Oral Answers to Questions

Tony Baldry Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Lansley]

The right hon. Lady will know that we have made progress in this country in reducing the amount of trans fats in foods. My personal view is that we should seek to eliminate them, rather than have them in foods and have them labelled. It is important that we have front-of-pack food labelling that identifies the extent to which there are saturated fats, and I am looking forward to making greater progress in getting a more consistent front-of-pack food labelling than we have achieved in the past.

[Tony Baldry (Banbury) (Con)]

T2. GPs and GP practice managers in my constituency are keen to get on with GP commissioning because they see that that can lead to better outcomes for local people but, unsurprisingly, they have a number of detailed questions as to how GP commissioning will work. Who will best answer those questions, and when will that happen?

Supporting Carers

Tony Baldry Excerpts

Thursday 1st July 2010 Westminster Hall

[Tony Baldry (Banbury) (Con)]

I am grateful to you, Mr Benton, for giving me the opportunity to contribute to the debate. With Baroness Pitkeathley in another place, I co-chair the all-party group on carers. We succeeded the hon. Member for Aberavon (Dr Francis), who during the last Parliament carried out that task alone and so brilliantly that it took two of us to succeed him. I pay tribute to his work—I am sure that he will continue to be a contributing member of the group—and many of those who have contributed to the debate have joined the all-party group because we want to be a strong collective voice in the House for carers.

The Minister is in a privileged position because the hon. Gentleman, the Minister and I were made parliamentary champions for carers during carers week earlier this year. It is rare to move from being a parliamentary champion to being a ministerial champion for carers within a few days. We will see how my hon. Friend delivers in his new and challenging task on behalf of carers. It is rare in Whitehall for a Minister to walk into a Department understanding part of the brief that he has been asked to cover.

[Mr Iain Wright]

That is dangerous.

[Tony Baldry]

The hon. Gentleman may say that, but I think that it provides a phenomenal opportunity for my hon. Friend to stride out and seize the agenda. I will try to keep my comments short. During carers week, I made a long speech which, for hon. Members and others who are new to Hansard and who may wish to read it, is on my website at tonybaldry.co.uk/campaigns/carers. We are all in the new technological world, and I do not want anyone to believe that only the new intake is up to date with the internet. Some of us who have been around for a bit can keep up with the new global technology.

I want to make various points to my hon. Friend the Minister. I am glad that we frequently have debates on carers, largely as a consequence of carers week and the previous Prime Minister’s intervention. Last year, we had a topical debate, and I am glad that we are having a full afternoon’s debate in Westminster Hall. One of the first issues is identifying carers. Many carers do not recognise themselves as carers, so they are not recognised in the system as carers. It would help them enormously if social services and the health service recognised and encouraged people to recognise themselves as carers. We would then have a much more accurate picture of the number of carers in the community.

GPs may have thought—I defer to my hon. Friend the Member for Totnes (Dr Wollaston) on this—that it would not be beneficial to identify carers because they could do little for them. The ability to recommend respite care for carers may have prompted GPs to ask themselves, “Is this person a carer; is there something I can do to help them and to support them through respite care?”

We are about to move to GP commissioning for services. I will try to ensure on my patch that I identify which partner in every GP practice in my constituency has the lead responsibility for carers. One objective of organisations such as the Princess Royal Trust for Carers and Carers UK is for them and us collectively to encourage GPs to engage with carers and to recognise and note those GP practices that are particularly helpful in supporting carers. With the best will in the world, the picture is patchy. Some practices work hard to support carers, but others, which may not be insensitive, have not taken such support fully on board in their list of priorities.

We must all recognise that the number of carers will inevitably increase with an ageing population. There is something else, which I fully appreciated only recently during carers week. At a reception in the Jubilee Room, I listened and talked to a number of carers who were looking after relatives with Parkinson’s disease. My mother was a theatre sister during the blitz in Coventry, and people either survived or died. People from earlier generations went into hospital for one acute incident from which they either recovered or died. Generally, the Greco-Roman medicine of western Europe works on the basis that people are given drugs or medicine and they get better.

The truth, however, is that an increasing number of people in our society have to care for people whom they love very much, but who are progressively getting worse and know that they will never get better. There are people who have Parkinson’s disease, dementia or Alzheimer’s disease, and in addition to the financial and other challenges that carers face, the psychological drain of knowing that, however much someone is loved and cared for, they simply are not going to get better but will progressively get worse must be enormous.

