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House of Commons Hansard
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NHS Services (Hertfordshire)
12 July 2006
Volume 448

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Hon. Members may take their jackets off, if they so desire. We have an interesting debate this afternoon and a lot of hon. Members want to take part, but everyone will get in if we all play fair by one another.

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I am grateful for the opportunity to speak this afternoon on changes to NHS services in Hertfordshire. Before I do so, I want to pay tribute to the many thousands of people who work for the NHS in Hertfordshire and do a difficult job very well. Although I shall highlight some of the difficulties that we face with the NHS in Hertfordshire, I do not want to detract from the great efforts made by those staff.

The debate this afternoon is about changes to NHS services in Hertfordshire, but to be honest we face something that could easily be described as a crisis. I shall outline some of the difficulties that we face. I shall start with the primary care trusts, of which there are eight. All eight are in deficit and under special financial measures, with a cumulative deficit of £37 million in 2005-06.

We must bear in mind when considering such deficits the average per capita allocation to Hertfordshire. In 2005-06, the average per capita allocation was £986, which is £109 less than the average in England. If we had £34 more per head—still £75 less than the English average—the deficits in Hertfordshire’s PCTs would be wiped out. There is another way of looking at it, which is quite constructive when we consider the whole issue. We receive approximately 90 per cent. of the English average, and if we were to receive 93 per cent. there would be no deficits in our PCTs and we would not face the current crisis.

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Would not another way of putting it be to say that if we had roughly the same amount as the Minister’s constituency we would be fine?

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That is absolutely right. There is a broader issue. To open out the debate for a moment, Hertfordshire is just one example of a county in south-east England that is facing great difficulties. We could consider Surrey, Sussex, Norfolk, Suffolk and parts of London and we would find that the difficulties are concentrated in the south-east in the areas that receive below average per capita funding. There must be a question about the formula. I gave advance notice to the Minister and hope that she will be able to address the issue of the formula that is used in Hertfordshire and whether there are any plans to change it, as it seems to me that there is something wrong with the balance. I can see the argument that deprivation might be a factor, but the balance does not seem to be right when there is such a concentration of deficits in counties such as Hertfordshire.

I come now to the changes that we are debating. PCTs are having to undertake substantial cuts. A front page story in the Hemel Gazette today concerns a letter leaked from a GP in my constituency highlighting that there might well be cuts in district nurses and health visitors in Dacorum PCT. Mental health, too, is an area of enormous concern. I want to pay tribute to my hon. Friend the Member for Broxbourne (Mr. Walker), who cannot be in the Chamber today because he is in Scotland on Select Committee business, because he has undertaken two Adjournment debates and worked tirelessly to raise the profile of the matter. Hertfordshire Partnership NHS Trust must reduce its spending by 5 per cent.—£5.6 million—despite never having been in deficit because the PCTs require it. We are seeing substantial cuts and both in-patient and out-patient services are suffering as a consequence. Another area that has been particularly affected is that of sexual health services. I hope that my hon. Friend the Member for St. Albans (Anne Main) will catch your eye, Mr. Hancock. She has worked tirelessly in this field and highlighted the many difficulties we face.

The issue of hospitals is perhaps the most emotive and the one that concerns my constituents maybe more than any other. Both of our hospital trusts are in deficit: East and North Hertfordshire NHS Trust has a deficit of £22.38 million and has announced 500 job losses, while my hospital trust, West Hertfordshire Hospitals NHS Trust, has a deficit that is even greater at £28.38 million and has already incurred about 250 job losses, with another 500 or so to go. In total, Hertfordshire hospital trusts will lose 1,250 jobs, and we are talking about not only administrators but health care professionals—doctors and nurses—whose jobs will be going as a consequence of the cuts.

I want briefly to give some history of the development of hospital services in west Hertfordshire. A few years ago, there was a process called “Investing in Your Health”, which considered the reconfiguration of hospital services in west Hertfordshire. It concluded that the way forward was to downgrade Hemel Hempstead general hospital to a non-acute site. That caused enormous concern to people in Hemel Hempstead and beyond, in my constituency and places such as Berkhamsted and Tring. My hon. Friend the Member for Hemel Hempstead (Mike Penning) has worked tirelessly to defend Hemel Hempstead hospital and has been a champion of the people of Hemel Hempstead on that point.

The conclusion was reached that Watford general hospital would be redeveloped and that acute services would be moved from Hemel Hempstead. I do not intend to re-open that debate, but I can fully understand why people who use Hemel Hempstead are worried about services being more distant. There was one consolation at the time of “Investing in Your Health”, which was that there would be a fantastic new hospital at Watford, and that services would not be moved until that hospital was built. The reality, however, will be somewhat different.

Services are on the move already. The birthing centre in Hemel Hempstead has closed, as has a ward for elderly patients, and there is more to come. Services have already been transferred to Watford, a hospital that I know well as I have had two children born there. Nobody, however big a fan they were of Watford, could say anything other than that it is a poorly designed site with outdated buildings, which is cramped and has little capacity. It is right next to Vicarage Road football ground, which I am pleased to say will be a premiership ground next season and is also used by Saracens. To get to the hospital on a match day is almost impossible, and even not on a match day it is difficult because transport links are not good. However, it is proposed that more services should be moved to Watford now.

I know, having asked the chief executive of the hospital trust, that during the course of the winter there were a number of occasions when notes were sent out to doctors, GPs and primary health care providers that Watford hospital was, effectively, full. That was in the winter and came before the closure of many of the acute services at Hemel Hempstead and their transferral to Watford.

How on earth will Watford cope in the interim period? By spring 2007, virtually all Hemel’s services will be gone. One might say that it is only an interim period of six years, but there is now severe doubt that we will get the new Watford hospital at all. It is supposed to be there by 2013. I will be grateful if the Minister can throw some light on the process. I know that one of her colleagues answered a parliamentary question on the subject in June, but it seems that we may have to wait some time before finding out whether the private finance initiative for Watford is to proceed. I sincerely hope that it will, because without it we will have the worst of both worlds, with Hemel losing its services but with no new facilities being made available for anyone in west Hertfordshire. I am greatly concerned about the matter, and I must ask how it has progressed.

Not long after being elected to this place last year, my hon. Friend the Member for Hemel Hempstead and I met the chief executive of West Hertfordshire Hospitals NHS Trust and its then chairman. At that point they were already talking about bringing forward the reconfiguration of hospital services from 2013, because word had come from the strategic health authority that deficits had to be reduced; there had been a change of focus. Indeed, the same would have been said by the primary care trusts—that there had been a change of focus last year.

I have given the Minister advance warning about my question, but when precisely did that change happen? I have been here only a year and I hope that I am not becoming a cynical politician, but we heard little from the Government before the last general election about the need to balance the books and to reduce the deficits. That change of focus seemed to occur, almost to the day, immediately after the general election. That is something that the Government must answer. Before the last general election, Labour had five marginal seats in Hertfordshire; it now has only two—and I hope the number will fall. None the less, the Government seem to have changed their focus. I should be grateful if the Minister answered that point.

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Has my hon. Friend had the chance to reflect on the fact that only two areas are now promised investment—Watford and Stevenage. Is there is any correlation between that and the occupancy of those seats?

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My hon. Friend makes a characteristically astute point. He has been a tireless campaigner for the new site at Hatfield. I hope that he has the opportunity to raise the subject later today. It was a PFI site, but it has already been downgraded and it may not proceed. Again, I hope that the Minister will be able to speak about that.

