Motion made, and Question proposed, That this House do now adjourn.— [Dan Norris.]
For some unaccountable reason, there appear to be fewer hon. Members in the House this evening than there were on Monday afternoon. Nevertheless, I am extremely grateful for the opportunity to raise a matter of considerable concern to my constituents.The availability of hospital services in east Kent has been a matter of intense local controversy for a number of years, and this is not the first occasion on which it has been raised on the Adjournment of the House. A number of my colleagues, notably my hon. Friend the Member for Canterbury (Mr. Brazier), whom I am delighted to see in the Chamber this evening, and I have raised this question in the past. The whole question of the reconfiguration of hospital care in east Kent is under independent consideration. That could have taken place some time ago if the Secretary of State for Health had heeded the representations that I and a number of colleagues, including my hon. Friend the Member for Canterbury, made about the need for another look at this vexed problem. The purpose of my representations this evening, however, is more limited, and relates specifically to a proposal by East Kent Hospitals trust to close the pharmacy at Royal Victoria hospital in Folkestone. The trust is clearly not opposed in principle to pharmacy provision in hospitals, as it does not propose to close pharmacies in any other hospital for which it is responsible. Its proposal to close the pharmacy at Royal Victoria hospital is, so far as I can see, based entirely on a desire to save money. No one would quarrel with sensible proposals to save money that did not affect the quality of the health care available to those who need it. It is clear that something needs to change in the way in which health care is delivered in east Kent. East Kent Hospitals trust is in considerable financial difficulty. I understand that its deficit is the second largest in the country. That can be a result of one of only two possible causes, so far as I can see. Either the way in which national resources for health are being distributed is grossly inefficient and unfair to east Kent, or the resources made available to East Kent Hospitals trust have been grossly mismanaged. The answer must lie in one or other of those causes or, I suppose, a combination of the two. I make it clear that I am not this evening asking for an increase in the amount of money devoted to health nationally. There are particular problems in east Kent that can have arisen only in one of the two ways that I have identified. I hope that the Minister will comment specifically on that point in his reply. I have repeatedly asked for explanations of why the deficit that East Kent Hospitals trust has incurred is so large. It is not at all clear to me, despite the explanations that I have received, which of the two causes is responsible. Whatever the answer to that question, it is essential that whenever changes are made to the provision of health care in a particular area, they should be clearly and convincingly explained, and the rationale behind such changes should be both comprehensible and persuasive. Despite the fact that I recently had a meeting lasting well over an hour with the chairman and chief executive of East Kent Hospitals trust, at which the head of pharmacy was also present, I regret to say that no clear and convincing explanation has been given for the proposal to close the pharmacy unit at Royal Victoria hospital, and that I, at any rate, am by no means persuaded of the logic of the proposal. The savings that the trust claims would result from the proposal fall into three main categories. The first, and by far the most significant, arises out of the trust's natural and understandable desire to reduce the costs that it currently incurs in paying for the supply of locum pharmacy staff in its hospitals. I am sure that most people would agree that it would be much better to avoid those costs by recruiting permanent staff whenever that is possible. I entirely understand that objective. The irony, however, is that only one hospital in the trust's area does not suffer from a shortfall in pharmacy staff, which makes it necessary to employ locums. That hospital is Royal Victoria hospital in Folkestone. The pharmacy at Royal Victoria hospital is fully staffed. There is no need to pay for or provide any locums in Folkestone. In effect, Royal Victoria hospital is being punished for the failure of other hospitals in the area for which the trust is responsible to recruit the necessary staff for their pharmacies. So far as the savings are concerned, the strategy of the trust seems to be based on the assumption that pharmacy staff currently employed in Folkestone will readily accept employment at one of the other hospitals in the trust's area. From my preliminary discussions with those involved, that assumption is questionable. In any event, it seems an entirely capricious way of achieving a desirable objective. To punish one hospital and the people whom it serves because of the failure of other hospitals in a particular area to recruit the staff that they need seems perverse, yet that is the principle on which the trust appears to have approached the issue. It is not an acceptable approach, and it should not be accepted without protest. The second major saving identified by the trust as a basis for its proposal is the reduced need that would arise, if the proposal were implemented, for stocking medicines at Royal Victoria hospital. Obviously, if no pharmacy services are provided at the hospital, there would be less need to stock medicines at the hospitals. But, save to a very small extent arising out of the need to provide particular quantities of some medicines at any particular location, those savings are largely illusory. The people who currently receive their medicines from the pharmacy at Royal Victoria hospital will still need those medicines. They will have to be supplied from other sources—either other hospitals served by the trust or pharmacies