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Community Hospital Services

Volume 455: debated on Tuesday 16 January 2007

Motion made, and Question proposed, That the sitting be now adjourned.—[Liz Blackman.]

I am grateful for the opportunity to speak again about a highly regarded local service: the community hospital. I introduced a debate on the same subject back in November 2005 when I spoke about the national crisis affecting community hospital care. Sadly, 14 months later, despite a raft of Government promises and announcements, that crisis has got slowly worse.

When I set up Community Hospitals Acting Nationally Together, an umbrella group for MPs and Lords of all parties who are concerned about the threat to community hospitals, the number of hospitals under threat of cuts or closure was about 80. According to the Community Hospitals Association, the latest assessment, which was completed yesterday, is that 148 community hospitals have closed or are under threat of cuts or closure—almost half of those that still exist. Twenty-two have already closed and 16 closed last year. More than 3,000 beds have closed since 1999. In Norfolk, eight hospitals are under threat and, in Devon, 19 are under threat and two have already closed. In Suffolk, seven hospitals are under threat, of which one has closed. In Wiltshire, eight hospitals are threatened, of which three have closed. There are 12 hospitals under threat in Derbyshire, two in north Yorkshire, four in the east riding of Yorkshire and two in Lincolnshire. Some 200 beds have closed in Devon in the past month alone. The list goes on.

Later today, I will join the hon. Member for Gosport (Peter Viggers) and his all-party parliamentary group on local hospitals to kick off a national rally in Westminster Hall. Health protests must seem a weekly occurrence for Ministers at the moment. The protests reflect the growing anger across the country towards Government cuts in services at a time, ironically, of record financial resources. The issue of health services has become so surreal that two health Ministers have protested against cuts on behalf of their own constituents.

In truth, it is disappointing to open yet another debate on community hospitals. This is the third debate on the subject in just over 12 months. There was a Government statement to the House during the middle of last year. It is frustrating because many of us—campaigners and politicians alike—share precisely the aspirations set out in Government policy. We share the commitment to bring care closer to home and welcome the vision of providing a new generation of modern NHS community hospitals and facilities. We are not opposed to all change and do not wish to set any service or facility in aspic. However, the Government’s vision is not being delivered.

First, I will talk about the worsening situation in my constituency, which is part of the east riding of Yorkshire, before moving on to the growing national crisis in community hospital care.

Hornsea, Withernsea and Beverley are medium-sized rural towns that have older than average populations and suffer from poor transport infrastructure. Hornsea is the largest town in the country not to have a single A road. The A1079, which runs between Hull and York, is notorious for congestion and has an appalling safety record, while the local bus service is patchy at best. Neither Hornsea nor Withernsea have a railway station and, without the luxury of a car, it can take several hours to travel even relatively short distances. One elderly constituent, who is fortunate to live in a town, told me that returning home to Hornsea from Castle Hill in Hull at 2 pm took her more than four hours using public transport.

Each town has a community hospital providing beds and a minor injuries unit and all three hospitals enjoy tremendous local support. Hornsea and Withernsea have successful friends groups that raise many thousands of pounds to improve the experience of patients. The hospitals are run by the East Riding of Yorkshire primary care trust, which was set up just a few months ago in October. The hospitals and the people have been fighting against service cuts for more than two years. During that time, the number of in-patient beds at Hornsea was slashed from 22 to 12 and the minor injuries unit at Withernsea was closed overnight. Only last September, managers tried to axe the 12 remaining beds pending a review in March 2007.

A consultation was not published and the plan was shelved only after I launched a legal challenge threatening to take the trust to court. Now, the new PCT wants to remove all beds at Hornsea, Beverley, Withernsea and Driffield, which is in the constituency of my right hon. Friend the Member for East Yorkshire (Mr. Knight). The PCT’s preferred option is to retain beds only in Goole and Bridlington. Those proposals would remove every single NHS bed from my constituency. Patients would be forced to travel long distances to receive care in Bridlington or Goole, which is a four-hour round trip by car for some of my constituents who live in Holderness. Alternatively, they would have to be cared for in a private nursing home. However, nursing home provision in the east riding of Yorkshire is patchy—for example, Hornsea has no providers at all. The trust has admitted that, if a provider could not be encouraged to establish a home in Hornsea, patients would have to be cared for in other locations, away from family and friends and their natural home environment. In such an event, a medium-small town with a catchment population of 12,000 would have no medium to long-term beds or health provision.