Hertfordshire is being treated poorly. Its funding formula is working against it, and it has crumbling and out-of-date facilities that may not be replaced. We have seen substantial staff reductions and plummeting staff morale, and services are being cut. The Government have not listened to the people of Hertfordshire for many years. I hope that they will listen today to what is happening there, because we are seeing the appalling running down of our services. As can be seen by the strong showing of Hertfordshire Members, the people of Hertfordshire will not tolerate it for much longer.

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I echo the tribute paid by my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) to NHS staff, who are dedicated, devoted and hard-working.

I have represented a Hertfordshire constituency for nearly a quarter of a century, and this is the worst crisis that the NHS has ever faced during that time. The words “cuts” and “crisis” have been used fairly frequently over the past 20 years, but throughout that time they meant a reduction in the anticipated growth in spending or employment. This is the first time that we have known a real crisis.

It is a crisis of jobs. The two hospital trusts that serve my constituency each plan to shed 500 jobs—a total of 1,000. That is clearly only the start, because those cuts meet only a portion of the savings that the trusts have been told to make. Those cuts include nurses and doctors as well as the vital staff who back them up.

It is a crisis of hospitals. Harpenden memorial hospital in my constituency is to lose all its hospital beds; effectively, it is to be closed as an in-patient hospital. It is clear that of the two hospitals that serve the East and North Hertfordshire NHS Trust, one is likely to be downgraded to little more than a cottage hospital. The promise of a new super-hospital at Hatfield that was floated and talked about assiduously before the election has now been downgraded from one costing £500 million that would have included a new cancer unit to one that will cost at most £300 million or £400 million; and within that envelope it will be impossible to include a new cancer unit—if it ever goes ahead.

It is a crisis of trust. At a public meeting that I chaired last September, my constituents expressed concern about rumours that the Harpenden memorial hospital might be closed. The PCT said at that meeting that it had considered all the options and that it had decided that it was an economic, efficient and caring way of providing health care for local people and that it wanted to build on that provision. Eight months later, it announced that every bed was to go. It is a crisis of trust in the management of the PCT.

It is also a crisis of trust in the Secretary of State. I asked her the other day why the East and North Hertfordshire NHS Trust will have to cut a quarter of its spending—£66 million of a total of £267 million over the next three years. She said that the Department did not require any cuts in its budget, just that it should live within its budget. However, the figures that I cite are from the press release of the national health service, so someone is not to be trusted. I fear that the Secretary of State must have been ill-informed. We therefore cannot trust what she says about our local health service.

It is a crisis of care. The new model of care is designed to discourage and if possible prevent GPs referring patients to hospitals. A target has been set for the number of such referrals to be reduced by 50 per cent. In six areas, the target is a reduction of 80 per cent. in the number of patients being referred to hospitals. I have no objection to people being treated at home or elsewhere better than or as well as in hospital, or even more efficiently. However, setting a target rather than saying that the Department would provide the best form of care, whatever the outcome may be, is dangerous. It makes it clear that this reduction in care is being imposed as a result of budget stringency.

At a street meeting last Friday, my constituents asked one question—why is this happening? If there has been such an increase in NHS expenditure, why for the first time in their recollection are 1,000 jobs to go? Why are hospitals to be closed? Why is care being rationed? They want to know. I cannot tell them. Will the Minister give us an explanation that we can give to our constituents?

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I almost do not know where to begin. Many of us share services; we do not all have our own hospitals or clinics. As a result, many of the cuts to services in other constituencies will affect my constituents. I was particularly touched by the tale of a nurse who lives in my constituency. She works in a thrombolysis unit in Hemel Hempstead. She told me that if that unit is relocated to Watford, nobody, including the staff, will have any confidence that the target of getting treatment within the target time of half an hour will be met. People who need to get there on a match day will not have that life-saving injection into the heart, whereas the system works in Hemel Hempstead.

Other shared services include podiatry and sexual health services. I have a number of letters from my constituents listing the cuts that they have been asked to face, some in my constituency and some just outside it. For example, there are the cuts in mental health services. I am sure that the Minister is only too aware that Hertfordshire has one of the highest incidences of mental health problems. We read about the amount of cuts for the adult care services—learning disability services, drug and alcohol services—and it beggars belief that that could be care in the community. Drug care services do not even bother tendering any more; they were being asked to provide so much that backed up the Government, even though they involve charities.

People with mental health problems often use homelessness services, and they have been cut back—for example, funding has been cut for the Open Door project in Bricket Wood. Funding has been cut to Grove House, the hospice in my constituency. Budgets for the elderly and mentally ill have been cut—£7.55 million. I have letters about the cuts from all the different services. Those are genuine cuts for my constituents, who do not understand how there can be extra care in the community and investment in health. As far as they are concerned, there is no investment in their health, just a hope that they will go away into a corner and not create a fuss about what are seen as some of the Cinderella services of our health service.

I have a letter about staff shortages in the foot health service that states:

“Dear Colleague…I am writing to let you know about the staffing problems the Foot Health Service is currently experiencing…In addition, our current financial position has also exacerbated the problems and has necessitated the taking of other remedial action…This equates to a 35 per cent. reduction in the department’s staffing.”—

that is, not caring in the community, but an actual reduction in department staffing. It continues:

“The net result of the staff shortages is that all podiatrists are now having to accept an increase in their workload and therefore are having to be more rigorous in prioritising their workload”—

that is, rationing health care.

I have written to the Minister about the issue of county sexual health promotion advisers. There used to be five in Hertfordshire; they went into schools, dealing with the issues at the sharp end, talking to pupils before they became sexually active. Such pupils may have had queries about sex or their relationships. We were then down to one last sexual health adviser post. Unfortunately, it seems that if we try to convince people that they can access services elsewhere, everybody says that somebody else is providing them and the post can be cut. The last post holder lost his job, despite active lobbying by his union and my writing on his behalf.

The gentleman in question met the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), at a chlamydia screening conference. She said that sexual health promotion was a core part of the Government’s choosing health initiative. We do not see that in Hertfordshire, where there is no longer a single sexual health promotion adviser.

People might say, “Well, go to your local sexual health clinic.” That would be interesting in St. Albans; people queue outside the door and into the car park. As I am sure the Minister is aware, sexual health clinics do not see only immediate constituents; people, for whatever reason—privacy, embarrassment or anonymity—will often travel across borders to go to clinics. My clinic in St. Albans and the clinic in Watford will serve the majority of people in Hertfordshire.

I have raised our belief that sexual health services in Hertfordshire are severely underfunded, despite a 1,500 per cent. increase in HIV infections, as well as other sexually transmitted diseases. As a result, a MedFash—Medical Foundation for AIDS and Sexual Health—review was undertaken; reluctantly, it seemed, but paid for by the Government. We were all terribly hopeful that it would deliver what we wanted to happen, but it was not to be. In fact anyone who knows the well respected Dr. Pat Mundy should be aware that she resigned because she was being asked to ration patient care and preside professionally over a service that was unsafe and subject to cuts.

Is sexual health one of the Government’s top six priorities in my constituency? I do not believe so. The trouble is that people wanting to use the services will not understand when they turn up and doors are locked against them. Are we really condemning people to an expensive, long illness of HIV/AIDS, for which we will eventually have to pick up the tab? Are we saying that young women may end up infertile and perhaps should seek the services later in life? Are we saying that we do not really care?