in the general community. If the Office of Fair Trading's competition proposals for pharmacies are fully implemented, many of my constituents, particularly those in rural areas, may find it difficult to obtain access to pharmacies, but that is a wider debate for another day. What is clear is that this proposal will not reduce the need for medicines among my constituents who obtain their medicines from the pharmacy at Royal Victoria hospital, so the medicines will have to be supplied elsewhere and the cost of stocking elsewhere will therefore rise, either in the other hospitals in the trust's area or in pharmacies in the community. Those savings, therefore, cannot be significant. Finally, and even more astonishingly, the trust claims as a saving the consequences of an astonishing anomaly in the way in which VAT is charged on medicines. I confess that I was completely unaware of the anomaly until my attention was focused on it by the trust's proposal, but it apparently exists and I shall be very interested in the Minister's explanation for it. Apparently, VAT is chargeable on medicine supplied from a pharmacy in a hospital. It is not chargeable on medicine supplied from a pharmacy in the community. Therefore, the trust argues that the health budget generally in the east Kent area will benefit from the closure of the pharmacy at Royal Victoria hospital because some of the patients who get their medicines from the hospital will instead get their medicines from pharmacies in the community, on which VAT will not be payable. That explanation is quite mind-boggling. I have written to the Chancellor of the Exchequer to ask him to explain the anomaly and to say what he proposes to do about it. I very much hope that the Minister will be able to enlighten us in his reply as to the Government's position on that matter. My constituents have been unhappy for some years now about the nature and quality of the health care provided to them by East Kent Hospitals NHS trust. I have said on other occasions that if I had in front of me two boxes full of the complaints that I have received from my constituents over the 20 years during which I have had the honour to represent them, and one box represented the complaints that I had in the first 15 years of that period and the other box represented the complaints that I have had in the past five years, the second box would be twice the size of the first. I deplore that situation. I have campaigned for some time for steps to be taken to reverse it. The proposal to close the pharmacy at Royal Victoria hospital in Folkestone is but the latest blow to strike my constituents in the area of health care. I do not think that it can be justified. I hope that in his reply the Minister will be able to offer my constituents some assurance.
I congratulate the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) on securing this debate on the proposed closure of the pharmacy department at the Royal Victoria hospital in his constituency. I know from the press cuttings that he has been a staunch defender of the interests of his constituents.The NHS plan sets out a challenging 10-year programme for NHS reform. Far-reaching changes are inevitable to try to provide the best possible services for patients in that context, and we all acknowledge the pressures on the service, not only in Kent but throughout the country, that result from trying to increase capacity so that patients can have ready, quick and responsive access to services. We want not only to increase capacity, but at the same time to raise clinical standards generally. We must ensure that services are accessible and flexible, and we want to design services around the needs of patients. As part of the modernisation programme, many NHS trusts are considering changes to the way in which they organise their services. We all recognise that hospital services need to change if we are to continue to fulfil patients' needs and to improve access. Matters clearly cannot remain static for ever. There are a number of different pressures on the service, including providers of health services having to live within their means. Those issues, and many others, need to be taken into account as the health service changes. The right hon. and learned Gentleman mentioned the financial difficulties that the area faces. I might say that those difficulties go back a considerable way. Over the next three years, services there will benefit from an increase in investment of around 30 per cent., which is similar to other areas—the biggest ever single investment in the NHS—but I recognise the pressures that the whole health service is under. We have a long way to go in terms of increasing capacity after, dare I say, many years of under-investment and a lack of capacity in the system. In the right hon. and learned Gentleman's area, that means a 9 per cent. increase for the Shepway primary care trust and an 8.9 per cent. increase for the Ashford PCT. We have backed the NHS with record levels of sustained investment. Through our policy of devolution, we have also placed our strong faith in those who know the NHS best—that is, the staff, patients and people in the local community. Rather than running the NHS by central diktat from Whitehall, it is our policy that primary care trusts, in partnership with local trusts and the strategic health authority, and with their specific local knowledge and expertise, decide the priorities for the NHS locally. That is the context in which to place this debate. The Government provide the funding and it is for the NHS locally—the stakeholders and the patients themselves— to decide how best to use the resources. It is not appropriate for Ministers to decide, in every part of the country, and for every trust, on the direction of travel and how services should be configured. We have made that clear. During the past year, I have made it clear as a Minister at this Dispatch Box on at least four occasions. Primary care trusts, in partnership with local trusts, the strategic health authority and patients, must be responsible for doing