Junior Doctors Contracts

Liam Fox Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

Let us be absolutely clear. The people who are responsible for the strike tomorrow are those who choose to do the BMA’s urging and withdraw emergency care for patients. That is where the responsibility lies.

Let me deal with the right hon. Gentleman’s point directly. There are a couple of trusts in the country that have been good at introducing seven-day standards in urgent and emergency care, but my judgment, and that of the Government, is that it would not be possible under the current contractual structures to roll that out across the whole NHS. Those trusts happen to have some of the NHS’s most outstanding leaders, and we need to learn from what they have done, but we also need to make it possible for those same things to happen at all hospitals, including the right hon. Gentleman’s own.

[Dr Liam Fox (North Somerset) (Con)]

Those of us who have served our time as junior doctors understand the hard work and very long hours that they do in a system that has had too few doctors since its inception. Many of us believe that there is no dispute about pay and conditions that justifies putting patients’ lives at risk.

There has been some confusion about what the Government have meant by a seven-day NHS. There has always been a seven-day emergency service, but it is too patchy across the country, which needs to be addressed. That is different, however, from a seven-day elective service, which simply cannot be achieved by doctors alone and requires bacteriologists, haematologists, and radiographers. Might my right hon. Friend get the Government’s case to be more clearly defined in future so that we know what we are trying to achieve? There is little difference between what the Government and doctors want, notwithstanding the fact that the BMA has behaved rather badly.

[Mr Hunt]

My right hon. Friend is right; the tragedy here is that what the Government want, which is to eliminate the weekend effect, whereby there are higher mortality rates for those admitted at weekends, is exactly what every doctor wants. We should be sitting around the table discussing how we can achieve a proper, consistent, seven-day service for urgent and emergency care. When it comes to elective provision, that is not part of our plans, although some trusts are operating elective care on a seven-day basis—that is their choice. We are trying to reduce the higher mortality rates for weekend admissions, and that will be at the heart of our vision for a true seven-day NHS.

Mental Health Taskforce

Liam Fox Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

I thank the hon. Lady for her questions, which give me an opportunity to say still more about what we are doing in relation to mental health and how far it has come since 2010. For instance, she could have pointed out that 1,400 more people a day have access to mental health treatment than had access to it in that year, simply as a matter of comparison between what was done then and what is done now. However, it is absolutely right to make the essential point that there is more to be done—a view that we share—and that is what the report did.

The timing of the report was not up to the Government. It is an independent report, commissioned by the NHS from an independent taskforce, and the timing and the content were decided by the taskforce. I had the occasional meeting with Paul Farmer about it. I made sure to speak to him to say, “This is absolutely your report. Forget the guff in the papers about who wants what in the report and all that; this is yours and it’s got to be yours”—and it is absolutely clear that it was. The decision to publish it was theirs. The Prime Minister was able to respond, which was great, and that emphasises again the importance given to this issue now, as compared with times past.

On the finance, the important thing to note is that the Prime Minister announced in January how the £600 million in the spending review, which is included in the NHS bottom line until 2021, would be spent. That included the new money for perinatal mental health, crisis care, psychiatric liaison in A&E and the crisis care community work. What was said by the Prime Minister in relation to the taskforce report represents new money that will be available for the NHS and mental health by 2021. That will be £1 billion extra by 2021, with the additional number of people to be treated that I outlined.

I spoke to the taskforce after the issuing of the report. I do not particularly want just to produce a response to the taskforce report; I said that I would prefer a series of rolling responses, as it were, so that when we have responded to a recommendation and when we are moving on and delivering on it, I would say so. That will come in a variety of different forms, but will be related to what the taskforce has done. That may well involve announcements to Parliament, whether by written ministerial statements or other means. I did not want one big bang of a response, as it were, because the Prime Minister has already said that we will accept the recommendations, as they go with the grain of what the Government were going to do anyway. I wanted to give an indication that the report will not just sit on a shelf gathering dust. By making constant reference to it when we do something—saying, “This is a response to what the taskforce said we should be doing towards 2021”—it can get the stamp of support and recognition, which is important.

On the hon. Lady’s claim that thousands have been let down, again I would gently remind her that this Government were the first Government to set waiting times for physical and mental health—a chance missed by the hon. Lady’s Government when they were in office and set physical health waiting time limits. It is this Government who have actually made the commitment of £10 billion extra to the NHS, a commitment never made by her or her party. It is very easy for people to talk about new things in mental health when they do not have a budget or an economic team producing anything of any credibility, but this Government have got the responsibilities and are doing the work.