Today I was pleased to read in a letter from Dr. Mundy that the 48 per cent. rationing that was to have been asked for in Watford has been put on hold. I am sure that the Minister has seen the MedFash report; I urge her to stress that that is not a temporary political hold for political expediency and that it is a recognition of the cuts and shortages that have been going on year on year in health service provision in Hertfordshire.

As I said, we all share many of the services, so when a birthing unit closes at Hemel Hempstead or a thrombolysis service moves from somewhere else, or when the cancer services at the QEII hospital go, I care.

I shall not take up too much time, because I know that my right hon. and hon. Friends feel passionately about the issues, but there is one thing I really care about. Unfortunately, my constituency, along with that of Hemel Hempstead, seems to have a cash cow. I regarded it as an excellent local hospital, but unfortunately it is seen as a wonderful building site, which may well be used to pay off deficits. I am not talking about people being put in other areas to make best use of the system. We have just opened—I know it was not long ago, because I opened it—a brand new breast cancer unit in St. Albans, but we do not know whether we are going to keep it. During a hearing for a report of the Select Committee on Health, David Law was closely questioned by my hon. Friend the Member for Hemel Hempstead (Mike Penning). He was asked about where he was going to find his money and replied:

“We shall have some redundant estate”—

he was talking about my hospital.

“We have a good facility in St. Albans with five theatres and beds and that will become redundant.”

That facility is going to pay off someone’s debts. I do not want some bean counter, who has been told to live within his budget, to ration health care. We are being asked to operate at 90 per cent. below national average, and we cannot do it.

St. Albans may be seen as a wealthy area, because it has high house prices, but I can point to areas of recognised deprivation, such as London Colney, in my constituency. They are on my council website. They have high immigrant populations and poor outcomes on health and cancer—many of the factors that this Government would accept indicate poverty. However, because they are in small localised pockets, St. Albans does not attract the funding as a whole, although the people need the services just as much.

I shall hand over to my hon. Friends now, but we are suffering huge cuts in our local services. People are not going elsewhere in the constituency, nor being cared for nicely at home. In St. Albans, we do not have a single NHS nursing care bed within our age care system—not a single one. I urge the Minister, please, to renegotiate the funding formula to take into account the fact that if we in St. Albans tried to meet our deficits, we would have no services. That is how it looks in my constituency.

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I was elected to the House after defeating a previous Health Minister, Melanie Johnson, on the subject of hospital health care in my constituency of Welwyn Hatfield. That happened despite the fact that the then Secretary of State for Health, now the Home Secretary, had come to my constituency and announced a huge, £550 million project to build a new Hatfield hospital, which was to have been the answer to many of the concerns of my right hon. and hon. Friends in the Hertfordshire area.

We now learn that that project will involve at best investment of only £250 million or £300 million, and that it will not include cancer care. In fact, nine years after the Prime Minister told us that there were 24 hours to save the NHS, we are sceptical about whether it will ever be built.

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Does my hon. Friend recollect that when the hospital was originally announced, amid the claims that he has described, the fact that it would include cancer care to reduce the long journey that my and his constituents would otherwise have to make was put forward as one of its principal benefits?

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Absolutely—I am grateful to my hon. Friend for raising that point. I have been through cancer; I went through the trauma of chemotherapy and radiotherapy for a year, and can say that the last thing a person in such a situation wants to do is travel. That point comes on to exactly what I was about to say: that we have recently lost our chemotherapy service at the QEII hospital. That means that my constituents and others are having to travel 14 miles to the Lister hospital in Stevenage—a journey that no one wants to make when they are feeling sick after chemotherapy.

The issue is not only about the chemotherapy unit, but the maternity unit where my kids were born just two years ago, that is set to be closed, and the ward of elderly care beds that has already gone; another is set to be closed. The issue is about the accident and emergency service, the core of any acute hospital, that is set to be closed.

I defeated the former Health Minister because the paediatric service was to have been closed at night. She said that I was scaremongering, but it is now being closed in the daytime and stripped out entirely. It is difficult to comprehend, but all surgery is to be lost from the hospital. I ask the Minister: if we lose our surgery, our cancer care, our maternity services, our paediatrics and our A and E, what is left of our hospital? The Government have talked recently about their intention to create more community hospitals. Is this the route to creating more community hospitals? The hospital does not offer fundamental core services. Of course, that would all be okay if there were to be a shiny, new £500 million hospital 2 miles down the road in Hatfield.

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As my hon. Friend knows, I defeated the former MP for St. Albans. During the election, we repeatedly sought assurances from Ministers that the hospital would be built. The Minister may be aware that I asked for minutes of the meeting. There have been no assurances from Ministers, and I believe that the public have been sorely misled over the status of the hospital.

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My hon. Friend is right, and we look today for an assurance about the super-hospital at Hatfield that was promised by the then Secretary of State for Health in a blaze of publicity. There has been no publicity around an announcement to reverse the decision, so we would like to hear that assurance. I invite the Minister to come to Welwyn Hatfield to explain to the people in my locality when and where the hospital will be built, and whether, as was originally planned, it will include the cancer care unit moved from Mount Vernon hospital. Or has that plan been dropped? Will there be a brand-new teaching hospital in Hatfield this decade, the next decade or the one after? All the things that were promised have been quietly dropped now that the attention and focus are off and there is no general election—indeed, now that the seat is no longer in Labour’s hands.

It is understandable that people are looking to their MPs and asking what is going on. The truth is that, as things stand, we will be left with so little hospital health care in constituencies such as mine and those of my hon. Friends that the Government will be putting lives at risk. It is inconceivable what a constituent who falls over from a heart attack in Hatfield is supposed to do in a busy rush hour to get themselves to the Lister hospital in Stevenage, given that the motorway narrows to two lanes. It is unimaginable how ambulance services, which are being regionalised and cut, will pick up patient or victims of car accidents and get them to the health service that they require.

It is extraordinary to my hon. Friends and to our constituents to hear the Prime Minister and others stand up at the Dispatch Box week in and week out to reel off numbers that bear no relation at all to the situation on the ground. What should be discussed are the 500 job losses—such figures should be stated—the closure of departments and the broken promises about new hospitals that, when it comes to it, simply will not be built. I ask the Minister to accept my invitation to come and explain in person.

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I congratulate my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) on obtaining this debate and on setting the scene so well. It is no exaggeration to speak of a crisis in health care in Hertfordshire for all the reasons that he and my colleagues have given. I shall deal with just one outcome of the crisis, but that does not mean that I overlook all the other cutbacks that are taking place in sexual health services, mental health services and hospital care. There are serious cutbacks in clinical care and in the numbers of doctors and nurses, and there is also the matter of targets for the use of hospitals by patients, including patients who have already been seen by their general practitioner. My right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) was right to raise that subject, about which many questions could be asked.

The one aspect that I wish to deal with in many ways epitomises the crisis in Hertfordshire at present. The Potters Bar community hospital is the responsibility of the Hertsmere primary care trust, which has a serious financial deficit. I have asked Ministers about it, and they say that the PCT must live within its means. However, if that is the case, some serious cutbacks at the Potters Bar community hospital will be required.

