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2.40 pm

The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) on securing the debate. She has made a powerful case on behalf of her constituents about Wilson hospital and about tackling health inequalities in her area. In the wake of our recent consultation on how to narrow health inequalities across the country, I will happily talk to her further about specific issues that she, general practitioners and in particular her constituents face.

The main subject of my hon. Friend's speech was the future of Wilson hospital. I welcome the opportunity to discuss the future of a facility that, as she has made clear, is strongly valued by her constituents.

As my hon. Friend will be aware, responsibility for deciding what services are provided in Mitcham rests with the local NHS in south-west London. The key decisions must be taken locally and with proper public consultation where appropriate. Nevertheless, I will respond to her as far as I can about the issues that she has raised, the local position, and how it fits in the context of the national approach to intermediate care.

Clearly, the issue is important to my hon. Friend's constituents. As she said, Wilson hospital, which was established as a cottage hospital by Sir Isaac Wilson in 1928, was a gift to the local community.

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In 1990, following consultation, it was agreed that in-patient services at the Wilson be transferred within the district, in line with the previous Government's policy. By that time, the Wilson was offering mainly out-patient services and elective orthopaedic surgery, and had some elderly in-patient beds. Many of the services were transferred to Sutton hospital, part of the current Epsom and St. Helier NHS trust. During that time, the district headquarters, now the Merton, Sutton and Wandsworth health authority, was searching for new accommodation, so it moved into the empty space at the Wilson.

A health clinic still serves local residents. It offers dental services, a blood clinic and district nurse and health visitor services for the South West London Community NHS trust. The Merton community mental health team is also based on the site. I am aware of local concern about the future of the site and have been very impressed by the strong community feeling on the issue.

My hon. Friend is right to stress the value of local cottage hospitals. The Government are committed to making appropriate and effective use of those community services. There is an important role for cottage hospitals in the delivery of local health care and in the future development of intermediate care.

In the NHS plan, we pledged that, as well as additional money, by 2004 there would be 5,000 extra intermediate care beds across the country. Some of those will undoubtedly be in cottage hospitals, some in existing facilities and some in new developments. I agree that often the potential of such hospitals has been ignored. Now, with a new emphasis on intermediate care and delivering care "closer to home", there is an opportunity to breathe new life into local services.

The NHS plan announced extra investment of £900 million annually by 2003-04 for intermediate care and related services to promote patient independence, of which around one quarter was earmarked specifically for NHS investment in intermediate care. With the £150 million made available recurrently from the previous financial year, that will bring earmarked NHS resources for intermediate care to a total of £405 million by 2003-04.

A substantial component of that money is to be provided to local government for a range of services to link to intermediate care—for example, through the provision of home care, giving people enough day-to-day help to enable them to live in their own home rather than have to remain in hospital or nursing care. The results of a survey on intermediate care undertaken in August last year show that good progress is already being made. From a baseline of 1999-2000, there will be 2,400 more intermediate care beds by the end of this year. Of course, there is still progress to be made. Our aim now must be to ensure that everyone has access to high-quality, effective intermediate care services.

Locally, Merton, Sutton and Wandsworth health authority, Merton social services and the proposed Sutton and Merton primary care trust have been working closely together to increase intermediate care provision. There are currently 31 intermediate care beds for Sutton and Merton residents and 10 beds for Wandsworth residents. Intermediate care provision for Merton residents includes beds for elderly people at Bolingbroke hospital, which is part of St. George's Healthcare NHS trust, as well as beds at Eltandia nursing home and Carshalton War Memorial

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hospital. Earlier this month, Merton social services received £248,000 from money allocated to councils to reduce the number of delayed transfers of care, and it has developed a plan with local partners to use the funding to offer older people more opportunities to return to or stay in their own home—for example, through the provision of additional home care arrangements.

Together, local NHS and social care organisations will develop a more detailed strategy on intermediate care over the next 12 months. Current estimates of need suggest that a minimum of nine additional beds plus additional community placements will be required by 2003-04 for Sutton and Merton residents, although projections are still being reviewed. To meet that need and to reach targets for intermediate care, the health authority, social services and the PCT will need to consider all the options, including enhancing home support as well as providing additional beds in the area.

It will be for the NHS at local level to decide how and where services should be provided and how best to use local NHS resources, but it is important to involve the local community in discussions on those matters and to take account of local people's views. I am sure that my hon. Friend agrees that there is also a need to take into account issues of clinical viability, accessibility for patients, and cost-effectiveness for the NHS, so that the NHS can provide the best possible services across the board.

My hon. Friend will be aware that some of the changes resulting from the NHS plan and "Shifting the Balance of Power" announced by the Secretary of State last year were about putting patients and staff at the heart of the NHS and moving power from Whitehall back to those on the front line. The key aim is to reshape the NHS around the needs of its users, to offer them choices and to involve them in decision making and planning. That is key to the discussions that must take place locally and involve local communities, as well as discussions with local authorities,

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the voluntary sector and other key partners. To create a more responsive health and social care system built around the needs of local communities, patients, front-line staff and local people must be involved in consultation.

My hon. Friend mentioned the fact that the Wilson is currently used for office accommodation. The proposed Sutton and Merton PCT is in need of headquarters office accommodation. That is currently under review, and I am advised that the Wilson is one of the sites being considered. She will be aware that, because the Wilson is not in the commercial sector, the cost of providing offices there is considerably lower than that of leasing commercial premises; that is one of the factors that must be taken into account locally. That will also be a factor in the considerations of the new strategic health authority.

How far facilities may need to be modernised will also have to be considered. If the Wilson were to be considered as a cottage hospital in the way that my hon. Friend and the community suggest, there will be concerns about the costs associated with modernising the building to the standards expected today for clinical services. Such factors must be taken into account by the local NHS when considering the future of the services in the area.

I have listened carefully to the points made by my hon. Friend, who spoke clearly and happily on behalf of her constituents. Merton, Sutton and Wandsworth health authority welcomes her interest in the matter and would be happy to discuss it further.

As far as possible, discussions and decisions must take place at the local level, but we shall take a continued interest in the discussions that my hon. Friend has at that level. I shall be happy to discuss the matter further with her when local discussions have taken place about the development of intermediate care in her area and the Wilson hospital.

Question put and agreed to.

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