The consultation period is due to run until March and, before then, the trust will hold four public meetings in locations across the region. However, only one of those meetings will take place in my constituency, outside of Beverley in Tickton, which has weak public transport links to it. There will be no meetings in Beverley, Hornsea or Withernsea, which are three of the towns affected despite the impact that the proposals have had on those communities. The people of Yorkshire are understandably angry. They feel that decisions are being taken over their heads and that they are being denied the opportunity to have a real say. A protest march was organised in Beverley on new year’s day and hundreds of people turned up, despite it being a bank holiday. Previously, on the last Saturday before Christmas, 1,000 petition signatures were collected in just three hours. There are marches planned in Hornsea and Withernsea and I pay tribute to the work of local campaigners; never have I seen communities so united.

The Beverley Health Action Group was recently established with united support from the Labour party, the Conservative party, the Liberal Democrats and independent councillors. After years of continuously fighting the threat of cuts, campaigners in Hornsey have brought everyone together, as have those in Withernsea. My right hon. Friend the Member for East Yorkshire is using his extensive parliamentary experience to oppose the threat to the Alfred Bean hospital in Driffield. The East Riding Mail’s “hands off our hospitals campaign” was launched in November 2004 and has collected about 20,000 signatures. The campaign has done an excellent job of keeping the issue at the top of the news agenda.

The future of community hospitals has brought communities together and united the whole region regardless of political persuasion. That is the current situation in my local area. However, I could be describing the situation in many constituencies across the country.

I congratulate the hon. Gentleman on this debate and on his work with CHANT, which is not a mindlessly partisan organisation—its website demonstrates that. He referred to the new PCT. The aggregation of PCTs in Leicestershire means that the Charnwood and North-West Leicestershire PCT, with three community hospitals, is now part of a mega-doughnut around the city of Leicester, which has two thirds of a million people. Under that new structure and with those inherited deficits, the new PCTs are more likely to take unpopular and unpleasant decisions because they are remote and detached from the areas where facilities will be jeopardised. Does he agree that that has played a part in this problem?

The hon. Gentleman makes a good point. I am not sure that I agree, as I would be arguing against the large conglomeration of any authority. The more important issue is accountability, which I will return to, and the fact that the PCTs are not accountable to local people. Whether the PCT is small or large, the truth is that people feel that PCTs are untouchable. The statutory position––more learned hon. Members may put me right––is that PCTs are accountable only to the Secretary of State and not to local people.

My hon. Friend makes a powerful case and I congratulate him on his excellent and continuing work with CHANT, which he set up. He made a good point about the fact that his part of the country is not the only area that has suffered. I hope that he is aware of the excellent campaign that successfully reopened one of the wards that was closed by the PCT in Skegness hospital in my constituency. He will also be aware that the accident and emergency department will be considered for reconfiguration, which in NHS jargon means downgrading. Does he agree that that is not sensible, particularly given the growing and ageing population in east Lincolnshire and the vast numbers of tourists who visit the east Lincolnshire coast? If it is downgraded, up to 600,000 people per annum will no longer have an accident and emergency service on the east Lincolnshire coast at all and will have enormous distances to travel, either to Pilgrim hospital in Boston or to Lincoln.

My hon. Friend is right and has fought tirelessly on behalf of his constituents. The situation in his constituency is reflected in many rural constituencies throughout the country and the problem particularly affects coastal communities. Perhaps the bureaucrats draw circles around units and use them to determine the viability of an asset. When a circle is drawn around a coastal town, there is an unfortunate tendency for half the circle to be in the sea, which is seen as a reason to remove services from people in what are often sparsely populated coastal areas. From Government downwards, we need to recognise the needs of coastal communities and the fact that they need resources, too.

