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2.44 pm

The Minister of State, Department of Health (Mr. John Hutton): I welcome the opportunity to discuss these issues with the hon. Member for Westbury (Dr. Murrison), who has displayed his usual knowledge and grasp of all the subjects he raised.

I hope that the hon. Gentleman will agree with me on two issues. First, the community hospitals in his constituency perform a valuable role and enjoy strong local support. I join him in expressing my appreciation and thanks to the people who work in them, for the care and support that they provide to their patients. The hon. Gentleman raised the issue of investment, and the change that has taken place in community hospitals, saying that we should recognise the contribution that local staff had made to some service developments and improvements. Of course, it is important to give credit where it is due. In relation to the examples that the hon. Gentleman gave, it is the hard work and energy of local staff that always make a difference in the national health service, both in planning changes and in seeing them through. I pay tribute to the work and energy of local staff in securing those developments.

The job of the Government is to set the overall standards and framework in which those service enhancements and developments can take place, and, most importantly, to provide the additional resources that the NHS needs to facilitate those changes, which cannot happen unless the resources are made available, and they are now being made available at a level that the NHS has never witnessed in the 50 years since it was established in 1948.

The second point on which I hope the hon. Gentleman will agree is that no part of the NHS can ever stand still. It is right that we always ensure that the services we provide are of the highest quality and are capable of

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meeting the health care needs of the local population safely and in the most accessible way possible. That discipline applies, of course, to the future of community hospitals, cottage hospitals and smaller district general and acute hospitals—whatever terminology we use.

That is why I should make it clear that there are no plans to close any of the community hospitals in the hon. Gentleman's constituency, in Westbury, Bradford-on- Avon, Melksham, Trowbridge and Warminster.

Dr. Murrison: Melksham is not in my constituency.

Mr. Hutton: I am grateful to the hon. Gentleman for pointing that out. It must be very close to his constituency, but I was not trying to mislead him or other hon. Members.

The hon. Gentleman suggested that Warminster hospital was threatened with demolition to make way for a car park. My understanding is that there are no plans whatsoever to do so.

Dr. Murrison: My point was that part of the hospital is threatened with demolition to make way for a car park.

Mr. Hutton: I thank the hon. Gentleman for clarifying that. Perhaps it is a matter to which we can return.

There are no plans to close the hospitals that I have mentioned. They have served the hon. Gentleman's constituents well for many years and are a valuable local component of the NHS in west Wiltshire. On the contrary, the local West Wiltshire primary care trust, which is now responsible for the running of the hospitals, is strongly committed to their future, and is seeking further to develop the services that the hospitals provide. In a number of important areas, extra investment is being made in those hospitals.

Last year, a new nurse liaison service was introduced at Trowbridge hospital, to work across the other community hospitals to facilitate the discharge of patients from the Royal United hospital in Bath. As the hon. Gentleman mentioned, cataract surgery has been introduced within the last year at Westbury hospital—an important and welcome development—and this year the primary care trust will be spending nearly £250,000 additional expenditure on day surgery at the hospital. Across the hospitals, staff numbers have increased over the last four years.

It is important for local health planners to try to strike the appropriate balance between the convenience of local services and the requirement to concentrate expertise for reasons of safety and quality. The hon. Gentleman referred to those problems as they apply right across the NHS in all parts of England, not just in his constituency. He made the important point—with which I strongly agree—that many needs can and should be met locally, close to home, by delivering care through networks of skilled providers working together, rather than in isolation. We must remain focused on that. I believe strongly that community hospitals have a positive contribution to make in that area. The hon. Gentleman suggested that the Government did not believe that community hospitals have a positive role to play in the future, so I certainly want to set the record straight on that.

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The provision of comprehensive and accessible services of the highest quality free at the point of use lies at the heart of the national health service, its purpose, its ethos and its rationale. The Government remain strongly committed to the values that underpin the NHS. The NHS plan, from which the hon. Gentleman quoted, offers what I believe—I do not know whether he does—is a good, strong framework for ensuring that those values can be reflected in a modern setting. Medical technology is changing very quickly, advances in science occur almost daily and, crucially, public expectations have risen substantially in recent years.

If we are to succeed in meeting those needs, we will need a broad range of local, regional and national provision that guarantees the best possible access to the full spectrum of care services. If, in turn, we are to do that, we will need to make maximum use of community hospitals and primary care organisations for delivering and co-ordinating a local population's care.

At the same time, we recognise that certain complex services and staffing requirements need the scale found only in larger centres. I am sure that the hon. Gentleman accepts that, given his expertise and knowledge. Numerous international studies—I am sure he is aware of them and may have contributed to many of them—have shown that patients fare much better when their care providers have more experience and the support of specialised teams and equipment, which is usually concentrated in the larger medical centres.

