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Evesham Community Hospital

: I will address that argument as I develop this hypothesis. The provisional recommendations that the primary care trust has set outare plans that must be drawn up to explain just how the local health economy intends to deliver the standards that people ultimately voted for in the general election a few weeks ago. They are set out according to guidance issued in July 2004 by my Department and snappily entitled ““National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06—2007/08””. The first point to make, however, is that these are not recommendations or provisional conclusions born of a financial crisis. Far from it. The hon. Member will know this. Revenue allocations are made to primary care trusts on the basis of the relative needs of their populations. It is quite right that, as a country, we invest health resources in areas where there is the greatest health need. This means that South Worcestershire will receive an allocation of £313.5 million next year, rising to £344 million in 2007–08. There is a cash increase of £57.1 million, 19.9 per cent. over the next two years. I hope the hon. Member for Mid-Worcestershire will accept that this is a significant increase in resources. The hon. Gentleman mentioned two points. He felt that the local primary care trust has been in some way short-changed. The response to that is that we must invest in areas where there is the greatest health need. Second, he felt that the cost of new standards was over and above the resources that have been invested. I want to point out that in 2002–03, the primary care trust had a budget of something like £200 million. When we look forward to 2007–8 and we see that the figure is £344 million, I think that an increase of £144 million pounds over a fairly short space of time is a very significant envelope with which to invest in delivering new standards. The second pertinent point is that the health professionals of South Worcestershire primary care trust will not and are not making decisions about how to spend this very significant amount of money without intensive engagement with the local community. This is a matter of fact and, I might say, a matter of law. The hon. Gentleman mentioned section 11 of the Health and Social Care Act 2001, which is very important. It places a new duty, from the beginning of 2003, on NHS trusts, primary care trusts and strategic health authorities to involve and consult patients and the public in service planning and in the development of proposals for changes. As the hon. Gentleman points out, that encompasses ongoing service planning, development of proposals—not just consideration of the final product—and decisions about general service delivery, not just major changes. Furthermore, the health care commission will regularly assess patient and public involvement as part of its review of clinical governance. The Act, as the hon. Gentleman pointed out, was reinforced by the approach and principles set out in ““Keeping the NHS Local””, published on Valentine's day 2003. It provided new guidance on service change that builds on the new arrangements for patient and public involvement. It challenged the view that biggest is best, and explore some innovative ways of keeping high quality and locally accessible services within the important bounds of patient safety. As the hon. Gentleman might know, one of the core principles of that guidance is to take a whole systems view of the local health economy, encompassing the different contributions of hospitals, primary care settings, intermediate care settings and social care providers. What does that mean for Evesham hospital? I understand that, as a result of the dialogue around the primary care trust's local delivery plan, three basic proposals were discussed at the primary care trust board meeting on 8 June, and will be part of the debate with local stakeholders prior to the public consultation which will then follow. It goes without saying that these proposals are at a very early stage. As the hon. Gentleman pointed out, I understand that the proposals encompass the possible closure of two wards at Evesham hospital, in the context of the development of community matrons and an increased district nursing service; the reduction of orthopaedic activity at Evesham hospital, with the treatment being undertaken at the new Kidderminster independent sector treatment centre; and changes to the arrangements for medical cover. I am advised that the PCT has been open in its handling of this matter and I am pleased about that. That is in no small part down to the hon. Gentleman's long-standing engagement with local health care professionals. The PCT is discussing the proposals with a wide range of stakeholders, including staff, patients, the local council, social services and the public. Those discussions are ongoing and I expect the PCT carefully to consider all the representations that it receives. It might help the House to weigh up what the proposals mean in practice if I explain that Evesham hospital conducted around 32,260 cases last year, spanning minor injuries, day hospital cases, and outpatient, inpatient and day cases. The combined total of discharges on Willows ward and Bredon ward was about 256. Of course, it is not very fair to set one figure against another but were I pressed to do that, I would point out that the total number of discharges from the two wards represents about 1.75 per cent. of total activity in 2004–05. The hon. Gentleman challenged the idea of chipping away at the service. It is probably fair to consider exactly where the local PCT is talking about investing the money that it is being given. It proposes that there will be £700,000 for new NHS dentistry, £700,000 for new mental health services, £2 million to be directly invested in access to acute services and the move to a maximum 18-week waiting time, £700,000 for community services, including four new community matrons, an intravenous therapy team, a community rehabilitation team, a muscular sclerosis nurse specialist, a Parkinson's disease nurse, community health trainers for the prevention of obesity and three heart failure community nurse specialists. So the proposals that the PCT is weighing up do not relate solely to the issue of closing one ward; there is also the serious issue of what other investments will be made. The hon. Gentleman mentioned the issue of Kidderminster independent treatment centre. My understanding is that the contract for that independent treatment centre was agreed on the basis of 100 per cent. new orthopaedic activity, as required by the local health community. South Worcestershire PCT was a signatory to the final business case and raised no concerns at that time. That was the basis on which that was put forward. There are important choices ahead for the local community. I am reliably informed that the intention is to discuss the matter further at the PCT's board meeting on 3 August. Ultimately, decisions about the local configuration of services are not made from Whitehall. I think that there is a degree of consensus about these issues. Among some of the extremely interesting reading that I was ploughing through last week I came across an interesting quote, which thundered"““we will stop trying to run the day-to-day health service from the desks of Whitehall””." That was not a quote from a member of the Government, but from the hon. Member for South Cambridgeshire (Mr. Lansley). The hon. Member for Mid-Worcestershire made a number of constructive suggestions and I congratulate him on his engagement with local health professionals in structuring some of these proposals, which will be a valuable input to the board meeting on 3 August. However, I underline that the role of Health Ministers and the Department of Health is to secure adequate resources for funding the NHS and to set out the strategic framework for the NHS to work within. My hon. Friend the Member for Worcester mentioned the possibility and indeed the opportunity of provision for greater community capacity in and around Worcester. The Government will undertake an important public consultation on out-of-hospital care later this year. I encourage both my hon. Friend and the hon. Gentleman to be active players in that consultation, because as the future of health care changes, it is important to change the shape and nature of local health care provision. Our policy structure allows decisions about local NHS services to be taken at a local level. It cannot be right for Health Ministers to stand in Westminster and write a prescription for what health services should look like in every community up and down the country. We have increased the funding for PCTs significantly. We have set the standards. It is now down to local PCTs to decide their local priorities. I look forward to hearing further news from South Worcestershire PCT as these plans are developed together with the local community, as it goes through the consultation procedures that have been set out over the weeks and months ahead.