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The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Devizes (Claire Perry) on securing this important debate. I know that local health services are a top priority for her and that she campaigned vigorously before coming to the House, and has done so since, as we have heard today, on behalf of her constituents to ensure that she obtains the best health care provision for the people she so ably represents. I admire her dedication and determination in fighting that battle for her constituents. I pay tribute to the NHS staff in Devizes and throughout Wiltshire for the excellent care and dedication that they provide day in, day out when looking after my hon. Friend’s constituents and those of other hon. Members in the county.
My hon. Friend is aware that my right hon. Friend the Secretary of State has launched our White Paper on liberating the national health service. It is our vision for freeing the NHS from the shackles of politicians and bureaucrats in Whitehall, giving power to people locally, and working with clinicians and general practitioners to provide those services that local communities in Devizes, Wiltshire and the country need. It is a vision for making the NHS more accountable to patients, whether my hon. Friend’s constituents in Devizes or people elsewhere. We want to free staff from excessive bureaucracy and top-down control. We want patients to be at the heart of everything that the NHS does and we want local people to have more choice and control than they have ever had and a greater say in their treatment, their needs and their health requirements. People in Devizes and the other small towns and villages that my hon. Friend mentioned will be in charge of making decisions about their care and provision of health requirements.
My hon. Friend has outlined the strength of feeling in her constituency for local minor injury services, and the support for the NHS generally. The minor injury units for Devizes and Marlborough at Savernake community hospital closed in September 2007, and my hon. Friend and her constituents were, understandably, disappointed at the decision, and have been frustrated by the difficulties and delays that have resulted from it. I am aware that people living in different parts of her constituency access different minor injury units, including those at the community hospitals at Trowbridge, Chippenham, Andover and Newbury, and that minor injury treatment continues to be available at the A and E departments in the acute hospitals in Salisbury, Bath and Swindon. As my hon. Friend rightly said, transport access causes problems for some of her constituents. I have considerable sympathy with the points she made about that.
I am also aware that my hon. Friend’s constituency covers a large rural area. She gave some interesting figures and comparisons with other rural constituencies when making her point so powerfully. I understand her desire for local minor injury units that are accessible as quickly as possible to her constituents. But I must be frank with her. Given where we are at the moment and the processes that have taken place in her county and constituency on reconfiguration of services, I am unable to ask the NHS to open previously conceded processes, or to halt those that have passed the point of no return. I know that that will disappoint my hon. Friend, but I am afraid that at the moment we are where we are because of previous decisions and the degree to which they are in process.
My hon. Friend asked what could be done, and whether pilot schemes could be introduced as a forerunner to the abolition of PCTs in 2013, and she suggested other ways of working with outside interests. I want to give her as clear a steer as possible, and unfortunately, until the PCTs are closed and cease to exist in 2013, due processes and proper procedures must be adopted to move forward. Until they are phased out from 2013, the PCTs will continue to have the same responsibilities that they have now for the provision and commissioning of health care in the areas for which they are responsible, including Wiltshire.
Guy Opperman (Hexham) (Con)
I pay tribute to my hon. Friend the Member for Devizes (Claire Perry) for carrying on the work that we have all been doing for a considerable period on hospitals in Wiltshire. I spent three years of my life trying to keep them open. The Minister is saying that in reality, whatever the situation, despite the Health Secretary saying in 2007 that clinical need should justify closure, despite this being fundamentally an accounting measure, and despite decisions apparently not being reviewed before 2013, people are desperate for a hospital to reopen that is pre-existing, prepaid and sitting there—
Guy Opperman
It is a long question. I apologise, Mr Streeter, but the hospital is still there, and capable of being used. With the greatest respect, I fail to see why it is not being used.
Mr Burns
I am grateful for my hon. Friend’s intervention and I fully appreciate his frustration at the situation. I also appreciate the greater frustration of my hon. Friend the Member for Devizes, because her constituency is directly affected by the issue that we are discussing. I repeat: we are where we are. We have a vision of a health service that works from the bottom up rather than the top down. However, until the changes occur, we are in a straitjacket because of procedures currently in place that have to be adopted.
