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Princess Royal And Royal Shrewsbury Hospital Trusts

Volume 404: debated on Monday 28 April 2003

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Motion made, and Question proposed, That this House do now adjourn.— [Mr. Jim Murphy.]

9.42 pm

I am very grateful for the opportunity tonight to raise my concerns and those of my constituents about the proposal currently being considered by the Secretary of State for Health and his ministerial colleagues to merge the Princess Royal and the Royal Shrewsbury hospital trusts. The Princess Royal is, of course, the hospital that serves Telford, the Wrekin and the east of Shropshire. I am grateful too for the opportunity to raise the implications of that proposal for my constituents.

I also want to touch on the scope of the consultation that has recently been concluded and its quality—the way in which it has been conducted. In the course of my comments, I hope that the Minister will accept that I will be expressing the views of a great many of my constituents. I am sure that if my hon. Friend the Member for Telford (David Wright) is fortunate in catching your eye, Mr. Speaker, he will make similar points.

It goes without saying that hospitals are important places. They are not just places that provide health care but local landmarks that help communities define their identity. People feel very strongly about their hospitals and take pride in them.

Certainly when I was a councillor in the Millbank ward in Westminster some years ago, the Conservative Government's announcement of the closure of Westminster hospital was met with almost as much alarm, despair and anger as were many of the depredations visited on the electors by Shirley Porter and Barry Legg, and their colleagues in the administration of Westminster city council. People had been born in that hospital and had given birth to their own children there; it was part of the cultural fabric of this part of Westminster, and they felt its passing very bitterly. I do not need to remind the Minister of the passions aroused in Kidderminster, not far from Telford and the Wrekin, when the hospital there was perceived to be under threat.

Hospitals are important in many ways, particularly in new towns such as Telford, because at this stage of the town's development, there are not many landmarks to steer by. We have no league football club, although we are very proud of Telford United and we look forward eagerly to seeing Telford play derby matches against Shrewsbury Town next season. We have no theatre, although one is planned, and the sooner it is developed the better. There are many reasons to visit Telford, but its nightlife is not one of them.

The town puts me in mind of the famous comment that Rayner Banham made about Los Angeles in his seminal book on that city, in which he spoke of 50 suburbs in search of a city centre. Telford does not have 50 suburbs, but the comment is not entirely inappropriate. It is a town seeking its identity. The suburbs are not so much in search of a town centre as fleeing it since USS imposed car parking charges there.

The Princess Royal hospital is important to us because we fought for it hard. It was built in 1989 after a long struggle. Many people, particularly in the west of the county, fought against the hospital's development, and they have continued to campaign against it, explicitly or implicitly, ever since. The hospital's future is of immense actual and symbolic importance, and I am sure that the Minister recognises that. I know from his speeches in the House that he is proud of his constituency and the landmarks that define it and its community. He will therefore understand the points that I am making.

Does my hon. Friend agree that the history of Shropshire's health economy has been dominated by Shrewsbury? One of the concerns of many people in Telford was that it was so hard to get a hospital built there. Families who have lived there all their lives had, for many years, travelled miles down the motorway or the A road to use hospital services in Shrewsbury, and Telford's hospital was so fruitful because people no longer had to do that.

My hon. Friend makes an important point, and I shall elaborate on it later.

We should not forget in this very mobile age that many of our constituents do not have access to their own transport. That is particularly true in Telford, where there are pockets of deprivation, and people find it extremely difficult to travel to Shrewsbury for their health care. As my hon. Friend will know, the problem is particularly acute for the families and friends of mental health patients, many of whom come from difficult backgrounds where mobility is a problem. It is all the more important that those families should be able to provide support to their relatives in the Shelton hospital in the west of the county.

It is worth noting, too, the reluctance of consultants based at the Royal Shrewsbury hospital to travel down the motorway to Telford. I understand that people like to be based in one place, rather than two or three, but it has often been suggested to me that one reason why decision making in Shropshire's health economy has rested in Shrewsbury is the power of the consultants, not least because they are rather fond of nipping round the corner from the hospital to earn money from their private practice nearby. Mobility, transport and distance are very important issues for all those reasons.