We are absolutely agreed that the state of mental health services cries out for more to be done; we have said that, and that is what we are doing. The direction of travel and the physical delivery is happening on a day-by-day basis. We will do more; we will continue to work together to do more, and I welcome the hon. Lady and her team’s very regular pressure on me and my right hon. Friend the Secretary of State to continue to do more. We will meet that challenge—and we are meeting it in a way that no Government have ever met it before.

[Dr Liam Fox (North Somerset) (Con)]

I congratulate my right hon. Friend and the whole of the Government health team on their personal commitment to this issue. Does my right hon. Friend accept that those who suffer from mental ill health are often poor advocates of their own cause, and that it is very easy for money to be diverted into other areas of healthcare spending where others are able to shout louder for the money? Will he and his Front-Bench team consider whether it is possible to ring-fence the NHS budget for mental health care so that it does not become the Cinderella subject in the future that it has been too often in the past?

[Alistair Burt]

I thank my right hon. Friend for the question and his own personal interest and work in this area. He, like me, has come across this conundrum: we talk from the Dispatch Box about more money going into mental health and then we go to areas and they say, “Well, it’s not happening here.” That has been a genuine reality that we need to do something about. We are being more hands-on towards clinical commissioning groups and having a more transparent system of examining their finances. In addition, guidance from the NHS says that it expects the increase in finance to the NHS to go proportionately to mental health services and we have now given specific commitments to the series of services announced by the Prime Minister and contained in these recommendations. In that way, we hope to make sure that the diversion of funds that has happened in the past will not happen in the future. Local areas will thus feel that they, too, must ensure that they have the share of the resource.

Mental Health

Liam Fox Excerpts

Wednesday 9th December 2015 Commons Chamber

[Dr Liam Fox (North Somerset) (Con)]

One of the ways in which we can measure how civilised a society we are is how well we deal with our most vulnerable citizens, and there are few groups more vulnerable in our society than those who suffer from mental illness, yet from when I began working in the health service as a doctor back in the early 1980s to right through my time as a Member of Parliament, mental health services have been the Cinderella subject in the national health service. Let us be very frank: we would never accept the level of care in cardiac disease, orthopaedic disease or cancer for our constituents that we are forced to accept in the treatment for mental illness.

There can be few areas where our advocacy role as Members of Parliament is more important than mental health, because the people involved are very often among the least able and least willing to stand up for themselves in the debate about how the NHS cake is going to be divided.

We have a role, also, in dealing with what the Secretary of State and the Opposition Front Bencher, the hon. Member for Liverpool, Wavertree (Luciana Berger), talked about as the last taboo. We do have to make societal changes and we can be instrumental in that, and I pay tribute, as the Secretary of State did, to our colleagues in this House who have used their often painful personal experiences to give colour to our debate and to take this issue forward. In all 23 years that I have been in the House of Commons, I cannot remember an attendance as high as that today for a mental health debate. That is indicative of how far we have come.

I very much welcome the Government changes both in terms of the funding they are proposing and the attitudes that have been fostered in recent years, not least, I have to say, during the coalition Government—it was one of the great achievements of that coalition Government that they put mental health much further up the agenda. I am particularly pleased at the announcement the Secretary of State has made about transparency on clinical commissioning group outcomes, because it is not the spending that we need to see, it is the outcomes. That is the crucial element, and I look forward to the details he will be bringing forward on that.

However many rights we give patients, it is the capacity-constraints that will ultimately determine what those outcomes are, and I want to deal with just two or three of them. The Government’s IAPT—improving access to psychological therapies—programme is a great programme. Getting access to talking therapies is, as the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) said, extremely important, and I was asked to do a short piece for the “Victoria Derbyshire” programme on the BBC in which we looked at the difference between the best and the worst in the provision of talking therapies.

It is unacceptable, in a national health service that is funded from the single basis of taxation, that in some parts of the country 100% of patients are seen within the Government’s target time, whereas at the other end of the scale, in East Cheshire, which is the worst area, only 4.6% of patients are seen within that time. We can accept something of a discrepancy between the best and the worst, but we cannot accept that level of discrepancy in a health service that is supposedly funded on an equal basis across the whole country.

As the hon. Member for Liverpool, Wavertree and others have said, experience suggests that when there is better access to talking therapies, doctors are less likely to prescribe medication, including antidepressants. That is an extremely positive development, because one thing that has worried me about the lack of capacity in mental health services is what I would describe as the medicalisation of unhappiness. Because medical professionals simply do not have the time to talk to patients about the causes of their symptoms, they deal with the symptoms themselves. That is not good medical practice.

