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3.29 pm

Mr. Jon Trickett (Hemsworth): May I apologise to you and the House, Madam Deputy Speaker, if I am unable to come back for the Minister's reply to the debate? I am shortly going into hospital, and have a number of domestic and constituency matters to which to attend.

Because of two separate medical problems, I have recently used the health service, sitting quietly alongside patients in my GP's surgery and in hospital. My experience of the health service is nothing like the one described by the hon. Member for Broxbourne (Mrs. Roe). It is of a service staffed by people who are always courteous and professional. In my experience, they

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are generally optimistic about the service and its future. My view is shared by patients I have sat alongside, and it will no doubt be shared by those I sit alongside next week when I am in hospital for an operation.

Most of my constituents did not expect the health service to be transformed overnight with the election of a Labour Government. They expected--and they are seeing--a steady and gradual improvement in the quality of the service. That is the experience throughout the United Kingdom. The description that we heard from the hon. Member for Broxbourne does not mirror the reality for patients in constituencies such as mine and for many tens of thousands of people throughout the country.

My constituents understand that the legacy of the previous Government will take some time to repair. I shall describe my constituency to explain the impact of Conservative policies on such an area. It is in the heart of the Yorkshire coalfield and my constituents suffer acute and chronic ill health.

One word describes the effect of Conservative policies on the health service throughout the 18 years that they were in power: inequality. The reforms that brought about a two-tier GP service meant that the quality of the service received by patients varied remarkably according to the sort of surgery that they attended. Effectively, fundholding was an opted-out service--it was outside the health service and run to its own rules. One received a different service in a fundholding practice than that received in an NHS practice.

The inequality was clear, as has been revealed so startlingly in the recent debate in the press and the House about what has become known as the lottery of postcode prescribing. An illness would be treated one way in one area and entirely differently in another--using different drugs or no drugs at all. In 18 years, the Conservatives failed to tackle that. I am pleased to say that that problem is being dealt with in a practical way through the establishment of the National Institute for Clinical Excellence.

My area is served by two hospitals, neither of which is in my constituency. Due to the underfunding of Wakefield health authority for many years, the Pinderfields general hospital in Wakefield is a disgrace. It has lacked capital funding, the buildings are shocking and it should have been replaced a long time ago.

Underfunding prevailed throughout acute services. There was pressure on clinicians to come up with a solution. In addition to the effect on acute services, the underfunding resulted in the effective, but surreptitious, closure of Southmoor hospital in Hemsworth and the running down of other hospital provision throughout the Wakefield district.

On top of that, a number of aged persons' homes that were run by the local authority were closed. The people I represent live in villages. When one has grown up and lived all one's life in a village, working down the pit there, one expects to be able to retire, live out one's life and die there. With the closure of those homes as a result of financial pressures, elderly people who require support often cannot live out their lives in the villages where they were born and worked.

People have been moved from South Kirkby and elsewhere in the area to as far away as Selby. That may not seem far when one looks at the map. To people who live in metropolitan areas, 15 or 20 miles may not seem

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far, but for people who have spent 80 years in a closed community, which every pit village was, to be moved from South Kirkby, Upton, or South Elmsall to a small town such as Selby seems almost like moving to another planet. The move can result in ill health and all the further consequences of which we know. Those were the consequences of the inequalities that Conservative policies produced in areas such as mine.

The Government have recently provided us with an excellent service. They have produced a statistical analysis--the index of deprivation. There are seven or eight indices and one is for health. I was shocked to find that my constituents must be among the most sick in the country. Of the six electoral wards, four are in the worst 5 per cent. in health terms. There are 8,000 electoral wards. Hemsworth, after which my constituency is named, is the 108th worst, South Kirkby is 139th, South Elmsall and Upton is 205th and Featherstone is 330th. To have four wards in the worst 5 per cent. for health provision is a shocking statistic.

