Keynsham and Paulton Hospitals (Hansard, 10 September 2003)

§ Dan Norris (Wansdyke)

May I say how nice it is to be here under your chairmanship, Mr. Taylor? I was not expecting to see you today. It is an unusual situation for us to be meeting here in September. It would not previously have been possible for me to air my constituents' concerns at this time of year. I am very grateful for the changes in the hours and sitting dates, not least because this matter would otherwise have gone unnoticed in this place.

This issue is about fairness, not favours. I want to stress that. It is a justice issue. To allow the Chamber to make sense of it, I shall explain something of the local situation in and around my constituency. The Bath and North East Somerset primary care trust, which is responsible for the decisions about Paulton and Keynsham hospitals that are the subject of today's debate, covers north-east Somerset, which is largely made up of about 80 per cent. of my constituency, as well as Bath. Although that forms one area, there is a distinct difference between how Bath operates and how Bath people see the world, and how north-east Somerset operates and views the world.

One of the most notable factors is that the north-east Somerset part of my constituency covers a very large area—as large as the neighbouring Bristol constituencies and Bath put together. There is a great difference in geography and in how people see the world and relate to it. It has an older population than average, and some of the proposals relate to older people. They have a resonance that might not be understood if one did not know how the population of my constituency was made up.

My constituency has, by and large, an affluent population. Unemployment is incredibly low, and was the lowest in the country six months ago. I think that I am right in saying that that is the first time that a Labour constituency has had the lowest unemployment in the whole country. It still remains very low, but there are areas of significant poverty. It is to people in those areas that Keynsham and Paulton Memorial hospitals are most valuable. If there are great distances to cover and one cannot easily afford to travel, they are all the more important.

I want to stress something that people will not understand without a local knowledge. The hospitals have great emotional resonance and importance for local people. Keynsham hospital is well known to many of my older constituents, not least because they remember it as being on the site of the old workhouse. In some respects, it strikes fear among the very oldest. Paulton Memorial hospital was established to recognise the needs of the mining community. It is centred in the heart of the former north Somerset coalfield area. Although the last pit closed 30 years ago this month, the miners whom I saw at a reunion on Monday were full of their concerns about the hospital. They know how important it is to that community, and what great service it has given over many years, not only in my lifetime but in previous generations.

This is not in any sense a criticism of the Government, because there is a perfect understanding in my constituency that the decision, on which I shall 124WH elaborate in a moment, to make changes that are in effect cuts to the local service has been made by the local primary care trust, Bath and North East Somerset, which is made up of local appointments and people who should well know the area and the reaction that there will be to the proposals—although I fear that they do not. For example, there is a complete understanding that the Government are investing hugely in the health service in my local area. Bath and North East Somerset primary care trust is to receive £40.7 million over and above what it had been allocated—some £12 million this year, £14 million next year and £14.7 million the year after.

Because such huge and welcome Government expenditure has resulted in extra staff and other improvements, there is consternation and disbelief that there could be any talk of cuts in local hospitals. That seems incongruous with what is seen as the good work of the Government, for which people voted in two successive general elections, and it causes puzzlement and concern. There has also been a welcome for the many millions of pounds of investment in local education.

On top of all that, there has been a particular welcome for the investment that has recognised the toil of and pain suffered by many former miners in my constituency and the surrounding areas. Wansdyke has just received £1.3 million in compensation for emphysema and related issues. That is something that people welcome and understand: they recognise that such huge investment is important, and there is no question but that they appreciate the local NHS staff. What is difficult to understand is my area's unique honour: two hospitals, Bath royal united hospital and Bristol royal infirmary, with its associated trust hospitals, both got zero ratings in the Government's listings. Local people do not perceive that as meaning that they are not doing good things; they recognise that they are clinically excellent and do some wonderful work. By and large, they welcome the scrutiny that went into the compilation of the figures and statistics—they long suspected that things were not of the standard that they should have been—and they recognise the importance of transparency. Unless a problem is identified, it cannot be dealt with.

Having said that, they also appreciate the work of local NHS staff, and that of the extra doctors and nurses who have been available since 1997. They understand that cancer treatment has improved significantly in the locality. Both in-patient and out-patient waiting lists have reduced a great deal, which is very welcome, as they were not satisfactory for a long time, and they also know that since last summer nobody has had to wait beyond the prescribed period of 12 hours on a trolley in Bath. That was not the case in past years, so there is great admiration for the work of NHS staff, not least those in Paulton and Keynsham, who have a good reputation and whose high standards are valued.

