Christmas Adjournment

I wish to raise two pressing constituency issues today. The first is about the financial crisis in Brent’s health service, which threatens to have a massive impact on patients and a devastating knock-on effect to local services provided by the council and voluntary groups. In Brent as in other areas, we have watched with horror as reports of the health savings necessary have escalated from £6 million to a projected £53 million over two years. We were initially told that Brent’s teaching primary care trust had a good reputation for balancing its books and that, unlike other primary care trusts in London, it finished each financial year in budget. However, the impact of top-slicing—not once, but twice—and then the failure to meet the initial savings plan, followed by a closer look at the books by the turnaround team and some incomprehensible budgeting brought us to the extraordinary level of debt that is now reported. No immediate solution appears to be in sight. The PCT expects to achieve only £14 million of savings by the end of this financial year, leaving a further £13 million that will be annually recurring. In a drastic attempt to resolve this crisis, countless services are set to be slashed, countless more costs shunted on to the council and all without any eye to long-term planning or even the Government’s own national preventive health agenda. The list of clinics set to be axed includes the Roberts Court clinic, Perrin Road, College Road, Helena Road, Hay Lane, Stag Lane, Mortimer Road, Neasden and the Wembley walk-in centre. Fifteen district nurses will go, children’s health services will be slashed and rehabilitation beds at Willesden community hospital shut. Services for young people with learning disabilities will be renegotiated, smoking cessation advisers cut and cuts to services in the mental health arena imposed that the mental health trust has said are impossible to achieve. Perhaps most damaging are the smallest cuts of all—those to the voluntary sector, such as grants to citizens advice bureaux to provide outreach workers to GP surgeries. Those posts almost certainly did more to cut the consultation time with GPs than any other single thing that the PCT could possibly have done. Grants to bereavement counselling and carers groups have also been cut as they are not seen to be core NHS activities. That is the whole point, is it not? Working with the most vulnerable members of our society is not core to anybody’s business, which is why those people always fall through the net. The long-term impact will take some time to assess, as the PCT renegotiates every section 31 agreement with the council, arbitrarily assigning previous joint working as social care, rather than health care, thereby shunting the costs on to the council and leaving people whose care was provided free previously to find that they are subject to means-testing and that they might be unable to afford or receive the care that they expect. The local council has no idea of how much NHS debt it must absorb. Early discussions suggested a figure of possibly up to £21 million, but the PCT’s debt has doubled since then. The PCT in Brent is in financial meltdown. Little or no communication is coming from the organisation, and it is impossible for the council to plan its long-term care provision. The PCT already owes the council about £10 million, because it has failed to pay for joint work that was previously agreed going back to 2004. Of course, it is not just the local authority that must pick up the cost of such cost shunting. Many voluntary sector groups will find themselves at the forefront of providing services for people who have otherwise been refused them. Perhaps the most frustrating aspect is that, as the hon. Member for Uxbridge (Mr. Randall) said earlier, given all that crisis debt management, there is no long-term planning and no sense of incorporating even the Government’s plans for preventive health. Many of the cuts will fall on essential health and social care outreach programmes, on community rehabilitation posts and on family planning, sexual health, drugs and alcohol services, as well as on help and advice for smokers or the obese—the very work that ensures that people do not need to go into hospital in the first place. If those programmes are scrapped, the burden on acute NHS services will increase, not decrease. That is idiotic—it is short-term planning—and it will not resolve anything for the long-term health of people in Brent. The voluntary sector—Brent carers centre, Brent Mencap, Age Concern Brent and Elders Voice—believes that those cuts will have a devastating impact on the most vulnerable members of Brent’s population. It beggars belief that financial management was so incompetent that that situation was allowed to arise in the first place; but having found that it has arisen, surely, it is ridiculous to expect the PCT to cut £53 million of services in two years—or, in practice, in rather less than two years, because the cuts have been found part way through a financial year. The PCT’s total budget is £400 million, so a substantial proportion of its annual budget is involved In Brent, it is not just the PCT that is in financial meltdown; the North West London NHS trust also faces a deficit of about £30 million, with a projected cumulative deficit of £67 million. Those figures are quoted from The Guardian, because the figures that come from the North West London hospitals trust are rather contradictory. A variety of figures are floating around, just as with the PCT, so it is difficult for local people to understand what the implications are for them. All patients and staff know is that the long-planned reorganisation of services across hospitals in north-west London—something that may or may not have a clinical basis—now seems to be obscured by financial crisis. Frankly, like everyone else in Brent, I do not believe a word that I am being told by hospital managers about what they are trying to do or why they are trying to do it. That is a very sad state of affairs, and it is time that everyone paid a little more attention to communication and transparency, given that the implications will be huge for everyone concerned. Very briefly, I should like to refer to the changes to legal aid, which are of considerable concern to many hon. Members. The issue was raised today in departmental questions, and it has been raised with me extensively by constituency organisations, such as the citizens advice bureau, the community law centre, Brent private tenants rights group and the refugee legal centre—and many interested individual constituents. Their concern is that a fixed fee, regardless of the complexities of the case, will dissuade lawyers from taking on the more complicated cases. Such cases will inevitably take longer in a borough such as mine, with very many vulnerable people, often with very complex needs, who frequently do not speak English as a first language. My concern is that vulnerable people, who need legal aid most, will find themselves unable to obtain it. The new fee system will have a particular impact on immigration cases. I will finish with an example of a constituent who I fear may find himself in difficulty. Let us call him Mr. A. He is an Iraqi. His problems are due to a failure of the Home Office to apply its own undisclosed policies to grant refugee status or exceptional leave to remain to certain categories of asylum seekers from Iraq. Following litigation in which the policies were finally disclosed, the Home Office now accepts that decisions to refuse leave to those people who should have been granted it need to be reversed. There are potentially large numbers of applicants who have been asked to apply to the Home Office again, saying why they feel that their cases were unfairly treated. Under the proposed graduated fee system, legal representatives would end up bearing the cost of such Home Office maladministration. They would have been deprived of an early resolution fee as a result of the Home Office’s failure to apply its own policy in the first place. There is no provision for representatives to be paid for reviewing old cases, but that work would have to be done to remedy what the High Court termed"““the series of errors which amounted to conspicuous unfairness on the part of the Home Office””." The failings of one Department have created a financial hole for those people who need their appeals funded. That is being passed on to legal providers, who will be forced to withdraw their services from clients. The original Home Office failing still has not been rectified. I know that the issue is of considerable concern to many Members and I hope that Ministers will listen to the representations that have been made today, both in this Adjournment debate and in Question Time. They are forcing through the changes without the necessary consultation. If we lose the experts who provide legal aid in the profession, they cannot be brought back into the system quickly. That could have a serious long-term effect on the most vulnerable members of our society, who must have access to justice in this country. I wish you and all the staff in the House a happy Christmas, Mr. Deputy Speaker.