatives are all too willing to spring on people. They wish to deflect attention from the good news in Worcestershire—the new hospital, modernised facilities in all hospitals, shorter waiting lists, more people being treated, more nurses and doctors. It is no wonder that they are so desperate to help fuel scare stories. I will go further and state that were the Tories to succeed in convincing people that the NHS was failing, their privatisation agenda would achieve even greater credibility.

The simple message for the people of Worcestershire who listen to this debate is that the Tories believe in a privatised NHS, while the Labour Government want to modernise it. That is the dividing line on which people will make up their minds whenever called upon to do so.

10.44 am
Mr. Christopher Gill (Ludlow)

I congratulate my hon. Friend the Member for Mid-Worcestershire (Mr. Luff) on obtaining the debate and on comprehensively and fluently describing the problems affecting Worcestershire health authority and its area. My hon. Friend's experiences mirror my own, so I sympathise with his difficulties in obtaining an accurate forecast of the bed numbers either before or after the plans have been implemented. Dalrymple's law is certainly operating. The previous Government spent £25 million on Kidderminster general hospital. Brand new wards and other facilities were erected as a consequence of that massive expenditure, yet to this day those facilities have not been used and now may never be used.

My interest in the debate arises from the downgrading of Kidderminster hospital and the concern of about 20, 000 of my constituents about the loss of a full accident and emergency unit at Kidderminster. The chairman of the acute trust has tried to convince me that as the numbers from my constituency using the Kidderminster facilities are relatively small, I should not worry. However, I have taken pains to tell him that that is all very well until someone desperately needs accident and emergency attention and must travel an additional 17 miles to the new hospital at Worcester. That journey involves travelling through and exiting from the other side of Kidderminster.

Since the health authority announced the downgrading plans, traffic calming measures have reduced the A449—the main road between Kidderminster and Worcester—from a full dual carriage way to a dual carriageway with only a single lane operating in each direction in parts. That has made the journey longer and more difficult. The future situation will not be as satisfactory as the present arrangements. Last Friday, I was at junction 6 on the M5. It will be necessary for ambulances taking patients from south Shropshire to circumnavigate the island there to reach the new hospital. The interchange was gridlocked last Friday, and that gives my constituents grave fears, because those travel problems are in addition to their current difficulties in reaching accident and emergency departments.

The Prime Minister and other Ministers continually boast about the upgrading of accident and emergency hospitals throughout the country. However, the situation is different for my constituents. In place of a fully-fledged accident and emergency unit at Kidderminster, we are promised an untried and untested concept known as ambulatory care and diagnostics. There are mounting fears about the adequacy of the health care provision after the downgrading in September. The Kidderminster Shuttle reports concerns expressed by the ambulance service as the D-Day for the downgrading of Kidderminster Hospital looms. Frontline ambulance staff have revealed the perilous state of affairs at Ronkswood Hospital, Worcester, where Kidderminster paramedics have been queueing to offload patients. Once the downgrading takes place in September, even more patients will have to be taken to Worcester.

My hon. Friend the Member for Mid-Worcestershire mentioned the demoralisation of staff. That is certainly happening in the ambulance service. Experienced staff are leaving as morale hits an all-time low. A spokesman for the ambulance service described the situation as a "nightmare scenario", stating, for example, that paramedics have not yet been trained to use clot-busting drugs on heart-attack patients. In future, my constituents face the prospect of being brought from their homes to the minor injuries unit at Kidderminster where nurses will give the drug to patients who need it before they are returned to the ambulance to continue their journey to Worcester. Hon. Members will appreciate my constituents' anxiety about such a situation.

It is not only the ambulance service that is worried; everyone involved expresses fears about the provision of medical services in the area. The Worcestershire local medical committee is a democratically elected, statutory body representing 300 or more family doctors in the county of Worcestershire—the secretary of the group, Dr. Simon Parkinson, is based in Redditch, and is therefore not partisan in his attitude to Kidderminster. At a meeting held on 13 July the Worcestershire local medical committee, in conjunction with the Worcestershire division of the British Medical Association, debated a report produced by Professor Pollock entitled "Deficits before patients". They listened to the chief executive and the director of public health of Worcestershire health authority, and at the end of the meeting stated that they were bemused and most unhappy; too many questions had been left unanswered and there was a distinct lack of clarity in the replies that they had received from the health authority. The Worcestershire local medical committee issued a statement saying that the serious questions posed by Professor Pollock simply had not been answered. It stated—the point was made by the hon. Member for Worcester (Mr. Foster)—that the consultation procedure which took place at an early stage was suspect and the LMC demands an independent and expert analysis as soon as possible to review the situation.