The second area that I am concerned about is child and adolescent mental health services. In the 23 years that I have been in the House of Commons, Government after Government of both political persuasions have told us that those services will improve, but I have seen very little sign of it. That matters because about 70% of adult mental health problems will have presented by the age of 17. One would have thought that, knowing that, we would prioritise healthcare early on to minimise the damage that is caused by untreated illness, yet we are still not fulfilling our duty on that front.

The biggest problem we face is that of in-patient capacity. When we debated the closure of the old Victorian asylums, it was very personal for me because I worked in one of those old hospitals. It was genuinely a Dickensian nightmare. There was a great fashion, which was supported right across the House, to move towards care in the community. However, the consequence of not having adequate capacity in the community was that a lot of patients fell through the net. The point has already been made about the large population of those with mental illnesses in our criminal justice system. In effect, we closed one type of inappropriate institution and ended up with patients in a different type of inappropriate institution, and called it progress. That is simply not good enough and we need to do much more to prevent patients who are mentally ill from being incarcerated in our criminal justice system, when they should be treated appropriately for their illness.

We also see patients being put in police cells because there is inadequate capacity in in-patient care. How would we feel if women with breast cancer or diabetic patients were put in police cells because we could not find beds for them? It would be on the front page of every newspaper and lead every news bulletin in our country.

[Paula Sherriff (Dewsbury) (Lab)]

Will the right hon. Gentleman give way?

[Dr Fox]

No, I will not.

I would love the money that is being made available for mental health by the Treasury to be ring-fenced in CCGs. If that money is not ring-fenced, it will go elsewhere, for the very reasons I have set out. We need to ensure that the money that is rightly being made available for mental health treatment ends up there and is not siphoned off into areas where the voice for spending is stronger. I would love us to give more support to the wonderful mental health charities out there, such as Marjorie Wallace’s SANE and Mind. All those charities are hugely important.

In closing, I ask the Secretary of State to look at one thing: the incipient crisis of suicide among men in the United Kingdom—a subject that is not hugely talked about. The culture of our society often makes it difficult for men to admit that they are unable to deal with the stresses of life, anxiety and depression. The statistics relating to the worst manifestation of that—suicide—are deeply worrying. British men are three times as likely to die by suicide as British women. Suicide remains the most common cause of death in men under the age of 35. More than a quarter of the 24 to 34-year-old males who die take their own lives, compared with 13% among women. That is a huge national scandal and we need to give priority to it.

Success or failure in dealing with mental illness in the 21st century in the world’s fifth richest country is not just a judgment on the Government or the NHS, but on our society as a whole and on our basic humanity.

Community Hospitals

Liam Fox Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Dr Liam Fox (North Somerset) (Con)]

I add my congratulations to my hon. Friend the Member for Dover (Charlie Elphicke). Having visited his constituency, I know how important community hospitals are for the well-being of his constituents. His commitment is greatly appreciated. I also warmly welcome the Minister to his place. It is wonderful to have a Minister in a Department who has a genuine passion for his subject, and a level of expertise that will be hugely welcomed—no doubt that will be a great threat to the civil service.

Like my hon. Friend the Member for Totnes (Dr Wollaston), I have served on both sides—as a Member of Parliament with a local community hospital, and as a doctor working in community hospitals. Clevedon hospital has been at the heart of our community in North Somerset for many years. Like many of those who have spoken, we have a league of friends, which over many years has performed heroically raising community funding to support the hospital. Despite that, our hospital is still under threat. We had a perfectly sound plan for a replacement, which we approved and then dropped. It was the subject of an Adjournment debate in the House. I will not repeat what I said then. Our CCG is under pressure from legacy funding issues, and from a funding formula that does not properly reflect issues of rurality or take into account our demographic patterns. The Department needs to look at that but, none the less, we have very good services in our community hospital. We have recently improved and replaced ultrasound facilities, we have increased facilities for ambulatory care and we retained our in-patient beds. I agree with my hon. Friend that that is one of the most crucial issues.

