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St. Michael’s Hospital, Aylsham

It is a pleasure to serve under your authority, Dr. McCrea, I believe for the first time. I initiated this short debate because under the Norfolk primary care trust consultation document—the consultation is taking place between 6 March and 5 June 2007—St. Michael’s hospital, Aylsham, in my constituency could close, along with two other community hospitals in Norfolk. That has caused widespread anger and dismay in Aylsham and the surrounding area, and those feelings are replicated elsewhere in Norfolk, where there are threatened cuts. My primary concern today is the standard of health care available to my constituents. I am not convinced that the alternative proposal of home health care will replace or enhance the facilities that will be cut at St. Michael’s hospital. The Minister knows that there have been widespread demonstrations against proposed cuts in community hospitals not only in Norfolk but elsewhere in England. People rightly suspect that the cuts have more to do with overcoming PCT deficits than meeting new health care demands. He will be only too well aware that his ministerial colleagues the Parliamentary Secretary to the Treasury, the Minister without Portfolio and the Under-Secretary of State for Health have publicly protested about proposed cuts in their constituencies. I do not think that that ever happened under previous Governments, and it stretches ministerial responsibility almost to breaking point. In Norfolk, there have been widespread protest meetings, petitions and demonstrations against the proposed cuts. That is not the consequence of some out-of-date sense of nostalgia. Local people, including health professionals, value their community hospitals and are unconvinced that alternative health care delivery is a substitute. I have received thousands of letters of protest and petitions, and I have spoken to both health professionals who work at St. Michael’s hospital and local general practitioners, and all are united in that view. I have not received one letter, e-mail or verbal representation that favours the proposed cuts or supports the view that an alternative home health care system would be a good substitute. One of the problems is that people in Norfolk have very little confidence in the PCT. The Minister is probably aware that the current chairman of the PCT, Miss Sheila Childerhouse, was an independent councillor on Breckland district council. She lost her council seat to a candidate who supported the campaign to stop the hospital closure. That says something about local feeling. The Minister should also be aware that my constituents are pretty well convinced that the consultation exercise that is now being carried out is, in the words of one health professional, ““a sham””, and that the decision to close St. Michael’s has already been reached. In the consultation document, St. Michael’s is flagged up as a hospital that may close—I believe that ““will close”” is the view of most of my constituents. The idea of closing community hospitals flies in the face of what was said in a letter dated 15 March that I received from the Minister’s departmental colleague, the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton):"““We are committed to empowering citizens to give them more confidence and more opportunities to influence public services in ways that are relevant and meaningful to them, and in ways that will make a real difference to services.””" I am not convinced that closing community hospitals and trying to substitute home-based health care in their place is, in fact, in line with Government policy. As the Minister knows, many of the problems that we face in Norfolk are a direct consequence of the continual reorganisation of PCTs that has taken place over the past six years. Reorganisation has been incredibly costly, and it has undermined professional morale and public confidence. The Minister will be aware that Norfolk PCT has an annual budget of £900 million but debts of £47 million—it is one of the most indebted PCTs in the country. That is a direct consequence of poor financial management in the past, the impact of Government NHS reforms and, of course, historic debt. Removing the deficit is one of the drivers behind the PCT’s proposals, and I accept the fact that it is not the only driver—there is, of course, a genuine desire to improve health care—but the consequence is the likely closure of St. Michael’s hospital. The strategic health authority set the PCT a target to cut the deficit of £47 million by £23 million by the end of March this year, and to clear all the debts by March 2008. I understand that at present the PCT has been able to cut only £3 million. How does the Minister think that it can reduce the deficit? Even if the deficit is reduced, what guarantee is there that it will not be repeated, given the fact that only three years ago, under the previous PCT reorganisation, PCTs Norfolk-wide had debts of nearly £30 million? It is also relevant to bear it in mind that the Government are urging that alternative health care be provided in the community as a consequence of closing community hospitals. The Times stated yesterday:"““A key target in the Government’s health reforms—to have thousands of community nurses treating the most seriously ill patients outside hospital—has been missed””," and that less than 50 per cent. of the required number of nurses are in place. Can the Minister assure me that we will not have a further reorganisation of the PCTs in the lifetime of this Parliament? My constituents and most Norfolk MPs, regardless of political party, are frustrated that responsibility and accountability for health care in Norfolk are passed around between the Department of Health, the strategic health authority and the PCT—it is like pass the parcel. It is incredibly difficult to get a grip on responsibility. Ministers say that they have devolved budgets and responsibility downwards, eventually to the PCT, yet it is obvious that PCTs are constrained and often lack the kind of professionalism that is required. The result is that my constituents suffer. So far, my constituents have not been impressed by the PCT’s consultation