Community Pharmacies

Claire Perry Excerpts

Wednesday 2nd November 2016 Commons Chamber

[David Mowat]

I do accept that point. We are working on the category M clawback, and I hope to be able to make some progress on that matter soon.

[Claire Perry (Devizes) (Con)]

If anybody can square this circle, it is the Minister, given his extensive experience in this area. I genuinely believe that we have to sort out this issue. I am not happy to subsidise large private companies through the system—some of the chains have already been mentioned—so it is right to look at where the clusters occur. The Minister is well aware of the Kennet pharmacy in my constituency, and we all have really value-added pharmacies that are doing very valuable work. How can we help him, over the review period, to identify and support the services that those pharmacies provide? They must not be allowed to close as a result of this policy.

[David Mowat]

I agree with my hon. Friend. I have set out the work that we are doing, and the fact that we are providing more money for services, over and above all the money involved in the cuts and efficiency savings that we have had to make, will help that process.

Backbench business

Claire Perry Excerpts

Thursday 14th February 2013 Westminster Hall

[Caroline Nokes]

My hon. Friend is aware of the work that I do with the all-party group on body image. We have been sending that message to the media time and again. We need more realistic images in magazines and publications. Shortly, I will quote a 21-year-old sufferer from anorexia who made that point to me powerfully.

The causes of eating disorders are complicated and varied, and although there may be broad similarities, it is dangerous to suggest that any two individuals will have identical experiences or paths into illness or recovery. I know from talking to sufferers, experts, charities and families that genetics, low self-esteem, stressful life events such as death or divorce, academic pressure and cultural and social pressures, can all contribute. For every sufferer there will be different triggers or different combinations of triggers. It would be naive to suggest that a single cause could be identified. However, an issue that brought me to this debate is the social pressure to conform to a stereotypical view of the ideal body image, so ably demonstrated to us in advertising and magazines.

Last November, I attended an event in this place organised by Anorexia and Bulimia Care, and was impressed by the moving account given by Katie Waters, a 21-year-old student, who told MPs:

“Six years ago the eating disorder well and truly look over. The stress of GCSEs in a high-achieving all-girls…school meant my weight dramatically plummeted and I…developed anorexia.

During this time I did everything—speech and drama exams, piano exams, I sang in the choir, I was in school plays, actively taking part in church activities and of course was buried under a mountain of homework. I constantly pressured myself to be perfect at absolutely everything.

But the trouble is, when it comes to weight and body size, the images I frequently saw in the media of apparent perfection were unattainable. We have only just been recently made aware in the last few years of the transformation airbrushing and digital photo techniques do to women’s bodies in the media. So what I was seeing from such a young, vulnerable and impressionable age was actually not a real person.”

To those who dismiss the impact of the images we routinely see in the media, I hope the words of Katie, and other sufferers like her, will hit home. Although I do not claim that such images are causing eating disorders, they are contributing to them, and editors and advertisers can work to portray more realistic and positive images.

I should like briefly to mention the relatively new phenomenon of pro-ana websites. First appearing in the 1990s, these sites are numerous and are often characterised by a frequent migration to different web addresses or blog sites. Ana, or thinspiration, is portrayed on many of these sites as not a serious mental illness, but a lifestyle choice, and although those supporting the sites claim that they can provide the only forum for socially isolated sufferers, solid academic studies support the claim that they do damage.

[Claire Perry (Devizes) (Con)]

I hope that you will accept my apologies for joining the debate late, Mrs Osborne. Does my hon. Friend agree that the progress we are making on making it much easier to filter out pornography, violence, abuse, anorexia and self-harm from the family home is welcome?

[Caroline Nokes]

I commend my hon. Friend on the work that she is doing in that area. I sincerely hope that we see some progress on that, so that these websites, which are proliferating—there is evidence of a 470% increase in just one year, between 2006 and 2007—can be prevented from being accessed from family homes. US studies have shown a clear correlation between increased body dissatisfaction and viewing such sites.

We live in a complex, changing world where higher numbers of people than ever suffer from mental illness, and so it is with eating disorders. It is not just the number of sufferers, but the severity, that is increasing. What would have been considered an eating disorder 20 years ago might now be regarded merely as a bit of disordered eating. I do not say that in any way to dismiss the seriousness of disordered eating, but to demonstrate that the conditions now have to be a great deal worse to be recognised as such, and to make a sufferer a priority for treatment. That is one of the serious issues that I would like to mention.