The overwhelming feeling of clinicians is that the situation in the national health service in Worcestershire is bad and will get worse. They have placed on record their great unhappiness about the matter; they are concerned that there are too many unanswered questions, and about the future provision and location of acute medical beds in the county. They believe that there is a real risk that the service provisions for the population of Worcestershire will be inadequate. To the population of Worcestershire, I would add the population of south Shropshire.

The LMC has urged the board of Worcestershire health authority to agree that an independent expert investigation committee should be formed and fully briefed to discover whether the proposed bed configuration will be adequate to meet the need of the county's population when the PFI is fully operational. The LMC thinks that that is important as the original consultation exercise was suspect and inadequate, and the full facts were not given. Evidence has come to light for the first time, and much needs to be clarified.

In summary, the LMC wants five matters to be considered: first, the financial implication of the PFI scheme on the health economy of Worcestershire; secondly, the interim arrangements when in-patient services are closed in Kidderminster; thirdly, whether credible intermediate care will be in place before there are bed reductions; fourthly, a review of projected bed numbers in the various categories across the county when the new hospital is open; and, fifthly, the safety of the new stand-alone ambulatory care and diagnostic centre in Kidderminster, which the committee questions.

The Worcestershire health authority has few friends and no allies; opposition to its plans is unanimous and universal. Wyre Forest district council, where 19 out of 42 councillors were elected on a "save Kidderminster hospital" ticket, is opposed to the health authority plans. The community health council tried to get a judicial review but it was not granted, which controverts what the hon. Member for Worcester said, and of course it remains opposed to the plans. The local medical committee, the Worcestershire British Medical Association, the population of Kidderminster and the surrounding areas are opposed, as needless to say, are my constituents in Alveley, Cleobury Mortimer, Highley and surrounding areas.

Apparently, when the decision was made to proceed with the new hospital at Worcester, there was no thought of altering the status of other Worcestershire hospitals. The downgrading of Kidderminster hospital followed later, as a financial imperative, when it was realised that cash resources would not stretch to existing hospitals plus the new Worcester hospital. By the admission of the hon. Member for Worcester, the hospital was established to redeem an election pledge, but my constituents were also given election pledges. They were told that they would have adequate and satisfactory health care provision and they are extremely disappointed. They are the innocent victims of a Government who have failed to get their act together to ensure an overall strategic plan that will deliver adequate and satisfactory health care provision for all patients, regardless of where they happen to live. I endorse the Worcestershire BMA's unanimous decision that the Secretary of State should undertake to establish an independent inquiry that will enable us to see exactly what has happened, and, more to the point, gain assurance that future provisions will be satisfactory.

10.56 am
Miss Julie Kirkbride (Bromsgrove)

I am grateful for the opportunity to speak in the limited time that remains. I associate myself with the excellent exposition given by my hon. Friends the Members for Mid-Worcestershire (Mr. Luff) and for Ludlow (Mr. Gill) of the circumstances in which we find ourselves in Worcestershire. Although I shall not go into too much detail, I should like to respond to the remarks made by the hon. Member for Worcester (Mr. Foster), who claimed throughout his disappointing speech that he did not want to make the health service a political football, but then proceeded to do that in every comment that he made.

The Labour party stood at the last election on the assertion that there were 24 hours to save the NHS, and all three Labour Members present in the Chamber made specific pledges about their local health services during the campaign. The hon. Member for Wyre Forest (Mr. Lock) promised that he would keep the local Kidderminster hospital, but he changed his mind. Now, much to the disgust of his constituents, he believes that it should be closed. I know that he is aware of his constituents' anger, as I recently witnessed a little altercation in Central Lobby in which some of them made clear their concern about his change of heart. [Interruption.]