that. Given that context, it is right and proper that I return to the detail of the issues that the right hon. and learned Gentleman outlined. The Royal Victoria hospital, which is part of the East Kent Hospitals NHS trust, is a community hospital with 41 rehabilitation beds and 16 stroke unit beds. It has a minor injuries unit, a one-stop neurology clinic, day hospital and a range of out-patient services. It employs approximately 237 staff, and I want to thank them and to pay tribute to the hard work that they do for their community every day. The trust has made significant progress over recent months, and I should like to spend a few moments outlining that. I know that the right hon. and learned Gentleman sees problems but, whatever he says, there have been improvements to NHS services in the area. The trust has achieved the Government's access targets for having no patients waiting longer than 12 months for in-patient treatment and no patients waiting longer than 21 weeks for out-patient appointments. In addition, the trust has significantly reduced waiting times in its accident and emergency departments and reduced its waiting list size. That is not all. The trust is investing in services across the whole of east Kent that will contribute to further improvements in standards and performance. For example, a new £1 million breast screening unit at Kent and Canterbury hospital was opened in May, and a medical ward with an additional 26 beds was opened in January. Last year, a new CT and MRI scanning unit was launched at William Harvey hospital in Ashford. There are also new initiatives to improve the delivery of primary care services. In the right hon. and learned Gentleman's area, nurse practitioners in Shepway are helping to reduce waiting times and improve the service for patients. They are working well to deal with minor health problems, and patients continue to have the opportunity to see a doctor if they wish. There are significant developments and improvements in the provision of health care in east Kent. However, I am aware of the significant deficit that faces the right hon. and learned Gentleman's health community in the next few years. I am therefore delighted that everyone has come together to work out a financial recovery plan. I understand that there will be calls to wipe the slate clean and start from scratch, but that is not realistic. The NHS must exist within the available funding, and NHS organisations that overspend should and must repay organisations that have had to forgo resources in order to fund the overspending. We cannot wipe the slate clean. Such an approach would be perceived as penalising those with good financial management performance. It would convey all the wrong messages about responsible managers and move things in the wrong direction. We recognise that some individual health bodies face financial pressures. Local circumstances may allow the phased recovery of deficits over several years. Clearly, any such arrangements would have to be subject to the agreement of local providers, commissioners and the managing strategic health authority. In addition, we have provided £100 million in support through the NHS bank to several organisations with the most serious financial problems to ensure the continued delivery of patient services. I am advised that the pharmacy department at the Royal Victoria hospital employs four people and dispenses approximately 19,000 items a year compared with 400,000 items a year dispensed by the East Kent Hospitals NHS trust. The trust, which is responsible for the hospital's services, has reviewed its pharmacy services to help tackle the financial position and to adapt to the changing ways of delivering clinical support services. I understand that the trust is supported by its partner primary care trusts and the strategic health authority. Although the pharmacy department at the Royal Victoria hospital is fully staffed, the trust has an overall shortage of pharmacists. That means that the trust regularly employs expensive locum staff to cover its vacancies. The proposal to close the pharmacy department at the Royal Victoria hospital has been made because the local health community believes that concentrating the service on other sites in the trust can achieve better value. I am advised that the individuals employed in the pharmacy department are crucial to the proposal and are being fully and properly consulted. It is proposed to fit existing pharmaceutical staff at the Royal Victoria hospital into vacancies on other sites, where not only could their expertise be fully used, but staff development opportunities are more readily available. I understand that two of the four staff at the pharmacy department in the Royal Victoria hospital have expressed a willingness to be relocated to an alternative site. The right hon. and learned Gentleman says that he is worried that the proposal is simply about money. It is true that the trust has a deficit and that reorganising pharmacy services will save it money. However, it is not simply about saving money. I am advised that the approach has benefits for patients. For example, the pharmaceutical requirements of the hospital's inpatients will be assessed in future by a pharmacist on the ward who has access to the patient's record. Throughout the country, hospital pharmacy services are being re-engineered to provide services that are designed more around the patient's needs. That is part of the Government's commitment in "Pharmacy in the Future", which we outlined and has much support in the pharmacy world. The Department's medicines management framework, which covers the clinical and cost-effective use of medicines, promotes decision making across local health economies. Medicine management is an organisation-wide issue on which managers, prescribers and pharmacists need to work together to ensure that patients get the best from their medicines. I can give the right hon. and learned Gentleman some examples from across the country of pharmacy services that are being reconfigured to the benefit of patients.