It is particularly ironic that the services and community hospitals that we are discussing survived post-war economic difficulty and through the economic difficulties of the 1970s, when we last had a Labour Government—sorry, I was not going to make a partisan point; I withdraw that. It is ironic that the events that we are discussing are happening at a time when the Government have doubled—in real terms; it is not fiddled—the expenditure on the NHS. I pay tribute to the Government for hearing the public desire for improved public services. Given that the services have been able to be sustained through all those periods of up and down and of recession and otherwise, how ironic is it that they are to be cut now, just as the money has been doubled? People are genuinely confused. As the hon. Member for North-West Leicestershire (David Taylor) mentioned, that is not a partisan point, because it unites people in the areas affected. I pay tribute to Labour party members, councillors and activists in my local area, who are absolutely onside in opposing the cuts.

The point about reconfiguration is important. The hon. Gentleman will be aware that, in Romsey and the New Forest, I worked with Conservative Members to preserve five local hospitals. Now, we are having to go back to the new PCT to re-establish the ground rules and the promises that were made then to keep the hospitals open. A recent article in the Health Service Journal pointed out that many people were not reappointed to the new trusts if they did not have financial expertise. Does the hon. Gentleman share that concern, too?

I do. We are trying to find out what has caused the deficits—what has led to the financial position that is often the trigger for the cuts. The larger PCT should offer the opportunity for better-quality financial management on the board. It should be easier to find half as many good people as were required previously. There is some truth in that. I was open-minded, when first elected, about the cause of the financial deficit in my local PCT—Yorkshire Wolds and Coast PCT. The view was that perhaps there was financial mismanagement locally, but the Government sent in their financial hit squad—one of the big four accountancy firms—and it found that there was no financial mismanagement in my local PCT, so the attacks that some people had made on it turned out to be ill judged.

Clearly, if the closures and the financial deficits are not the fault of local health service managers, they must be caused by central Government. PCTs are struggling to cope and are being quietly urged by the Government to close smaller units. As the boards of PCTs are appointed and unelected—[Interruption.] Would the Minister like to intervene? I would be delighted for him to do so.

I am listening carefully to the hon. Gentleman and he just said that the Government are urging PCTs to close smaller units. Can he provide some evidence of that?

I am glad to have the Minister’s intervention. The guidance that has been sent out is that, ideally, services should serve a population of 100,000. For many urban-based Ministers, that may seem to cover a very small geographical area, but if the Minister cared to look at a map of my area, he would see that three constituencies in Hull form an area perhaps the size of my hand, yet my constituency, with one third of the population, covers an area 10 or 12 times greater than that. There is that geographic difficulty. I would be grateful if the Minister would address whether that 100,000 population figure is being used, because if there is not such guidance, it is hard for those of us on the ground to work out what is the invisible hand. Statements from Ministers say that they welcome community hospitals, support them and want to see them, yet right across the country an invisible hand seems to be closing smaller units.

One problem, which I hope the Minister will also address, is the nature of the accountability of PCTs locally. As the Minister will know, when I last spoke on this issue, opening a debate on exactly the same issue in November 2005, the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), said in effect that it is not up to the Government; it is all being decided locally by the PCT. However, the PCT is not elected. It is not accountable locally but only to the Secretary of State. Surely in a democracy it is essential that someone who is democratically elected should take responsibility and that surely must be Ministers. I hope that the Minister present today will give a more parliamentary and more constitutional answer and accept accountability for the behaviour of PCTs, which are, as I said, accountable to no one other than Ministers.

I notice that the policy of the hon. Gentleman’s party is an independent NHS. How would that work? How would Ministers be more accountable for decisions in an independent NHS? What rights would they have to step in under the policy proposed by the hon. Gentleman’s party in such situations?

I am grateful to the Minister for that intervention. As so often with Ministers today, they are keener to debate the emerging Conservative party policy than they are to debate the policy of the Government, who have been in place for 10 years.

