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Health Care (Norfolk)

I congratulate the hon. Member for Mid-Norfolk (Mr. Simpson) on securing this Adjournment debate about an issue that is important not only to his family but to his constituents and the local community. The description of the dialogue, both in the hon. Gentleman's presentation today and in my briefing for the debate, is almost an example of best practice. He said that the process would not have happened without the overview and scrutiny committee's referral, but that is the very reason why the Government gave local authorities for the first time the statutory right to comment on NHS reorganisation proposals locally and, if they were dissatisfied with the proposals, the right, as he knows, to refer them to the Secretary of State, who would then refer them to an independent review configuration panel. Although I agree that it is probably unlikely that those discussions would take place without the role of the overview and scrutiny committee, I hope that the hon. Gentleman agrees that the new role for local government in scrutinising NHS decisions, which can be uncomfortable and difficult, is right. The hon. Gentleman, understandably, represents the views of the local community, which feels, also understandably, that it would like to preserve what it has. People are attached to the hospital, which they believe provides an excellent service. The hon. Gentleman referred to demographic change, so the issue is not just about the existing situation, but about projections of future need. The local community would like the hospital to be preserved in its current form. I do not live in the area, so I am less able to comment than the local people who make those decisions and live there, but the vision is for a much wider range of community-based services. The hon. Gentleman rightly raised the question of what a wellness facility is. These days, we use all sorts of jargon in public services, which confuses people, but the principle of a wellness service is the recognition that the modern health service—this is at the heart of Lord Darsi's review—is as much about preventing sickness and ill health as about intervening once somebody becomes very ill. That can be achieved through better health education, promotion, screening and so on, and by intervening early to prevent people's health from deteriorating, which is particularly relevant to older people. Once they deteriorate, the danger is that it is difficult to get them back on their feet and living independently. The notion of a wellness approach is about prevention, early intervention and ensuring that people are aware of how best to stay healthy. We must get the right balance of prevention and early intervention services in the hon. Gentleman's community and ensure that there are some beds, which is indeed part of the plan. Those beds might not be in the existing hospital environment, but there is a commitment to develop a nursing home-type provision in the community. That seems to me a better outcome for health care provision in Aylsham than the current position. The cynicism and scepticism among residents and professionals may be because they have not yet seen a tangible vision of what the alternative will look like. In defence of the primary care trust, it seems to me that it is trying to develop that vision in partnership with the local community rather than simply impose on it a ““managers know best”” or ““professionals know best”” approach. From all the information I have, from both the hon. Gentleman's contribution and my briefing for the debate, I think that what is happening is what we would want to happen in communities where change is essential. We want engagement between the health bodies and local communities, and we want the local authority, Members of Parliament and local residents to be involved to try to come up with a solution in the best interests of the relevant community. The hon. Gentleman asked about resources. It is important to point out that if the PCT can emerge from the process with a credible, sensible vision, which will improve health care and be more up to date, modern and responsive to the needs of the community, and if it puts a credible and robust bid to the strategic health authority, demonstrating improved outcomes for patients, of course resources will be available. There are resources both regionally and nationally—SHAs can seek resources from the Department of Health—to support the reorganisation and reconfiguration of services. The hon. Gentleman says that has not yet happened, so resource problems are not preventing progress. We need a clear vision about a new range of health services that best meet the needs of the Aylsham community. I will be happy to meet the hon. Gentleman at a later stage if he is dissatisfied with the outcome of the engagement and consultation process. I urge him to show a little leadership in the local community—I am not saying that he is not already doing so, because I have no reason to believe that—and to say that, although not all change is good, if there can be change that leads to a better range of services, focused on prevention, early intervention and ensuring that older people do not deteriorate and need acute hospital care, it will be in the interests of all families in Aylsham. The hon. Gentleman was right about the impact on the work force and on professionals, recruitment and so on, but the changes mean that a different mix of professionals—doctors, community nurses and social care staff—will need to work together to ensure that there is a shift to prevention and early intervention. I understand that it was originally feared that, under the proposals, the five existing beds would be removed and not replaced, but from what the PCT has said, it seems that as well as an NHS campus with integrated services and a shift from acute to primary health care, there will also be guaranteed protection of at least five beds in any new organisation of services. I ask the hon. Gentleman to see the proposals as a major opportunity, not as a threat. He must consider the range of services currently provided and the consequences for patient care in Aylsham and surrounding areas, and whether the proposed changes would lead to better outcomes in the long term. It is easy to hang on to the status quo and, understandably, people are emotionally attached to existing services. They are not necessarily persuaded of the need for change until it is clear to them what the change will be and whether it will lead to improvement or to the diminution or undermining of existing services. The hon. Member for South-West Norfolk (Mr. Fraser) made an important contribution, but it is difficult to see how he can argue that we should seek maximum devolution for managers and professionals on the front line and minimal Government interference—his party supported the foundation hospital model on the whole, for example—and then ask the Government to intervene in individual hospitals where he feels the car parking charges are excessive. Although it is acceptable for hospitals to charge for car parking, and there is no law or rule to prevent them from doing so, they certainly should not abuse that right by charging extortionate amounts. The test of reasonableness should be applied to decisions on the matter. As a Member of Parliament, the hon. Gentleman has the right to make strong statements and representations if it can be demonstrated that the charging regime is either extortionate or disproportionate. I do not know the details of the case that he mentioned, so I cannot make a definitive comment, but charges should be proportionate and reasonable.