In my home city of Southampton—not in my constituency, but in that of the right hon. Member for Southampton, Itchen (Mr Denham)—is April House, a unit specialising in eating disorders, which I have had the privilege of visiting, and where I met service users and health care professionals. I attest to the outstanding work done there. Some of the service users and staff are here today. I admire their courage and determination.

I agree with the firm message that I received from staff at April House. With all eating disorders, there is a critical window of opportunity when a sufferer has been diagnosed, wants help, has acknowledged that they have a problem, and are reaching out for the assistance they desperately need. That opportunity can easily be lost if help is not available at that time.

Winterbourne View

Claire Perry Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

The right hon. Gentleman makes an extremely valuable point, and I would be happy to discuss that with him further. Too often in the past there has been a paternalist approach in which others have decided what is best for individuals. Hearing the voice of people with learning disabilities is absolutely central to getting this matter right.

[Claire Perry (Devizes) (Con)]

People who watched “Panorama” will know that a tall, flame-haired young man named Simon Tovey was one of the patients who suffered horrific abuse. His mother, Ann Earley, is my constituent, as is Simon, who has now returned to a lovely community care home in West Lavington. Mrs Earley believes that the views of parents in particular were not heard under the system—they knew for years the problems pertaining to Simon’s care. What reassurance can the Minister give to Mrs Earley, and the House, that the views of parents and other responsible adults will be included when seeking to avoid these tragedies in the future?

[Norman Lamb]

It struck me when I listened to the story of that family that I would like to meet them if they are interested in having that discussion. Just as it is essential that people with learning disabilities have their say, it is critical that the family is involved in the discussions before the commissioning takes place, so that they are partners in the decisions that are taken in respect of those individuals.

Oral Answers to Questions

Claire Perry Excerpts

Tuesday 12th June 2012 Commons Chamber

The Secretary of State was asked—

[Claire Perry (Devizes) (Con)]

1. What progress clinical commissioning groups have made in improving care for patients.

[Nadhim Zahawi (Stratford-on-Avon) (Con)]

17. What progress clinical commissioning groups have made in improving care for patients.

[The Secretary of State for Health (Mr Andrew Lansley)]

This year, developing CCGs have delegated responsibility for more than £30 billion of local commissioning. Clinical leadership is using NHS resources more effectively, as part of improvements in care. In particular, we are seeing many improvements in community-based services—for example, a pulmonary exercise programme in Durham; a community spinal service in Reading; and a new musculoskeletal service in the Vale of York CCG.

[Claire Perry]

I thank the Secretary of State for that reply. During the Easter recess, I helped to organise a number of health question times in my constituency, where we brought together the commissioning groups, doctors, people from acute hospitals and hundreds of interested constituents to talk about how we would improve local health care. The good news was that doctors and clinicians—

[Mr Speaker]

Order. Let us just have a quick question and then we will move on.

[Claire Perry]

Will the Secretary of State help by telling me how we can communicate out this example so that other MPs can repeat this valuable exercise?

[Mr Lansley]

I am very grateful to my hon. Friend for demonstrating how these new developing relationships that CCGs and local authorities are creating with NHS providers and care providers are delivering improvements in care for the constituents we all represent. I urge other hon. Members to follow her example in stimulating exactly those relationships.

Oral Answers to Questions

Claire Perry Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

Yes, of course. My hon. Friend understands very well indeed how difficult are the circumstances of his trust, which includes two PFI hospitals, and Queen Mary’s at Sidcup has suffered from the consequences of those PFIs. I am looking forward to the proposals on the future provision of health services on the Queen Mary’s Sidcup site. South London Healthcare is clearly an extremely challenged trust and we inherited very substantial problems there. We are looking to resolve them with it, but it will need additional national support.

[Claire Perry (Devizes) (Con)]

In addition to struggling hospital trusts, many, many community hospitals throughout the country, such as Savernake hospital near Marlborough, are also labouring under the burden of an enormous PFI contract and having the indignity of vital local services hollowed out under that lot’s leadership on the Labour Benches. Will the Secretary of State please tell me what he will do to help those smaller hospitals with vital local services?

