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St. Michael’s Hospital, Aylsham

The PCT is agreeing a recovery plan with the strategic health authority so that it can get itself to a sustainable position. I am informed that by the end of the next financial year that recovery plan should have been implemented fully. No new national targets are being handed down through the system this financial year. Admittedly, there is the 18-week target and there are other challenging targets on MRSA, but over and above those we want people to use the money to respond to local priorities and needs. The hon. Gentleman’s PCT is no different from any other; we want it to have that freedom. On a further point of context, hospital lengths of stay have fallen by 20 per cent. in the last few years, and 70 per cent. of surgery is now carried out on day cases, with no need to stay in overnight. More and more people do not have to go to hospital at all, and up to half of the 45 million out-patient appointments each year can be provided in the community, along with minor surgery. It is recognised that people greatly value their local community hospitals; I hear what the hon. Gentleman says. St. Michael’s Hospital is no exception. However, the public are telling us also that they want more convenient and appropriate services available at times and in places more convenient to them. That was very much the conclusion of the Government’s White Paper of the same title as the local consultation that his PCT is running. After extensive consultation with patients, that became the paper’s main theme. It is not some policy diktat from Whitehall; it is the message that has come over repeatedly to the Department through public consultation. We want more services in the community and, where possible, in the home, but in that regard we do not compare well with other countries. For example, in Germany all out-patient appointments take place in the community, and that is true in other countries as well. Public consultation on the PCT’s proposals began on 6 March and will end on 5 June. The PCT’s aims in taking those proposals forward are to provide flexible, patient-centred care delivered at home, or as close to home as possible; to provide health care in the most suitable place, and not, for example, in a hospital just because it is the only option available; to achieve a balanced and consistent range of services across the whole PCT area; and to achieve better outcomes for patients, helping them to maintain an independent life for longer. I want to dwell on that point for a moment because, without commenting directly on the proposals and whether they are right or wrong from a departmental point of view, it is important to draw attention to the fact that the PCT is saying that it can provide care to 25 per cent. more patients than is currently the case. Although I understand the strength of local feeling, it is important that the message is heard that the proposals are about providing people with more convenient services. They will allow 700 people to be cared for in their homes, rather than in a hospital. I accept that we have some way to go before we can convince the public conclusively that that is better, but the more that patients experience those kinds of services, where proper support is provided in patients’ homes, the more minds will be changed. Some of the proposals announced yesterday demonstrate that lots of PCTs are taking forward the idea of the ““virtual ward”” where intensive support is provided for more elderly patients, or those suffering from a long-term condition, with the specific aim of preventing unnecessary admissions to hospital. In my view, that must be the aim of the health service. It should not just be about building big hospitals and filling them, but about keeping people out of hospital in the first place, which the health service has not always done particularly well. It is right to move money around the system with that aim in mind—that is human progress and health progress. I understand that the PCT has organised a series of public meetings throughout Norfolk to give people the opportunity to express their views on the proposals, and I have been informed that they have been well attended; clearly, people are engaging with the process. I believe that I have signed many letters to the hon. Gentleman responding to his constituents, and obviously we will continue to respond to concerns raised. I shall address some of the specific points that the hon. Gentleman raised. He asked whether the PCT will be further reorganised. I recognise that the more recent changes caused disappointment among some NHS staff. There were good reasons for those changes—for example, to make them more coterminous with local government services. That was a very important part of the rationale for those changes. At the moment, I cannot envisage any reason for further changes or reorganisation of the PCT. Indeed, I would not welcome that at all, as he would not. I cannot tie the hands of a successor Minister, but from my point of view, there will be no discussion of that, and nor should there be. We want the new PCTs to bed down and work closely with their local authorities in order to provide the kind of co-ordinated services that I am talking about. The hon. Gentleman asked how the deficit can be reduced. I hope that he will agree that we are working with the SHA, which believes that there is a way forward for the PCT to tackle its overspending, but at the same time improve services to patients. That might require some difficult decisions, but I believe that a good plan is being formulated to ensure that it happens. He asked also about population growth in his area. I can assure him that in the next round of PCT allocations, adjustments will be made and consideration given to areas experiencing population growth, or likely to. The formula can be adjusted to pick up those pressures. The hon. Gentleman talked about the difficulties of people travelling around the county. I understand that fully and know that many of the villages are some distance apart. It can be difficult to get older people to use public transport, but let us remember that, as I understand it, the proposal is to provide many more services in patients’ homes and greater convenience, thereby avoiding the need for the individual to be in hospital and for their family to visit them. So there are potentially huge benefits. I cannot say a great deal more because it is a live consultation. I know that the hon. Gentleman is representing his constituents’ views clearly and directly in the consultation. I hope that he will allow it to run its course and then take the right decision in the best interests of his constituency. Sitting suspended until 2.30 pm.