With the Labour Government committed to the national health service, there have been many significant improvements in the east of the county from which both hospitals have benefited. Shropshire health authority's budget doubled between 1997 and 2001—and that does not take account of the most recent comprehensive spending review and the exponential increase in funding that will take place in the next three years. The numbers of consultants and doctors are up, we have more nurses and treatments, and our waiting lists are down. We should celebrate all of that, but in a climate of expansion of, and investment in, the health service I do not want to talk any more about the survival of the Princess Royal hospital. Too often, that is the issue for many of my constituents who, like me, want to talk about growth, development and expansion.

That development is certainly justified by the growth of Telford and the Wrekin. Telford is the growth point for the west midlands. Between 1991 and 2001, its population grew by 16,000—a 12 per cent. increase— and the town is one of the fastest 20 growth points in England. Development is also justified according to the indices of clinical need in our part of the county. We have one of the poorest health profiles in the west midlands. Sixty per cent. of the population of Telford and the Wrekin live in the top 25 per cent. of the most deprived wards in the country, compared with a national average of 35 per cent. Forty per cent. of children in Telford and Wrekin live in families claiming some form of benefit, against a national average of 27 per cent., so there is a significantly greater proportion of such children in our neighbourhood. Half the wards in Telford and Wrekin are in the top 25 per cent. of wards with the poorest health and disability profile. A third of them are in the top 25 per cent. of wards with the poorest housing.

In more clinical terms, we have above average fertility, with the highest levels in the most deprived wards. Life expectancy for both men and women is lower than the national average, and premature death from heart disease is significantly above the national average, as, indeed, is premature death from cancer.

My hon. Friend is outlining in detail issues of deprivation in Telford and the Wrekin. One reason why primary care trusts were established was to look at the health care needs of people in the area. Does he agree that we should bed the primary care trust in before we proceed to examine a merger of our major general hospitals?

My hon. Friend is right. We owe a debt of gratitude to the Minister, to whom we made representations last year. We were concerned about the unseemly haste of the consultation on the merger, which was launched just a fortnight before Shropshire health authority passed into history and the two PCTs—Telford and Wrekin PCT and Shropshire county PCT—came into existence. It seemed to us and, evidently, the Minister, who deferred the start of the consultation, that that was prejudging the issue and putting the cart before the horse, hardly allowing the two most important organisations in our health economy to get their feet under the desk before considering an important development in the structure of health care delivery in Shropshire.

If the merger was going to help focus investment in Telford and the Wrekin and help the Princess Royal hospital address the growing needs to which I have just referred, I would not hesitate to support it. Indeed, I support the idea of merger in principle. In principle, I believe in a truly national NHS where there are no market mechanisms or false demarcation lines between one area of delivery and another.

Of course I would support the principle of merger, if I could be convinced that it would meet the needs of my constituents, cut bureaucracy costs and transfer money to the frontline of health care. However, I have grave misgivings about the practical details of what we are being asked to consider. I know that they are shared by my hon. Friend the Member for Telford. Before his time, they were certainly shared by his predecessor, Bruce Grocott. Yet the proposals for merger are silent on the issues that are of the greatest importance to us. It is because of that silence that we have serious concerns.

Those concerns are based on bitter experience. For years, Shropshire health authority promised us a reconfiguration of acute services. It recognised, as we did, that our constituents in the east of the county were under-resourced and under-provided for. It was recognised that there needed to be a rebalancing of health care provision. However, every year, in spite of the pledges and commitments made by the health authority, and in the face generally of opposition from Shrewsbury and the west of the county, the health authority failed to deliver and, indeed, failed my constituents.

We are now being asked to accept that a merger will put an end to what has too often been unseemly and bitter rivalry between the west of the county and the east, between the Royal Shrewsbury and the Princess Royal hospitals. Many of my constituents see merger less as a warm embrace than as a more subtle form of strangulation. They do not see the merger as a partnership between equals. Instead, they see it as a takeover. They regard it as the absorption of a smaller hospital by a larger hospital; the creation of a satellite that can be extinguished at will. At best, the merger, in my view, in the absence of a development plan for the Princess Royal hospital. will lock in the imbalances in resourcing and provision to which I have referred for the next generation at least.