However, there is great anger and intense and passionate feeling about the proposals to cut services at hospitals in my constituency, which would involve Paulton's losing six beds and Keynsham 10, and the relocation of Keynsham clinic. People are concerned 125WH because they recognise the good work that is done there, but most of the anger relates to the bed cuts rather than to the relocation; they understand the need for change, provided that it means better services in the future.

There is also a worry that services to older people are under threat. Most of the population in Wansdyke and north-east Somerset is older than average. People also feel that there is an attack on mental health services and respite care services. Many carers are totally dependent on the respite care provided by the hospitals in one form or another. There is distress about the proposals because people had understood that when the new primary care trust came into being it would address mental health issues, issues for older people and respite care. Despite the opening up of communications, and the understanding that there would be proposals to make cuts if that were deemed necessary to balance the books, they did not expect soft targets to be hit. We are talking about the most helpless people in our communities and, along with the bed cuts, people are mystified as to why they should be targeted in that way. Having attended all four public consultation meetings, I know that they are not persuaded by the plans allegedly to maintain the standard and quality of service by new methods, not least care in the community.

You probably remember as well as I do, Mr. Taylor, that a Government of a different political persuasion set out on the care in the community road many years ago, thinking that it would bring cost savings, but it turned out to be a more expensive way of doing things. I think that, by and large, it was a better way of doing things, but it was not a mechanism for saving money. People are not convinced by the arguments put by the primary care trusts that the moneys that they want to save by making bed closures and other changes will fill the shortfall, although some of the money will be redirected to care in the community; people want to ensure that standards remain the same or, better still, that they improve.

I started by saying that there should be fairness and not favours for my constituents. They are aware of the overspend of £15 million, and they recognise that one has to balance the books. They do not want extra money, over and above their fair share, and they recognise that they are getting a lot more now, in line with many other parts of the country, which is right and just. However, if the books have to be balanced, they believe that the overspend should be corrected where it occurred. That was not in Paulton or Keynsham. Indeed, two thirds of that £15 million overspend took place in or around Bath royal united hospital. My constituents are rightly asking why the remedy is not being targeted at the place where the overspend occurred. The books must balance, but why should good hospitals that did not run up a deficit pay? That is to overlook the main culprit.

There is a history of poor management in relation to the Bath NHS trust under its various names over the years, not least the fact that it was so poorly managed at one time that three chief executives were salaried. Indeed, one of them was successful in obtaining £200,000 for unfair dismissal for being sacked while ill. An awareness of such figures when compared with saving beds does not go down terribly well with those whom I represent.

126WH Consultation meetings are a great forum for people to express their feelings—they are an important part of the process—but it is fair to say that some of the meetings have been quite stormy. I think that people have not been personally angry at the members of the trust, and although it might sometimes have felt like that to the chief executive, I assure her that that is not the case. However, it is a measure of the intense passion and feeling that has arisen. As a result, the chief executive sometimes thinks that it is being suggested that she does not care and that she is being cold and calculating. I do not believe that to be the case. I have found her to be accessible and prepared to talk at length about her plans. I am not convinced by the plans, although they have some merit because the books have to be balanced; but a range of other cost-cutting options that would be fairer and more just would not have created such a strong public reaction among my constituents.

In one matter, however, I am critical of the Government. I do not expect the Minister to share my view, but when the Government appoint primary care trust chairmen, they should be as partisan as necessary. One of the reasons for the current difficulty in the Bath and North East Somerset primary care trust is that the chairman is not of the same political persuasion as me or you, Mr. Taylor, and the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) is his leader. This Government are clearly committed to extra expenditure, to reform and to a set of values. After all, the Labour party, my party, created the NHS and wants to ensure that it becomes even stronger and better. It is therefore very difficult for many local people to comprehend how someone of a different political persuasion can, in all integrity, properly accept the thrust of Government thinking and want Government policies to be implemented. Clearly there is disagreement, although I respect their right to hold their own views.

We should reconsider how we appoint people to become chairmen of PCTs. There is nothing wrong with appointing people of the same political persuasion as the Government and being straight and open about it. People would understand that completely. They would not like it, however, if someone's political persuasion were somehow hidden or disregarded when it was an important factor. We should know that everyone is pulling together and working together in the same way. That issue has caused consternation among local people.