The number of people who have to care for people with age-related dementia and Alzheimer’s is increasing. When I was first elected nearly 30 years ago, each Christmas I would go round every nursing home in my constituency. Most of the residents were frail widows in their 70s who were perfectly spritely and intellectually sound. I have now given up going around nursing homes on my patch at Christmas, because almost everyone is suffering from some form of age-related dementia and they have absolutely no idea who I am at all. There is that standard joke where an MP goes in and says to a resident, “Do you know who I am?”, and they say, “No dear, but if you go and ask matron she may be able to help you.”

The pressure on staff is enormous, and if someone is old and frail, their chances of getting into a residential care home are increasingly less, so people have to be looked after at home by carers. Furthermore, the number of people who have early, pre-senile dementia and are waiting for places to get into a nursing home is increasing, and those people have to be looked after by carers. Therefore, the number of carers in our communities will increase substantially over time, and we must ensure that any carers strategy takes account of that.

We must ensure that new policy initiatives, such as GP commissioning, help carers and do not work against them. There are also other initiatives. For example, local authorities are, quite rightly, being enjoined to ensure that they get value for money in all services, including carer services.

In Oxfordshire, as in the constituencies of other hon. Members I am sure, carer services are going to be tendered. However, in Oxfordshire, we already have three good carers centres that are manned—or womaned—by volunteers. There is the Princess Royal Trust for Carers and other carers centres that have grown up over a period of time. The North and West Carers Centre in Banbury won the Queen’s award for unsung volunteers. Those people are not going to go away; they are committed to supporting carers.

However, there is a risk of an inevitable momentum, and that the county council social services department might feel that it has an obligation under some EU or Government directive to put services out to tender. It might feel obliged to contract out carers services to some completely different provider in some other part of the country. That does not seem to go with the grain of what I understand when I hear colleagues from all sides of the coalition talk about the big society. If the big society—as opposed to the big state—means something, it means building on the work of those volunteers and on the community spirit within one’s own community. It means building on civic pride and local roots, not undermining those things. I hope that ministerial colleagues in the Department of Health and other Departments will understand that although we should ensure that every Department gets value for money, that should not undermine the volunteers who have the competencies that are needed.

That brings me on to how we train carers, and I make this point simply so that my hon. Friend the Minister can respond to it should he wish. There has been some concern about the Department’s contract with Caring with Confidence, which is an organisation that has trained carers at carers centres. The Department has felt it appropriate to cancel that contract, possibly because it felt that sufficient carers were not being trained. However, there is an issue about how one ensures that carers and people who, often late in life, find themselves as carers can acquire the skills and competencies that will help them.

I make my final point so that we can have some clarity on this issue, either now or at some stage in the future when the carers strategy is published. Hon. Members from all parties have drawn attention to the carer’s allowance. At present, the only assistance that a working carer receives is the carer’s allowance, but those who are retired—many carers are above retirement age—get no further recognition in the system because Treasury rules state that people cannot claim two benefits. That is not new; it is a long-standing rule. If someone draws a state retirement pension, they can draw only that and cannot get anything more for being a carer.

During the previous Parliament, a couple of Select Committee reports were published on this subject, and that work should not be lost. The new Government must respond to those reports, and either make it clear that they cannot afford any further financial support for carers, or give some indication that they may be willing to consider recalibrating the benefit and financial system in support of carers.

In 2008, the Work and Pensions Committee recommended an overhaul of the benefits system. A report entitled, “Valuing and supporting carers”, which was the fourth report of the 2007-08 Session, recommended a new two-tier support system with a carer support allowance paid at the same rate as jobseeker’s allowance and a caring cost payment that would be available to all carers in intensive caring roles, similar to child benefit and set at between £25 and £50. That element would be available to some carers who were unable to claim the first element, including those carers in receipt of a state pension. The Committee also recommended that the Department for Work and Pensions commission an urgent examination into introducing a taper to the carer’s allowance earnings limit and lifting the 21-hour study rule.

Like so many Select Committee reports in the last Parliament, that report got lost in a review—I do not wish to criticise; it is just a fact, a process. The then Government said that they were introducing the carers strategy and would take the report on board and think about it, but I cannot recall anything coming out at the other end on what they thought about the Committee’s recommendations.

