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Evesham Community Hospital

: The hon. Gentleman is absolutely right. We need more community beds, and that location would be very suitable for them. We must support an acute hospital under desperate pressure. Put simply, and perhaps more controversially, the financial pressures on the South Worcestershire primary care trust are the direct result of the enforced implementation of national Government policy. That is why it is right that the Minister should be here. The Government imposed on the NHS well-meaning but expensive commitments—such as the waiting time initiatives and the new GP contract—but did not provide sufficient extra funding to pay for them fully. They forced acute hospital trusts and primary care trusts to find every creative device to balance the books in the year before an election. Then, incredibly, they ordered those same trusts to achieve balance again in the current financial year. That last instruction, which no trust manager dare ignore, precipitated the crisis for Evesham. The tricks of election year cannot be repeated, but the Government have made the cynical calculation that howls of outrage the year after one election will be forgotten by the next one. However, if those cuts are allowed to proceed, the people of Worcestershire will not forget it. We do not even know what the acute hospital is going to do to find the £20 million it needs to balance its books. Two specific local problems, imposed on the county by central Government, lie at the heart of our difficulties. First, the Government built a major acute hospital under the PFI that was too small and had a contract that was too inflexible. All the risk is borne by the NHS, and when the Worcestershire Royal hospital operates well beyond the sensible and contractually agreed level of 85 per cent. of capacity—as it has to most of the time; sometimes it operates at more than 100 per cent.—the contractor receives massive penalty payments to compensate for those excessive activity levels. Secondly, the Government imposed on the county—for reasons rightly set out by the hon. Member for Wyre Forest—an orthopaedic independent sector treatment centre at Kidderminster, where the profit making contractor gets paid the full contractual sum, irrespective of how many procedures are performed there. It is not full; no wonder the PCT is trying to bully Evesham patients into making the impossible journey to Kidderminster. The Government are imposing high and unavoidable costs on the local NHS to meet contractual obligations to profit making private sector operators, and that has led directly to cuts in local services. Evesham hospital is being sacrificed to meet the bills of two private sector contractors; that is what makes the story truly remarkable. The only matter for local decision making now in Worcestershire's NHS is which local services should be cut to meet the obligations imposed on it by Whitehall. What makes this matter additionally disturbing is that the South Worcestershire primary care trust appears to be one of the worst funded in England. In 2003–04, the latest year for which I have figures, the trust was funded at about £100 per head below the English average. Given that there is a population of roughly 250,000, that means we were short-changed by at least £25 million. I am trying to get more up-to-date figures from the Government, but the figures that I have mentioned, taken from an article in Pulse magazine, appear to show that the South Worcestershire primary care trust should not be seeking £4 million in cuts, but looking for ways to spend an extra £21 million. As it is, the PCTs have said that saving around £2 million from the cuts at Evesham is unrealistic. Additional costs flowing from the proposals—the costs of longer stays at Cheltenham General and Worcestershire Royal hospitals, of additional nursing and day rehabilitation services and of spending more on hospital care outside the PCT—would further reduce savings. The campaigners have some positive suggestions to address the financial situation. The merger of the county's three PCTs—South Worcestershire, Wyre Forest and Bromsgrove and Redditch—would cut central costs a bit and significantly improve the efficiency of commissioning. Equitable funding for Worcestershire's NHS would give us enough resources to abandon the cuts, and the redevelopment of Evesham Community hospital—a new hospital—could reduce capital and maintenance charges, improve efficiency and expand services, repatriating work to the county and costs back into the PCT. To sum up, here are some specific points for the Minister. He will not be able to answer them all today, but they are the local points that need to be answered. On orthopaedic services, can the Minister confirm that it is NHS policy to encourage and support patients to choose the hospital from which they receive treatment? What makes the Government confident that they will choose Kidderminster hospital rather than Cheltenham General hospital? As the procedures at Cheltenham will be at full tariff price and therefore more expensive than at Evesham hospital, how would that save money? On the processes of the primary care trust itself, section 11 of the Health and Social Care Act 2001 requires PCTs to involve patients and the public from the very beginning when developing possible service changes, rather than just consulting them on proposals developed by PCT management. Can the Minister explain how patients and the public have been involved in developing those proposed service cuts? With respect to the closure of wards, can the Minister confirm that patients who need rehabilitation but who are discharged home from the acute hospitals instead of being transferred to Evesham would receive the same level of therapy and nursing? Can he confirm that the closure of the two wards would not lead to more patients being forced to enter care homes to free up acute hospital beds because they are not fit enough yet to return home? Can he confirm that the ward closures would not shift costs of care to social services or to individuals and their families? With respect to the proposal to remove GPs from Izod ward, can the Minister explain why the PCT wants to do that at Evesham but not at Malvern, Pershore or Tenbury Wells? Can he confirm how much the reduction in quality of service at Evesham will actually save? Will it be easy to recruit good staff-grade doctors in the future? There are doubts about that. With respect to the capacity of the county's health service, the acute hospitals are regularly on alert and unable to find beds for people requiring emergency admissions. Worcestershire Royal was on black alert only last Friday night, so how will the loss of 38 more beds from the Worcestershire health economy affect the situation? As the hon. Member for Worcester suggested, should not we be developing new community beds rather than cutting existing ones? Can Evesham still expect the new hospital that it has been promised for so long and that it so urgently needs to provide a broad range of services similar to that currently provided? Can the Minister assure me that the capital sums raised by any sale of the existing site will not be used to plug one year's deficit, but will be reinvested in the health service of south Worcestershire in the shape of that new hospital? I hope that the Minister understands that he cannot shrug off responsibility for the mess and say it is all about local decision making. It is the decisions of the Government that have created the situation, and I hope that it is the Government who will help get us out of it.