Primary care trusts will play an increasingly important role in the national health service. The decisions, thinking and strategy that the hon. Gentleman was calling for will need to focus on the work of primary care trusts. They will have a much greater influence in developing local services, and will be better able to tailor those services to local needs. If that is to be achieved successfully, they will need to engage front-line staff, local communities and partners in the independent and the voluntary sectors—to which the hon. Gentleman quite properly referred and with which we are keen to develop further and stronger links—in their plans for improving health services. In their role as primarily local organisations, PCTs will bring about improvements in local services by engaging and involving local people, patients and staff.

I understand that Wiltshire health authority has drawn up a strategic framework within which all the primary care organisations are currently working and to which they are committed. One of the most important elements of the framework is that care should, when practical, be provided at home or as close to home as possible.

The hon. Gentleman quite properly referred to the work being done in Westbury hospital and the new dedicated stroke unit. I think, as I hope he does, that that provides tangible evidence that our approach is working in practice. Patients from west Wiltshire who suffer a stroke are taken to the Royal United hospital at Bath, but are then quickly visited by the stroke co-ordinator from Westbury, who assesses them. Patients are transferred to Westbury hospital when they are ready, where they receive an intensive course of rehabilitation. I am glad to say that, in the vast majority of cases, that enables them to return to their own homes as soon as possible, where they want to be and where they will continue to receive support as necessary from the multidisciplinary community support teams. That is a good and successful model.

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The PCT is now considering how to make best use of the skills of staff and the facilities of the other community hospitals and the two clinics in the area to see how other specialist services can be organised to provide local care in west Wiltshire.

The hon. Gentleman referred to the need for a vision behind this work. I am glad to say that the vision that the PCT has for its local community is positive. It is to support and promote independence; to reduce social exclusion and provide services with equitable access; to provide better care and higher standards; to provide choice for people using services and their carers—I believe that choice is increasingly important as we consider the future of the NHS—to provide care at or closer to home; to provide a wide spectrum of care options; and to deliver services through integrated working unimpeded by organisational boundaries and supported by shared or joint budgets.

I meet people in my surgeries—perhaps the hon. Gentleman does, too—who feel frustrated when they come into contact with public services in this important area of the welfare society. They are bounced between social care and health care organisations, and we need to improve on that. It should be our job, in the context of public services—in this instance, care services—to make navigation of the system much easier than it is now.

I consider the "vision" aims of the local PCT laudable. I understand that the PCT has already conducted a review of services provided at community hospitals, and that during the coming year it will work with local organisations, patients and carers to develop services that meet the health needs of the people of west Wiltshire. That is right, because it is its primary responsibility.

I know that there are worries about possible changes in services, especially in rural areas, where travelling can present difficulties. Careful consideration must always be given to such concerns. I understand that the PCT already provides some transport, both between local hospitals and to the Royal United hospital in Bath. I am told that it will work closely with the county and district councils to improve the service.

I said at the outset that the right strategy for all these issues should be based on local solutions. It must be for the trusts concerned, working with all local agencies, to consider how that can best be achieved—with, of course, the involvement of local people: that should be at the forefront. The public have a right to be consulted on matters of this importance, as, after all, it is their national health service.

We are fundamentally committed to a system of patient and public involvement providing not only more support and representation for patients, but rigorous scrutiny powers for local government. The hon. Gentleman mentioned the abolition of community health councils in the NHS Reform and Health Care Professions Bill. We believe—we have engaged in these conversations before—that the present arrangements do not meet the exacting standards required, which is why we are strengthening the arrangements for patient and public involvement.

West Wiltshire PCT will engage fully with local people and other agencies in discussions on how services are provided. If the hon. Gentleman has any concerns about the process in future, he should bring them to my attention.

The hon. Gentleman mentioned intermediate care—the important standards that we have set in the national service framework, and our wish to expand that part of the

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national health service. I agree with him that community hospitals can make an important contribution to intermediate care. All too often older people, in particular—through no fault of their own—find themselves in accident and emergency departments or busy hospital wards and stay there much longer than they need to, because there is no real alternative. Alternatively, they are admitted to residential or nursing homes prematurely because of that lack of real alternatives. Intermediate care means providing such alternatives.

In the development of an intermediate care service, the need for different organisations to work together in partnership with the older person involved to maximise that person's health and well-being is paramount. We are making a substantial investment in resources for such care and in related services: an extra £405 million of NHS money will be earmarked by 2003–04. That has already allowed us to commission an additional 2,500 intermediate care beds this year, as a contribution to meeting the total requirement mentioned by the hon. Gentleman.

The hon. Gentleman referred to residential care homes. They give cause for concern, and the Government have been discussing the issues with the care home sector for some time. We are trying to make progress, and I think that the extra money for local authorities this winter, and next year as well—£300 million—will make a substantial contribution. Moreover, Wiltshire county council will receive more than £700,000 this year to enable it to speed up the handling of problems relating to discharge.

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