Last year, the Public Accounts Committee published a report on “Supporting Carers to Care”, which criticised the confusing and complex processes and poor communication involved in the support that carers received from the Department for Work and Pensions, including benefits and employment support—that point was made tellingly in a good contribution by my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard). The Committee found that one fifth of carers who received benefits struggled with the application process, which is not surprising if no one helps them to fill in the forms. It found that the complexity of the system discouraged applications, and that Jobcentre Plus advisers were not given enough incentive to help carers to find part-time work. I am not sure that we ever had a response from the last Government to the Public Accounts Committee’s report.

It would be helpful if, early in the life of the present Government, we had an indication of how Ministers collectively see the opportunities for supporting carers financially. Of course, everyone recognises that that is set against a background of very difficult financial constraints and circumstances. That is a given. It should not be necessary, every time that one makes a speech now, to explain that we are the country with the largest amount of debt in the world, due to circumstances. However, it would be helpful, with a view to taking forward policy on carers, if we had an understanding of how the Government see the ability to give carers further support. I am referring to support that is valuable not only in financial terms, but because it makes carers feel that they are being recognised by the wider community for the work that they do and the role that they play.

My hon. Friend the Member for Totnes rightly raised the issue of young carers and my hon. Friend the Member for Blackpool North and Cleveleys raised the issue of young carers being bullied. I am always at a loss to understand why, in the 21st century, schools, the education system and all the people involved are not capable of being more supportive of young carers. That goes back to the point about identifying carers. Young carers deserve to be identified just as much as any other carer. One would hope that the education system and schools were capable of recognising young carers, that social services, GPs and others would try to ensure that schools knew who the young carers were and that schools would give young carers support. Often, they deserve double the support for the tasks that they are undertaking.

Many hon. Members, at different times in their lives as constituency MPs, come across families that include young carers and find out that the stress is incredible because they are often asked to take on adult responsibilities. Another difficulty is that the parent for whom they have taken on responsibility is sometimes able to look after themselves and be a parent, and sometimes is unable to look after themselves and is being cared for. For a child, having to cope with a parent who sometimes acts as a parent and an adult and sometimes is not capable of looking after themselves must be incredibly difficult, because they never know when they go home whether their mother will be poorly, drunk or whatever and whether they will be the carer or the child.

Schools and the system therefore need to give young carers particular support. I do not understand why every year when carers week comes round, we continue, a bit like groundhog day, to have the same debate about young carers. This area does not require huge amounts of extra money; it just requires the system and the community—society—to work out how we give younger carers greater support.

It is clear from the debate and I can tell the Minister that it is clear simply from the number of hon. Members who have joined the all-party carers group—I am sure that many more Members of both Houses have not yet got around to joining it but are equally interested—that there is considerable interest in and support for carers in Parliament. Those Members will be anxious and keen, in the course of the Parliament, to see what further work we can do in support of carers. Particularly for Government Members, if what my right hon. Friends in the coalition Government are saying about the big society and about engaging the community is to have any meaning at all, a very good test of that will be how we deliver enhanced and better lives for those who are caring in our society.

--- Later in debate ---

[Mr Burstow]

I am grateful to the hon. Lady for that point. I spent time earlier this week on the phone with all the carers organisations that have a direct interest in the matter. We are discussing actively with them the best way to reinvest the money to deliver good outcomes for carers. As and when that becomes clearer, I will certainly make further announcements to the House.

[Tony Baldry]

Will my hon. Friend tell us when the general issue of funding for carers will be addressed, and whether it will be addressed in the carers strategy?

[Mr Burstow]

I am looking at my notes on the points about benefits that the hon. Gentleman made and the precise time scales. Obviously, I am not the Minister responsible for the review of welfare benefits, which several hon. Members have mentioned, but it is clear that the timetable is quick and that reports back will be made during the spending review. Hon. Members who have representations to make about how we ensure that carers’ interests are served within those changes should therefore make them now. This debate is a good part of that process, and I will ensure that the matter is kept in the minds of Ministers and officials.

There will be tough decisions, one of which has been my decision about caring with confidence. We will need to ensure that every penny we spend has an impact on the lives of carers, but we must make no false economies. One of the themes of this debate is that we must ensure that the investments that we make deliver good outcomes, and that when we must reduce public expenditure, we do not just shunt costs around the system. We understand that point.