In-patient beds in community hospitals are good for several reasons. They are good for patients. As my hon. Friend the Member for Maldon (Mr Whittingdale) said, one of the most important things is that families are close by. With increased centralisation of acute hospitals in cities and away from many communities, community hospital beds are valued for enabling people to get close. They can make frequent visits to their relatives, who often are elderly or disabled. We cannot put a price on that social element. Community beds also allow preparation time for patients with complex support needs. All too often, patients leave an acute hospital with nursing or social care needs, and there is not sufficient preparation time before their discharge. As my hon. Friend the Member for Totnes said, community hospital beds used on a step-down basis allow proper preparation time, so that that patient gets proper support.

In addition, I believe that community hospital beds are good health economics. There is too big a gap between our increasingly specialised acute services in hospitals and patients’ homes. Because acute beds are expensive, there is often pressure on hospital staff to discharge patients early. We have all come across far too many constituency cases in which patients have been discharged inappropriately early from an acute hospital. The trouble with that in terms of health economics is that it leads to rebound admissions. Patients are sent home too early and it is not possible to prepare appropriate care, or they cannot recover sufficiently, and they end up back in an acute hospital, blocking another acute bed. The system is less efficient than it would be if patient care were put at the centre.

The value of respite care beds has not been raised in the debate. Society depends hugely on carers, who are often the unsung heroes of the health care system. Respite care beds can be invaluable in giving carers a break, so that they can be strong enough to give the care they want to give. We have lost far too many respite care beds. In my constituency, we lost the planned Portishead cottage hospital, which meant fewer beds, and we lost a range of respite care beds at Orchard View. We were always promised that alternatives would be found, and they never materialised. We must understand that if we do not care for the carers and if they become unable voluntarily to carry out those functions, for which they should be given more thanks by the nation, it will cost the NHS a great deal of money.

The issue is not a party one, although I am rather surprised that not a single Labour Back Bencher seems to have a community hospital problem to talk about today. However, there is no doubt that people believe that community hospitals are good for them and their local identity. They are good value for money and good health economics and, above all, good for patients. My hon. Friend the Minister is new to his post, and I want to tell him that community hospitals are what the public undoubtedly want from health care. It is up to the Government to ensure that that is what the public get.

Health

Liam Fox Excerpts

Monday 9th June 2014 Commons Chamber

[Dr Liam Fox (North Somerset) (Con)]

Perhaps I may allow the House a slightly more bipartisan interlude by concentrating for the moment on a different part of the Gracious Speech, which is the part relating to our country’s national security. I was delighted to see in the Gracious Speech the Government’s commitment to the NATO alliance, which is underpinned by the hosting in Wales of the NATO summit later this year.

From 4 April 1949, when it came into being, NATO has become the major instrument of stability and security in Europe. It has taken in newly emerging democracies, such as Greece and Spain. It has been extended to countries formerly in the Warsaw pact, creating a far more safe and stable continent. It has embraced countries such as Norway in the far north and Turkey, giving us security in places where we perhaps have greatest strategic vulnerability.

However, as we approach the summit in Wales, we need to accept that there are big weaknesses inside our major military alliance. To an extent, the political and military roles that we clearly understood during the cold war have dissolved away, and western countries existing in peace and freedom have become fat on the prosperity and security that they have come to take for granted. Only four members of the NATO alliance currently meet the 2% of GDP floor of spending that they undertook to meet when they joined and, as a consequence, the European continent gives a lower priority to defence and is ever more addicted to welfare. As the Prime Minister and Chancellor Merkel have regularly pointed out, we have now reached a situation in which the European Union represents 7% of the global population, 25% of global GDP and 50% of global social spending. That picture is utterly unsustainable. It is a situation in which the pressures of defence have become great.

Of course, NATO has had recent success in the way it took charge of operations in Afghanistan, what it did in response to the invasion of Kuwait and, perhaps more successfully, what happened in the Balkans. However, not long ago the Libyan conflict showed us how many weaknesses the alliance has. We did not have enough of some key assets—such as intelligence, surveillance and reconnaissance, or air-to-air refuelling—to the extent that we would not have been able to carry out the Libyan campaign without the United States being on board. Such is the current weakness of European NATO.

We are confronted with a growing threat in the shape of Putin’s Russia, and we have stood by and watched serial bad behaviour from the Putin Government. They cut off gas to Ukraine, in breach of the NATO-Russia treaty, and we did nothing. We saw a cyber-attack on Estonia, and we did nothing. Russia invaded Georgia, parts of which it still occupies, and we did far too little. I am afraid that the signal the House sent after the debate on Syria only gave Putin the understanding that further aggression would not be rewarded with real resistance by the west, and I am afraid that the events we have seen in Ukraine are, at least partly, a result of how such decisions have been interpreted. We must be careful to ensure that our behaviour does not further reinforce that position.