[Mr Lansley]

As my hon. Friend knows from her conversations with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), we are very sympathetic to her concerns. By devolving commissioning responsibilities to clinical commissioning groups, I expect the local clinical leadership, understanding fully the contribution that community hospitals can make, to be supportive of that in their commissioning intentions in her constituency and others.

Oral Answers to Questions

Claire Perry Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Lansley]

I am sure that the hon. Lady will have heard the reply from the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), who explained the continuing process that the joint committee of primary care trusts will undertake. In the context of her question, it is important to make it clear that the intention of the review is not to close paediatric cardiac centres. Surgery in some of the centres might cease, depending on the conclusions the committee reaches, but they will continue to provide specialist non-surgical services for local populations. The review intends to ensure that as much non-surgical care is delivered as close to children’s homes as possible through the development of local congenital heart networks.

[Claire Perry (Devizes) (Con)]

T2. Under the previous Government, Savernake hospital in my constituency was redeveloped. As a result, taxpayers have got stuck with nearly £1 million a year in private finance initiative unitary charges and local services offered have been cut drastically. Will the Minister undertake to look at all hospitals labouring under uneconomic PFI burdens and meet me to discuss the Savernake hospital situation specifically?

[The Minister of State, Department of Health (Mr Simon Burns)]

I am grateful to my hon. Friend, because she has been campaigning on this issue for more than a year, and rightly so. Work is being done on the whole issue of PFI and the NHS to ensure value for money. Given her concerns, I would be more than happy to meet to discuss this particular case.

Umbilical Cord Blood

Claire Perry Excerpts

Monday 31st January 2011 Commons Chamber

[Anne Milton]

There is no doubt that close discussions with all the devolved Administrations are critical. We have a patchy and disjointed service, but as the hon. Gentleman rightly says we need a single register. I am pleased to say that some work is already bearing fruit. At the last meeting of the forum, well-advanced plans were put forward on how NHSBT and Anthony Nolan can work together in future, with targets for reducing the average search time by six weeks and the establishment, for the first time in England, of a single bone marrow register and cord blood inventory. However, we must go further. I cannot praise enough that type of innovative and professional approach. It is collaboration like that that means real improvement for patients. We must have notable improvements on the wards, not just on the spreadsheets.

The UK Stem Cell Strategic Forum review was a Department initiative, and the work was paid for by the Department. We have heard of the efforts of organisations such as Round Table. I would like to take the opportunity to thank Lynda Hamlyn, the chief executive of NHSBT, Henny Braund, her counterpart at Anthony Nolan, and their dedicated, hard-working staff for the work they have done so far. I have no doubt that there is more work to be done and that it will continue in the future.

[Claire Perry (Devizes) (Con)]

I am grateful to my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) for securing this incredibly important debate. I confess that this is something about which I knew nothing. He mentioned the importance of education and the need for a programme that is similar to that for organ donations so that mothers are informed about the value of umbilical blood and blood products before giving birth. Certainly, that is something that I was never informed about. Is the Department considering any sort of education programme so that people can opt in to the system as donors?

[Anne Milton]

I thank my hon. Friend for that intervention. It would be terribly simplistic to think that it is just a matter of donors coming forward. We know from organ donation—it is also the case for umbilical cord blood—that it is important to streamline the processes, because there are unacceptable delays. The report’s recommendations cover the whole process from beginning to end. I do not underestimate the need to raise the importance of this issue. Many hon. Members can play a critical role in their local areas and with their local media by highlighting the importance of organ donation.

Diabetes (Young People)

Claire Perry Excerpts

Wednesday 15th September 2010 Westminster Hall

[Mr Adrian Sanders (Torbay) (LD)]

I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing this important and pertinent debate. It is timely, given that we have a new Government and a new Health Secretary with responsibility for the issue. This is a great opportunity for us to help him to help those with the condition. I register that I am a type 1 diabetic whose condition is controlled by injections of insulin.

Diabetes, whether type 1 or type 2, is a chronic condition for which there is as yet no cure. Type 1 diabetes is believed to be genetic, rather than a consequence of lifestyle; type 2 diabetes is firmly believed to be a consequence of lifestyle and diet, and not necessarily of genetic factors.