Despite Telford's growing needs and despite the fact that the Princess Royal hospital has a larger catchment area than the Royal Shrewsbury, the Royal Shrewsbury has almost twice the budget of the PRH. It has three times the number of consultants. It has well over 500 beds compared with the PRH, which has fewer than 400. It has about 1,200 nurses compared with the 800 of the PRH. Critically, it has 12 countywide specialisms compared with the two that are based at the PRH. Every attempt over the years to rebalance that imbalance has failed.

There was a vigorous campaign in recent years to locate maternity services at the PRH. Every demographic and clinical index set out the argument that maternity services should be based at the PRH. However, that campaign failed. More recently, with the closure of Copthorne South at the Royal Shrewsbury, for sensible reasons—the buildings were falling down—there was a tremendous opportunity to relocate some of the services to the PRH, where there is ample room for development. That opportunity was missed.

It is not only in the acute sector that imbalance exists. It exists also in the mental health sector. A promise was made by the Shropshire health authority to develop acute beds on the site of the Princess Royal. That commitment was reneged upon. There is a need to redevelop the Shelton, which is one of the last Victorian asylums to be closed. The smart money is not on getting our provision in the east of the county. It is on redevelopment over in the west.

When primary care groups were established in 1999, Shrewsbury and Atcham had 3.5 per cent. above its fair share target while Telford and Wrekin had 6 per cent. below its target. Even now, with a generous settlement on the Telford and Wrekin primary care trust of a 34 per cent. increase in funding over the next three years, we still face an annual shortfall of £12 million a year.

The issue is equity. I am sure I speak for my hon. Friend the Member for Telford when I say that we do not wish to disadvantage anyone in the west of the county, but we want to improve access to health care for our constituents in the east. The merger should have offered us a once in a generation opportunity to redress the balance, redistribute specialties, address local health needs, and to develop the Princess Royal—

It being Ten o'clock, the motion for the Adjournment of the House lapsed, without question put.

Motion made, and Question proposed, That this House do now adjourn.— [Gillian Merron.]

—and to develop the Princess Royal hospital and its ability to attract top consultants. But that has not happened. The merger has not even attempted to do that. It has been made clear to me, for example by David Nicholson, the regional director of the Department of Health in a letter, that the proposal is to merge two organisations managerially, and because of that, that the proposal cannot address issues of provision of services. The question that I would ask, and which my hon. Friend asked earlier, is how we can make decisions on one without regard to the other.

The consultation has been flawed from the outset. As we discussed earlier, it was initially launched just a fortnight before the PCTs' establishment, which fuelled suspicions of a fait accompli. Those have not yet evaporated. I am grateful for the Minister's intervention then. He will not be surprised that I am not so grateful for his subsequent decision not to intervene to ensure a proper integration between the consultation that has taken place on merger and the development of local delivery plans by the PCTs. Decisions about structures seem to have been afforded greater priority than decisions about the delivery of health care.

The consultation that we recently experienced was a shambles. It was inadequate and misleading. Material was poorly circulated. The consultation was poorly publicised. At public meetings, the staff representing the NHS often outnumbered the public. The presentation of a fait accompli often interfered with people's preparedness to contribute to the public consultation.

Telford and Wrekin council's health and care scrutiny commission has done a good job of assessing the consultation and the issues that have arisen. Its report states that it does not believe that
"members of the public and hospital employees have had an adequate opportunity to consider and respond to merger issues. It is concerned that the proposed merger has been presented as a fait accompli. It is unhappy that possible configurations involving the Robert Jones and Agnes Hunt Orthopaedic Hospital have been excluded. It is far from persuaded that a major structural merger can be contemplated without attending in more detail to related service implications."
The report goes on to state that staff at the PRH

"said they had not even seen a copy of the full consultation document."
With regard to GPs in the Telford and Wrekin area, the report says that