We have allowed wishful thinking on Russia to replace critical analysis. We have all wanted to see Russia develop as an open, democratic, pluralistic system, but that is not going to happen, at least not under the current regime. The quicker we understand that, the better for the wider security picture. It is a bullying and thuggish regime that is not likely to change. Its modus operandi is clear: it pumps money into regimes or city states—wherever it can—to try to encourage them to be more Russia-friendly. It issues huge numbers of Russian passports to citizens in those places and then claims that it has to defend them.

The whole debate about the Ukrainian crisis misses one essential point: it is not to do with strategic or even tactical interests; it is a direct challenge to international law. Putin has said that the protection of ethnic Russians—not even Russian citizens—lies not with the states in which they live, or with the laws, constitutions or forms of government of such states, but with an external state, Russia, which can intervene to protect ethnic Russians wherever they may be. If we allow that to stand, there will be no international law, because it will sweep away every norm of international behaviour that has been accepted since world war two.

[Geraint Davies]

President Obama has made it clear that he is against Britain leaving the European Union or Scotland leaving the UK. What does the right hon. Gentleman think President Putin’s position would be on those issues?

[Dr Fox]

With all due respect to anybody outside our own borders, what the United Kingdom decides to do is a matter entirely for the United Kingdom, and what Scotland decides to do is a matter for Scotland. Nevertheless, since the hon. Gentleman asked me what I think about President Putin’s view on those issues, I will tell him what I think about Scotland. Any fragmentation would be not only a fragmentation of our country’s defences but a potential weakness inside NATO, and that is unlikely to help or give comfort to anyone other than those who are a potential threat to our national security. The hon. Gentleman raises an important point, in that events that take place inside the United Kingdom may well have resonances that are not naturally considered when decisions are being taken.

I want briefly to mention another area of national security of which the House must be very cognisant: the changing nature of the threats we face. We have gone from state threats in the cold war to the domestic terror threat we faced from the IRA, and we now face a transnational terrorist threat. That threat has come at a time when we have seen a huge growth in the internet, which allows a lot of the enemies of this country to hide. Back in 1995, when President Clinton was President of the United States, there were 130 websites in the world; at the end of 2012, there were 654 million. That is a lot of places for our enemies to hide.

Our security services need to be able to operate in the same environment as our enemies, and that to me was the essence of the great betrayal of Snowden. We depend on a moral and legal relationship between our employees and the Governments of our allied states to maintain our security, and there were three elements to what Snowden did. The first was his disclosure about the extent of National Security Agency surveillance. Had he done that inside the law it would have been a legitimate debate in a democracy, but to go further and set out the means by which our security forces carry out their business, or even potentially to set out the names of particular operatives, goes well beyond what is acceptable. In my view it goes from legitimate debate into the business of treason.

We do not have massively overwhelming security apparatus in this country. We spend 0.3% of Government spending on all our agencies put together, which is what we spend on the NHS every six days. We have good, strong oversight of our security services in this country that we should be proud of, but we must be clear when it comes to national security that peace and security are not the natural state of the world. Those things have to be fought for with every generation, and we have a responsibility to fund that appropriately. We can have neither such restricted freedom that we start to become what we claim to oppose, nor go off on a libertarian rant that takes us to a place that leaves us far less secure than we ought to be. If we get that balance right, we will be doing our duty in this House.

Clevedon Community Hospital

Liam Fox Excerpts

Wednesday 5th December 2012 Commons Chamber

[Dr Liam Fox (North Somerset) (Con)]

I am pleased to have the opportunity in this short debate to raise some of the issues related to Clevedon community hospital.

There has been a cottage hospital in Clevedon since 1874. The hospital has a fine tradition of providing care for more than 100,000 people living in Clevedon and the surrounding area. The current cottage hospital has 18 in-patient beds, along with limited X-ray, physiotherapy, musculoskeletal and minor injuries facilities. It also hosts a range of out-patient clinics. It is an invaluable service for the local community, especially for the many pensioners who live in my constituency, for whom travelling to Bristol or Weston-super-Mare could take more than an hour on the bus—when the buses come, that is.

The original Victorian building has been tweaked over the years, but it is bursting at the seams and there is open concern among locals and NHS professionals that the building would not confidently pass a Care Quality Commission inspection. Those concerns are not new, so plans have been developed over the past four years for the building of a new community hospital in Clevedon.