The ill health left by the mining industry was further exacerbated by a failure of care in the 18 years of Tory control. I will describe the effect of the financial stringencies that were imposed on the health service in those days, and the proposals that had begun to emerge when I came to Parliament in the dying days of the previous Conservative Administration. The financial pressures were such that the health authority was faced with difficult choices. Effectively, clinician-led solutions began to emerge, which would have meant the closure of one of the two acute hospitals--the one in the east of the district. Hon. Members must bear in mind the fact that, geographically, the communities in the area are dispersed. They suffer from chronic and acute illness and poverty. My constituents have difficulty getting to hospitals in any event because they do not have motor vehicles and there is a lack of transport infrastructure.

I do not attribute blame to the clinicians, who were dealing with severe financial problems. Their decision was to close the hospital in Pontefract that was used by most of the villagers in the villages that I have described. The closure would mean that they would have to travel greater distances. Many of the old men suffer from chronic bronchitis, emphysema and other miners' respiratory diseases. Many of them can hardly get from their living room television to their toilet without using an oxygen cylinder. To have to travel all the way to Wakefield is almost like travelling to another civilisation.

The situation that I have described--the run-down of Southmoor hospital in Hemsworth and the closure of the aged persons' homes--has exacerbated the problems that the community I represent was facing. I described the problems with GP fundholding and the other Tory legacies. No one in my area expects an immediate turnaround. Given the poor position that we are in, no one in my constituency imagines that it would be possible to achieve even an average standard of health in the area, never mind the length and quality of life that people elsewhere in the country expect, but we expect a gradual and steady improvement.

First, we had to begin again with a new plan for the area. I am pleased to say that my noble friend Lord Lofthouse, who became the chairman of the health authority, operated wisely and transparently to review the situation in the Wakefield area and has produced a plan that has been almost unanimously accepted. His plan will

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not mean a reduction from 1,900 to 1,300 beds, which is what a district with such poor health was facing; he has produced a plan that will save Pontefract hospital. Indeed, it will put £18 million or £20 million into the hospital and give it a future. One can be proud of that.

The Queen's Speech will allow us to build further on that steady improvement. The development of intermediate care provision for the elderly is especially to be welcomed. After a recent meeting with the health authority, my suggestion for a working party was agreed. It will look in particular at the needs of my constituency--for example, the site at Southmoor that is on the verge of closure because it has been run down over many years. I hope that the working party will draw up a rescue package, building on the national beds inquiry and other Government initiatives.

For a long time, the Wakefield and Pontefract and District CHCs have stood alongside their communities. Wakefield CHC defended and promoted Pinderfields hospital, which desperately needs £150 million worth of capital improvements. The Pontefract CHC, which services the rest of my constituency as well as that of the Under-Secretary of State for Health, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), was also steadfast in the campaign to retain some medical provision on the Pontefract site. It did an eminently good job.

Although I understand that my right hon. Friend the Secretary of State is determined to press ahead with the proposals in the NHS plan to abolish CHCs, I regard those proposals with some trepidation. CHCs are susceptible to criticism; their powers are limited--although that is not their fault; and, as we have heard, they cannot deal with primary care. Some CHCs are not of the same quality as others, although I have no experience in that matter. I know three CHCs extremely well: Leeds, Pontefract and Wakefield. They are all well led, and they try to make themselves accountable and to work professionally.

When there was a proposal to close the hospital at Pontefract surreptitiously, the CHC was adamant that the hospital would not be shut. When my noble Friend Lord Lofthouse became chairman of the health authority and began to work differently, the CHC showed itself capable of pragmatism; it did not stand in the way of change and accepted that there would have to be changes at the hospital. The CHC promoted the new proposals.

CHCs are probably most vulnerable over accountability. It is clear that they are not accountable in the same way as hon. Members or locally elected councillors. That is an Achilles heel for CHCs. Given the weaknesses that I have described--there may be others--CHCs are due for reform. However, if my right hon. Friend the Secretary of State intends to press ahead with their abolition, I and Members on both sides of the House will look carefully at his proposals. We shall need reassurance that services currently provided within one institution are not fragmented and made incoherent. For example, if a patient advocate works in a CHC that is examining the strategic character of clinical services, it is clear that the advocate's experiences can inform the views of the CHC when it evaluates particular departments. That close proximity can produce a synergy that may be lost if the two functions are separated and dealt with by two institutions, especially as it

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seems likely that patient advocacy services will be incorporated by trusts--with the fear that such services may lose their independence.