The PCT is consulting on a significant reduction in the capacity of Potters Bar community hospital, which is a 45-bed community hospital that is barely 10 years old. It replaced an older hospital that was built in the 1930s and had become dilapidated. The hospital is in a new location. It is a purpose-built community hospital that provides services for all the residents of Hertsmere, including, of course, those of Potters Bar. Although the hospital now serves the whole of Hertsmere as opposed to just Potters Bar, which it used to do in the past, the PCT proposes closing 15 of its 45 beds and using the space that is freed up to relocate services already provided at other premises in Potters Bar. We must be clear about this: there is no question of providing new or additional services at Potters Bar community hospital. It is a case of merging two sites into one to provide both sets of services from the same premises. The premises that are “freed up,” in the words of the PCT, will be closed and sold, and the proceeds of the sale presumably used to address the financial position of the PCT.

However, Potters Bar community hospital will lose one third of its beds for good under the plans. The PCT has introduced consultation and said what it proposes to do about community health care to make up for the losses, but the proposals are being driven by financial cutbacks in response to a financial crisis. Nobody can say that if the PCT or any other health service provider were planning the best way to provide health care for the residents of Hertsmere they would begin by closing a substantial number of the beds at Potters Bar community hospital.

I can do no better than quote what the Government said about precisely such a situation. Their White Paper stated:

“Some community hospitals are currently under threat of closure, as PCTs consider the best configuration of services in their area. Where these closures are due to facilities that are clinically not viable or which local people do not want to use, then local reconfiguration is right. However, we are clear that community facilities should not be lost in response to short-term budgetary pressures that are not related to the viability of the community facility itself.”

That is precisely the situation with the Potters Bar hospital. Local people certainly want to use it. They value it for all the reasons that community hospitals are valued. It is particularly valued by elderly residents of Potters Bar and Hertsmere and those with chronic conditions.

There is no question about the hospital’s clinical viability. It is a modern facility. I have to confess that I attended its opening, which might suggest that I have been here too long. In fact, I have not been here too long. It is a modern facility—it is almost brand-new— and the only reason that its position is under threat is because of the financial predicament of Hertsmere PCT.

My right hon. Friend was right to say that there is a question of trust, given what the Government have said about community hospitals. I put it to the Minister directly that if those words mean anything at all, and if the Government are to be trusted, Ministers must step in and do something about the situation at Potters Bar, which corresponds precisely with what they said. My simple plea is that the Minister will step in and assume responsibility for the Potters Bar community hospital to avoid a permanent loss of beds and a permanent loss of a significant part of the health care that is afforded to my constituents, which will come on top of all the other problems that have been outlined. Such a permanent loss to the residents of Potters Bar and Hertsmere will do serious, irreversible damage to the fabric of the health service in my constituency. I ask the Minister to step in and do something about it.

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I join the general congratulations to my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) on obtaining this debate on the crisis in Hertfordshire’s health service. I wish to pick up on the point about trust that my hon. Friend the Member for Hertsmere (Mr. Clappison) made a moment ago. My right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) also spoke about it.

There are various categories of trust; for example, there is trusting the Government’s word in respect of their policies. The Government spend a great deal of time telling people in the mental health field that modern mental health provision is about early intervention, respite for carers, modern therapies and catching problems early—getting in there to help children and adolescents when they are pre-onset or at the onset of severe mental illness. I have taken a particular interest in that issue. In Hertfordshire, however, the Government are scrapping the early intervention service, the respite care and the in-patient therapies that are so valued, and they are cutting the child and adolescent health services.

The Government say that community hospitals can be valuable centres in which general practitioners can do things such as minor surgery. We have a community hospital in Royston, and there was a plan to develop it in the same way, but it is now on hold and has been for a long time. I have asked the Minister about the future of Royston hospital, but she says, “Ask the PCT.” However, the PCT is being scrapped and is becoming part of a larger PCT. If one asks the PCT, therefore, it says, “We don’t know if we’ll even be here.” The truth is that we cannot trust what the Government say.

At the local level, we were promised a brand new, spanking great hospital in Hatfield, which was going to cost £550 million, as has been said. We were told that it would have cancer care facilities, which are a crucial issue in Hertfordshire. Now, however, we are told, “Oh no, you can’t spend more than £250 million.” The whole thing is in limbo.

It is well known that we have had a structural funding problem in Hertfordshire over the past few years. Before the 2001 general election, the then Health Minister, the right hon. Member for Southampton, Itchen (Mr. Denham), put an extra one-off payment into our local health system and said, “It’s a structural problem, and we’ll have to look at it.” However, nothing happened. Of course, he paid the money, but the Labour party won the election again, and no permanent review was done of the funding for our local health system. Every year for the past few years, therefore, a non-recurrent payment of £10 million has been made to our local health system. Now, we are suddenly being told, “Oh no, you can’t have any more money. You’ve got to manage within your budget.”

The Government know that there is a structural problem in Hertfordshire and in the East and North Hertfordshire NHS Trust—they made the non-recurrent payments. Now, however, they have the cheek to turn round and say, “Oh no, you can’t have any more money. You’ve got to manage.” That means that £66 million has to be taken out of our small East and North Hertfordshire NHS Trust over three years. Five hundred staff—or 10 per cent.—will go, including 150 doctors and nurses, and we will lose three wards at our two hospitals. Those are major problems, which the Government knew about.

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My hon. Friend mentions the £66 million, but does he agree that the number seems to go up by £1.5 million a week? The chief executive briefed my hon. Friend on the issue just before me, but when I had my briefing last week, the figure had risen to £69 million. Does my hon. Friend have a projection for the end of the year?

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Well, it will clearly be higher still. We really are in an appalling situation, and my hon. Friend makes an excellent point.

I come to my last point, because I hope that the Minister will be able to reassure us, although I doubt it. We are asking for nothing more than common fairness in Hertfordshire. It is true that the county is better off than some others, but we pay twice as much tax per head as people in the Minister’s constituency.

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indicated dissent.

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Yes we do. In our area, the average is £5,820; in the Minister’s constituency, it is £2,710. We are therefore paying a lot of tax in Hertfordshire, but we are not asking for any more than anybody else. We are perfectly willing to accept that we should have a level playing field and a fair allocation of resources. However, while the Minister’s constituency gets £1,362 per head, we get £1,057, which is £300, or 30 per cent., less per head. In Hertfordshire, there are many people who are disadvantaged and there are also pockets of deprivation, as my hon. Friends mentioned.

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And learning disabilities.

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Yes, there are also very high figures for learning disabilities and mental health problems. We therefore have real problems, and it is just unacceptable to say that we will be treated in such a mean and unfair way. Will the Minister look at the issue again?

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May I, too, congratulate my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke). This debate is very timely, and Opposition Members feel very passionately about the issues involved.

As the Minister will recall only too well, the Secretary of State told the Royal College of Nursing in Bournemouth in April that the NHS was enjoying “its best year ever”. That brought howls of derision from her audience, and rightly so, but it also generated real anger in my constituency. Over the past year in east Hertfordshire, we have had job losses, which my colleagues have described. We also face possible ward closures and longer queues for dentistry and cancer screenings, and there are real concerns about mental health services. To echo the points made by my right hon. and hon. Friends, let me tell the Minister quite genuinely that people in Hertfordshire no longer trust the Government with our health service—that is the reality.

In the district of east Hertfordshire that I try to represent, we face real problems with preventive services, such as those provided by NHS dentists. The PCTs tell us that they have tried to address the issue, but the combination of new contracts and uncertain funding has seriously undermined confidence among dentists and their ability to do their job. Some of my constituents travel 20, 25 and, in some cases, 30 miles just for a basic dental appointment. As a result, many people are being left behind, and that is particularly true of the elderly, who cannot make such a journey or afford to do so. I could go into that in greater detail, but I am aware that my hon. Friend the Member for Hemel Hempstead (Mike Penning) will want to make a contribution, so I shall be brief.