The treatment regimes for types 1 and 2 are slightly different. Treatment of type 2 is very much about diet, exercise and changing a sedentary lifestyle. Medicines might be introduced to induce what insulin the body still produces to work better, although injections of insulin are increasingly being prescribed for people with type 2 diabetes, particularly those who have had the condition for a long time. The type 1 diabetic is someone whose pancreas has effectively packed up and said goodbye, so in order to stay alive, they must take injections of insulin—there is no alternative. Medication is sometimes prescribed later in life to ensure that the insulin taken works a little faster or more efficiently. For those considered to be at risk of other complications that tend to come with diabetes, such as strokes or heart problems, statins and other such drugs can be prescribed.

Just under one in five people with diabetes has type 1. Most are likely to have been diagnosed before age 40; I have had the condition since my late 20s. This debate is about diabetes in young people, so I will focus on that. I am glad that I was not diagnosed with diabetes as a young person, because it has a major impact on a young person’s life, educational chances, social interactions and psychological attitude to life.

The typical treatment for somebody with type 1 diabetes is perhaps three injections a day of fairly fast-acting insulin, taken at meal times. Before going to bed, they might take a fourth injection of a slightly longer-lasting insulin to maintain their body’s balance through the night, when they are not exerting themselves and require a different type of insulin. There are dozens of types of insulin—fast-acting, slow-acting, mixed—and which insulin or insulin mix is right is a decision for the patient and their GP in light of their circumstances.

The condition changes with age. The first insulin that someone is prescribed is not necessarily the one with which they will continue later in life. New insulins come on the market all the time, promising better control and fewer complications, and from time to time the treatment regime is reviewed and the GP or consultant may recommend change. Of course, that can cause complications, as the effect of any change is specific to the person. I am sure that the right hon. Member for Knowsley will know, if his daughter has ever been asked to change her treatment regime, that a degree of adjustment must take place before the patient is comfortable with the new regime.

Many people with diabetes make contact with the health service only once a year. It is a condition that must be managed by the diabetic themselves. For 364 days of the year, they are their own consultant. They know their body better than anyone else, and they must take the decision whether to increase or decrease the dose according to how much energy they are expending or what type of food they are about to eat. Once a year, the diabetic has a medical check-up. Some good GP practices bring in people twice a year: once to see the GP, once to see a specialist nurse. Some diabetics might see a medical professional three times a year in addition to seeing their consultant in hospital, but most people who have been diagnosed and are living with the condition normally come into contact with the health service only once a year. It is vital, therefore, that at that point the health service can detect whether there is a problem, analyse what it is and make correct suggestions about any changes in treatment.

For young people of primary and secondary school age, one big problem is the stigma of diabetes. There are a lot of misconceptions out there about what the disease is, what it does and what the condition brings. A young person might be told, “I’m sorry, you’re going to have to inject yourself,” but there is a stigma to that. They need a clean, perhaps private environment in which to make that injection. Although great advances have been made in injection devices—some are disguised as pens—there is still a stigma attached to having an injection, even a small, subcutaneous one. They are not great big syringes, as they used to be in the old days, but even with those advances, there is still a stigma.

Injections are not the only part of it. A sensible diabetic will want to test their blood sugars, which means taking a blood sample and putting it through a testing machine so the reading can advise them what injection of insulin is required. A clean, discreet environment is needed, which is difficult to find for someone in school—far more difficult than for me, a Member of Parliament. That is another reason why I am glad I did not have the condition as a child.

There are three stages for a young person with diabetes. Often, in a primary school environment, they may be the only person with the condition. Kids are quick to pick up on somebody who is a little bit different or has special requirements. Often, the primary school might have difficulty coping with a child who has diabetes. Many cases are on record—Diabetes UK has done a lot of work to highlight the issue—in which primary schoolchildren have not been able to get teachers or other school staff to assist them with testing or injecting because the school insists that a parent come in to do so. Working parents simply cannot do that, so in some cases, parents have had to move children away from their desired school to a bigger school, or one that can cope with a child who has diabetes.