If the contention is that medicines cart be provided to hospital patients in a more effective way by doing away with existing pharmacy units and using some of the methods that the Minister has suggested, why on earth are those methods not being introduced in the other hospitals for which the East Kent Hospitals NHS Trust is responsible, in which there is a shortage of pharmacists, rather than in the Royal Victoria hospital in Folkestone, which is the only hospital—so far as I am aware—that is the subject of such proposals?
As I have said, these plans—outlining the way in which we are moving forward with pharmacies—have been outlined in "Pharmacy in the Future", and hospitals are getting around them around the country. There is clearly a financial imperative in the right hon. and learned Gentleman's local context. He has discussed that; I have outlined it. That, however, is not the only issue. Clearly, the fact that only 19,000 prescriptions are given a year will have a bearing on how those services are configured. What must be right is that patients in the Royal Victoria get access to the right pharmacy services. The local trust believes that this proposal will give them access to that, improve services and meet the desire to see the deficit reduced. That must be about balance, and about fiscal accountability. It is right that the local economy should have that discussion.Such proposals are also taking shape in other parts of the country. The West Middlesex University hospital provides a pharmacy service to Teddington Memorial hospital, which has around 60 health care for the elderly beds. Northumbria Healthcare NHS Trust provides a medicines supply and clinical pharmacy service to Berwick infirmary and four other small hospitals. The clinical service at Berwick is provided in part by community pharmacists who review patients' medication prior to discharge as part of an LPS—local pharmaceutical services—pilot. Cumberland infirmary provides supply and clinical services to a smaller hospital with medical and care for the elderly beds. Pharmacy services can be, and are being, configured in different ways in different parts of the country. This accords with the needs of smaller hospitals, and it is right and proper that individual trusts should look at those needs and make their own assessments. I want to emphasise that it is for them to make their own assessments locally; it is not for me to stand here and say what is right or wrong about what they say. The right hon. and learned Gentleman says that he disagrees with his trust's decision, and that is his right. But, in a sense, that is his subjective analysis of the information with which he has been provided. In conclusion, we have provided—
The Minister is very generous to give way again. He has suggested that he is reaching his conclusion, but he has not yet touched on the VAT anomaly. I hope that he will say something about that before he sits down.
The right hon. and learned Gentleman is quite right to pick me up on that point. There is a situation in which European Community law and the way in which VAT is configured in this country affect hospital services in this way. He has written to the Chancellor on this matter, and I will undertake to work with him to consider it, and to see whether I can write to the right hon. and learned Gentleman about it. I understand that the matter has come up and that it affects pharmacies in particular. As the Minister responsible, it is something that I want to take an interest in.We have provided record resources for the NHS, but it must be for primary care trusts to decide how that money is spent, and—in conjunction with local stakeholders—how services should be delivered. I can understand that the pharmacy's closure might set alarm bells ringing locally, but I have been assured that whatever the future of pharmacy services at the Royal Victoria hospital, patients will continue to receive the very best care. A high standard of pharmaceutical services will still be provided. Stephen Cook, the trust's director of pharmacy, has himself said:
"I will not shut the door on the Royal Victoria Hospital pharmacy until I am sure the service in place meets the needs of all our patients. We would not do it if it was going to have a detrimental effect".
Question put and agreed to.
Adjourned accordingly at Eight o'clock.