"they felt unable to form a view on the merger owing to their lack of information on the subject."
That was a problem shared by the voluntary sector. The document goes on to state:

"The Shropshire Council for Voluntary Services (CVS) considered that they had not received enough information about the proposed merger during this consultation process."
Even the Shropshire and Staffordshire strategic health authority expressed serious concern. It stated that

"the recently-established SHA would have preferred public merger consultation to have been postponed until at least later this year. It was stressed the 'historical and political tensions' need to be overcome if a single acute hospital trust is to work effectively."
The scrutiny commission concluded:

"The Commission felt that the consultation failed to engage the public due to the very narrow terms of reference prescribed. The public were unable to debate the areas of most concern to them, i.e. service configuration and in the view of the Commission this meant the consultation was seriously flawed."
Those serious views expressed by the commission were borne out by the views expressed to me. A consultant at the PRH, Bruce Summers, wrote to me to say:

"I am by no means convinced that a merger will be in the best interests of patients who currently look upon the Princess Royal as their local hospital. My experiences over the last 13 years are such that I do not have any faith in a combined Trust Board and combined management to provide equity of healthcare for all patients in Shropshire."
Another consultant, Peter May, wrote to say:

"Only a minority of the Telford medical staff are in favour…In truth professional staff have been tired by the endless wrangling. There seems to have been an unstoppable pressure from above",
and adds in parenthesis that it is

"the same pressure that merged Redditch and Worcester, closing Kidderminster".
He went on to say:

"Telford fears that its hospital will be downgraded after merger."
The nursing union and other unions at the PRH said:

"We have now consulted with our members but there appears to be an air of apathy and expectance that the merger will go ahead regardless of our views and concerns."
Certainly from the soundings that I took among staff at the PRH, the overwhelming view was against merger and there was deep concern that their views were not being heard.

The same is true of GPs in my constituency. Graham Thompson, a local doctor, wrote to me to say:

"We feel that the share out is too lopsided in favour of Shrewsbury when in fact most clinical need is in the East of the County."
Even the Telford and Wrekin PCT, which in the end voted for the merger, wrote to me in the following terms:

"That decision will not be made with enthusiasm; the PCT remains as concerned to avoid any drift of services or 'centre of gravity' to the Shrewsbury site as I know you are yourself."
That is hardly a ringing endorsement. That view is held not just by those in the medical community, but by people outside as well.

I received a letter from Lilleshall and Donnington parish council, which suspects that

"funding will be diverted from the Princess Royal Hospital, to aid Shrewsbury, thus devaluing"
the hospital's

"ability to serve Telford and its surrounding areas."
Similarly, Wrockwardine Wood and Trench parish council in the constituency of my hon. Friend the Member for Telford wrote to me to, say:

"we are now in danger of having"
our hospital

"taken away from the area. We need more services in Telford and Wrekin, not less."
Again, those are hardly ringing endorsements for the merger proposal.

Does my hon. Friend agree that the process could have been positive had a development plan been in place for the Princess Royal hospital? Significant development land is available at the hospital and the way in which it is designed means that services can be added on to existing wings. We can still make the process positive, but we must have a development plan.

My hon. Friend is right. There is a lot of land at the PRH and it has a huge potential. There is also a great deal of commitment in the local community. Staff at the PRH are anxious that they are not being allowed to fulfil their potential in serving their community. The hospital has difficulties in securing and retaining staff, especially consultants, because it has relatively little to offer. That in turn feeds our constituents' anxieties because they think that in the absence of specialisms and a development plan, the future of their hospital is in doubt. The merger proposal makes it difficult to dissuade them from that point of view. Many regard the proposal as the thin end of the wedge because it omits to discuss the future of the hospital and does not set out a development plan. That is why we are worried that a merger before a redistribution of services in the county will lock in the imbalance to which I referred. That is one reason why I believe that I would betray my constituents and their interests if I supported it.