process. At a public meeting held in Aylsham on 23 April, the chairman of the PCT and a senior official were unable to answer some obvious and straightforward questions concerning the future of the hospital, alternative health care provision, redundancies among staff and, given that the constituency is a rural one, the ensuing transport problems. In proposing the closure of St. Michael’s and other hospitals in Norfolk, the PCT hopes to make financial savings, hopes to reduce redundant bed capacity, hopes to concentrate facilities and resources on fewer sites and hopes to meet the Government’s policy of providing health care to people in their homes. I emphasise the word ““hopes””, because so far I have seen little evidence that it will be able to achieve that. Perhaps the Minister will be able to convince me that it will. Let me remind the Minister of the important services that are currently being delivered at St. Michael’s hospital. They include physiotherapy, incontinence clinic, occupational therapy, occupational health, chiropody, speech therapy, women’s health, falls clinic, Parkinson’s clinic, splint clinic, dietician, Dr. Woodhouse clinic— Dr. Woodhouse is a Norfolk and Norwich University hospital consultant for the elderly—and a district rehabilitation centre consisting of 24 operational bed spaces and six spare bed spaces for emergencies. I know from talking to local health professionals, particularly local GPs, that those services make up a critical mass that provides total health cover 24 hours a day, seven days a week, which, in their considered opinion, health care teams cannot and will not provide. Many of my constituents have given me examples where elderly relatives stayed at St. Michael’s hospital for post-operative recovery. Under the PCT proposals, local doctors have told me that many of those patients would have to be taken directly home without a stay at St. Michael’s. If they were to have a relapse, they would find themselves back at the Norfolk and Norwich University hospital, which already has considerable pressure on beds and facilities. When and if St. Michael’s closes, many of my constituents will have to travel to alternative health care centres at Dereham, Holt or Norwich. The Minister may not have travelled in Norfolk, but as I live eight miles west of Aylsham in the market town of Reepham, I can assure him that, to say the least, public transport is not good. The proposed changes to St. Michael’s will create major transport problems, particularly for the elderly, and for the journey times of mobile health teams. The closure of St. Michael’s hospital flies in the face of the Government’s aim to enhance community health centres. Localism is an important matter for all political parties in relation to not only health care, but many other delivery systems that central Government were expected to provide in the past. None of the proposed changes takes into account the profile of Norfolk’s population, let alone the projected population profile. Norfolk primary care trust provides services to a population of more than 700,000. It is an ageing population, and more than one fifth of people are over 65 years old, which is approximately 150,000 people. By 2020, the elderly population of the area will rise to 200,000, which is a quarter of Norfolk’s population. Currently, 30.9 per cent. of Aylsham’s population is already over 60 years old, which is above average for Norfolk. The elderly often require many kinds of intense health care, and if St. Michael’s hospital, Aylsham and at least two other community hospitals are closed, I suspect that in five or 10 years’ time, this Government or a future Government would want to provide the kind of community facilities that exist now in Aylsham. Such facilities would probably be brought back to Aylsham or near to Aylsham. The Government and the PCT have not taken the age profile of the area into account. Furthermore, within the next 10 years, under local government proposals, Norfolk is likely to have an extra 70,000 houses, which will mean a population increase. In conclusion, I will ask the Minister a number of questions—I contacted his office to inform him of the questions, because I knew that it would be helpful if he had them in advance. Local people are unconvinced that the proposed home care teams will provide a credible alternative to what St. Michael’s currently offers. What is his Department’s assessment of Norfolk PCT’s proposed plan? When St. Michael’s closes, how will the 24-hour services that are currently met, in large part, by the provision at St. Michael’s be met by mobile health teams? If patients have to go for treatment in Dereham, Holt and Norwich, what transport facilities will be provided by the PCT or the strategic health authority in addition to those available to individual families, either by using public transport or their own cars? If St. Michael’s closes, what are the estimated financial savings over five years? Meeting health care needs is an expensive business. Governments must continually look at how health care is delivered, and rightly so. There are continuing changes in developments in medicine and in the kind of total package that can be delivered. There must be an assessment of how populations change in an area—some areas effectively lose population while others experience population growth. I accept all those factors, but in 10 years of being an MP I have never known so much deep anger and resentment about proposed closures not only in my constituency, but across Norfolk. This is not just a question of nostalgia, although that is important. The hospital has received much financial support from voluntary organisations in Aylsham. It was originally a workhouse and then became a war memorial hospital. There has been a lot of local investment in the hospital, but the bottom line is that any changes in health care must, as a minimum, provide the same level of health care as my constituents have now. Any changes should, of course, aim to provide much better health care, and my fear is that, as a consequence of Norfolk PCT’s proposals, my constituents in the Aylsham area will receive a reduced level of health care. I hope that the Minister will answer some of my questions.