Mental health services are also under threat. We have heard that the Hertfordshire Partnership NHS Trust faces a £5 million cut, which is 5 per cent. of its budget. When we are told the reason for it, we find that the irony is that it is because of a general overspend. However, the trust has always lived within its budget and has never strayed beyond it in the five years since its inception. The attempt to cut its budget has seen the trust—

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Punished.

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As my hon. Friend rightly highlights, the trust has been punished. Genuine concern has also been caused among what are probably the most vulnerable parts of our community. Clouds are hanging over good services, such as Signet house, Oxford house and the Seward Lodge day care unit, which are invaluable to our constituents.

As hon. Members have said, the worst news was probably when we were told about the 500 jobs that would be lost from the East and North Hertfordshire NHS Trust. As my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) said, 150 of those affected will not simply be managers, but doctors and nurses. Up to three wards could well be lost at the two hospitals in Stevenage and Welwyn Garden City. The best way of describing how people feel about that is a quotation that I recently read from a local nurse, who said:

“Nurses are scared, upset and demoralised—they feel like they’ve worked flat out to deliver Government targets and this is their reward.”

With all those developments affecting the NHS in east Hertfordshire, hon. Members will see immediately how hollow the Secretary of State’s words sound to my constituents.

Part of the problem is the Government’s obsession with reorganisation. I have been a Member of Parliament for five years, and in that time the Government have restructured, de-merged, re-merged and reorganised the ambulance trust at least once and the PCTs twice. The new strategic health authority will be in its third incarnation—I thought that only Dr. Who could change his form so often. The whole structure of health care in Hertfordshire seems to be up for grabs. Chairs are delicately moved around, but nothing is done about the service. Reorganising and restructuring will make no difference if the fundamentals are not dealt with.

That leads me to my principal point. In Hertfordshire, the truth is that patients are not getting their fair share. NHS spending per person in Hertfordshire is just 90 per cent. of the average for England. On last year’s figures, the shortfall is £69 per person, which means that my constituency lost out by £5.2 million last year. For the county, it is £69 million in one year. Of course, it does not stop there. England itself is a poor relation when compared, for example, with Scotland. On last year’s figures, patients in Hertfordshire got only £614 per person, but Scottish patients received £855 per person. That is a gap of £241 per person or, in my constituency alone, £18 million in one year. It is an iniquity, which will appal many people, and to which I hope the Minister will respond.

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Does my hon. Friend agree that it is also odd that people in the Secretary of State’s constituency get £1,306 per head, whereas people covered by the PCT that we share get £1,057 per head? Again, the first figure is 30 per cent. higher.

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I think that that leads quite accurately to the central point that concerns us all. We simply seek our fair share. We do not want better treatment, but we certainly do not want worse. Whatever the apparent wealth of our areas, whether that is measured by house prices or incomes, the truth is that an elderly person’s worry in Hertfordshire about whether they have cancer is as important as it would be if they lived in any other part of the country. That is the iniquity that we are dealing with today. I hope that the Minister will have the courage not to hide behind the usual platitudes that we hear from her boss, but to tell us the truth, and give us the assurances, that our constituents seek.

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I congratulate my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) on obtaining the debate, and my right hon. and hon. Friends who represent Hertfordshire constituencies on showing the House and our constituents how much we care about their health care.

The national health service was created as a level playing field. It was there for all those who needed health care and could not afford to pay for it. On the estates where I grew up in north London, the hospital was the focal point of the community, because that was where people could go when they needed help. Many people in the areas of north London where I was brought up moved out to Hemel Hempstead in the 1950s, to the wonderful new town with its gardens, hospital and college, and all the facilities that they perhaps struggled to get before.

A wonderful acute general hospital was built in Hemel Hempstead in the 1950s. Smaller hospitals were closed and the full acute hospital was created. It fought for 30 years, under different Governments, to find out whether it was safe and would remain. Eventually, 10 or 12 years ago, it was concluded that it should be left alone, and investment was put into it, which meant huge amounts of money, under Conservative and Labour Administrations. A brand new stroke unit was built; huge investments were made in the cardiac unit; and a maternity unit was built up, which then closed, after which a new birthing unit opened—no one quite understood why, but there was an election in the middle, so perhaps we may assume that that had something to do with it. That hospital is a facility that is there to be used.

Great Ormond Street hospital was there to deal with the need for specialist care for children, and people who needed specialist cancer care could go elsewhere. My wife is presently visiting the Royal London hospital, because it has the best haematology department, whose services she needs. That is not what we are asking for in Hemel Hempstead. What we wanted, and what we have, is an acute hospital.

I shall probably be the last hon. Member to speak in the debate before the Front-Bench spokesmen make their speeches, and that is right, because what is happening is terminal for Hemel Hempstead. The acute hospital will go. If the trust gets its way, next spring it will send the bulldozers in to Hemel Hempstead hospital. It will become a housing estate. If we are lucky, I am told, we shall have an independent sector treatment centre—a surgery centre for elective surgery. I have plainly said that I do not want an ISTC. We have three theatres and an elective surgery unit. We have five theatres at St. Albans, doing the job now.

As I understand it from the evidence given to the Select Committee on Health, on which I have the honour and privilege to sit, the rules for ISTCs are that they are not permitted to create a demand; an ISTC is supposed only to replace something that is missing. What is happening in our part of Hertfordshire is that a demand for an ISTC is being created by knocking down a hospital and five theatres, an out-patient department and an elective surgery department at St. Albans. We must ask why.

Several of my hon. Friends have discussed the fairness of the funding formula. I think that it is unfair that the Minister has been picked on for the fact that her constituents receive more than mine, because there are some constituencies, such as Sedgefield, where people get £300 to £400 more per head than my constituents. I do not know why. Evidence was given to the Health Committee about that last week—by the way, we in my constituency got about £960 per head of population last year, rising to about £983 this year; some constituencies get as much as £1,600 per head. That is shameful when it is to be hoped that patients will, in the end, be treated similarly for the same ailments and problems.

I have a problem in Hemel Hempstead because, as a London overspill town, it has areas of serious social and economic deprivation. That is not just because of the Buncefield disaster—after which the hospital’s emergency services did fantastically well in treating the injured; God forbid that the hospital should not have been there, which would have meant going to the emergency centre at Watford. Perhaps some of those people would not be alive now, because two people were very seriously ill after the explosion.

What would it take to clear the deficit and to decide, “We do not need to do this”? The chief executive, in the presence of my hon. Friend the Member for South-West Hertfordshire, said that the closures would not take place if there was no financial problem. What is happening is not reconfiguration; it is cuts. We are trying to get more out of less. It is that simple. We will move all acute services to Watford; we will not go ahead with the promised private finance initiative building; we shall put in portable buildings. Eventually we dragged from the chief executive the truth about the life expectancy of those buildings. It was 40 years—instead of the promised new hospital.

The residents of Watford, Welwyn and Hatfield, St. Albans and other parts of the country were duped. They were made promises that there was no intention of keeping. The funding formula problem—the deficit—has existed for years. Ministers in Select Committee and chief executives of other trusts have argued that the problem is one of management. The managers are not doing their jobs properly. How can that be, when the trust has been changed three times, the PCTs have been changed and the whole of the strategic health authority has been changed? They cannot all be bad, surely. Surely there must be one good manager somewhere in the NHS, because, clearly, they do not have such a problem in other areas. There is clear evidence, however, that areas without so many problems get a lot more money.