I will, none the less, answer the question. The point of an independent board is to ensure that the gerrymandering of financial resources that is at risk of happening––and that is suspected by many at the moment––cannot happen and that, once the moneys have been allocated by Ministers who are responsible for the overall budget setting and for the strategic aims of the NHS, they are allocated downwards. The other aspect of the Conservative plan is a genuine return of power and real budgets to general practitioners, so that we have advocates on behalf of the patient at ground level. However, we are here not to discuss Conservative party policy but to discuss the failure of implementation of the current Government’s policy.

As PCTs are appointed, unelected and too often unaccountable, few people on their boards want to rock the boat, but Pat Barlow, a non-executive member of the Cheltenham and Tewkesbury PCT, recently resigned over cuts to local services. She said:

“I certainly could not stand up in public again and expect local people to believe that their wishes counted for much in a climate where every decision could be over-ridden on the basis of financial balance.”

That is from the inside of one of the PCTs set up and appointed by the current Government. That is the climate in which decisions are being made.

In 2003, the NHS policy document, “Keeping the NHS Local—A New Direction of Travel” stated that the guiding principle of any health service changes should be

“developing options for change with people, not for them”,

yet the views of local people, however unanimous, seem to be ignored. The problem, as most people can see, is the lack of accountability. Ministers continue to point the blame at PCTs for the loss of facilities.

When I wrote to the Secretary of State for Health recently to ask for a meeting to discuss the situation in the east riding, which one would think was a legitimate request by a Member of Parliament who is about to see every single NHS bed in his constituency closed, she wrote back saying that it would not be worth while because

“decision making on the configuration of local services must always be a matter for the local PCT.”

To turn anger on the PCT is useless. PCTs are not elected; they are wholly appointed. So much for the Government’s commitment to accountability in the NHS. Every day, it seems, I read of Labour MPs—I am not making a partisan point—who can meet the Secretary of State, yet despite the calamitous situation in my area, I am denied a meeting with her.

I just want to clarify that, although PCTs are not legally accountable to the populations that they serve, there have been PCTs that have striven to be accountable. I am thinking of the former Charnwood and North West Leicestershire PCT, serving 250,000 people, which strove to be accountable, holding open meetings and conducting polls and surveys of opinion in relation to changes that it was considering making. Some PCTs have tried, and are trying, to rise above the narrow legal definition of accountability that the hon. Gentleman articulated.

The hon. Gentleman is right. He is also right that we should pay tribute to PCTs that behave in that way, but the difficulty is that the system does not ensure that PCTs that do not wish to behave in that way are accountable, and I think that many hon. Members would agree. I hope that the Minister will tell us how the Secretary of State is being accountable to voters when she refuses, for instance, to meet a democratically elected Member of Parliament and throws up her hands, saying “It’s nothing to do with me.”

Talking of meetings, it is only three months since we were told that a secret meeting had taken place between Ministers and Labour party officials to work out ways of closing hospitals without jeopardising key marginal seats. We discovered that the Health Secretary had called for those at the meeting to be provided with heat maps.

The Minister shakes his head, so perhaps he can tell us that no heat maps were provided. We also found out that community hospitals in Conservative and Liberal Democrat constituencies are bearing the brunt of the Government’s hospital closure programme, and more than 70 per cent. of the community hospitals under threat are in Conservative-held seats. Every NHS bed is to be closed in my constituency, and there are headlines in the local paper about the marches, campaigning and petitioning against the closures. Not long ago, the same paper revealed that the local trust in Hull had announced that it was to build at least three new mini-hospitals at a cost of £45 million to take pressure off Hull Royal infirmary and Castle Hill hospital in Cottingham—the self-same acute hospitals that my constituents use and to which they may have to turn increasingly if the beds in my constituency close.

Does the hon. Gentleman recognise that there are proposals to increase the capacity of the NHS in Brighton, where, as it happens, all three MPs are Labour Members? Under other proposals, however, the Princess Royal hospital at Haywards Heath, in the constituency of the hon. Member for Mid-Sussex (Mr. Soames), would probably be closed and the Eastbourne district general hospital could be downgraded. There has also been a failure to provide a community hospital in Seaford, in my constituency. Given the population figures, the town should be provided with one under the proposals in “Creating an NHS Fit for the Future”, but there is no proposal to do so.