I hold to the view that carers are an important thread that holds communities together. We need to do more to support them. Their value will grow as our society ages and people with disabilities live longer. We must ensure, both across parties and within the coalition, that the refreshed strategy delivers tangible results, rather than being just a statement of intent. It must be clear about delivering change for carers. That is this Government’s commitment, and I look forward to making the difference, along with colleagues, as we go forward.

Question put and agreed to.

Horton General Hospital

Tony Baldry Excerpts

Wednesday 16th June 2010 Commons Chamber

[Tony Baldry (Banbury) (Con)]

I am grateful to Mr Speaker for allowing this debate on the future of services at the Horton general hospital in Banbury. This continues to be one of the most important constituency campaigns in which I have been involved during my time as a Member of Parliament. I am pleased to see in their places my constituency neighbours and hon. Friends the Members for South Northamptonshire (Andrea Leadsom) and for Stratford-on-Avon (Nadhim Zahawi). Their presence in the Chamber makes the point that the Horton general hospital’s catchment area, which is home to some 190,000 people, reaches well into Northamptonshire and Warwickshire.

The Horton general hospital also provides services for a significant part of Oxfordshire, including a sizeable part of the constituency of my right hon. Friend the Prime Minister. I am also grateful for the support of my hon. Friends the Members for Henley (John Howell) and for Oxford West and Abingdon (Nicola Blackwood), who, as usual, show great Oxfordshire solidarity on such important issues.

I am also pleased to see the Minister of State, Department of Health, my hon. Friend the Member for Chelmsford (Mr Burns), at the Dispatch Box, as he has taken particular trouble to ensure that he is briefed to respond to what I will say in this evening’s debate.

On Monday, the board of the Oxford Radcliffe Hospitals NHS Trust met in public in Banbury. Its meeting had only one agenda item: the Horton general hospital, to agree a vision for the hospital and proposals for the enhancement of services at the Horton. The ORH Trust board agreed to implement proposals made by the Oxfordshire primary care trust that would ensure 24/7 consultant-delivered children’s services, a 24/7 special care baby unit and a significant enhancement of consultant-led maternity and obstetric services at the Horton and the employment of further consultant anaesthetists for the hospital—all of which will also enhance the robustness of the accident and emergency service.

The chair of the ORH Trust, Dame Fiona Caldicott, and the trust board’s paper made it very clear that

“The Oxford Radcliffe NHS Trust is committed to a positive and vibrant future for the Horton General Hospital”

and that they and the Oxfordshire PCT want to see a situation where

“the vast majority of care required by the people of Banbury and the neighbouring communities will be delivered from an innovative and modern local District General Hospital working closely with primary care and other health and social partners.”

They made it clear that

“the strategy of the Horton General Hospital must exploit the very real strengths of the Horton to develop innovative ways of providing care in order to address the present challenges within a very difficult financial environment”

and that

“the objective will be to advance the opportunity to use the Horton General Hospital as the basis of a newer model for providing care where there is greater integration between services provided in a hospital setting and community based services while maintaining the appropriate level of immediate/emergency service support needed by the population.”

A strategy is needed that exploits the strengths of “Banburyshire”, as there is a general recognition that the area served by the Horton benefits from some unique strengths that must be fully exploited. In its vision for the future of the Horton hospital, the Oxford Radcliffe Hospitals NHS Trust has noted that

“the Horton is in a similar position to many other small District General Hospitals across the country. It should be an objective of the strategy to articulate a vision that will position the Horton as a national exemplar of how the challenges faced by such hospitals can be addressed in a positive and effective manner.”

Of course, as has been recognised by everyone involved with the Horton general hospital in recent years, if it is to aspire to be a national exemplar, its services will need continuously to change if they are to continue to meet in a clinically and financially sustainable manner the evolving health needs of the populations of Oxfordshire, Northamptonshire, Warwickshire and the surrounding areas that the hospital serves.

All this is very welcome news. I have no desire in this debate to dwell on the past, but it is important to explain how far we have all travelled in a campaign that has lasted for some seven years.

It was in July 2003 that the Banbury Guardian reported on its front page:

“The children’s ward at Banbury’s Horton Hospital is under serious threat and could be reduced to a daytime-only service...staff on the ward were gathered together by bosses this week and warned that current pressures could spell the end of the 24-hour acute paediatric services the Horton has enjoyed for the past 27 years.