We then move to secondary school. Although secondary school is ever longer ago, we can perhaps remember what we were like as teenagers, and the reality is that people do not want to be different when they are at secondary school. They do not want to admit that there is something that they cannot do, particularly if they are male. The reality, however, is that, with the right treatment, there is nothing that they cannot do. However, if they cannot, for whatever reason, do what they need to do, they will have difficulties doing what they wish to do.

We then come to the third stage—higher education. Things are different again when people go up to university. They may break the link with their home-town medical support, whether it is a GP or a consultant. They suddenly come into a university environment, which is very different from the home environment. The encouragement to do all the things that a diabetic should not do, in terms of when and what to eat and how much to drink, becomes that much greater. Young students with diabetes have reported to me that whatever medical support services there are at universities lack an understanding of that pressure, so there needs to be some improvement in that area.

The right hon. Member for Knowsley rightly mentioned the NICE guidelines on insulin pumps, and it is worth realising what they say, because they are quite limiting, in terms of the number of people who can be prescribed pumps. The guidelines recommend that the therapy be used when every other treatment has failed. Someone who has not got on well with injecting insulin or medication will be put on an insulin pump as a last resort. The NICE guideline for children under 12 says that they

“can have access to insulin pump therapy if multiple daily injections are considered impractical or inappropriate.”

There are lots of incidences of young children finding that injections are impractical and inappropriate because their school cannot help them, but their cases do not always come to light.

The criteria are very narrow. In many respects, a child should be put on a pump as soon as they are diagnosed—that should be done straight away, no question. What seems to be holding us back is not simply the cost of the machine, which is about the size of an iPhone, and which is permanently attached, giving the wearer a small dose of insulin throughout the day so that they can go off and do everything they want without having to worry about syringes, needles and all the rest of the paraphernalia. What is important, however, is that pumps have proper back-up from technical and medical staff who understand them, and that is where there is a big gap. The all-party group on diabetes came across the case of a child on a pump who lives in Portsmouth, but who is supported by a hospital in Leeds.

[Claire Perry (Devizes) (Con)]

I apologise for missing the start of the debate, which is particularly topical, given that my hon. Friend the Member for Salisbury (John Glen) and I had a meeting with the JDRF this morning and discussed the very point that the hon. Member for Torbay (Mr Sanders) raises. I was struck by a number of points, which I hope that he will agree with. One is that the importance of what he has just said about managing the disease in a far more cost-effective and efficient way cannot be overstated, and we can have remote monitoring of blood sugar and dosage levels with a pump. The most shocking thing that I have heard is that although our wonderful scientists in Cambridge are developing an artificial pancreas, which is an amazing breakthrough that will mean a mechanical solution to type 1 diabetes, UK citizens will not be able to avail themselves of the technology. Pump usage is only at about 4%, including among the young group that we are discussing, but levels of pump take-up in the US and other areas are as high as 40%. It is absolutely self-evident from the point of view of cost-effectiveness and long-term treatment that the adoption of pumps should be a high priority—

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a great pleasure to serve under your chairmanship, Mrs Riordan, for the first time, or certainly the first time in my experience. I congratulate my right hon. Friend the Member for Knowsley (Mr Howarth) on securing the debate.

We have heard a number of telling statistics about diabetes. As has been said, of the young people and children who have diabetes in the UK, about 98.6%—a very large proportion—have type 1 diabetes. It is estimated—and it is a pity that we have to talk of estimates, and do not really know the true figures—that type 1 diabetes affects more than 25,000 children and young people. As we have heard—there are some very useful definitions—it is a chronic condition, which can be life-threatening, and which occurs when the body’s immune system attacks insulin production cells in the pancreas. It is usually diagnosed in childhood, but as with most other conditions children are often kept waiting for a diagnosis. People must live with and manage the condition for the rest of their lives. Even when it is managed through regular injections, type 1 diabetes can bring long-term complications, such as heart disease, stroke or blindness, as my right hon. Friend the Member for Knowsley mentioned.

[Claire Perry]

On that point, a shocking statistic that I was told this morning is that the management of the disease is so sub-optimal that it is estimated that more than 80% of relevant children have blood sugar levels that are too high, despite the best efforts of their parents, the community, hospitals and support groups. That has enormous long-term health and economic consequences. Surely better management of the disease at an early stage would save the children, the family and the taxpayer enormously in the long run.