One further issue only came to light in recent days. In the past we have been reassured that even if Shropshire health authority let us down and the merger proposal was not accompanied by a development plan, the introduction of PCTs and their commissioning power would give Telford and Wrekin PCT an influential say in the future of our hospital and an important role not just in underpinning its future but in helping to develop its future through its commissioning power and funding. As I said, however, despite the generous increase in funding for the PCT over the next three years—I acknowledge that 34 per cent. is at the top of the range—and the 14 per cent. increase in capital investment over the next three years, we are starting from an annual deficit of £12 million, which means that we are 9 per cent. short of our fair share.

The spend per patient in Telford and Wrekin every year through the national health service is about £719, which compares with a national average of £819. That severely compromises the commissioning power of our primary care trust with regard to the Princess Royal hospital.

As I understand it, the problem has further intensified in the past week. As recently as March, the strategic health authority confirmed that, as I believe has previously been the practice in hospital mergers, the NHS would write off at the point of merger the accumulated debt of the two hospitals, which amounts to about £4 million or £5 million. As of 11 April, when a meeting took place between the health authority and the PCTs, the rules have been changed so that any debt recovery is within the strategic health authority area and not the NHS as a whole. That will come as extremely unwelcome news not only to Shropshire but to Staffordshire, which will have to pick up its share. It will also be unwelcome not only to the acute sector but to the primary sector, which will also have to reach into its already pressurised budgets to find its contribution. Yet again, the purchasing power of our PCT and its ability to support the future of our hospital will be still further undermined.

The Government rightly have a vision of the NHS that puts patients first. Of course I applaud that, but I suggest that the plans that are currently before us meet the needs of the bureaucrats before those of our community. What is worse is that, without cast-iron, copper-bottomed assurances about the future of our hospital, they could prove disastrous for my constituents.

If the Minister cannot find it in himself to reject the proposal or defer it until the issues that I have raised are properly considered, a well-conceived argument for merger is advanced and the health service communities and wider communities are properly consulted, I entreat him to give us assurances not only that the Princess Royal hospital will not be undermined by the merger that is currently being contemplated, but that the hospital will be developed and expanded to meet the needs and expectations of its staff and the community that they serve.

10.12 pm

I will keep my remarks very brief.

I am dismayed and disappointed by the remarks of the hon. Member for The Wrekin (Peter Bradley). He talked in the language of great misgivings, bitter experience and rivalry. Those terms were very appropriate under the Conservatives before 1997, when there was bitter rivalry between the Royal Shrewsbury and Princess Royal hospitals. That is certainly no longer the case. I am afraid that he most certainly speaks as one of the minority—the tiny minority.

Having checked with the PRH and the RSH tonight, I can say that it is clear that there is overwhelming support for the merger in Shropshire and Telford and the Wrekin. Seventeen out of 18 stakeholders, including community health councils, local authorities, the trusts, primary care trusts and the hospitals themselves, are in favour of merger. The 18th stakeholder has passed no motion in favour or against merger and expressed no opinion. There have been 35 meetings with the public and staff to explain what is happening, and there has been overwhelming support.

I genuinely wish that the hon. Member for The Wrekin had not been quite so strident in expressing his views. If the merger is delayed, it will be at a grave cost to the hospitals. A population of about 500,000 is needed to make a hospital viable in this day and age.

The joint population of Shropshire, Telford and the Wrekin is about 436,000. However, if he expects that the Princess Royal hospital can survive alone as one of the two smallest district general hospitals in the country, he is sadly mistaken. All the clinicians, GPs, consultants and other health care professionals are on board. The public are on board—more than 95 per cent. are supportive. It is incredible to think that the hon. Member for The Wrekin, and possibly the hon. Member for Telford (David Wright), too, are against the proposed merger. I urge the Minister to think carefully and to take everybody's views on board. We want a thriving, sustainable future for Shropshire health care services, and if we delay on this proposal we jeopardise the futures of the Royal Shrewsbury hospital and the Princess Royal hospital.

