Health Services (Gloucestershire)

I agree and make no apology for concentrating on that point, because that is the most urgent consultation. On Saturday, the hon. Gentleman heard a lady make a most emotional speech about the implication of the proposals for her nearest and dearest. People feel very let down because they have been given almost no time or opportunity to make their case. The Chamber heard the request of the hon. Member for Tewkesbury that the Minister clarify whether we are talking about a month-on-month balance or historical deficits that have to be cleared in a matter of months. We need an explanation, because that is the nub of the problem we face in Gloucestershire. There is a second problem and I make no apology for continuing to labour the point, because it is important: the relationship between Gloucestershire and its partners in the SHA. It is hardly acerbic to note that Gloucestershire feels let down by the fact that it happens to be in a strategic health authority, other parts of which have run up large deficits over a period of time. The hon. Member for Tewkesbury made several points about why that should not have been allowed to happen, but it has been allowed to happen. As a result, according to the operating framework that the SHA is passing down on tablets of stone, Avon, Gloucestershire and Wiltshire SHA is being asked to reduce its turnover by 5.3 per cent., against a national average of 3.4 per cent. That may not sound much, but there is still a problem. Some trusts in Gloucestershire have been in balance or close to balance, although it is true that Cotswold and Vale PCT, which is my PCT and that of the hon. Member for Cotswold, has been a problem for a long time, but that problem does not extend to other parts of the SHA. We are being asked to provide ballast across an area for considerable problems in the past. We know that, because about £175 million from the NHS bank has gone elsewhere into other parts of the SHA, not a penny of which was ever put into Gloucestershire, even though Cotswold and Vale has had its own problems. I ask the Minister for a commitment that we shall get some real figures—disaggregation of the figures—for the entire SHA, even in breaking it down within primary care trusts so that we know where the money has been spent as well as where the cuts are being levelled. It is vital that we know where the real money has gone and how that money can be accounted for. I have one request from the overview and scrutiny committee, which I will put to the Minister. It wrote some seven weeks ago to the Secretary of State seeking clarification on budgetary issues. That was mainly in terms of the month-on-month balance. It has yet to receive a response from the Secretary of State. The committee seeks clarity and it wants to see the Secretary of State. I pass on to my hon. Friend the Minister that urgent request. The committee is now mid-way through the first of its consultations. Yet it could be labouring under a great misapprehension, as the hon. Member for Cotswold rightly said. The committee could be being asked to make a decision on something that is a false premise. There should be quick clarification. I will concentrate rather more on the partnership trust, the mental health and learning disability trust in Gloucestershire, which is mid-way through its existing consultation. What is the trust being asked to save? I have already said that the national average is 3.4 per cent. in turnover. The SHA is asking us to save 5.3 per cent. in turnover. The partnership trust is being asked to save 12.8 per cent., which is £9.6 million, of its planned expenditure. I do not know whether that means one and the same as turnover. However, I take it to be that an even greater amount of savings is required of the partnership trust than anything else that is being required within Gloucestershire, and maybe within the entire SHA. As the hon. Member for Cotswold said clearly, about 36 per cent. of older people’s services for mental health and learning disabilities are to be cut. That is a huge reduction in expenditure. It is all driven by the mad idea that we have to come into balance. I do not know where the figures come from for the partnership trust. That is given the historic overspend, which I did not know was there until suddenly it appeared, and the deficit that is coming this year. I do know where the £2.2 million comes from, which is the contribution to the NHS recovery programme. That seems so unfair given the other cuts that have to be made. It would help me and other Gloucestershire Members who are in their places this evening to know exactly where the figures come from and why a small trust—a specialist trust—is being asked to make a disproportionate contribution in trying to come back into balance. This makes a big difference to my constituency because of the potential changes at Weavers Croft. It is not likely that Weavers Croft will close completely but it will lose its beds. We do not know the impact of the beds that were brought across from Bourton ward in Cirencester, in the constituency of the hon. Member for Cotswold. As far as I know, that has never been evaluated given the impact that that had when we had some 120 beds for older people’s services. We now intend to cut the number to 65 if the proposals are adhered to. I move on to the Tyndale centre in Dursley in my constituency, where we have already lost day centre provision. That has been lost also at Weavers Croft. There must be questions about whether those facilities will ever be picked up and from where they will be run. As was rightly said by the hon. Member for Tewkesbury, we must focus on the impact, which will be dramatic on social services. I heard the social services committee make a presentation to the overview and scrutiny committee. I was not clear whether anyone has undertaken a detailed impact analysis of the changes that are being proposed. If that has not been undertaken, somebody should see that it is. In this place, we would never allow the nature of proposals to be given superficial treatment, which is what they appear to be receiving. That is not a criticism of the overview and scrutiny committee because it is saying that it has unclear and scanty information about the different proposals. The organisations in the voluntary sector need to be brought into the process. Underneath the radar, as well as the institutions that are much loved and being fought over, many other changes are being proposed. For example, it is proposed that there should be a 50 per cent. further cut in the passenger transport service. In Gloucestershire, if someone does not have a car they have no quality of life. If someone does not have a car and he or she is ill, it is unclear how they can get to the necessary services. The local newspaper—I refer again to the lady who spoke on Saturday—ran a particular campaign to try to get her to Cheltenham. Visiting took two hours and the situation was difficult for her. Is that something that people can and should be asked to do? I could go on much longer about the impact on maternity provision. There will be future debates in this place and I have no doubt that, if we do not get satisfaction, we shall go on to examine some of the other service provision, such as the community hospital closure programme, including the Berkeley hospital, which will not save any money because the idea is to move Berkeley up to the Cam and Dursley area. In some instances that makes sense because that it where the larger population is. However, I am not in the mood to agree to a cut in provision when we have no money, apparently, to re-provide a better service anywhere. It would be daft for any Member to say, ““I can see that that will be a good move.”” We are being asked to make dramatic cuts without any possibility of new investment coming into the county. It would be ludicrous to go along with the proposal unless we have some clarity on what needs to be done. I ask my hon. Friend the Minister to provide clarity so that we can nail tonight what we mean by coming into balance. We must examine the particular problems of the strategic health authority. These are matters that are serious to Gloucestershire. We feel unfairly treated because of the nature of the SHA with which we unfortunately happen be placed. We need clarity also about the series of consultations that are being held so that we understand more about the impact analysis. That is clearly not happening at present. That is all to do with the speed at which the changes are being driven through. The direction may be right, but we need to separate the direction from the financial imposition. We certainly need to separate it from the speed at which people are being asked to make drastic decisions that have an impact on the young and the old and everyone else who is either a carer or someone who really cares for the facilities in question. I hope that my hon. Friend the Minister has listened to these difficulties. She will hear about them from hon. Members on both sides of the House. I hope that she will realise also that this is not a party political issue. All the parties are united in Gloucestershire. We need some help, otherwise we will see services lost that have been in place for a generation and more, and for no purpose whatsoever.