Christmas Adjournment

I wish you, Mr. Speaker, and all members of staff of the House a very happy Christmas. I thought that I would put the festive greetings in at the beginning because last time I had a bit of a rant, and when I said ““Happy Christmas”” at the end, everybody burst out laughing. I am not sure why. I want to raise one thing. On 8 November The Daily Telegraph carried a story as a result of information that the Conservatives had obtained under the Freedom of Information Act 2000 about proposed closures in small hospitals around the country. When I read the article I was surprised, because it listed the Mid Devon primary care trust in my constituency as one of the PCTs that was likely to suffer closures, in our hospital at Tiverton. The Daily Telegraph said that the Secretary of State had drawn up maps with something that she called ““hot spots”” to ensure that closures did not occur in marginal Labour seats. There is no way my seat is a marginal Labour seat, I am pleased to say, but I kept the cutting. Although I was unaware of any proposed closures, lo and behold, in the past three weeks they have been announced, not only at the Tiverton hospital in what was the old Mid Devon PCT, but at the Honiton hospital, which serves a large catchment area of the east Devon part of my constituency. It was obvious some time ago that the Government anticipated the closures, and the form that they have taken means that the minor injuries units at both hospitals are closed to the public between 11 pm and 8 am. In addition, beds have been closed, albeit on a temporary basis until the end of next March. Small hospitals, serving sparsely populated rural communities, which is what I have in my Tiverton and Honiton seat, rely very much on local services. In particular, I want to consider the implications of the closure of minor injuries units. It is important to flag up why that has happened. As a result of Government policy, what were six primary care trusts have been brought together as a pan-Devon primary care trust. Collectively, by the end of the current financial year they must claw back some £7.6 million. As we all know, according to the bizarre formula that the Government apply to the NHS, if PCTs overspend they must recoup not just the amount overspent but twice that amount, thus making cuts even deeper than they would otherwise have been. The two hospitals also serve local general practices, in that GPs often make referrals to them. If my constituents could not have access to the minor injuries units at night, they would be forced to go to the casualty department in Exeter, quite some distance away. Obviously, in some cases they would depend on an ambulance service. Devon PCT tells me that the minor injuries units are little used at night, but a father from Tiverton wrote to me:"““as a worried parent whose 3 year old son has benefited from the immediate treatment he has received””—" from the local minor injuries unit—"““three times for serious attacks of croup, all occurring overnight … the worst attack … was treated by a doctor within 15 minutes””." What worried that father was that if the unit closed—as it now has—the delay involved in taking the child to the larger casualty unit a long way away could have a devastating effect. Even if we accept that minor injuries units have less throughput at night than during the daylight hours, we must ask what the consequences of closure will be for the patients who present there. It worries me that although the closures were flagged up in The Daily Telegraph on 8 November, there has been no proper consultation. There are no contingency plans to deal with the possible knock-on effects on the general hospital, on the ambulance service or on referrals through NHS Direct. It looks as if the decision was made in order to tick some boxes and save some money. I have some sympathy for those who must administer the health service and balance the books according to the formula that they are required to employ. However, the people of whom no account seems to have been taken are patients—and, for that matter, professionals. One might have expected the doctors who service the hospital at least to have been consulted, but that has not happened. I was told by a GP in my constituency this morning that a meeting had been called for tonight, long after the closure of the units. Apparently, a bizarre process will now operate when people turn up at Honiton hospital after 11 pm thinking that they can receive treatment at the minor injuries unit, as may happen. A nurse—and there is sometimes only one trained nurse—will have to come to the casualty department from one of the wards, fill in a form stating that he or she has received the patient, and then redirect the patient elsewhere with the form. Nurses on night duty, particularly those on medical wards, are kept pretty busy. The proposal to divert them to perform an administrative function and, if a patient has a serious problem, to cope with that as well, shows a lack of forethought and also a lack of knowledge of what goes on in a hospital, especially at night. Seven beds have been closed at Honiton hospital. Beds in small hospitals, particularly during the winter months, are an important facility for elderly people with respiratory problems. Respiratory problems can develop quickly and turn into something serious very quickly, so getting those people into hospital beds is very important. However, no thought seems to have been given to the fact that we are approaching the months of the year in which demand due to flu, or just among the elderly, is likely to increase rather than decreasing. When I spoke to someone at the hospital this morning, I was told that yesterday it had discharged two patients, and both beds were filled within half an hour. It is not that there are empty beds sitting about, or that there is a lack of demand even now. The fact is that none of these matters seem to have been discussed or considered from the point of view of patients. The closure of hospital beds usually means a reduction in staff, especially nursing staff. I am told by the nurses’ union representative that there has been no consultation with professional staff about the impact on nurses. I always understood that employers had a statutory obligation to consult union representatives, and to take account of the views of professional staff. On so many counts, the way in which information has come into the public domain suggests that these decisions were made with only one purpose: to reduce the budget by cutting services—we are told—at the end of the financial year, which means the end of March. Meanwhile, none of the procedures that might have been expected to take place have taken place. Let us consider what has happened to the health service in recent years. I picked up, literally at random, a couple of the documents that have arrived on my desk, most of them from the Government. In 2002 we all received copies of ““Delivering the NHS Plan””. Paragraph 5.9 states"““For some services, for example emergency care, however, choice will have a more limited role to play. Here most patients will only want fast access to their nearest local hospital.””" I do not think any of us would disagree with that, but if it is part of the national health service plan, what has happened to that plan? I know from raising matters with Ministers that they often pray in aid the idea that ““It’s the trusts out there that must make the day-to-day decisions. Nothing to do with us, guv; we provide the money, they decide what to spend it on.”” That is all well and good, but we know that the trusts are not free to make the decisions that they want to make at local level. They must constantly work within a framework in which finances are controlled from the centre, and all the boxes that must be ticked if financial penalties are to be avoided are imposed from the centre. There is no real freedom of choice for trusts, or for the professionals managing local services in our NHS hospitals around the country. Everything is predicated on the priorities of the centre, despite the fine words in the documents that we find on our desks every day. When the Government decided to abolish those primary care trusts and group them together, South West Peninsula strategic health authority invited consultation, which ended in March this year. The consultation document talks of ““working closely with partners”” and others to ensure integrated services, and providing ““appropriate clinical leadership.”” When I asked the chief executive of Devon primary care trust what clinical advice he had received or taken in deciding to make changes and cuts, I was assured that there were clinicians on the PCT’s board. The clinicians who were out in the field delivering the service were clearly not part of the consultation.