Before the intervention by my hon. Friend the Member for Hexham (Guy Opperman), I was responding to the question from my hon. Friend the Member for Devizes about the way forward. I hope to give her a glimmer of hope and I will give her some advice about how I see the situation, both as a constituency MP and as a Minister. As long as we are in what is effectively an interim period since the publication of yesterday’s White Paper, with the PCTs still commissioning services and having the lead role, I advise her to continue her spirited and dedicated campaign to get what she seeks for her constituents. She should continue seeking to persuade the PCT, local clinicians, GPs and the local community to stay onside in the desire to establish a minor injuries unit, and ensure that the other care services she mentioned are instigated for her constituents. At the moment, that route is the only way forward because the PCTs are the commissioning agents.
I urge my hon. Friend to continue her campaign in the hope that during the interim period over the next three years, she will see a change of heart if that is possible. If it is not possible, when the changes come in, she should use the new system to seek to persuade those in charge of reconfigurations and the provision of services to reinstate the services that she so passionately and rightly believes are needed and deserved by her constituents. That is my advice. It may not be as palatable as she would hope, but I know that she will appreciate and understand that under current circumstances, we have not yet changed the system. That vision was announced yesterday and it is a vision for the future.
Claire Perry
By 2013, if we get our ducks in a row, get our clinicians onside and our draft contracts drawn up, will we be able to present that business plan—in whatever forum we are in—to the national commissioning body and have some chance of success? Is there hope that within a three-year period before the next election we might get those services back under a new contract commissioned by the central body?
Mr Burns
Obviously, I cannot give a commitment that my hon. Friend would be successful. I wish her well in her endeavours, but it is not for me to prejudge what might happen. She is certainly right that if she puts all her ducks in a row—as she put it—with a business plan for what she believes her constituents need, she can present it to the national commissioning board and to GP consortiums in her area. Everybody will then work together, and make an overwhelming case for what my hon. Friend wants to see delivered for the local people of Devizes and her constituency.
As my hon. Friend will accept, “The times they are a-changin’”. The Government’s approach is different from the top-down approach taken by the previous Government. We believe that local decision making is essential to improve outcomes for patients and drive up quality. We will do more than just talk about pushing power to the local level; as the Secretary of State’s White Paper shows, we are going to do it and make the dream a reality. That will be of considerable help to my hon. Friend in her campaign.
Given my hon. Friend’s experiences during her ongoing battle, she will agree that we must move away from having Whitehall dictate how care should be delivered in Devizes, Westbury or any other town or village in Wiltshire. We believe that change must be driven from the bottom up, and that the patient must be the heart of health care provision. The patient must be put first; their interests and quality of health care is the No. 1 priority, not the decisions, ramifications and shenanigans of politicians and civil servants.
In future, all service changes must be led by clinicians and patients, not driven by Ministers such as me, or civil servants from the Department of Health. Only then will the NHS achieve the quality improvements that we all want to see.
Duncan Hames
In his search for local accountability in decision making, it would be helpful if the Minister advised hon. Members where in the process the public’s demand for these services will be heard. Is there a role for locally elected politicians to secure influence in determining outcomes through the health overview and scrutiny committees of our local councils?
Mr Burns
If the hon. Gentleman refers to current arrangements, he will no doubt be aware that in late May, the Secretary of State announced changes to the criteria that need to be taken into account in any reconfigurations currently under way—providing that those reconfigurations are not so far advanced that it would be impossible to reverse them—and any future reconfigurations. The main priorities include taking into account the views of local people, clinicians and GPs and ensuring that health care is relevant for the local area.
If the hon. Gentleman is asking what will happen after the changes in the White Paper, let me say that once the PCTs are wound down and abolished, there will be a transfer of powers to the national commissioning board and all that flows downwards from that. Provision and responsibility for the commissioning and delivery of health care in a local area will be linked to local authorities, and accountability will be through local authority input with locally elected representatives. Public health is currently dealt with through the input from the primary local authority level in each area. That is where the accountability will be. The predominant point is that because one must have a locally driven health service, the wishes of the patient—not only in their individual care but in the requirements of the local community—must be fundamental to the decision about units or configurations. I hope that the hon. Gentleman and my hon. Friend are reassured by that.
In conclusion, I once again pay tribute to my hon. Friend for her commitment and dedication in fighting so hard for her constituents, not only before the election but afterwards. She has been in the House for about eight weeks, and she has already made her mark fighting for her constituents on the issue that she promised, during those long days in April, to take to Westminster. She is now in Westminster and has brought the issue to the debate today. I have every confidence that she will continue to use the means available to her in the House to pursue her agenda, and that she will mobilise support in her constituency to ensure that the issue does not go away. She will be determined to get what she believes to be the best health care for her community, and I wish her every success.