10.15 pm

I want to respond briefly to the hon. Member for Shrewsbury and Atcham (Mr. Marsden). In general terms, neither I nor my hon. Friend the Member for The Wrekin (Peter Bradley) is. as he suggests, opposed in principle to the merger of the two hospitals: we are interested in ensuring that a medium to long-term development plan is in place to ensure the future success of the two hospitals. The problem that communities in Telford have had over many years is that we have not had any reassurance from numerous Ministers—I have to say that my hon. Friend the Minister is excellent at liaising with Back Benchers—about a long-term commitment to ensuring that we have a sustainable hospital in Telford. That is what we are seeking in this Adjournment debate and have tried to seek throughout the consultation process.

I am extremely concerned by the final point made by my hon. Friend the Member for The Wrekin about the possible budget deficit for the two hospitals, which may mean that resources have to be found from the wider health authority and strategic health authority economy in Shropshire and Staffordshire. I hope that the Minister will reassure me that we can look to some central provision to support the strategic health authority in progressing the merger and ensuring that, if it goes ahead, it is successful, so that the needs of both communities—in Shrewsbury and Atcham and in Telford—are met, and we have the highest-quality health services that we can possibly have for our people.

10.17 pm

I begin by congratulating my hon. Friend the Member for The Wrekin (Peter Bradley) on securing the debate on an issue that is important to him and to his constituents. I commend him for the assiduous way in which he has continued to lobby on behalf of the people of The Wrekin and Telford. He, like the people of Telford and Shrewsbury and the surrounding area, is eager to secure the very best-quality health services that those communities expect. In that sense, I hope that I share common ground with him and, indeed, with my hon. Friend the Member for Telford (David Wright).

The proposed merger of the Princess Royal hospital and NHS trust and the Royal Shrewsbury hospital and NHS trust was subject to public consultation following a decision to merge on 26 June 2002. The consultation ran between December 2002 and March 2003. As my hon. Friend will know, following that consultation the chairs of the two trusts decided to merge the two hospitals. The matter was then automatically referred to the Secretary of State for Health for a final decision. I am currently considering my decision on the merger, so my hon. Friend's debate is timely. I welcome this further opportunity to hear his views and assure him that I will take them fully into account as I consider every last detail of the merger plan over the next few weeks.

It will be useful if I remind hon. Members of the background to the consultation and give an indication of the issues that I will consider before making any decision.

As my hon. Friend said, much local history surrounds the proposed merger of the two trusts. Although they have separate boards, for several years they have shared an executive management structure and they collaborate closely on clinical networks and services.

Before approval to go to formal consultation, the two trusts prepared an expression-of-interest document. It set out a range of reasons for an acute hospitals merger based on factors such as the effective use of resources and building on the existing shared arrangements at chief executive level. As my hon. Friend the Member for The Wrekin said, I met him and my hon. Friend the Member for Telford before the start of the public consultation to discuss his request that it should be delayed. I am grateful for the credit that he gave me for delaying the consultation for a period of weeks. I stated that it must be as
"open a consultation as possible."
As my hon. Friend would expect, I shall look to that condition.

I also stressed that no service change is being proposed in the merger discussions. I listened to my hon. Friend's comments about that. As he knows, the consultation specifically covers structural merger and is not about the services provided by the hospitals. However, I am fully aware that some stakeholders are anxious about the future provision of services. I have looked for them to be addressed in the merger proposal.

Let me summarise the key consultation issues. The consultation was on the proposal that the two existing NHS trusts should be dissolved and a new NHS trust established from 1 October 2003. It focused solely on organisational benefits, both managerial and clinical. It states:
"The proposal does not discuss nor propose any changes to the services provided by the hospitals. There are no plans to change clinical services as a consequence of this proposed merger."
The second point is very important. No other organisations were involved in the proposal. The catchment area for the trusts covers the unitary authority of Telford and Wrekin, largely served by the Princess Royal hospital, and the whole county of Shropshire and parts of mid Wales, largely served by the Royal Shrewsbury hospital. The range of consultees reflected the interested stakeholders in the catchment area.

The consultation document set out three options: reverting to separate management arrangements; doing nothing and having continued collaboration; and merging the Princess Royal and the Royal Shrewsbury NHS trusts. The third option was the preferred option. The form of the consultation had two elements. The Secretary of State has conducted a formal consultation with the community health councils of Shropshire and Montgomery and with the staff of the two hospitals. A public consultation has also taken place so that Ministers—in this case, me—could decide whether there is local support for the proposals.

