Health Services (Gloucestershire)

I rather regret the need for this debate, but having said that, I am pleased to have secured it and thank the Minister for attending. I want to set out the picture regarding health services in Gloucestershire and seek clarification from the Minister on a number of issues. There are three primary care trusts in Gloucestershire and one hospital trust. Cheltenham and Tewkesbury primary care trust, which covers most, but not all, of my constituency, is in surplus, but other trusts have been in deficit. The result is that across the county, there are some £40 million-worth of deficits. All the trusts together are proposing cuts in health services amounting to some £30 million, as things stand. There is of course great opposition in Gloucestershire to this proposal. I have a petition with more than 2,200 names on it, which I hope to present it to the House in the next few days. That constitutes a high percentage of the population affected. Indeed, there have been rallies and marches across Gloucestershire. My hon. Friend the Member for Forest of Dean (Mr. Harper), who cannot be here tonight, initiated a debate in the Chamber on 25 May, and he has been very active in opposing the cuts. Indeed, there is united opposition to them throughout the House. Members from the Conservative and Liberal Democrat parties, and from the Government party, will seek to catch your eye to contribute to the debate, Mr. Deputy Speaker, and it might be helpful if I confirm that they have approached me to ask for permission to do so. I should say at the outset that we of course have no disagreement with organisations balancing their books; every organisation must do that. Also, no one is going to accuse the Government of having cut spending on the health service, as that is not the case, so I hope that the Minister will not defend the Government against charges that I am not going to make. I turn first to my main, particular and most immediate concern—I shall come on to others shortly—which is the proposal to close Winchcombe hospital. It was built in 1928, with a lot of the funding provided by local people and benefactors. It provides a caring and comfortable convalescence for people, especially older people, recovering from operations or other treatment. It also provides a very helpful minor injuries unit in a rural area where public transport is not particularly useful. The White Paper on community hospitals issued some while ago made it clear that community hospitals should not close"““in response to short-term budgetary pressures.””" Sensibly, it recognised the value of, and need for, such hospitals—as, indeed, do I. I was recently treated at Tewkesbury community hospital within five minutes of having had a rather nasty car accident. The staff were excellent, and I pay tribute to them, and place on the record my thanks to them. The alternative to that treatment would have been a long car journey and delayed treatment, thereby putting additional pressure on staff at, say, Cheltenham or Gloucester hospital. So although the White Paper opposes such closures, that is exactly what is being proposed in Gloucestershire. People in Winchcombe are united in total opposition to the proposed closure of their hospital; they value it and they need its services. If it closes, they, too, will have to go to Cheltenham or Gloucester for immediate treatment, and those who are currently being treated or operated on in one of those hospitals will, presumably, have to be sent home early if Winchcombe hospital closes. I acknowledge that there is a debate going on about how long people should stay in hospital, and I accept that nowadays, some people can go home earlier than they might have done in the past. Often, home is the best place for people to recover, but not always. A while ago, my daughter was sent home from hospital after a major operation the very next day, even though she had no one to look after her and had two children to look after herself. That is unacceptable these days, but if we close hospitals and reduce bed numbers, it will become common practice, which I would greatly regret. Have the people who make these decisions considered the knock-on costs—to social services, for example? Have they calculated when people need help at home? In the light of meetings that I and others have had with Gloucestershire county council, which would have to provide many such services, it appears that those knock-on services have not been costed. According to the local primary care trust, they have not been costed. Its director of finance said today, when asked about the future alternative proposals:"““we have not calculated detailed costs yet.””" How does it know that the books will balance even after the cuts have been made, if those cuts have not been thoroughly thought through or properly costed? What that director did confirm was that closing the hospital will save only an estimated £240,000 a year. How can that be right? How can that make financial, let alone clinical, sense? I am also concerned by the lack of joined-up thinking about the knock-on costs, and generally. For example, just recently the doctor’s surgery in Winchcombe closed, and it was proposed that another one be built outside the centre. Why was no consideration given to moving the surgery to the hospital, and expanding the services available there instead of cutting them? The surgery would have remained in the centre of the town, where many old people live, and there would have been no need to build another one. If the hospital is not needed, why are local health chiefs considering buying in several beds, for the very purpose of convalescence? We already have 22 beds at Winchcombe hospital, so why lose them and buy in beds from elsewhere? I totally oppose the proposal to close the hospital, but other cuts across the county also worry me. For example, Delancey hospital, which is just outside my constituency and in that of my hon. Friend the Member for Cotswold (Mr. Clifton-Brown), is also proposed for closure, but it provides a good service. St. Paul’s maternity wing in Cheltenham general hospital was opened just 10 years ago at a cost of £6 million, and that is proposed for closure. The overnight facilities at Battledown children’s ward, also in Cheltenham hospital, will be closed, and other hospitals in neighbouring constituencies are closing. Mental health units are being proposed for closure, and further cuts are being ““considered””, but are not confirmed yet. All that represents short-term thinking. Where will it end? The proposed closure of those and other services is extremely worrying. Why are we having those cuts at all, and whose fault are they? People are taking a stand not only because of the present proposals, but the further ones that they fear. We are not a third world country—we are supposed to be the fourth largest economy in the world—so why do we face those cuts? Are we not entitled to expect enhanced, more efficient health services, not just services cobbled together to match the particular budgetary pressures at the time? On 6 April 2005, the Prime Minister said from the Dispatch Box:"““It is correct that we raised national insurance to pay for extra investment in the national health service.””—[Official Report, 6 April 2005; Vol. 432, c. 1409.]" My constituents have paid the extra tax, but where is the money going? All they are seeing is cuts. Yes, they are getting vague promises from local health chiefs about better provision being on the way, and that health care will be provided in a different way in future. Well, we will believe it when we see it. If there is a better way to treat patients, why was not that way pursued before? Why does it take budgetary pressure to force decision-makers to follow the correct clinical path? Who is to blame? It is an interesting question. No doubt the Government have increased funding, but have they increased their requirements from trusts to the extent that the extra money has been swallowed up in extra costs? Or have the local health chiefs mismanaged the extra expenditure? I would like the Minister to give me her view of Gloucestershire, because I do not necessarily blame the Government. I want to explore tonight exactly where the fault lies. Who is to blame for the deficits? What is the Minister’s view? How do we sort the deficits out? It could be done by closing front-line services and making patients suffer, but it could also be done more sensibly, given a little more time. The question that I would most like the Minister to answer—it is a crucial question that has been raised before—is about the balancing of the budget. The local trusts claim that they have to balance their books for the whole of this financial year, including making up historic deficits within this financial year. I quote from their consultation document published just today:"““PCTs have to achieve in-year balance and recover 2005-6 deficits””." They say that they have been told, unequivocally, that they have to do that. They told hon. Members that that was the case just last Friday. However, the Secretary of State, in a letter to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), said that trusts would be expected to make improvements this year and achieve month-by-month balance by the end of the financial year. That is quite a different thing. In a statement last week, the Secretary of State said again:"““We are aiming for all organisations with deficits to reach monthly balance of income and expenditure by the beginning of April next year.””" She went on to say that in some cases, the worst ones will be allowed even more leniency. Who is right? Do the trusts have to achieve total balance for the year, including historic deficits, or do they have to achieve monthly balance by the end of this year? Because if the Secretary of State is right, the consultation paper in Gloucestershire has been launched on a false, even dishonest, premise.