[Barbara Keeley]

Indeed, and we heard earlier that the incidence of type 1 diabetes is increasing by about 4% each year. The biggest increase is in children under five. A fivefold increase in the past 20 years, as my right hon. Friend the Member for Don Valley (Caroline Flint) said earlier, is a matter of great concern. It is important that more attention be paid to helping GPs, pharmacists, other health practitioners and teachers to identify type 1 diabetes in children and young people. As with many long-term conditions, early identification is the key, because the later the diagnosis of diabetes, the greater the impact.

My right hon. Friend the Member for Knowsley asked the Minister in an Adjournment debate on diabetes last week to introduce protocols for GPs on dealing with certain symptoms. That would ensure that GPs were better equipped to diagnose diabetes. The Minister said then that he would consider the point and would have more to say on it during today’s debate. I hope that we shall hear his answer.

As we have heard, the Government’s NHS White Paper proposes to give GPs the power to commission services, instead of primary care trusts, which will be abolished. I have raised on a number of occasions recently the fact that there is great concern that many GPs do not have the depth of knowledge required to commission specialist services for conditions such as diabetes. GPs may not have the skills, experience or desire to assess whole-population health care needs, to manage the market, to negotiate contracts and to monitor performance. That is becoming a key point of concern, because GPs did not necessarily come into medicine to do those things. Indeed, I understand that the Royal College of General Practitioners is urging the Secretary of State for Health to put back his plans for GP commissioning. The college’s report on the Government’s consultation has unearthed “major concerns”. That is in line with the responses from medical charities such as Rethink and campaigns such as the Muscular Dystrophy Campaign, which also have concerns that GPs lack the skills and experience for commissioning across such a range of conditions.

There are also concerns that in taking on such a wide role, GPs’ primary role of making diagnoses and providing patients with all the information and support that they need could be affected. Some of the statistics are already becoming a cause for concern. Surveys by Diabetes UK have found that 20% of young people feel that they rarely, if at all, discuss their goals for their diabetes care during check-ups. Further, only 26% have attended a course to help them learn about managing their diabetes. The essence of managing a long-term condition is recognising that people must become expert patients. If they are young, their family members must become expert carers. Will the Minister outline what steps the Government will take to make sure that GPs are better equipped to diagnose conditions such as type 1 diabetes and to continue, and improve, their support for people with the condition?

There is a clear need for people with diabetes to be given better information about how to manage their condition. The hon. Member for Torbay (Mr Sanders), who chairs the all-party group on diabetes, has tabled early-day motion 72, which notes that 65% of the 2 million people in the UK with diabetes are not taking their medication as prescribed, because two out of three do not understand what those medications are for or how to take them. We have heard from my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) what it is like to land at home with a host of medications, without having a real idea of what to do with them.

Minor Injuries Services (Devizes)

Claire Perry Excerpts

Tuesday 13th July 2010 Westminster Hall

[Claire Perry (Devizes) (Con)]

I am grateful to you, Mr Streeter, for chairing the debate. I believe that your constituency is also devoid of minor injuries units, so you might pay particular attention to the debate. I am also grateful to colleagues, including my hon. Friend the Member for North Swindon (Justin Tomlinson), for taking time out of their hectic schedules to attend. I am grateful to my hon. Friend the Member for Hexham (Guy Opperman), who, as many will know, worked selflessly on the judicial review that resulted from the shutdown of services at Savernake hospital. If I had a pound for every time I was told during my selection campaign, “If Guy Opperman was standing, you would not stand a chance,” I would be a very rich woman today. Thankfully, we have both made it to this place and can campaign together on this and other important topics.

I am also especially grateful to the Minister for attending, as I know that the launch of his team’s momentous proposals yesterday means that he must have an extremely long “to do” list. I would also like to mention briefly my local paper, the Gazette and Herald, which is a tireless campaigner against the loss of our local health services, as well as the hundreds of other individuals in the constituency who have protested, petitioned, written letters, held meetings and tried their best to roll back the tide of closure and service erosion.