It did not help that the chairman of the trust missed the first three of the four consultation meetings. Of course, he may have gone on a well-deserved holiday. Who would not want someone to have a holiday in the summer? However, PCT chairmen presumably want to support their staff in the difficult proposals that they are presenting to the public, so when they know that a consultation meeting is coming up and have a choice about the times and dates of consultation meetings, surely they would want to be there to defend them and to explain, even to enthuse, if they felt so minded. I can say, in all charity, that not being present at the first three meetings was not the best way to win friends and influence people. I hope that he will be present at the final meeting in my constituency, so that he will have been present at two out of five meetings at least.

127WH The strength of feeling is best illustrated by petitions that have been collected in my constituency. At the risk of boring hon. Members, I will read them out, but promise that I will do so quickly. I penned the first petition myself, on behalf of the Wansdyke Labour party. It states: We, the undersigned, are deeply concerned by local plans to reduce the number of beds at Paulton and Keynsham Hospitals at a time when the Government is providing £40 million extra funding over the next three years to improve the NHS in our area. We urgently call upon the Bath and North East Somerset Primary Care Trust to reconsider its ill thought out plans to cut hospital beds, at a time when extra Government funding means there should be improved NHS services. That petition was also taken up by the friends and users of Paulton hospital, who have done great work in collecting signatures.

The second petition was undertaken by a local newspaper, the Somerset Guardian. I thank Joanna Roughton, its editor, for running it. It says: We, the undersigned, strongly believe that there should be no cuts in the number of beds or staff at Paulton hospital. Another petition, undertaken by another local publication, The Journal, says: We oppose the closure of beds at Paulton and Keynsham hospitals, and other proposed economy measures, at a time when there is increasing NHS funding. I thank George Donkin, its editor, for running that petition.

I want briefly to thank others, such as the friends and users group and everyone involved with it, especially Tony Clements, Mavis Ditte and Sue Padfield. They spent much time on their petition over the summer. I am very glad that it was a good summer, as they were outside for a great deal of time collecting signatures. I mentioned the local editors of the relevant media in and around Paulton. I also thank the local councillors, who have been part of an action group to fight the proposed cuts, especially Keynsham councillors Adrian Inker and Hilary Fraser and Paulton councillors Hattie Ajderian and Brian Barrett. They, too, did tremendous work over the summer with the ward constituents. They have been a source of advice and help to me, for which I am grateful.

I also thank members of Wansdyke Labour party, and all the other people unknown to me, many of whom have worked so hard to collect what is now approaching 10,000 signatures. That is roughly one in six of all my constituents. I am sure that it could be much higher with enough bodies to collect the signatures. It is certainly the biggest petition that I have received since becoming a Member of Parliament in 1997. It is fair to say—I am bound to be subjective—that the issue has created the most intense feeling in my time representing the people of Wansdyke.

The issue is about fairness, not favours. Local people do not want to be let off any financial impediment that would otherwise come their way. They recognise that if there has been an overspend the books must be balanced, but they want the balancing to occur where the overspend took place, which predominantly means the Bath royal united hospital. The Bath and North East Somerset primary care trust has not weighed that up in its proposals to make cuts.

128WH I believe in devolved decision making. Bearing in mind my proviso about the appointment of chairs, primary care trusts are a good way of making important local decisions in the NHS, but many people—in my view they are wrong—feel that the consultation is a sham. It is not a sham, and I am quietly confident that there will be a compromise because of the strength of local opinion, which is expressed through petitions, public meetings, letters and phone-ins to radio stations and various other media. There will be a compromise, but I ask the primary care trust to be careful not to jump out of the fire and into the frying pan. There may be a strong public reaction if it keeps beds open but changes their purpose.

§ The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I congratulate my hon. Friend the Member for Wansdyke (Dan Norris) on securing the debate. I have listened to and appreciated his comments, which he has expressed with concern and passion, about an issue that matters to people in his constituency and thereabouts. I should also like to take this opportunity to join him in paying tribute to all the staff he mentioned in the local health economy. They are obviously committed to the improvement of the local NHS and also to the provision of services to patients.

I shall discuss the local issues in a moment, but it is important that we acknowledge the pressures on the NHS not only in my hon. Friend's constituency but throughout the country. We want not only to increase capacity but to raise clinical standards. We do not want more of the same; we want a radical re-examination of the best ways of providing services for patients both now and in the future.