The hon. Member for Redditch (Jacqui Smith), who has just made a sedentary intervention, campaigned heavily on keeping open the accident and emergency department at the Alexandra hospital. She knows only too well that the A and E department at the Alex will be scaled down as part of the new configuration of hospital services in Worcestershire. It may or may not be called a local emergency centre—although the name is merely political, they are still worrying about it in the Department of Health—but the fact is that the A and E service at the hospital will not be the same as that which is currently provided and will rely on part-time consultant cover. The pledges of the hon. Member for Redditch to ensure that the A and E department at the Alex was maintained as a proper, functioning department have proved to be hollow. She has been silent on the matter, which is hardly surprising in the circumstances.

Of course, the main A and E centre for Worcestershire will be situated at the Worcester hospital. Although that may be a reasonable decision in terms of clinical care, it is not what the people of Worcestershire expected when the Labour party was elected. I remind Labour Members that they have failed the people of Worcestershire. The hon. Member for Worcester failed them when he did not recognise in his speech the legitimate concerns expressed by local doctors. Opposition Members are present because we have been contacted not by party political apparatchiks, but by local doctors. They are the front-line service in Worcestershire and they are deeply concerned about the effect on their clinical services of the new configuration of hospitals in our county. If Labour Members had any respect for their constituents, I should have thought that the hon. Member for Worcester would at least have asked the Minister the important questions that the Government have so far failed to answer.

I support the view expressed by my hon. Friend the Member for Ludlow, who said that an independent inquiry should be conducted. Such an inquiry would not concern judicial process, which has been the subject of previous inquiries, but real bed numbers, staffing numbers and service provision. We want answers about those things, not about judicial inquiries processes. We want answers about real services provided to real people in Worcestershire.

I should be grateful if the Minister would let us know whether she was prepared to instruct Worcestershire health authority to have the inquiry. If she were not prepared to do that, would she please answer the specific questions raised by my hon. Friends? We want to know the real number of beds to be available to the people of Worcestershire after the new Worcester hospital comes on stream under the Worcestershire acute trust. We want the beds to be classified according to the Department of Health's classification. We want to know how many seven-day acute beds we will have after the new health service configuration. We want to know how many intermediate care beds there will be. We do not want the figures lumped together as an answer of 1, 400—an answer that the Minister gave in May and continues to give in July when the situation is clearly changing. We want to know the precise numbers of those beds so that we can ask the relevant services about the situation. According to the Worcestershire acute trust plan, there is to be a 17 per cent. cut in nursing staff. Is that true? It would be wonderful if it was not true and we would like reassurance. Will she kindly clarify the matter?

11 am

Mr. Nick Harvey (North Devon)

I will not detain hon. Members for more than a few minutes because Worcestershire Members have asked questions to which it is important that they receive answers. The hon. Member for Mid-Worcestershire (Mr. Lull) opened his debate sensibly; I congratulate him on securing it. However, it seems strange that calling such a debate is still necessary at this late stage—almost the end of July—just two months before changes start to be implemented. The hon. Gentleman must still press for fairly basic figures that ought to have been transparent to all before any of the processes were ever commenced.

Answers have been too long in coming. The hon. Member for Ludlow (Mr. Gill) tabled questions on 10 February that took until 2 May to get an answer. If the Department of Health is in such difficulty coming up with perfectly straightforward answers to perfectly straightforward questions, the whole thing has not been thought through as well in advance as it should have been.

In moving the debate, the hon. Member for Mid-Worcestershire said that the Kidderminster campaigners had focused on the wrong issue, making their goal keeping an acute hospital going in the town rather than addressing the question of whether the proposed alternatives were satisfactory. I know what he means but, if one considers the issue from the campaigners' point of view, it is understandable that the key issue is keeping the full range of facilities in their community.

I do not believe that the campaigners have been reassured or dissuaded from that aim by anything that has happened or by the way in which the matter has been handled locally. In one sense, that shows the shortcomings of democratic accountability in the NHS at a community or regional level. Campaigners have gone to umpteen meetings, asked questions and sought to put their view. However, at the end of it all, they have not been given answers that offer them reassurance.

I was grateful to the chairman of the trust for taking time out of a busy day to brief me on what was happening and on what the new facilities would look like. He certainly seemed determined to press ahead and to do so with all haste. I can understand why, if campaigners have had audiences with him, they have not emerged reassured that he had listened to anything that they had to say or that he had endeavoured to meet the points raised. If they ended up thinking that he was hell bent on ploughing ahead, I could see why.