We shall examine the proposals carefully to ensure that fragmentation does not result in lack of coherence. If that were to happen, many of us would find it difficult to support them. They have of course barely been formulated, so we await the detail. However, there is a further problem in that CHCs are statutory consultees when services are being reconfigured. They try to represent the community, but if--as seems likely--their functions are to be hived off elsewhere in the NHS, it is important that the exercise of those functions is not influenced solely by clinicians.

Clinicians are powerful advocates for the health of an area, but they are equally--perhaps more so--excellent advocates for clinicians. That does not necessarily mean that they would advocate a service that was in the best interest of the rest of the community. Questions as to who should be consulted, and how, about the closure or reconfiguration of services are crucial. Again, we await the details. It would be a mistake if hiving off that function of the CHC resulted in clinicians predominantly determining reactions to proposals on reconfiguration from the Secretary of State or others. I would find that difficult to support.

I have no doubt, however, that, as the Secretary of State is a distinguished advocate for the health service, he will bear all those matters in mind--as well as many others--when reaching a conclusion. We shall examine the proposed legislation with interest in the hope that he will have addressed many of our worries about the CHC proposals.

The Queen's Speech included proposed legislation on crime, which I hope will be universally welcomed in the House. All our constituents, especially the poor--many of whom I represent--are subject to crime and criminality. They expect us to improve the ability of the criminal justice system to deal with what is felt to be a rising tide of crime and criminality.

In the west end of Hemsworth, for example, we have had particular problems with youths. Perhaps if the curfew powers had been in place, those problems would not have arisen. Elderly people, and even those who are not so elderly, feel incredibly intimidated by crowds of young people, some of whom are drinking--often under age. The police and local authorities seem to lack the power to deal with that. We welcome measures on those matters, and I hope that we shall see a continued reduction in crime.

I hope that, in the legislative burden that the Home Secretary continues to take on his shoulders, we shall continue to pay attention to victims' needs. Hon. Members on both sides of the House and people outside this place often talk about victims, but the criminal justice system does not yet give sufficient attention to the needs, feelings and aspirations of the victims of crime.

Anna Fisher, aged 14, was killed as a result of reckless driving. Obviously, the victim was that lovely young girl who had all her life before her, but her parents and family were also victims. The criminal justice system--the police, the coroner, the Crown Prosecution Service--demonstrably failed to meet the bereaved parents' needs. The parents learned that the trial had taken place--and that a conviction had been made, which resulted in a

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£100 fine and a three-year driving ban for the person who had committed the crime--by reading the newspaper. No one had even bothered to tell them that the trial relating to their young daughter's death was taking place; they discovered it in the newspaper. It was also bizarre that the parents were not told that an inquest was to take place after the trial. You, Mr. Deputy Speaker, might think that that is extraordinary, but apparently it can happen. During the inquest, facts emerged about the nature of the incident that had not been considered at the time of the trial. It seemed to me that insufficient attention was paid to the victims' needs.

I hope that, if the Home Secretary cannot find room in the legislative programme to remedy this situation, he will at least bring forward administrative measures to ensure that all the enforcement agencies are fully aware of the need to bear in mind the needs of victims.

All the legislation that the Home Office is introducing would increase the authority of the state apparatus--the police and the criminal justice system. Fine; they are there to protect victims and to protect us all from criminals, so I do not mind that the state apparatus is being strengthened. However, it seems to me that from a Government who speak about rights and responsibilities, duties and obligations, we should be looking for some balancing moves that protect the citizen.

I am thinking particularly of the police complaints procedure. The time is long overdue for the Home Office to bring forward proposals, as it said it would at the time of the Stephen Lawrence inquiry--I spoke about that when we debated the previous Queen's Speech, when several months had already passed--to the effect that the police complaints procedure should be reviewed and made independent, at least for serious complaints. The Home Secretary has several times promised in the House to bring forward proposals, but as yet they are not here. Apparently, they are still not in the Queen's Speech. I know how busy he is and I accept that he must deal with priorities first, but somewhere in his priorities and somewhere on his desk is a report that makes proposals about the criminal complaints procedure.

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