The hon. Gentleman is right to raise those issues on behalf of his constituents, and many other hon. Members could tell us similar stories from across the country. That is why I am so glad to have the opportunity today to hear from the Minister, who will be able to address some of our concerns and perhaps announce a policy U-turn on some issues—we can but hope.

We currently have a large gap between ministerial rhetoric and the reality on the ground. For several years, the Government have recognised the important role that community hospitals can play. In 2000, the NHS plan, for those who can remember it, was to be the salvation of community hospitals. It committed the Government to introducing 5,000 extra intermediate care beds and said that there was

“near universal support for development of ‘care close to home’”.

In my area, care close to home is still used as the watchword, but care is being moved away and is now four-hours’ return drive from my constituents. “Keeping the NHS local: a new direction of travel”, which was published in 2003, stated:

“Community hospitals can provide a rich variety of local health and community services…One common theme for this type of hospital is a key role in the provision of intermediate care”.

The Labour party’s 2005 general election manifesto pledged to

“help create an even greater range of provision and further improve convenience”—

I would be interested to have that explained to my constituents. It continued:

“we will over the next five years develop a new generation of modern NHS community hospitals.”

Nobody could have predicted last year’s health White Paper, “Our health, our care, our say”, which was positively glowing about the merits of community hospitals. Normal users of English assumed that, when the Government said “community hospitals”, they meant community hospitals as commonly understood—in other words, as existing in 326 or 327 places across England. The document said that community hospitals provided better recuperative care than district general hospitals. In that respect, in my first debate, I mentioned an elderly man I met in Hornsea cottage hospital, but I mention him again because he helped to cement my commitment to community hospitals. When I first visited the hospital, I asked him, “What’s it like in here?” He screwed his face right up and said, “What’s it like in here? I had eight weeks in Hull Royal infirmary. When I woke up in here, I thought I were in bloody heaven.” That is how people feel in community hospitals and community hospital beds. When asked, patients say that they want more care provided in community settings. The White Paper said that intermediate care was

“good for the patient—it is often closer to relatives—and evidence has shown that care standards are higher.”

If the evidence shows that, it could have come only from the community hospitals that existed at that time, but they were not some new model of community hospitals—they were the existing ones. The document was everything that we could have hoped for, but as things stand, Ministers are heading in the opposite direction. Policy announcements are not being followed through.

Up and down the country, the very community facilities needed to make the change from acute hospital-centred care to care provided much closer to home—either in the community or, where appropriate, in the home—are being closed down. Thousands of beds have been closed in community hospitals at the same time that the Government have espoused the need for care closer to home. That is the current conflict between stated Government policy and the reality on the ground—a conflict that must be resolved, and quickly.

I shall leave the Minister with a couple of questions and I should be grateful if he could answer them now; indeed, he could intervene if he wishes. First, may we have a definition of a community hospital? I fear that the Government have perhaps quietly redefined what a community hospital is without telling anyone. Perhaps the definition of a rural community hospital as being one that serves a catchment area of 12,000 or 20,000 no longer fits some national model for community hospitals. Without a definition or an explanation, it is hard to see what invisible hand is driving closures.

My second and most important question, to which I hope that the Minister will give greatest thought, is whether the Government are serious about listening to the patient voice. They have boasted, perhaps fairly, that they have insisted on formal, proper consultation to give local people a say over any changes in the health service; they have said that that is unprecedented, that the position is better than it was under the previous Conservative Government and so on. If they mean that, and if they meant it when they said that changes should be made only with people, not for them, let me ask the Minister one question. In Beverley and Holderness, and beyond into east Yorkshire, every GP surgery, every district nurse, every elected member of the Labour party, the Conservative party, the Liberal Democrats and the independent parties, every parish council, every community group and every school—literally everybody in the community—believes that the beds should remain. That position is unanimous, and not one person takes a different view. Indeed, we had two public meetings in Hornsea last year about a different matter, and I asked the chief executive about this issue at the first meeting. He did not answer, so at the second meeting, I asked “Has a single person agreed with your clinical argument that the proposals are an improvement?” He said no, and I certainly felt at that point that he surely could not carry on with the proposals. If the local communities in my area are utterly united, must the primary care trust listen? Is there anything that Ministers will do to make PCTs listen if they want to carry on and ignore the views of local people?