It is important to remember that the consultation specifically provides that no part of the proposals related to a plan to change any services. Indeed, the consultation is explicit about the commitment to retain accident and emergency, critical care and paediatrics at both hospitals. An independent chairman, Mrs. Cessa Moore, who has no direct connection with the two trusts, was appointed to lead the consultation. She established a consultation project board to oversee the process.

The project was led by a project director, Mr. Neil Lockwood, again with no direct interest in the result of the consultation.

Membership of the consultation project board included the chief officers of the two community health councils. The chief executive of the two trusts was also a member to ensure a link between the consultation process and the ongoing activities of the hospitals.

My hon. Friend will be aware that section 11 of the Health and Social Care Act 2001 puts a new duty on the NHS to make arrangements to involve and consult the public in planning services. The Department has recently published a document entitled "Strengthening Accountability" providing policy and practice guidance to support the NHS in meeting the requirements of this duty.

That Act also gave new powers to the overview and scrutiny committees of local authorities to review and scrutinise the planning, operation and development of health services. That ensures that the democratically elected representatives of local people, with responsibility for their well-being, have proper influence over the NHS. Those powers also came into effect on 1 January.

Overview and scrutiny committees have a particularly important role to play when a substantial change or variation to services is proposed. The NHS must consult the overview and scrutiny committee on any such proposal. The committee has a specific right to refer the proposals to the Secretary of State if it considers that public involvement has been inadequate or that the proposal itself is flawed.

Any consultation documentation needs to demonstrate that it was clear, simple, concise and could be readily understood. It also has to be readily available in both its full and summary forms, and all groups must have had sufficient time to consider their responses. I shall be looking to ensure that those statutory obligations have been met as I consider my decision.

I shall also be concerned to ensure that the analysis of responses was both accurate and comprehensive, covering both positive and negative aspects raised as part of the consultation. I will pay particular interest to the responses given by the local authority scrutiny boards, clinicians, nurses and other hospital staff, as well as the views of hon. Members.

My hon. Friend has many times made his misgivings on the merger clear, in particular the omission of Shropshire's third hospital, the Robert Jones and Agnes Hunt orthopaedic hospital. I am also aware of my hon. Friend's view that in any merger the west of the county might tend to dominate in decision making about access to services and facilities, potentially adversely affecting services at the Princess Royal hospital.

I recognise those concerns and in making my decision I shall be mindful of what is said in our recently published document, "Keeping the NHS Local". That states that hospital services need to change—

I will not give way at this stage.

That states that hospital services need to change if we are to continue to meet patients' needs and improve access to local services and that biggest is not always best. We recognise that patients want more, not fewer local services.

Mention has been made of the expenditure of the trusts. After any merger of two NHS trusts, the income and expenditure account of a new trust would be set to zero. However, under resource accounting rules, strategic health authorities are not allowed to write off accumulated deficits of trusts within their health economy area. Appropriate financial recovery plans will therefore have to be drawn up irrespective of whether the Princess Royal and Royal Shrewsbury hospitals trusts merge. The local strategic health authority will consider financial recovery plans with stakeholders across its health economy should the merger go forward.

As I said at the beginning of the debate, I welcome this opportunity to listen to my hon. Friend's views on the merger. I listened intently when he and my hon. Friend the Member for Telford (David Wright) came to see me and continued to lobby hard on behalf of their constituents on the issue. I am also pleased that we have been able to make record financial allocations to their areas because they were pressing on the financial issues as well. I listened then and I delayed the consultation. I believe that I did well by the people of Telford, the Wrekin and Shrewsbury, and I hope that in the decisions I will take in the next few weeks, based on close examination of all sides of the argument, that I will do well by the people of—

The motion having been made at Ten o'clock, and the debate having continued for half an hour, MR. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.


Official Report, 14 April 2003: in col. 766, Division No. 170, delete "Goggins, Paul" from the Noes and insert in the Ayes,

In col. 778, the first petition should read as follows: