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Mr. Michael Foster: Let me intervene to put the right hon. Lady's mind at rest on one point. The community hospitals serving Worcestershire have not been affected by the building of the new PFI hospital. Indeed, they are part of the strategy to allow acute treatment to occur in the new district general hospital. Patients can be treated there and move into community hospitals at a later date. In terms of the acute service reconfiguration, all the options under discussion included the building of a new hospital, because, quite frankly, it was 40 years overdue.

Mrs. Shephard: I am delighted to have that elucidation from the hon. Gentleman. He and his constituents are much more fortunate than my constituents and me. It is an extraordinary irony that people are being expected to travel 60 miles for community hospital care. What are we talking about? No replacement facilities have yet been provided, and even when they are provided, there will be no local community beds, as was originally promised. Instead, the health authority is

That is a deeply fruitless search, as I shall go on to demonstrate. An increasingly elderly population will be left having to travel scores of miles for services—where they exist. I cannot believe that that is the sort of improvement that has been so much vaunted by Ministers, but it will be the daily experience of people in my constituency and in Norfolk as a whole.

As if to rub the problem in, during the recent crisis at the new Norfolk and Norwich hospital—I emphasise that it was a beds shortage crisis—the chief executive of Norfolk health authority, Neil Wilson, made this bland announcement:

"But not in the southern half of the county, "he might have added", and nor can the pressure on the new flagship £229 million hospital be eased by care in the community provided by social services". That is why I began by emphasising that Ministers need to think out how one set of policies impacts on another: there can be unintended consequences.

Liz Railton, the director of Cambridgeshire social services, is quoted in Public Finance this week as saying that the flagship hospital cannot rely on social services because the Government grant is inadequate. She says:

In another example of micromanagement, the propensity of Ministers to set local authorities' priorities in social services, namely for child care, means that their own announced health policies are not working.

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What about residential homes? Two years ago, I initiated a debate in the House on the implications for bed numbers in residential homes of the Government's approach to uniform standards in those homes. I said then that although everybody supported proper standards in residential homes, they have already had to contend with the impact of the working time directive, huge hikes in fuel costs and cuts in social services. I added that having to cope with the uncertainty and confusion surrounding the Government's new proposals would drive many out of business altogether, with a devastating effect on frail and elderly people, their families and in turn the NHS, which would have to cope with the result. Oh dear, that has proved to be all too true.

According to Laing and Buisson, also quoted in this week's Public Finance,

That figure is significant because it is

Care home owners are not being paid their inflation costs, which are between 5 and 7 per cent., and receive instead an annual increase of about 2 per cent. That is why many are going out of business. Just as serious is the fact that, many are being redesignated as residential rather than nursing care homes precisely when the national need is for more nursing care in residential homes.

We can add to those bleak facts the additional problems in rural areas—I look at the hon. Member for Dartford—where closures occurring under this Government mean more travelling for families and staff, less choice for residents and a greater concentration of jobs in towns. One is obliged to ask if Ministers meant things to turn out this way—or has their concern always been the slick headline rather than what is happening to people?

Mr. Brazier: I am most grateful to my right hon. Friend for giving way in the middle of her powerful case. Given that it costs between three and four times as much to fund an NHS bed as it does a typical bed in a nursing home, does not the experience of an area such as mine, which has lost 15 per cent. of its nursing home beds in just 12 months, show that it is possible for a really incompetent Government to raise spending and lower standards of care?

Mrs. Shephard: My hon. Friend's point is borne out by the comments of Liz Railton, who said:

Ministers' commitment to spend more of people's money is being eroded by the fact that they fail to think through the impact of one set of policies and headlines on the delivery of other services.

By no group is that more clearly perceived than by GPs. I recently did a survey of GPs in my constituency to find out their views on hospital provision and bed blocking.

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Their replies were very instructive for Ministers. Dr. Barton of the Campingland surgery in Swaffham replied:

I hope that Labour Members noted his use of the word "never"—his comments apply not to a Conservative Government but to this Government. He continues:

Many of his patients would agree.

Dr. Grace Barlow of the Necton surgery wrote in December:

not five years ago but now—

Well, there is fat chance of that, but it is worth reminding Ministers of their responsibilities in these matters.

Dr. Young of Watton says:

Those are the views of GPs in my constituency, and they contain small comfort for Ministers. It is, perhaps, not strange but a little sinister for them to find, at every hand's turn, that professionals and the public seem more aware than they do of the effects of quick-fix headlines combined with a lack of strategic direction.

Most recently, the pressure of population increase locally has caused one surgery to announced the complete closure of its facilities in Brandon. That will affect many hundreds of my constituents in the nearby villages of Weeting and Hockwold. On 14 January, Mr. Tunstall of Weeting, in an interesting letter, wrote:

and so on. I wish that Mr. Tunstall were here because I think that if he were a Member of the House, Ministers would be having quite a rough ride. He encapsulates

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perfectly the views of the millions who experience daily the mismatch between what Ministers say and what they, the public, see.

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