I want to mention briefly the DASH2 group—Devizes Action to Save Our Hospital—and the new Devizes health matters forum, which was set up only this month to try to resolve the impasse we have reached. I will also mention the CASH group—Community Action for Savernake Hospital—which fought long and hard to keep open the day hospital and the minor injuries unit at Savernake hospital in Marlborough. That hospital was completely rebuilt in 2005 under a PFI contract that will cost taxpayers almost £70 million over 25 years, but the services at its core—the day hospital and the minor injuries unit—closed less than a year after it reopened. The hospital now hosts a multitude of services completely unrelated to local health care, such as the eating disorders clinic for patients of the Oxfordshire and Buckinghamshire mental health partnership, while Wiltshire primary care trust scrambles to pay its unitary charges.

For my constituency, which is the 25th largest in England by land area and home to more than 91,000 people, the past 13 years of NHS management has meant multiple top-down initiatives, a continual reshuffling of priorities and the management of local health services by quangos. The result is clear: a slow and steady erosion of our local health services, despite the protests of clinicians, patients and politicians. Let me refresh people’s memories of what we have lost. In the Devizes hospital, the UNICEF award-winning maternity unit, the in-patients’ facilities, the minor injuries services and now the X-ray department have all gone. In Marlborough, the day hospital, the maternity unit, the minor injuries facilities and now 50% of in-patient beds have also gone. That pattern has been replicated throughout the rest of Wiltshire as services have been farmed out to neighbourhood or community teams—they can deliver good outcomes in some cases, but not all—or concentrated in larger hospitals in Swindon, Bath and Salisbury.

In January 2007, Wiltshire PCT set out its vision for services in the now infamous document “Reforming community services in Wiltshire”, which announced the closure of minor injuries units in Devizes and Marlborough and the axing of a host of other services, which was driven in large part by the burgeoning financial deficit that the PCT had inherited after the merger of three other organisations. In my view, the loss of reliable local minor injuries services was the most keenly felt of all the changes. My constituents literally have nowhere to go locally if they suffer a fall, cut, wound or some type of minor trauma. Nurse practitioner-led minor injuries units had served the constituency well for years. They were well used, cost-effective in comparison with sending patients to far more high-spec accident and emergency departments, and extremely popular. Indeed, with the exception of the head of the PCT, I could find no one—literally not one person—who though that it was a good decision to close those minor injuries units and ask people to travel instead to Trowbridge, Chippenham, the Great Western hospital or a walk-in centre in Swindon, the Royal United hospital in Bath or Salisbury district hospital.

My constituency ranks among the 20 lowest by population density in England, with only 20 people per hectare. Members who have visited Devizes—I hope that many will—will know that there are almost no dual carriageways, no railway connections between our major towns and few direct bus services. As a result, there are extended journey times, which is particularly problematic for families or individuals without full-time access to private transport, who account for 25% of the people in Devizes.

[Justin Tomlinson (North Swindon) (Con)]

I thank my hon. Friend for giving way in this crucial debate that she has secured for Wiltshire residents. I want to highlight a concern that supports her specific point about public transport. When the Great Western hospital in Swindon was set up in my constituency, there was an emphasis on green travel, so there was a limit on parking provision. The residents of Devizes who are sent to Swindon almost invariable come by car, and there simply is not adequate parking provision.

[Claire Perry]

I thank my hon. Friend for that important point. We have built hospitals following the sound principle of encouraging local travel and walk-ins, but the major service review forgot that most bus services do not run to the existing services from the places where minor injuries services used to be provided. In fact, it is impossible to take a bus from Marlborough to any of the six suggested units for minor injuries services.

I was interested to learn what the current PCT guidance recommends, so last night I phoned NHS Direct and asked what I was to do if I had a bad cut and lived in Pewsey, which, as many will know, is in the centre of my constituency and, as home to around 4,000 people, one of the largest villages in the area. I was advised to go to Swindon hospital’s A and E unit, which is considered to be a journey of only 16 miles. However, as we know, the concept of “as the crow flies” does not give a good indication of distance in rural constituencies. In fact, a simple search on Google maps reveals that that journey takes between 38 and 46 minutes by private car, which is far too long for a mother of a child with a bleeding head wound, or the carer of an older person with a fracture that needs immediate attention.