I pay tribute to the League of Friends of Clevedon cottage hospital for its unstinting efforts in support of the existing hospital over the past 50 years. Since 2005, it has spent £500,000 on building improvements and endoscopy, ultrasound and other facilities. For the past four years, it has supported the plans for a new hospital and has raised another £200,000 towards further improving health care provision in Clevedon. It is a shining example of the volunteer groups that make such a difference in our local communities, and we should applaud its extraordinary efforts.

Over the past four years, four business cases have been submitted for the building of a new community hospital. The third business case was submitted in 2011 and was given to the consultancy firm PricewaterhouseCoopers for external scrutiny. It confirmed that the plans were affordable within the existing budget and made a number of suggestions to improve a subsequent business case. Those were incorporated in the fourth and final business plan.

During the development of the plans, a preferred bidder for building the hospital was engaged under a private finance initiative arrangement. The plans developed by Amber Solutions for Care were also changed as a result of the consultancy process to bring the PFI annual rental charge down to £858,000 and, therefore, within the amount affordable to North Somerset primary care trust. So by March 2012, building plans had been tailored to be within affordability levels, and an independent consultancy firm had improved and endorsed the business case.

In March, the business case was considered by the cluster board of the Bristol, North Somerset and South Gloucestershire primary care trusts and was recommended to the South of England strategic health authority for its endorsement at a meeting in May. North Somerset PCT issued a press release on 28 March, confirming that plans for the new community hospital were “on track”, and that

“the business case was revised to take into account changes in the NHS locally and to ensure the long term viability of the Hospital. This work has now been completed and has been endorsed by the Cluster Board.”

It ended by saying that

“the projected opening of the new Community Hospital will be in early 2014.”

After years of development, campaigning and fundraising, the many stakeholders and supporters in my constituency were delighted by the news.

However, on 19 July, North Somerset PCT issued a new statement, saying that the business case had been reviewed and that the hospital was

“unaffordable given the economic circumstances”.

It is hard to see what new information came to light between March and July, so it is natural to conclude that either someone in North Somerset PCT got their numbers very wrong at the beginning, or that the U-turn was not actually based on affordability, but on priorities.

I ask the Minister to confirm exactly what new information came to light between March and July. It is scandalous that perfectly reasonable questions from the community and its Member of Parliament were almost completely ignored, and left unanswered. We were all understandably disappointed at such a quick—and seemingly unexplained—reversal.

Research has shown that the North Somerset PCT underspent in 2010-11 and 2011-12 by £1.6 million and £1.06 million respectively. Transfers of £1.8 million were also made from North Somerset PCT to South Gloucestershire PCT last year, and plans exist to make a similar transfer this year.

North Somerset PCT, in its operational plan for 2011-12, notes that, for that year, it was the lowest funded PCT nationally. Being the lowest funded PCT in the country and still underspending seems mightily unfair to my constituents when they perceive that money is being transferred to other, better funded but less frugal PCTs, seemingly to the detriment of capital projects in North Somerset.

The PCT has also expressed concern that financial shortfalls at the general hospital in Weston-super-Mare have forced a changing of priorities, which, again, is to the detriment of capital projects elsewhere in North Somerset. It appears that they are losing out, not on grounds of affordability but because priorities lie elsewhere. If others cannot function competently, that should be their problem, not ours.

Then there is the wasted money. The process of developing the plans, securing planning permission and fees for external consultants, and administering the tendering process has cost around £1.5 million. The same again has been spent on procuring the Millcross site in Clevedon for building the new hospital. The preferred bidder may also be in the process of trying to recover some of the costs it incurred while redesigning the hospital at the PCT’s behest. More than £3 million of taxpayers’ money and more than four years of administrative effort may have been wasted on a hospital that never gets built.

The people of Clevedon and North Somerset want a new hospital, and that is my main aim in the debate. Local reports are that endoscopy examinations have already been transferred out and the gynaecology unit is being transferred to Portishead, and rumour has it that the minor injuries unit is being transferred to the physiotherapy department, raising the question of the future location of the physiotherapists. I also understand that visits by consultants from Bristol are to be scaled back.

I also want to secure the Minister’s assurance that there are no plans for reducing the services currently provided at Clevedon cottage hospital, and that the move of endoscopy and gynaecology services are only temporary measures.

The handover from the North Somerset PCT to the North Somerset clinical commissioning group could be both an opportunity and a threat. I know the CCG has been involved in the decisions taken thus far, but it is important to know whether it has the same view on the need for a cottage or community hospital in Clevedon.