I want to close by explaining exactly what will happen to the Hemel Hempstead hospital. We have a full acute hospital with out-patients, elective surgery and, most importantly, as was explained earlier, the acute blue-light facilities, for those who need them. There are 250,000 people relying on the accident and emergency unit at that hospital. It is proposed that all of that should go by next Easter. The whole site will be up for redevelopment. I know that, because I was lucky enough to find out that the trust had had meetings with my local council asking what it could build on the site; I know, because eventually at the Select Committee I dragged from the chief executive the information that the land and facilities will be surplus to requirements. Surplus to requirements? It is a general hospital, which people rely on!

Lives are at risk. I am conscious of the need to leave time for the Minister’s response, but we are not playing a numbers game. We are not saying that some people are nasty and some are good. We are talking about ordinary people, who deserve the NHS that was created many years ago as a level playing field. Watford is in the premier league; it is a fantastic result. The Saracens are doing very well. Hon. Members might like to try going down the A41 from Hemel Hempstead at any time without a blue light. I drove blue-light emergency vehicles and I know how difficult it is. They will not get there. The Government are putting lives at risk.

My hon. Friend the Member for Welwyn Hatfield (Grant Shapps) invited the Minister to visit the hospital in his constituency. I shall not do that, because thousands of my constituents have invited the Secretary of State, but she is too busy. I asked to see her diary and she was too busy to show me that, too. It is a disgrace, and lives will be lost.

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I congratulate not only the hon. Member for South-West Hertfordshire (Mr. Gauke) but all hon. Members who have spoken so emphatically about their fears for their services. I shall not comment in detail on the local circumstances—I defer to their greater knowledge on that subject—but I shall make some general remarks, as the issues affecting Hertfordshire emphasise some familiar themes and common problems that occur elsewhere.

The hon. Gentleman originally drew to our attention two problems. One was the problem of underfunding, which seems to affect all services across the piece, and the other was the problem of hospital reconfiguration, with the hospital trusts having substantial deficits, in excess of £20 million. The Government’s response to deficits is usually that trusts should get a grip and balance the books, which of course always travels with a presupposition that we already have a fair formula across areas and even within areas, between institutions. However, I see no evidence that we have yet arrived at that state.

There is also another common phenomenon in Hertfordshire, which is that of a number of smallish hospitals in clusters, with pressures on all services.

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I do not think that the hon. Gentleman has been to my part of Hertfordshire, but we do not have a small hospital. The Watford general hospital is not a small hospital and neither is the QEII hospital. They are massive acute hospitals, not little community hospitals, as he is describing them.

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I was not suggesting that they were community hospitals, but the descriptions are relative, and we could compare them with St. Thomas’ hospital over the river from here.

I am familiar with the scenario, because I come from an area where there are two hospitals that I would describe as relatively small in NHS terms and that are separated by the sort of distance that separates some of the Hertfordshire hospitals. I am fairly familiar with the problem—I know that hospitals belong to distinct communities, I know that travel between them is rarely ideal and I know that there is strong community resistance to changes in local hospitals. I also know that when change takes place, there is an unconvincing process of local consultation that satisfies nobody and buys nobody off.

There are usually two drivers for reconfiguration. A clinical driver to do with the concentration of expertise is usually cited in evidence, and there is usually a financial driver. The financial drivers on hospitals involve not only deficits but other things, such as the working time directive and the junior doctors’ contract, which put additional pressures on hospitals in all areas. None the less, people in Hertfordshire are quite justified in fearing reconfiguration, because reconfiguration and all that it evokes has a pretty poor reputation across the NHS.

Looking at the SHA consultation on reconfiguration in 2003 from an external point of view, I thought that an attempt was being made—although probably not a successful one—to give everybody a little piece of the action or to satisfy everybody, if I may put it like that. Clearly that effort failed and was replaced by something much more unacceptable. In my neck of the woods, with two hospitals separated by the same sort of distance as between Watford and Hemel Hempstead, we have already lost obstetrics and paediatrics in Southport.

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The hon. Gentleman talks about the same distance as between Watford and Hemel Hempstead, but would he agree that the Minister should ensure that if any service is to be moved to Watford, the road configuration should be altered—which is exactly what we were promised—before any development of the hospital takes place? Perhaps the Minister knows better than I do, but I have yet to see any details of that road configuration or that road investment.

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Order. That sounds like another speech.

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That is absolutely the point that I would re-emphasise, as similar problems are faced in many areas. In my neck of the woods, where two hospitals are owned by the same trust, the road is an issue and travel is the one thing that is most ignored.

I was not surprised to find, on looking into the matter, that the offer that was originally made in the 2003 consultation has been further downgraded. At one stage there was talk of having a birthing unit in Hemel Hempstead and using it to spread good practice elsewhere, but I understand that that is now unlikely to happen. As the hon. Member for Hemel Hempstead (Mike Penning) said, the best that will happen is that an ISTC will emerge. That is a common pattern in different places, with the same meaningless consultation forming a backdrop. Scrutiny and review sections of councils debate things, but the financial position continues to deteriorate.

We can anticipate the Government’s response, which is also fairly familiar. In most such debates, the Government will say that people ought not to be wedded to bricks and mortar, that services can be delivered in the community and—to a lesser extent—in secondary care, that institutions have to co-operate, that clinical networks have to be delivered and that people will travel for the best possible service.

However, that aspect of Government policy does not hang together with something that was cited several times in the consultation, which is the Government’s own policy of keeping the NHS local, which produced a well-known pamphlet that is much cited but rarely acted upon. That policy recognises that although people are ready to travel for specialist care, they expect to find many services locally, particularly A and E services and those that look after people with chronic conditions that involve repeated journeys to hospital. Additional travel in such cases means extra trauma. Someone who has to go further to an A and E department might not arrive with a long-lasting problem or even with a major trauma, but for someone travelling with a child to A and E who is not sure what is wrong, every extra mile is a very unpleasant experience.

People do not mind clinical networks, if that is what the Government want, but they want the clinical networks that suit them and their clinical needs. As it is, reconfiguration across the piece normally results in health authorities presenting a menu, a rather bogus form of consultation taking place and, when it is completed, people often choosing to go in unexpected directions, rather than to the hospitals to which they were expected to travel in the first place. As many hon. Members have said, the backdrop is often the need for a quick financial fix, which discredits any reconfiguration proposal whatever.

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On a point of order, Mr. Hancock. Is the hon. Gentleman’s speech in order, as it is not about Hertfordshire?

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The hon. Member is entitled to put a view about the consultation, but I remind hon. Members that we are about to have a Division and it would be appropriate to give everyone a fair chance to speak in this debate.

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I shall finish shortly, as I said I would, although I also said that I would make some general remarks that would probably apply to Hertfordshire, as well as to other places.

If there is a mistake—as there must be—it is not beginning with community needs. The public are not stupid; they know that they cannot have everything everywhere. However, they want good quality, timely and accessible services but, as hon. Members who have voiced their opinions so far have made clear, Hertfordshire is not getting them.

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I, too, congratulate my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) on securing this important and timely debate.

Sitting suspended for a Division in the House.

On resuming

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Having congratulated my hon. Friend on securing the debate, I also pay tribute to the measured, serious way in which he presented his overwhelming and unquestionably cogent case on behalf of his constituents, demonstrating his concern for their health and well-being.