I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart), who has again chosen an important topic, on securing the debate. I also congratulate him on setting up CHANT, which is an all-party group. We have many common issues, as well as some differences, but those are locality based, rather than party political. I also welcome the topic that he has chosen because it allows me to go wider and talk about what I deem to be community services, which have a community focus, but which may or may not come within the definition of a community hospital. In that respect, one problem—the Minister heard the hon. Gentleman’s question—is what we now mean by a community hospital, and it would help to clarify the debate if we had some response to explain exactly what we mean by the term.

I take issue with one point. If Conservative and Liberal Democrat Members think that only they are feeling the heat, they should come to Stroud, because we have exactly the same problems. I do not feel victimised and I have a good relationship with my hon. Friend the Minister—[Interruption.] Well, I should not feel victimised. However, the issue transcends party political debate, and our constituents feel strongly about it.

I think part of the problem is that the point at which we enter the debate, and the basis on which we conduct it, is sometimes as important as the outcome. People are concerned, and certainly confused, about where we are going. I have two points to make, beginning with a financial issue.

I have been through the whole process, in Gloucestershire, of a debate that has transcended community hospitals and has gone into maternity and mental health provision. The latter is a very live debate at the moment because of the potential closure of three smaller units for older people with mental health difficulties. An issue to be dealt with is what information is available, and the basis on which the financial decision is taken. Those matters also relate to the second area that I want to discuss: what are the underlying medical priorities or prerogatives? Those, too, are not easy to unpick.

As I have said, the debate is a live one in my constituency, where we face the closure of one community hospital, in Berkeley. One could argue that that makes complete sense, because although we are losing a community hospital we are potentially gaining another in the Cam and Dursley area, which happens to be where the majority of the population in the South Vale live. One could take the view that we are swapping one for another. If things were that simple I should have to say, taking account of the population, and with regard to voting, or whatever, that we should go with the place where most of the population live. Stroud is like many other constituencies, in that it is semi-rural. Parts are very rural, but there are concentrations of population in the market towns. If resources alone are considered, hospital facilities, or even medical facilities, should be where there are the largest populations, and people should be allowed access to those facilities. That is part of the problem: it would be okay if we lived in a world where people could get that access, through good public transport, but things are not as simple as that. If Berkeley is closed, other provision will be made, but I would always start to consider the issue from the other end: why do we not think of other uses that can be made of community hospitals, which may not currently be providing the services we want from them? I hope that that debate will go on.

I begin with the financial picture. Gloucestershire is typical, although, with my hon. Friend the Member for Bristol, North-West (Dr. Naysmith), I might say that it is somewhat untypical. We in Gloucestershire felt that we had run a reasonably tidy ship with our budget, and because—I have said this before so I will say it again—we were in the strategic health authority from hell, with Avon and Wiltshire, which had significant underlying deficits which continue to this day, we felt a bit put upon when we had to find £40-odd million in savings in a year. As things have transpired, most of that money has been found. Whether it has really been found, or whether changes are still to come, we shall have to find out. When I entered the debate about these matters, I wrote to my then primary care trust, which, in the nature of a small PCT, sent my letter on to another PCT. We always had a strange situation in Gloucestershire—although we had three PCTs, on virtually every issue there was a lead PCT. In the end, therefore, it was not my own PCT that I corresponded with to try to get the information.