The hon. Member for Ludlow rightly focused on the worries in the Kidderminster area and over the county border in his area about the emergency arrangements to be available to people living in those parts when there is no longer an effective accident and emergency department at Kidderminster. Those points have not been addressed or answered at all. With his local knowledge, he is able to offer examples of traffic congestion on crucial junctions in even the past week or two. I was completely astounded that, when I spoke to the chairman of the trust, he seemed to consider that his responsibilities lay in the county of Worcestershire because that was what the trust covered but had barely taken into account the problems that would be faced over the county boundary in Shropshire. I can well understand why people in the Kidderminster area and in Shropshire are far from reassured. It seems to me that the whole thing, or at least the speed with which the changes are being introduced, is largely driven by finance. I am well aware that the Pollock report has been knocked: its motivation has been queried and some of its findings have been challenged. There might be some problems with the report, but even if the number of beds remains more or less the same as it was before the restructuring, bed provision in the area will remain far lower than the national average, so it does not put things right.

I hope that we will hear answers to those questions today, in particular, to the questions asked by the hon. Member for Mid-Worcestershire. I regret that the Government are not able to answer questions on the PFI rather more quickly. In the House of Lords, my noble Friend Lord Clement-Jones asked questions about some basic figures relating to the PFI, to which it took the Government six months to reply. The Liberal Democrats have no problem in principle with the PFI, but we believe that the public should be able to see that it offers better value for money than alternative methods. As yet, that information is not forthcoming. Even the House of Commons Library says that it is completely impossible to cost PFI compared with other methods.

11.6 am

Mrs. Caroline Spelman (Meriden)

I shall be brief because this debate is of great concern principally to hon. Members who represent Worcestershire constituencies. They have made their points well and we would all like to hear the answers.

I want to say for the record that this is one of the most disappointing debates that I have heard in this Chamber because it was spoilt by the party-political intervention of the hon. Member for Worcester (Mr. Foster). I have always enjoyed the fact that there is a different tenor to debates in Westminster Hall. My hon. Friend the Member for Mid-Worcestershire (Mr. Lull) tried hard to keep away from party politics, and I congratulate him on securing this debate. There is some urgency in the air because, as the hon. Member for North Devon (Mr. Harvey) pointed out, we are on the eve of major changes. My hon. Friend the Member for Mid-Worcestershire recognised his responsibility in calling for the Adjournment debate, which enables us to articulate publicly our real concerns about the overall change and the transitional arrangements. It is entirely justified to have such a debate before the changes are introduced because, who knows, we could be successful today in encouraging the Minister to do something to improve the transitional arrangements. Our questions have been designed constructively for that purpose.

We are not trying to reopen an old debate and we are not being politically opportunist—none of the opposition parties has been politically opportunist in today's debate. We accept that the change will take place and our purpose is to articulate the real concerns of Worcestershire's residents about what will greet them in the brave new world of restructured Worcestershire hospitals. The hon. Member for Worcester resorted to swiping at the Conservative party's desire to privatise the NHS, but that has never been our intention, as we have made clear on many occasions. In case the hon. Gentleman has not heard what we have said, I shall repeat that we would match the Government's spending on health.

The key issues are financial viability, bed availability, staff shortages and the range and standard of services. The viability of the new hospital is an important issue. I speak from my experience of seeing a new hospital get up and running in Solihull. That hospital ran into serious financial difficulties almost immediately and, ultimately, a merger had to take place because the hospital proved unviable. Once bitten, twice shy. My concern is that the special allocations that the Government have given in the past two years have simply been used to mop up deficits, which, as I read the figures, are a structural problem at the hospital. I know for a fact from the managers of the trust that there is a problem with the roof on the Alexandra hospital, which will cost £1.7 million to repair. The financial weakness of the situation must be taken into account when we ask the Minister about the financial viability of the project. The preliminary cost of the PFI proposal has escalated by 118 per cent.—a significant increase. What are the primary causes of that? I understand that one of them is the 22 per cent. increase in the original projection of bed availability, but I should be interested in the Minister's comments on the ultimate price tag on the new hospital.

