Health Services (Gloucestershire)

Thank you, Mr. Deputy Speaker, for allowing me to catch your eye in this debate. I congratulate my hon. Friend the Member for Tewkesbury (Mr. Robertson) on securing a constructive and—given the circumstances—good tempered debate. Rarely have I heard a debate in the House in which I have not disagreed with anything that other hon. Members have said. As my hon. Friend and the hon. Member for Stroud (Mr. Drew) made clear, this is a cross-party issue. There are no political differences between us. We are interested solely in our constituents in Gloucestershire receiving the best possible health care within the budgets available. I thank the Minister for being present this evening. As the hon. Member for Stroud said, she has been dragged to four such debates. She is in an unenviable position, but we would be grateful if we could get some answers and some clarity from her this evening. As has been pointed out by everyone who has spoken in the debate, the chief issue on which we need clarification is exactly what remit our primary care trusts are working to. Are they working to a remit of clawing back previous deficits, or are they working to a remit merely of bringing the situation back nearer to balance by the end of the financial year? That is critical. I hope that the Minister, who is consulting her Parliamentary Private Secretary behind her, will be able to give us the answer tonight. If she cannot, I should be grateful if she placed an answer in the Library as soon as possible. More important, I hope she will be able to give an instruction to the strategic health authority if the remit is different from the one to which it is working. If the SHA is working to the more severe remit, it may well be making decisions and unnecessary cuts to institutions. We had a dire announcement on what I call black Wednesday a few weeks ago, in which 12 of our health institutions in Gloucestershire were shut or severely curtailed, and several hundred jobs and 250 beds were to be lost. In my area, the Cotswolds, we had already had an announcement of closures in in-patient care in both Tetbury and Fairford. The in-patient care at Bourton is still subject to discussion, and we have had the curtailment of 10 beds in Moreton-in-Marsh community hospital, with the lure of the possibility of a new community hospital to replace those lost facilities in Bourton and Moreton—but only the lure, and with the scale of cuts that we are facing and the financial stringency, I wonder whether we will get any new facility builds. We may find beds being closed on the lure of a possible new facility, but we may well not get that facility. That type of comment pervades the whole debate. The hon. Members for Stroud and for Cheltenham (Martin Horwood) made that point clearly. In Cirencester I am faced with the cut of an entire ward of elderly mentally ill patients. We were on the march together on Saturday, as the hon. Member for Stroud said. We were marching not only to protect maternity facilities in his constituency, which are attended by people from my constituency, but to protest at the cut of Weavers Croft—further cuts in facilities for mentally ill patients. No new facilities are yet available in Gloucester, where all those elderly mentally ill patients are supposed to go. The existing facilities could be closed before the alternative is arranged. That would be a cruel irony for elderly mentally ill patients. The hon. Member for Stroud noted that a cut, if it is that, of 30 per cent. of the activity of the partnership or mental health trust is a huge cut, and it affects some of the most vulnerable people in society. My constituency used to have—I do not know whether the statistic is still up to date—the third highest number of over-80-year-olds of any constituency in the country. This level of cuts will affect my constituents very severely. At the meeting on Friday that all Gloucestershire’s MPs attended with health chiefs, it was made clear that the proposals are being driven not only by financial considerations, but by the short time scale in which balances must be restored. The health chiefs have asked for a longer time. If facilities are being cut and people must adjust to the changes that are being made, the Government should allow a little more time and provide a little more certainty about what is happening. I repeat the plea that I made in an intervention on the hon. Member for Stroud that the partnership trust overview and scrutiny process should have the same symmetrical time scale—that is, 12 weeks. I say to the Minister in all sincerity that if we change the institutions where elderly people have been for many years, the very least we can do—a kindness that we can do for people in such a vulnerable position—is allow them plenty of time to get used to the idea of the changes that may well occur. As I said, we in the Cotswolds faced the closure of our community hospitals way back in March, long before the big announcement a few Wednesdays ago about the other institutions. With regard to Tetbury and Fairford, the overview and scrutiny committee submitted a case to the Secretary of State on 16 March 2006. It has yet to receive a reply from her. When is a reply likely? If the Minister cannot tell me tonight, perhaps she will let me have a note. I quote one paragraph from the letter from Andrew Gravells, the chairman of the overview and scrutiny committee, in which he states:"““The local community have concluded that the changes are purely finance driven, which appears at odds with statements in the Government’s own White Paper, Our Health, Our Care, Our Say, which indicates that community hospitals should not be lost in response to short-term budgetary pressures.””" That is what worries me about this debate. We may close facilities in Gloucestershire, and facilities elsewhere that are facing the same budgetary pressures, and regret it later. With modern technology it is possible to do more treatment locally than was ever possible before. For example, with digital X-ray technology, it is easy to send X-rays to a consultant sitting many miles away at the district general hospital and get advice as to the sort of treatment that should be given. It can then be given locally, instead of all the time wasted by the patient having to be taken, perhaps by ambulance, to the district general hospital on another day with another appointment, with all that costing a great deal of money. I urge the Minister to look into some of the modern technologies available and see what can be done locally. As a chartered surveyor I am the first to suggest that we should not necessarily keep old Victorian facilities that cost a great deal of money in upkeep. That is not what I am suggesting. If they cost a large sum to maintain, for goodness sake let us sell them and build new facilities that are cheaper to maintain. In Fairford, where the local community has rallied round the League of Friends of Fairford Hospital, we have a very innovative solution. Since March, they have got a private sector provider involved, they have found a new site, they have been talking to the planners, who have given the matter favourable consideration, and it is possible for them to propose a package to provide a new modern day care facility, combined with doctors and elderly treatment services. The NHS would be charged a reasonable rate for those facilities. That seems a possible way forward for a number of our facilities in Gloucestershire. Will the Minister lay out a blueprint of the pitfalls and the way forward for such a scheme? In particular, the League of Friends is asking how much of the proceeds of the sale of Fairford hospital they are likely to receive to put forward for the new facility. Such questions need to be considered. The Minister should consider this innovative proposal, as it might get her off the hook in similar difficult situations. The situation of maternity services, about which the hon. Member for Stroud spoke, is one of the strands of the cuts that we are facing. As he said, he and I marched, along with 4,000 people, on a boiling hot day in Stroud on Saturday. We met young mothers and many of the children born at that hospital. About 400 young mothers a year have their children at Stroud maternity hospital. It is one of the few maternity facilities left in Gloucestershire, and if we lose that and the facility in Cheltenham, as the hon. Member for Cheltenham mentioned, all the young women will have to travel to Gloucester to have their babies. I was not making a disparaging intervention on the hon. Gentleman. I was trying to point out to him that if he is worried about the risk of patients travelling for 20 or 25 minutes from Cheltenham to Gloucester, the people from the north Cotswolds have first to travel to Cheltenham and then on from Cheltenham to Gloucester, so whatever the risk for his constituents, they are double for mine. If it takes 40 minutes to get there, I think it entirely possible that some babies, especially second babies, will be born in the ambulance long before they get to Gloucester. I think that there will be an increasing tendency for young mothers to have their babies at home. I am not a clinician and will not comment on that possibility, but we have been told for years that young mothers should have their babies in hospital because better care can be provided there. I think that more and more young mothers will choose to have their babies at home, particularly when no clinical danger is identified in pre-natal and post-natal classes. I am concerned about the large unit in Gloucester, and the hon. Member for Cheltenham has already mentioned the risk of MRSA. A small unit would be useful, because many mothers will not need to stay in it for very long.