The NHS plan sets out a challenging 10-year programme for the reform of the NHS. In that context, it is worth saying that far-reaching changes are often necessary to provide the best possible services for patients. We must ensure that services are accessible and flexible and we therefore want to design services around the needs of patients. As part of that modernisation programme, many economies and organisations in the NHS are considering changes in how they organise their services with stakeholders.

Hospital services must change if we are to continue to fulfil patients' needs and to improve access. Services cannot and should not remain static for ever. They should be responsive to local needs and to the changing opportunities for developing services. Local providers of health services have a responsibility to live within their means. My hon. Friend sketched out the balance between those two issues at play in this situation.

As my hon. Friend knows—I will not go into this in great detail—it is obviously for the primary care trusts in partnership with strategic health authorities and other local stakeholders to determine how best to use their funds to meet national and local priorities for improving health, tackling health inequalities and modernising services. They are in the best position to know, because they are closest to the local community.

In my hon. Friend's constituency, the local PCT, Bath and North East Somerset, is recovering from a £15 million deficit, and I appreciate the concerns that he has expressed on behalf of his constituents. The local 129WH strategic health authority, the Avon, Gloucestershire and Wiltshire strategic health authority, has worked closely with the whole health community to make the necessary savings. Savings are required not only from community and primary care but from the acute sector. My hon. Friend emphasised fairness, not favours. The whole health community needs to tackle the problems that it faces together. That is why the local PCT has published the consultation document, "Living within our Means", which identifies how it proposes to make the savings.

The consultation ends at the end of September. I assure my hon. Friend that local stakeholders have been involved in the process, and he knows that full well from his own close experience. Since the document was published, the PCT has engaged in wide consultation and there have been 30 to 35 meetings with specific interest groups. He has been active in attending many meetings on the subject himself.

My hon. Friend is right to say that the proposals in the consultation document include a reduction of 23 beds across three community hospitals. I recognise the interest in and love for those community hospitals that he expanded on. The plans also include expanding the PCT's hospital at home scheme, and working with social services and other partners to reduce the length of patients' stay in community hospitals to speed up discharge and get people back to their own homes, which is where most of us would rather be at the end of the day.

The PCT has been running the hospital at home scheme since 2000. It provides 24-hour cover, seven days a week and has been extremely successful. External evaluation of the service, which focused on the patient experience, has also been positive. The Commission for Health Improvement considered the scheme on a recent visit to the PCT in March and commented favourably on the extended service.

By extending the hospital at home service, the PCT is confident that it will be able to meet at least some of the needs that are currently being met in community hospital beds. Obviously, under the consultation arrangements, all those hospitals will still exist. It is simply the number of beds that is at issue.

The model of care proposed should provide a much more personalised and local service, tailored to the individual patient. That is in line with our policy on intermediate care, particularly for elderly people. Intermediate care is not an optional extra. It is central to the modernisation agenda. There could be slight confusion concerning both the modernisation agenda 130WH and the budget deficit. There may be attractions to making the changes in any event. I recognise that people must be more sceptical when there is a deficit, and that is probably part of the difficulty with considering the case and its issues objectively. That is not surprising.

Returning to the local health economy, it is only fair to say that I acknowledge that Avon, Gloucestershire and Wiltshire strategic health authority has inherited serious financial and performance issues. I was pleased to hear the account of the performance of many parts of the NHS. However, Avon, Gloucestershire and Wiltshire is one of the most challenged strategic health authorities in the whole of England. I am pleased to say that in order to assist the strategic health authority to manage the considerable financial pressures that it faces, an additional package of financial support has been agreed.

I recognise the pressures that the strategic health authority is under, but I repeat that our policy is that PCTs, in partnership with the local NHS trust and the strategic health authority, decide the priorities for the NHS locally. That is where local knowledge and expertise lie, and it is not appropriate for Ministers to decide on that direction of travel and how services should be configured. We have made that clear, and I know that my hon. Friend accepts it. It is right that the local NHS should deal with that. I hope that, having secured and driven forward the debate, he will continue to work with the local NHS, as I know he will, to build a better future for the residents in his area.

Whatever decisions are reached locally will involve full and public consultation, and the passion and expression of views that are a part of that. They will be made after much consideration and healthy, open debate.

I hope that hon. Members will understand that it is not appropriate for me to comment further on the issue, in case, following the local process, that pre-empts any future ministerial decision that may be necessary. However, I assure my hon. Friend that the Department and Ministers will continue to work with the local NHS to review the progress of the local economy, to ensure that the difficulties faced continue to he manageable and that changes to the service are in the interests of patients.