That leads me to the question of bed availability, which, on the setting up of the new hospital is, apparently, already tight. The framework for that state of affairs is that NHS bed numbers have declined by 7, 000 every year since 1964, whichever party has been in power, to the point at which we all accept that they can decline no further. The shortage of beds is reflected in the waiting lists, and on the Government's annual report website the harsh fact was revealed that in the area for which my hon. Friend the Member for Mid-Worcestershire is responsible, the number of people waiting for in-patient operations has risen, and in the out-patients category the number waiting has doubled. That is despite a pledge to reduce waiting lists—which may have happened elsewhere, but is not happening where the new structure is about to come into operation. That is the reason for the concern about whether there will be enough beds.

I endorse my hon. Friend's remarks about categories of beds. Care should be taken about counting intermediate care beds. The winter pressures last year were due in no small part to a shortage of medical beds. The relevant patients were largely elderly people, often with serious chest infections requiring an emergency medical admission. It is not possible to decant elderly men and women in that predicament to a residential nursing home without the full range of clinical support that they need. A bed in a nursing home cannot be classified as the kind of bed that an emergency medical case would need. Even when an emergency has passed, it is not suitable to give that classification to an intermediate care bed. The categories will become very important.

On staffing, I should like to hear about the projected reduction in the number of nurses. When I visited Kidderminster hospital I heard from staff about loss of morale and concern about having to commute to the new hospital to keep their jobs. Seventeen miles is a considerable distance; it is a lot for a working mother who might have been able to walk to the hospital previously but will now have to incorporate commuting time into her day. I know that a bus service will be laid on, but I hope that the Minister will accept that that is not the same. Such disincentives affect non-clinical staff strongly, particularly catering staff, who will not commute in search of jobs in the new hospital.

Will the Minister confirm how many paramedic ambulances will be stationed at Kidderminster hospital? My hon. Friend the Member for Ludlow (Mr. Gill) explained the importance of that. I was deeply affected by the death of the late Sir Denis Howell, who died in my constituency while waiting 19 minutes for an ambulance from our acute hospital. Given the distance, and with the equipment on board, perhaps it might have been possible to save his life. It is important for the public to be clearly aware of the number of paramedic ambulances, where they are to be stationed, and the type of equipment on board.

The main purpose of the debate is not political but a matter of responsibility to ensure that hon. Members' worries are dealt with, if possible in the nick of time, before the changes are made. We have tried hard to avoid party political contributions, and I am sorry that that has not applied to all interventions. Good, clear answers to our questions would go a long way towards helping us to answer the questions that we receive from people affected by the changes.

11.14 am
The Minister for Public Health (Yvette Cooper)

I congratulate the hon. Member for Mid-Worcestershire (Mr. Luff) on securing a debate on a subject that is important to his constituents and the residents of Worcestershire. My ministerial colleagues and I are fully aware of the concerns that have been raised in Worcestershire and Shropshire about those matters, which have been debated in the House on several occasions. I and my hon. Friends in the Department of Health have also had meetings with my hon. Friends the Members for Wyre Forest (Mr. Lock) and for Redditch (Jacqui Smith) who are here this morning; they have both been assiduous in representing their constituents' interests.

Hon. Members have raised a series of questions—I shall try to answer them in as much detail as time allows. First, I shall deal with the proposals based on "Investing in Excellence" and the new Worcestershire hospital and, secondly, I shall deal with the transitional arrangements. We take seriously the concerns that have been raised by hon. Members and constituents.

The Government's priority is the modernisation of the NHS and the provision of high-quality care to everyone. We want to ensure that patients receive clinically appropriate service when and where they need it. That means making appropriate use of existing facilities and, if necessary, developing new services. The health service needs to respond to demands from doctors and other health professionals for the skills and experience that result from greater specialisation. That approach, based on "Centres of Excellence", is aimed at providing patients with the very best that medical science can offer.

The backdrop for Worcestershire's strategic review was the need to secure appropriate and high-quality clinical services. The local health authority, the local trust, local clinicians and the Government would be failing in their duty to provide top-quality care for everyone if changes were not made in Worcestershire. Without appropriate specialisation, patients will simply not receive the best-quality care. That is the driving force behind the changes that are taking place in Worcestershire.

The decision to make changes in Worcestershire was based on a thorough and detailed process of strategy development, option evaluation and consultation over a considerable time. It is wrong to say that the changes are being made at the last minute, without proper consultation or investigation of the options. The extended consultation exercises were carefully evaluated by the health authority and, following the formal objection of Kidderminster community health council, they were fully and properly reviewed by Ministers.