Let us consider the journey that the residents of Honeystreet, a lovely village in the heart of my constituency, would be advised to take to get to the nearest service. By private car, it would take them 37 minutes to get to Chippenham hospital, or 40 minutes to Trowbridge hospital. In fact, there is only one other constituency with a lower population density and no minor injuries provision: South West Norfolk. Most of the other spread-out rural constituencies are blessed with more than one such unit. Indeed, they trumpet their facilities as being appropriate for populations in a rural area. North Devon has four units, Rutland and Melton has three, and the nearby constituency of The Cotswolds also has three units. Those constituencies all have population densities that are similar to or slightly lower than that of Devizes.

We might all be asking how the situation has arisen. I submit that it is because decisions about our local health care have been taken by decision makers who were unelected and unaccountable, and often uninterested in the local consequences of their actions. It was not because they were bad, malicious or unintelligent—there are many good and dedicated health care professionals in the PCT—but because the whole system rewarded top-down compliance with central Government diktat and ignored the needs and wishes of the population. Indeed, when I went to see the head of Wiltshire PCT only last week about the proposals in the White Paper that we have heard about, he said that he had no intention of reopening the minor injuries units that we have lost and that there was no case for doing so. I would like the Minister’s opinion of whether a case can be made for those services.

I would like to cite four facts to frame the debate. The population in my constituency, as is the case across much of rural Britain, continues to grow. There is a population flow from the cities to the villages and hamlets of the UK. The population in my constituency has increased by 5% since the turn of the decade. Indeed, part of the support for the redevelopment of Savernake hospital resulted from the prediction of 20% population growth in the Swindon area.

The Alberti report “Emergency Access”, which was published by the NHS in 2006, suggested that it was better clinically and more cost-effective to send patients out of A and E departments and into local urgent care centres where more nurses, paramedics and nurse-led emergency care practitioners could be used to treat them. I am grateful to the PCT for providing data showing that, in the past year, there have been 17,086 attendances by patients registered in my constituency at the minor injuries units in Trowbridge and Chippenham, and the A and E departments in Salisbury and Bath. As I have already stated, the journeys that people have to take to access those facilities are unacceptable. The cost of providing the services at the current tariff is £1.352 million.

With our new localism agenda, and given the cost that the PCT is paying for minor injury services for my constituents, surely a business case could be made for restarting a minor injury service in the constituency, as long as the total cost was below the current tariff. Some doctors in Devizes and Marlborough have expressed an interest in restarting the service and having it delivered by nurse practitioners located in their practices. Premises are certainly available in which the service could be located, including the half-empty and shuttered Savernake hospital.

Will the Minister tell us how, in the light of our NHS reforms, we can move the process forward? The current PCT, which will be in existence for at least another two and a half years, has no interest in recommissioning the service, so can we go around it in the interim period and use sustainable communities legislation, for example, to get back those services that we so desperately need?

[Duncan Hames (Chippenham) (LD)]

I commend the hon. Lady on securing the debate. Some years ago, when the closures first happened, we petitioned Wiltshire county council’s health overview and scrutiny committee to intervene on our behalf. I will be grateful if the Minister indicates whether it had a role to play in standing up for the residents, constituents and patients who have written to the hon. Lady and me. Melksham in my constituency has lost its minor injury unit, and it was far closer to her constituents than the one in Chippenham.

[Claire Perry]

I thank the hon. Gentleman for that excellent point. It is interesting that a subtopic of the debate is the PCT’s failure to deliver a new primary care centre in Devizes, which was promised as part of the quid pro quo when the closure announcements were made. When I suggested last week that perhaps the time had come to rip up the original plans that seem to be stymieing progress, return to the drawing board and ask whether we can deliver a hospital in Devizes under the current constraints, I was referred back to the council’s overview and scrutiny committee, which clearly has an important role to play in defining the services that we need for our local community. Will the Minister say whether, instead of waiting until 2013, we can submit pilot proposals to the national commissioning body when it is up and running and start to make progress, for example by looking for voluntary sector partners to begin a pilot programme?

There are few things that unite all the people in my constituency, but the feeling that we have been short-changed by our PCT and the NHS over the past 13 years is almost universal. I am sure that we are all united in welcoming the exciting proposals that the Secretary of State announced yesterday, and I know that the ideas of equality, excellence and liberating the NHS, and the possibility of getting back some of our minor injury services, make my pulse beat a little faster.

--- Later in debate ---

[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.