We have heard from the massed ranks of Conservative Members of Parliament representing Hertfordshire this afternoon; eight out of nine have contributed to this debate and the ninth would have attended, but for being away necessarily on Select Committee business. It is notable that the two Labour MPs who represent Hertfordshire are absent. The Liberal Democrat spokesman, the hon. Member for Southport (Dr. Pugh), concentrated on general points because, thankfully, Hertfordshire, like Cheshire, is a Liberal Democrat-free zone.

I make no apology for focusing on the financial issues, because those lie at the heart of so many of the points that have been raised and have real effects on patients and the constituents of my right hon. and hon. Friends, as we have heard. It is right for us to debate financial issues today, because those are in the power, remit, gift, discretion, authority, responsibility, duty—whatever people want to call it—of the Minister and the Secretary of State; there is no escaping that.

Bedfordshire and Hertfordshire strategic health authority, which is now subsumed into the East of England SHA, has had to make significant savings in an attempt by the Secretary of State to mitigate the NHS deficits. In month six of 2005-06, the SHA was predicting a surplus of £18,000, which was 0.2 per cent. of its turnover. In month 12 it delivered a surplus of more than £19 million—20.7 per cent. of its turnover—which was generated by a mere £200,000 underspend on administrative budgets and enhanced by underspends on training at £3.5 million, the national programme for IT in the NHS at £3.9 million, central budgets of £6 million, a carry-over of £2.6 million from the 2004-05 underspends and an allocation from the national health service bank of £3 million.

As a total health economy across all the NHS organisations in this area, the SHA had a total deficit of £107.9 million in 2005-06. I found that figure, which breaches the SHA’s control total by £33 million, in the financial report of 20th June 2006, presented at the final board meeting of the Bedfordshire and Hertfordshire SHA before it was subsumed into the East of England SHA. The SHA has been given a control total deficit of £80 million for 2006-07, necessitating savings of £150 million, which is enough money to employ just over 8,000 nurses a year and is eye-watering by any standards.

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My hon. Friend rightly highlighted many of the financial issues, but is he concerned about the constantly changing figures coming from the Government? People working in health care keep being asked to do new things and change, which is debilitating for many of them.

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My hon. Friend is correct. Anybody with any management experience would know that that is precisely the case.

I am delighted to inform hon. Members that the hon. Member for Watford (Claire Ward) has had a baby. I congratulate her on behalf of the Conservatives. That is the best excuse for not attending a debate. However, there is no excuse for the hon. Member for Stevenage (Barbara Follett), who has not had a baby.

The savings that I have mentioned, which are equivalent to 8,000 nurses a year, are so high risk that the SHA has told the Department of Health that it requires a control total of £99 million, but expects that downward pressure will be applied to the control total requested by the SHA. With that cash squeeze, it is unsurprising that the SHA area is resorting to drastic measures. In 2006-07, the SHA is reducing education places by 12 per cent. on the previous year—a total of 122 places—and is looking to shed 1,100 whole-time equivalents. In addition, underspends are not being returned and the primary care trusts are required to deliver 3.5 per cent. in cash-releasing efficiency savings. Cuts to mental health services were ably described with deep concern by my hon. Friend the Member for North-East Hertfordshire (Mr. Heald). We are also talking about cuts in podiatry, a transfer of thrombolysis services and cuts to sexual health services. My hon. Friend the Member for St. Albans (Anne Main) also cited a long list of services knowledgeably, robustly and compassionately.

The situation is so bad in the west Hertfordshire quadrant that the auditor issued a public interest report in April 2006, which highlighted the apparent weaknesses in the arrangements established by the PCTs to ensure effective financial governance and the poor financial information being presented to the board. The auditors also highlighted the adverse impact of the considerable uncertainty caused by NHS restructuring. Most of all, the auditor’s report shows that Ministers have failed in their duty to oversee our NHS, as my right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) ably illustrated in his contribution.

This crisis did not happen overnight. For example, the West Hertfordshire Hospitals NHS Trust’s deficit grew from £4.6 million in 2003-04 to £14.6 million in 2004-05 and £43.2 million in 2005-06. In both 2003-04 and 2004-05, the Audit Commission’s relationship manager for the SHA reported on the weaknesses in financial management and the structural issues contributing to the poor financial standing of all bodies in the Bedfordshire and Hertfordshire SHA area.

Furthermore, the public interest report constitutes one of the 20 referrals in 2006 of NHS bodies to the Secretary of State under section 19 of the Audit Commission Act 1998. There were seven referrals in 2005, two in 2004 and none in 2003. This is a worsening picture. In addition, auditors posted 93 qualifications on the accounts last year—accounting for the doubling in the forecast NHS deficit for 2004-05—53 in the previous year and none in any year before that.

The problem of NHS deficits has not suddenly appeared; it has been allowed to worsen because of the failings in the Department of Health and among its Ministers. My hon. Friend the Member for Hertford and Stortford (Mr. Prisk) quoted the Secretary of State talking about the best year ever. He also observed rightly that reorganisations are often the Government’s only retreat to try to escape accountability and blame others. Above all, failed managers are being recycled, thereby demoralising the best, who move on and out. We have a downward spiral of morale and performance.

Despite the financial difficulties, it is unacceptable that the former SHA area should be forced to make cuts to front-line patient services to find cash, especially where such cuts are driven by financial rather than clinical needs.

Regarding the West Hertfordshire Hospitals NHS Trust, we have heard about the scaling down of services at Hemel Hempstead and the building of an independent sector treatment centre there. My hon. Friend the Member for Hemel Hempstead (Mike Penning) eloquently described how the argument for the introduction of the treatment centre puts the cart before the horse. That is no way to manage our NHS.

Does the Minister find it acceptable that most of a relatively new hospital should be demolished and turned into a housing estate because it is “surplus to requirements”? Acute and emergency services are to be centralised at Watford general. Can the Minister guarantee that that will in no way affect patient care? The trust has announced upwards of 700 job losses and 878 bed cuts. East and North Hertfordshire NHS Trust, which has to save £69 million over three years, is set to lose 100 jobs and 1,055 beds, as described in a passionate and sincere speech by my hon. Friend the Member for North-East Hertfordshire. In addition, services are being decimated at the QEII hospital in Welwyn.

Part of the difficulty for hospitals has been the financial pressure put on them by primary care trusts, although it is the organisations that do not have payment by results, such as the mental health trusts, that are most at risk from cuts in front-line services by the eight Hertfordshire PCTs, all of which are in deficit. The effect on, for instance, Potters Bar community hospital was rightly and graphically described by my hon. Friend the Member for Hertsmere (Mr. Clappison). Two sites are being forced into one as a “solution”.

Above all, as my hon. Friend and others rightly highlighted, this leads to a serious collapse in trust in the Minister and the ministerial team, because of what they have said about community hospitals. There was, rightly, a huge outcry when confidence was undermined by the various messages that appeared to be coming out of the Government, but then the Secretary of State corrected that impression at the Dispatch Box. As my hon. Friend said, surely this is the time to step in and stop the permanent loss of services to his constituency.

Most worrying is the fact that the services are being closed down without hope of substitutes. Both the private finance initiative rebuild at Watford and the PFI super-hospital at Hatfield seem to be frozen. The latter has already been downgraded and there is no indication that either will ever arrive.