In arriving at their decision, Ministers took the advice of clinical professionals, both nationally and locally. We were satisfied that it was not possible to sustain three centres for emergency medicine and surgery in Worcestershire. However, concerns were expressed, particularly by my hon. Friend the Member for Wyre Forest. As a result, we instructed the health authority to modify its proposals in order to strengthen the new county-wide accident and emergency service and to increase investment at Kidderminster hospital to ensure that the new emergency centre could deal with as many patients as possible.

We responded also to the concerns raised by my hon. Friend the Member for Redditch about the Alexandra hospital, which has led to hundreds of thousands of pounds of additional investment in the accident and emergency services. As hon. Members are aware, "Investing in Excellence" has already been subject to external evaluation, including independent scrutiny by the King's Fund. The health authority's approach was upheld in three judicial reviews.

Mr. Gill

Does the Minister not recall the recommendation of the King's Fund that the changes should be made on a two-year pilot project basis and formally reviewed by a reputable external source…before any irrevocable decisions are made on the future of services currently provided at Kidderminster General Hospital? That recommendation seems to have been totally ignored.

Yvette Cooper

The strong view of local clinicians is that the changes need to be made as quickly as possible. We have spent a long time circling round the issue of new hospitals in Worcestershire and the configuration of services around the county. Proposals for a new hospital have been discussed for 30 years. It is time to get on with making the changes that are essential to improve the quality of care for people who live in the area.

Mr. Luff

Will the Minister give way?

Yvette Cooper

The hon. Gentleman asked a lot of questions, and I should like to make progress.

Mr. Luff

Can the Minister confirm whether the National Audit Office is inquiring into the process, as Wyre Forest district council claims?

Yvette Cooper

There have been many investigations and discussions. I shall write to the hon. Gentleman about his question.

I want to deal first with the concerns that were raised about Kidderminster hospital. The hon. Member for Bromsgrove (Miss Kirkbride) suggested that it will close. That is definitely not so. It has never been proposed, and it is simply not true. Kidderminster hospital will be developed with a state of the art ambulatory care centre delivering out-patient and day case procedures, using the latest technological facilities for telemedicine to speed up access to diagnostic tests and consultant opinion. That will be done according to protocols that have been properly agreed by clinicians across the country and by the royal colleges. We expect Kidderminster hospital to be a leading light nationally in the development of telemedicine, and we believe that it can be a pioneer for modern health services.

Miss Kirkbride

I stand by what I said. Doctors in the county believe that it is unlikely that matters will proceed in the way that the Minister describes, simply because it would prove to be clinically unsafe. It may not be possible to put young children and elderly people under general anaesthetic at the hospital, because the nearest emergency hospital is 18 miles away. Will the Minister confirm that there is uncertainty in that respect?

Yvette Cooper

I can confirm that we will proceed with a state of the art ambulatory care centre. The hon. Member for Bromsgrove is trying to make party political points and to spread scare stories by suggesting that Kidderminster hospital will close. For the record, I can state that that is absolutely untrue.

It is estimated that over 40 per cent. of patients who currently use Kidderminster's accident and emergency department will continue to use the hospital's minor injuries unit. That figure does not take into account further changes and increases that could take place as a result of telemedicine development. In addition, rehabilitation facilities will be used by patients returning from major surgery in Worcester.

In recent weeks, my hon. Friend the Member for Wyre Forest has raised with Ministers further concerns about Kidderminster hospital. As a result, meetings have taken place between local GPs and the Secretary of State, who has made it clear that he expects detailed cooperation between the health authority and local GPs about the development of services in Kidderminster to continue.

My hon. Friend raised specific concerns about heart attack patients who arrive at Kidderminster and need to receive life-saving thrombolytic drugs as fast as possible. I can tell hon. Members that as a result—

Mr. Luff

On a point of order, Mr. Deputy Speaker. Surely the idea of a Minister's speech is to respond to the debate, not to correspondence that he or she has received.

Mr. Deputy Speaker

That is not a point of order for the Chair. The hon. Gentleman has been here long enough to understand that.