Let me be clear that my constituents are wedded not to any particular piece of ground but simply to the maintenance of community facilities. That is why we need reassurance from the Minister. We have watched plans for the proposed Portishead community hospital disappear, and we watched Orchard View, with its exceptional care facilities, disappear. We will not tolerate community facilities in Clevedon disappearing too. If the Millcross site cannot be built on and is subsequently sold, we must have assurances that the moneys raised from the sale will come back into our health authority, so that they can be reinvested in the Clevedon cottage hospital on its current site.

It is clear that there has been a managerial shambles, so the management should pay the price, not the people of Clevedon and the surrounding area. Responsibility, accountability and transparency are all we seek. Surely that is not too much to ask. This has been a long, costly and frustrating process that has damaged my constituents’ trust in their local PCT. Millions of pounds have been wasted. It is still unclear what changed between March and July. The old cottage hospital is in an ageing building that has previously been deemed not fit for purpose.

If the cottage hospital is to remain in service, it must be invested in so that its future is secure. At the very least, the proceeds from the disposal of Millcross must be reinvested in the current site. I seek an assurance that, if no new hospital is to be built, there will be no reduction in the services offered by Clevedon cottage hospital, and that endoscopy and gynaecology will be returned soon.

We need to know whether there is really no way that a new hospital can be built. The plans are made; the affordability study has been completed; a contractor is secured; planning permission has been received; and public support is firmly in favour. The League of Friends Of Clevedon Hospital has been outstanding in its support for both the old hospital and the development of a new one. Whatever the outcome of this administrative tangle, I hope it will not be deterred from maintaining its fantastic efforts.

We stand as one community to ensure that in the NHS we get fair treatment, a fair hearing and our fair share of the health care that is due to the people of Clevedon.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate my right hon. Friend the Member for North Somerset (Dr Fox) both on securing the debate and on his strong advocacy for Clevedon community hospital.

Members who represent more rural constituencies know the importance of high-quality community health care facilities, including community and cottage hospitals. They provide important close-to-home care for patients in more rural areas, particularly frail and elderly patients who have long distances to travel to receive health care.

We know the importance of such hospitals in meeting the long-term challenges of the NHS. We need to redesign services and deliver more services closer to home, and prevent inappropriate hospital admissions to big acute hospitals such as those in Bristol or Weston-super-Mare. That means ensuring that we have the right community resources properly to support local people, including those with long-term medical conditions such as asthma, diabetes and dementia. In particular, we need to ensure that we have community-based support for older people—the biggest group with long-term conditions.

We want to move the emphasis of care in this country away from acute crisis management, to which the NHS is accustomed, both to save the NHS money and to provide better care for people in their homes and communities. Community hospitals such as Clevedon are important in delivering such care. They provide invaluable beds for people with long-term conditions to give their carers respite, and important rehabilitation in a setting close to home, family and support networks for people who have broken hips, or who have had strokes or heart attacks. They provide the opportunity for step-up care for people who are not so unwell that they need to be admitted to an acute setting, but who can be better looked after temporarily in an environment that provides the additional care that people need. The Dr Foster report, which was published this week, highlights that 29% of patients did not necessarily need to be in acute hospital beds. If we are to meet the challenge of ensuring that people are better looked after and are not in hospital beds when they do not need to be, it is important that we invest properly in community resources, and Clevedon community hospital is just one of those resources.

I share with my right hon. Friend and the community he represents their frustration with the primary care trust, as I have Hartismere community hospital in my constituency. My predecessor, Lord Framlingham, had considerable struggles with the PCT about the potential closure of an important rural hospital. From what my right hon. Friend says, his constituents and local patients have been having considerable struggles and difficulties with the local PCT in Somerset.

I acknowledge the special role the League of Friends plays in the life of Clevedon community hospital, a point my right hon. Friend made in his speech. It has worked to raise a lot of money for the hospital and to ensure that it is retained as an important community health care resource. It is dismayed and disappointed, as are others in the local community, by the attitude of the PCT. I understand his disappointment, but under the PCT arrangements the provision of local NHS services remains with the local NHS. However, he is concerned that approximately £1.5 million or £1.6 million has been spent on project costs and other costs over a four-to-five-year period, in proposing to develop a new and sustainable community hospital facility in Cleveland. The money has been spent, but there is still no new facility. As physicians, we would rather the money had been spent on a new facility or on community care.