A senior children’s doctor said the end of children’s services could mean the demise of other Horton Departments.”

Without 24/7 consultant-covered children’s services, it would not longer have been possible for the hospital to have a special care baby unit. Without a special care baby unit it would effectively have been impossible to have had a consultant-led maternity service, and the maternity unit at the Horton would have become a midwife-led unit with a very large number of mothers, many of them in labour, being obliged to go to Oxford to deliver their babies, and there would have been a cumulative knock-on effect on the effectiveness of the accident and emergency unit. In short, if those proposals had gone ahead seven years ago, the Horton would have ceased to be a general hospital and simply become a somewhat random collection of medical services.

This is not the opportunity and time does not permit me to give a full account of the exemplary way in which local people rose up to confront this challenge. The “Keep the Horton General” campaign, ably led by local Labour Councillor George Parish, now chair of the Cherwell district council, ensured that soon the whole community was involved in a campaign to “Keep the Horton General”. In due course the then proposals for downgrading services at the Horton were referred to Oxfordshire county council health overview committee, which unanimously decided to refer the proposals to the then Secretary of State, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), with the recommendation that they be referred to the independent reconfiguration panel—the IRP.

The then Secretary of State did exactly that. The IRP took evidence and produced a report. The IRP’s report was very clear. It concluded that

“our main focus is always the patient.”

The report continued:

“The Horton General Hospital in Banbury must continue to serve the local community in North Oxfordshire and surrounding areas...we concluded that the local community’s access to services would be seriously compromised if the Trust proposals were implemented. Panel members were particularly concerned about the difficult and costly journeys that local people would need to make to Oxford and felt this might even prevent or delay some people from seeking medical advice or treatment. The Trust’s proposals are not in the best interests of patients, families and carers.”

The IRP went on to state that

“local patient choice and access must also be a priority and that there are other possible solutions to the Horton Hospital”.

Not surprisingly, the chair of the IRP, Dr. Peter Barrett, commented:

“During the course of this review we were left in no doubt that local people are passionate about the Horton Hospital. The hospital is well located for the population it serves, and the Trust’s dedicated staff will play a vital role in the future success of the organisation. All parties should now work together to redevelop the proposals in response to our recommendations”.

The IRP recommended that Oxfordshire primary care trust should develop a clear vision for children’s and maternity services and a clear strategy for hospital services within north Oxfordshire as a whole.

It should be put on the record that I have no doubt that among the factors that caused the IRP to come to such robust conclusions were the very clear and unequivocal views put forward by my right hon. Friend the Prime Minister when he, as the local Member of Parliament for Witney, but also at the time Leader of the Opposition, gave evidence to the IRP, along with myself and my hon. Friends’ predecessors, John Maples and Tim Boswell, both of whom I am delighted to see will shortly go to the other place, where I am sure they will continue to champion the interests of the Horton general hospital.

My right hon. Friend the Prime Minister made it very clear to the IRP that as far as he was concerned, the only things that mattered were the best interests and the health care of his constituents, a view supported without equivocation by the Horton’s other Members of Parliament.

It is right that I should report to the House that in the just over two years since March 2008 when the IRP published its recommendations, the leadership and staff of the Oxfordshire primary care trust and the Oxford Radcliffe Hospitals NHS Trust have worked tirelessly and in an exemplary manner, on a process that sought to involve the whole community in finding a solution that works. Too many people have been involved in the process—the PCT, the Banbury better healthcare programme, and the community partnership forum, ably chaired by Julia Cartwright—for me to be able to name and thank them individually, but they all know who they are and they deserve our thanks.

During the time that this work was going on, we had visits to the Horton hospital from my right hon. Friend the Prime Minister, and several visits to Banbury by my right hon. Friend the Secretary of State for Health. Indeed, I do not think there was a single Opposition health spokesperson in the last Parliament who at some point did not come and visit the Horton hospital. The last Labour Secretary of State for Health, the right hon. Member for Leigh (Andy Burnham), came and visited the staff and patients at the Horton and observed:

“I am very impressed. This is a much loved hospital which is crucially important to Banbury...there have been question marks over the hospital for too long and that will have had a destabilising effect on any hospital. I came to signal my commitment to the Horton. The time has come to take away the doubts. There comes a point where you have to take a decision”.