Mr. Gill

Further to that point of order, Mr. Deputy Speaker. I may be able to help. I think that the Minister is probably referring to me, because the question that she is answering was posed by me, not by the hon. Member for Wyre Forest, who has not spoken in the debate.

Mr. Deputy Speaker

I am obliged to the hon. Gentleman for his observations, but the original point of order was not a matter for the Chair.

Yvette Cooper

Thank you, Mr. Deputy Speaker.

I clarify for the record that I am discussing points that were raised about Kidderminster by my hon. Friend the Member for Wyre Forest, and which are relevant to the debate. It is important to make clear the changes that have taken place as a result of representations by my hon. Friend. Life-saving treatments for heart attacks—thrombolytic drugs—will now be available in Kidderminster emergency centre to ensure that people get the timely care that they need for urgent conditions such as heart attacks.

Several hon. Members asked about bed numbers. Following hospital reorganisation, approximately 1, 400 acute and community-based beds will be available in Worcestershire, compared to 1, 387 in 1998–99. As the trust has pointed out, there are 1, 035 acute beds. From September 2000 until the new hospital opens, there will be 1, 041 such beds. After the new hospital opens, there will be 988 such beds, plus the 56 winter pressure beds that are currently under consideration, which equals 1, 044 beds. In addition, we expect the number of intermediate care beds in the area to increase, because it is clear that the type of bed in question is an extremely important issue. I should point out that, in line with the announcement on the expansion of critical care services, the new Worcestershire hospital has capacity for as many as 15 intensive therapy unit beds. As a result, it will have more critical care beds than the current capacity in the county as a whole.

Mrs. Spelman

Does the figure for ITU beds include high-dependency beds, as well as the "all bells and whistles" ITU beds? If so, how many?

Yvette Cooper

Final decisions on the exact number of critical care beds will depend on further decisions that are taking place at a national level on their expansion throughout the country. That expansion is the result of my right hon. Friend the Secretary of State's announcement on the number of intensive care and critical cares beds. If the hon. Lady wants to raise that issue again, I hope to be able to give more detail at the appropriate point.

Capacity for 2002, when the new hospital in Worcester will open, has been designed to accommodate the anticipated number of emergency and elective patients. At the same time, we expect continuing development in intermediate care. The national beds inquiry found evidence of significant inappropriate or avoidable use of acute beds, and a recent audit in Worcestershire showed that 42 per cent. of patients in acute beds would have been better cared for in another, lower dependency setting.

Hon. Members asked whether intermediate care is expanding sufficiently quickly. It is clear that this is an important issue, and a great deal of work has already been undertaken. An increasing number of schemes are in place to prevent hospital admissions, such as rapid response teams and intensive home care. Worcestershire's investment in intermediate care has increased from approximately £1 million in 1999–2000 to £1.7 million in 2000–01. Local primary care groups have developed a wide range of schemes to prevent admission and support early discharge. Many GP practices in Worcestershire have indicated a desire to develop a wider range of services for patients by bidding for personal medical services.

Improved bed management and discharge planning in acute hospitals is already paying dividends, and the extra £2 million that was invested in continuing care this year is reducing bed blocking. We expect that work to continue. The multi-agency local winter planning group has refined its winter plans for next year, and will submit them to the regional office at the end of July. Last year, Worcestershire managed the winter pressures period well, and expects to do the same this year. In addition, over the past two years we have awarded Worcestershire health authority a special allocation—amounting to £8 million—to help re-configure its services. A significant proportion of that sum has been used to pump-prime development of intermediate care in advance of any bed closures.

The exact timing of the move of services is a matter for local clinicians and service managers in Worcestershire, rather than this Chamber. However, the decision to implement the acute in-patient moves was the result of clinical advice given by medical staff at Kidderminster in particular, where an early move was felt to be important.

Miss Kirkbride

What about nurses?

Yvette Cooper

The hon. Member for Bromsgrove made a series of allegations, including some relating to nurses and to bed numbers. I have responded in detail to her point about bed numbers. On the question of nurses, her allegation is utterly untrue. A media statement put out by the local hospital trust states: An active recruitment initiative is under way. It is estimated that up to an additional 30 nurses will begin work at the trust. A reduction in the number of nurses is nonsense. The statement goes on to say: Miss Kirk bride should stop using hospital services as a political football. I hope that hon. Members will take note of that, and of the importance of this issue.

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