Auditors have highlighted problems with financial management in the Hertfordshire area, but the struggle in that area is symptomatic of an NHS that has been centrally mismanaged. The fact that deficits are arising in places such as Bedfordshire and Hertfordshire, Thames Valley and Surrey and Sussex—the areas that are hardest done by in the resource allocation—reflects the fact that those areas are becoming too underfunded. Constant central restructuring has contributed to the difficulties, as has the scandalous political meddling in the PFI programmes, such as the one at Hatfield, laid bare in the powerful speech of my hon. Friend the Member for Welwyn Hatfield (Grant Shapps).

However much the Secretary of State and her Ministers may dislike the south-east and middle-income Britain, is there any credible effort that the Minister can make in her speech now to start rebuilding the trust between them and the people of Hertfordshire, represented so passionately and ably by my right hon. and hon. Friends? Do this Government govern for all or just for the reducing number of Labour voters in this country? Will the Minister now commit to a simple ministerial duty—fairness to all—and correct here today the deep, damaging unfairness that has been done to the people of Hertfordshire’s health under Labour?

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I, too, congratulate the hon. Member for South-West Hertfordshire (Mr. Gauke) on securing the debate. It will not be possible for me to address every point that has been made. I hope that right hon. and hon. Members understand that. I should also say that I am meeting the hon. Member for Broxbourne (Mr. Walker) next week to discuss specific issues relating to mental health, and, as I understand it, the hon. Member for Hemel Hempstead (Mike Penning) as well. On behalf of the Lord Commissioner of Her Majesty’s Treasury, my hon. Friend the Member for Watford (Claire Ward), I thank all hon. Members for their congratulations on the birth of her baby. I will pass those congratulations on to her.

I should like to deal with some of the issues by making general comments about the situation in Hertfordshire and the approach that the Government believe needs to be taken to sort out what is a very difficult situation. I am grateful to all right hon. and hon. Members who have paid tribute to the hard work of the staff in the local NHS, who have contributed to the real improvements that have taken place in recent years, such as the cuts in waiting lists and the improvements in general health outcomes. Those are real changes, of which the staff are proud. I am proud to be part of a Government who have helped to bring about those changes, but there is no doubt that they could not have taken place without, first, the hard work and dedication of NHS staff.

Secondly, the changes could not have taken place without the increased investment that has gone into the NHS. I believe that there is actually quite a lot of political consensus on the fact that investment in the NHS has increased from some £33 billion in 1997 and will increase to some £92 billion in 2007-08. The combination of increased investment and the changes that have been made because of the work of NHS staff has led to real improvements in health care.

Hertfordshire has been a beneficiary. Whatever is said at the moment, there is no doubt that there have been increases in resources. A number of hon. Members mentioned the funding formula. It is true that PCTs in Hertfordshire receive less funding per person than the national average, but that is because a formula has been put together to address the health needs of an area. That means that in some of the more deprived areas there are higher levels of funding. I would be amazed if the Conservative party was saying that it wanted to adopt a policy whereby it ignored the fact that some areas have greater health needs than others and that therefore it would reverse the efforts made to tackle health inequalities.

The hon. Member for Hemel Hempstead talked about the establishment of the NHS, which was about providing equal access to health care throughout the country. Inevitably, that means that in some areas there are higher levels of funding, but that does not mean that PCTs cannot target funding within their overall area to tackle health inequalities. That is why the Government have put a lot of emphasis on tackling health inequalities. No matter what we say, right hon. and hon. Members in this room know that a boy born in Manchester, for example, is likely to die eight years earlier than someone born in, I think, Dorset.

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I appreciate what the Minister is saying about health inequalities, but surely the way to tackle inequalities is not to drag down an area where, in the past, the position may have been better, by closing down important services such as cancer care, maternity and accident and emergency services. That seems to be the approach that the Minister is taking.

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No, that is not the approach that I am taking. The approach that I am taking is to challenge the assertion that has been made by the Conservative party that it is wrong to channel funding into areas where there are greater health inequalities. I am challenging that belief because it would be completely the wrong approach to the NHS. The new formula takes account of the impact of deprivation on health need in ways that were not possible before. It also considers unmet need. In certain areas, there may be people—for example, people from ethnic minorities and socio-economically deprived groups—who are not receiving health care services to the same level as others. If the Conservative party decides to reverse that approach, it will reverse everything that we have been doing to tackle health inequalities.

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I do not think that anyone here is saying that everyone in every area should get identical funding. We want a level playing field in relation to the areas that the Minister has described, such as Manchester, where people die earlier. In our part of the world—the debate is about Hertfordshire—more people are living longer, and that costs the NHS more. When people get old, they get ill and need health care, no matter where in the country they live.

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But the hon. Gentleman cannot have it both ways. He talks about a level playing field, but there will always have to be some way of allocating funding. It has long been proved that in areas of deprivation where health needs are higher and there are inequalities, there is a need for greater funding.

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rose—

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rose—

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I need to move on, because I have only five minutes left, and I want to address some of the other points that were made. If there is time, I will come back to this point.

Overall, no matter what is said, the amount being received in Hertfordshire has grown enormously in recent years. It received £135 million in 2002-03, £151 million in 2003-04, and £165 million the year after—and that is just the Watford and Three Rivers primary care trust. Those are enormous increases in the allocated funds.

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I am grateful to the Minister for giving way. She is very generous. She says that it is not possible to adjust the figures so that they could be, broadly speaking, at 100 per cent., yet, according to a written answer that she gave to a question from my hon. Friend the Member for Hertsmere (Mr. Clappison), that is exactly what the Government did in the financial year 2001-02, when the figure was 103 per cent. Why has that not been possible in subsequent years?

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The hon. Gentleman well knows that the point that I was making was that if the Conservatives are saying that they want to reverse the idea of targeting funding into certain areas—[Interruption.] The figures were given. It was said that in Doncaster, Central, the figures are something like £1,300 per head, whereas in other constituencies it may be lower. That is to reflect the deprivation.

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That is the point. Will the Minister give way on that?

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I will not.

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Order. Let the Minister have some time to speak.

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I need to move on, because the point that I want to come to—

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They are all Labour constituencies.

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Actually, it is about where there is deprivation. It is quite wrong to suggest that the way to deal with health inequalities is to remove the ability to target areas with high levels of deprivation. [Interruption.]

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Order. Everyone listened with great tolerance and understanding when others were speaking. Let the Minister be heard in the same way.

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I do not think that they like it, Mr. Hancock.

It is true that deficits have built up in Hertfordshire over several years, but Opposition Members are, in a sense, suggesting that we should ignore that position and that it will somehow go away. That would be quite the wrong approach. We need to look at how services are delivered. The worst thing for staff, patients and services such as mental health services would be to continue such a process. If the Conservatives were to adopt a policy of ignoring those deficits and making no effort to deal with them, that would not do patients or staff any good. We need to say, “This is the problem that we are facing; we should look at this in the light of the extra resources that have gone in.” The Department can give help through sending specialist teams in to work with local trusts.

I have visited a number of hospitals in the area—unfortunately, I am no longer the Minister with responsibility for Hertfordshire, but I would be more than happy to go back there to look at the mental health services—and people have told me that there have been difficulties with managing the finances over a number of years. We need to consider that. There are ways in which the strategic health authority and the Department can work with areas such as Hertfordshire to ensure that some of the changes that need to be made are made with the minimum of disruption to staff and patient services—

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Order. I must bring the debate to an end. I thank all those Members who worked wondrously well to allow everybody to speak, and I thank Members for the courteous way in which they listened to the Minister, most of the time.