If it is any consolation to my right hon. Friend, I had a conversation with local health care representatives yesterday. They reassured me that even without the new facility at the allocated site, there are no concerns about any loss of services with the transfer from the PCT to the clinical commissioning group that will have responsibility for running community services. I hope it reassures my right hon. Friend to hear that when the new arrangements come into place in April next year services will remain as they are now.

On endoscopy services, as clinicians we know that strict evidence-based clinical standards must be achieved when delivering endoscopy services, which, for patient safety and to maintain high-quality patient care, have to be adhered to. There were concerns that facilities at Clevedon hospital were not able to maintain those high standards. For example, arrangements for the decontamination of endoscopy equipment would have to be substantially improved if the service was to achieve external accreditation by the national joint advisory group for endoscopy, and that would need to be achieved for the service to return to the hospital.

Despite my conversation yesterday with representatives from local health care commissioners, I am alarmed by what my right hon. Friend tells me about the business case to all intents and purposes being approved and then suddenly, between March and June, being disapproved—an extraordinary turn of events. It is inexcusable to raise the expectations of local patient groups, effectively giving a green light suggesting things were going ahead, and then to remove that expectation. I am happy to look into the matter further and to write to my right hon. Friend about it in more detail, because I am concerned about the issues he has raised. When something like £1.5 million has been spent on planning, and various plans and business cases have been brought forward, it is all the more concerning. It is not a satisfactory state of affairs, as far as the local management of NHS resources is concerned, and it is certainly not a satisfactory state of affairs, as far as local patients are concerned. I shall further investigate the matter and write to him on the basis of those investigations.

On future provision, I would like to reassure my right hon. Friend that, according to what local health care commissioners told me yesterday, the services currently provided at the hospital are safe and will still be provided. Even though plans do not appear to be in place, as they once were, to build a new hospital on a new site, it would be relatively easy, I understand, to maintain the buildings and the facilities on the current site in a state that would allow for the safe delivery of high-quality patient care and the ongoing provision of services for patients in the area. I understand that the older building can be improved, if required, to ensure that it can still deliver high-quality patient care.

With those reassurances, I will further investigate why the business case has gone from being approved to disapproved, as my right hon. Friend said. We have been reassured that the services currently provided at the hospital will continue to be provided for the foreseeable future.

[Dr Fox]

If we are to maintain clinical services on the original site, substantial investment will be required. I am sure that my hon. Friend will be sympathetic to our view. If a business case can be perfectly fine in March but dumped in July, if we, the poorest funded PCT, can give money to other less well-performing PCTs and given that the transfer is being put forward again this year, how can we have much confidence in the local management? Then, when our questions are not answered, as they continue not to be, we feel that there is not only insufficient competence but a lack of transparency. I am grateful for his reassurance that the matter will be looked into, but I would also like him to kick our local PCT in the proverbials to ensure we get the money required from the sale of the Millcross site or from additional investment, so that we can get the facilities that our taxpayers contribute towards but which seem to be getting siphoned off into other areas, whether because of a lack of adequate priorities or competence.

[Dr Poulter]

My right hon. Friend makes a good case. From what he has outlined, I fully agree that some of the circumstances surrounding the decision seem extraordinary and completely unacceptable. He described it as being far from competent, and I would not wish to disagree, judging from his analysis.

We are interested in delivering high-quality front-line patient care. The challenge for the NHS is delivering that care close to home and close to people’s communities. That is what Clevedon does and what it needs to continue to do. We need to ensure that PCTs, as they are at the moment, and clinical commissioning groups, as they will be in the future, invest in high-quality local health care services in order to meet the challenge of better looking after older people. That is the clear challenge that David Nicholson set for the NHS in 2009 in the quality, innovation, productivity and prevention challenge. It is about the need to redesign services in order to deliver better and more affordable care in the community.

That was also the challenge that Dr Foster outlined for the NHS earlier this week. It is about time that my right hon. Friend’s local health care commissioners acknowledged that challenge, invested in local health care services and made the argument for keeping investment locally, rather than, as he said, siphoning it off elsewhere. I will clarify the matter further by investigating with the PCT what has happened. From our discussions so far, I can reassure my right hon. Friend that the PCT and the clinical commissioning groups reassured me yesterday that they would, they thought, be able to find the investment to continue with the current older buildings, maintaining them as fit for purpose to continue with patient care, and that patient care will continue on the current site, as it does now, in April. Nevertheless, there are clearly questions for the local health care commissioners to answer.

Question put and agreed to.