I simply asked for the information that would allow me to make a dispassionate decision, as best I could as a local Member of Parliament, on where the money was currently being spent and whether that was in accordance with health priorities. I wrote a letter last September, when the debate was at its height. It was a few weeks into the period in which we had been asked to send consultation responses. I sent responses about the maternity unit in Stroud and also about older persons’ mental health provision. I also made general comments on community provision. I am still awaiting a reply. I was at one time very critical of PCTs, because I am expected to make decisions on the basis of good-quality information. I asked only four or five questions. I wanted to know what each individual practice spent and how that related to areas’ health needs, because although there has been a debate about unfairness between areas, and the way in which the budget is divvied up, I am fairly certain that there are also instances of unfairness within areas and that the current distribution of spending does not necessarily reflect health needs, whatever we deem them to be. The location of the facilities does not necessarily respond to health priorities. I am still waiting, but I am less critical than I was, because when the figure were completed the new PCT chief executive refused to issue them, saying that they were embarrassingly wrong and that she would not issue them until they were right.

One thing that the current crisis has unearthed, for good or bad, is the dearth of good-quality information on what is being spent and by whom, and whether that spending is being done fairly. I hope that the Government will continue to push primary care trusts so that we receive that information, and so that I can make some proper judgments on the appropriateness of health provision. That really matters for community hospitals, because we need to know the implications as far as who goes to them and whether they receive the right provision.

My second topic is medical priorities. As we are talking about community hospital services, I shall consider mental health. Aspects of some of the decisions that have been taken worry me. There was an underlying pressure to cut with, in Gloucestershire’s case, an attempt to take from the partnership trust 35 per cent. of the budget with regard to older people’s services in mental health. That is a dramatic and indefensible cut. With regard to adults of working age we reallocated the money in question, through closing a centre in Cheltenham and concentrating facilities at Wotton Lawn in Gloucester. We took the money and put it into community and crisis teams, which makes sense. That cannot happen with older people’s health, so a continuing problem arises in that case.

The medical priorities give rise to difficult issues. The arguments that are always used include risk and the idea that there is, increasingly, a greater risk in providing services in very local, small-scale settings. The obverse of that is increased specialisation. Of course there are also many advantages to having consultants all in one place, even though they always seem to like going out to places such as Stroud hospital to do out-patients clinics—and, indeed, to Berkeley hospital. No attempt is being made to get rid of Berkeley in relation to out-patients. Those arguments always confuse me, because of the demand for more centralisation and specialisation.

Besides the fact that I want the Government to explain clearly what we mean by the terms “community hospital” and “community services”, it is important that we should understand that there are non-medical reasons for needing community hospitals. That is certainly true in relation to older persons’ mental health. I should like experimentation with intermediate care to take place. I have a vested interest: some hon. Members know that my father is in intermediate care at the moment. In my view, Berkeley hospital is crying out to be turned into an intermediate care facility, which will transcend health and social care and tackle some of the problems of who pays, and how. Community enterprise models could be examined and alternative streams of money could be sought. There is no big-time alternative to the NHS funded by the state, but there are models to consider. I hope that that debate will be taken forward.

The problem is that we always end up with the question: “Do we close this?” and, if we are lucky, we may get something instead. That is the wrong debate, and it gets a terribly emotional reaction from constituents. That is understandable, because they love their health facilities and hospitals. However, we must move the debate on to consideration of the two issues of fairness that I outlined, and other ways of providing facilities, including GP facilities. We must make sure, in addition, that the debate is not driven purely by medical priorities. There are other reasons why the facilities in question are important.

I should like to be able to call the Front-Bench spokesmen at 10.30 am. Four hon. Members have indicated that they would like to speak, so I should be grateful if they could keep their remarks to about five minutes.

Thank you, Miss Begg. It is a pleasure to have you in the Chair. I start by congratulating my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) on securing the debate. As he said, we have discussed these issues several times in the past 12 months or so. As usual, he vigorously and vociferously championed his area and the cause of community hospitals in general. I also congratulate him on setting up CHANT, of which I am pleased to be a patron.