We were grateful for the visit of the previous Secretary of State and are grateful that decisions to support the Horton hospital have been taken. I am now concerned to look to the future. I want, so far as is humanly possible, to ensure that we will never again have to pursue a seven-year-long campaign to keep Horton general hospital.

I very much welcome my right hon. Friend the Secretary of State to the Department of Health, together with an impressive ministerial team. He is probably better prepared than any of his predecessors, and his knowledge of the NHS is as impressive in private meetings as it is in his public speeches. I suspect that people have seriously underestimated the scale of the ambition of the new Government in their health policies. Health professionals are swiftly starting to recognise that the Government’s proposed programme is intended fundamentally to change the health care system and has the intention of shifting power from the centre to patients and clinicians. The Secretary of State obviously has a clear vision of where he wants the NHS to get to over time.

There are several issues on which I would welcome the Minister’s thoughts. There is going to be commissioning by GPs with funding going directly to them for such commissioning. When the Secretary of State visited the Horton, he made it clear that he believed that GP commissioning would potentially be a great support to the Horton that would enable the many GPs in Oxfordshire, Warwickshire and Northamptonshire who refer their patients to the Horton to collectively commission services at the hospital and help to develop new services. We will want actively to engage with local GPs in support of the Horton.

What is the timetable for the transition to GP commissioning? What will then be the role for primary care trusts? The Horton has only one potential weakness—it is a smaller general hospital. The cost of underpinning the new consultant appointments at the Horton will effectively be about £2.5 million over tariff. That is an annual cost that will be shared between the PCT and Oxford Radcliffe Hospitals NHS Trust. It is the price of maintaining services in a smaller general hospital serving a significant catchment area, where the distances to the next general hospital are such as to justify extra investment in maintaining services at the Horton. But who in the new system will make the value judgments and have the funds to ensure the continuity of care at the Horton? I understand that in due course there will be an independent board to set standards in the NHS, allocate resources and oversee the system. Can my hon. Friend provide more details?

My next concern relates to consultant provision. The effect of the European working time directive is that there has been a need for more doctors. I think I am correct that the previous Government were the only Government in the European Union who decided to interpret the directive in such a way that training counted as work. A few days ago, the British Medical Association issued a response to the review of the impact of the working time directive on training, concluding that

“the review defines and calls for a consultant-delivered service. The BMA has long advocated a service organised in this way—it will assure a high quality of care for patients as and when they are in the greatest need.”

By developing consultant-delivered services at the Horton, we are in the vanguard of this trend, but the Government will of course need to ensure as time goes on that there are sufficient consultants to take up these places.

Medicine and medical training is one of the few disciplines where the numbers are almost entirely controlled by the state. I fully appreciate that medical manpower planning involves a whole number of difficulties in getting it right. However, all too often in the past, there has been a tendency to believe that if at any time we have insufficient doctors, we will always be able to busk it by recruiting doctors from overseas. For all sorts of reasons, that is now becoming much more difficult, and I think we all need to be confident that there will be sufficient training places today to ensure that there will be sufficient consultants tomorrow. Moreover, we should not in any way underestimate the changes in work practices that a consultant-delivered service will bring about. I would like to give particular thanks to Dr Janet Craze and the consultant paediatricians at the ORH Trust for the incredible work that they have done in devising consultants’ rotas that will enable there to be effective 24/7 consultant-delivered paediatric services at both John Radcliffe and the Horton.

I have two brief final points. First, Horton general hospital is not the only small general hospital in the country. Such hospitals exist because the geography is not convenient, and they usually have a particular purpose in serving a significant community. Will my hon. Friend the Minister support any initiative that would bring those smaller general hospitals together in an alliance to see how they can maximise their contribution to the NHS and, in particular, how they can become, as we hope that Horton will become, an exemplar of how best to integrate community primary and hospital services? Secondly, I very much hope that my hon. Friend, given his ministerial responsibility for hospital services, will find time to visit Horton general hospital. I know that such a visit would be much appreciated by staff and patients, by me and my hon. Friends, and by our constituents.

There can be no conclusion to this debate because much of the story of Horton general hospital is yet to be written. I am simply glad that by our collective endeavours, we have managed to “Keep the Horton General”. All the many thousands who have taken part in this campaign, in whatever way—by petitioning, writing letters, offering professional advice, or just being there—can take pride in what we have achieved. But let me be very clear: as far as I am concerned, the well-being and welfare of Horton general hospital will always be unfinished business.