I participated in a similar debate a year ago when all three community hospitals in my constituency of 600 square miles were threatened with closure. I am pleased to say that the reaction in the community was so strong and vigorous that one of those hospitals is now secure and has managed to reopen the maternity unit, which was then closed, and has completed a redevelopment allowing additional services to be provided in Bridgnorth. The future of the other two remains highly uncertain, however, so I want to concentrate on them today.

In Ludlow community hospital, which is at least 25 miles from the nearest district general hospital, we suffered the loss of the mental health ward six weeks ago. That has meant a loss of jobs, closure of beds and disruption for patients. There are now no in-patient beds for acute elderly mentally infirm patients in my constituency. The only provision available is in a hospital in Shrewsbury that was built in 1843. I believe that it is the last Victorian asylum in the country that is still being used for mental health patients. The closure was against the preference of the responsible clinicians and happened solely because of the financial straits in which the primary care trust found itself.

We are also threatened with the closure of one of the two rehabilitation wards in Ludlow community hospital. That has been staved off entirely as a result of the vigorous community response: the PCT has agreed to a consultation period to allow the community time to come up with an alternative solution. Also, the minor injuries unit in Ludlow has been saved although the hours of operation have been reduced.

The other community hospital with an uncertain future is in Bishop’s Castle. The PCT board is meeting a week today to consider what to do with it. The board had a plan for its reconfiguration which would have involved a nursing home operator taking over management responsibility for the hospital and redeveloping the site. While that plan was seen as controversial in the town, it was at least a plan that the PCT had put forward, consulted on and was keen to progress with, but the plan appears to be doomed to fail almost entirely because of arcane accounting practices in the NHS.

The problem for the PCT is that the community hospital is too small. It sits in the NHS books at an accounting value below the threshold at which opportunities are available for larger hospitals to deal with the problem of impairment, with which the Minister will be familiar. The community hospital is leased from the county council so there is no freehold asset value available. The buildings are in the books at £704,000, which is below the £2 million threshold at which much more flexibility is provided by the NHS. Will the Minister address this issue in his remarks? Where is the logic for that arbitrary threshold? It is entirely within the power of the NHS to relax the threshold at which the NHS bank can be used to provide loans to PCTs to overcome impairment problems.

The PCT has approached Ministers, the finance director of the NHS, the strategic health authority, the Department of Health bank and the county council—the freeholder and the nursing home operator. It has spent 11 months trying to come up with a solution to a £704,000 impairment problem. If it cannot find a solution by next Tuesday, there are no alternatives. All this is to save £150,000 of operating costs. A small-scale problem poses a threat of there being no hospital provision for a large number of my constituents in a remote area.

I deal now with what is happening in Ludlow and a potential way forward for Ludlow community hospital and others. The prospect of salami slicing into the size of activity and the services offered in Ludlow is so worrying to our community that we have been galvanised into trying to find a solution because the PCT is clearly incapable of doing so. At the initiative of the League of Friends, we are working with the local council and the PCT to find a social enterprise solution in which the commissioner-provider role is split and the community takes social responsibility for the provision of health care in the community.

Consultants were appointed last week to prepare a business case over the next three months to establish the viability of an independent Ludlow community hospital managed by the community, through a structure yet to be determined, that would fall outwith the PCT’s management. The idea is to release the management of the hospital from the shackle of the PCT’s financial constraints. Services would continue to be provided by the NHS under contract with the PCT and with nearby acute hospitals, which would provide some rehabilitation cover. The new mental health trust would take responsibility for mental health in Shropshire from 1 April and try to restore some of the provision that the PCT has ended. That is an imaginative way forward. We hope that it might be a pathfinder, certainly for our area within the SHA, which was very positive about the development, and might be suitable for other community hospitals. I urge the Minister to do what he can to ensure that that idea succeeds.

I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) on securing the debate, on his work in forming his group, of which I am a member, and on leading this issue.

“Community” is an overused word nowadays and is used in all sorts of contexts, but in this instance it is the right word. The sort of hospitals we are discussing are central to the communities in which they sit; they provide excellent care and are often a source of pride to residents. Unfortunately, they are also increasingly a source of concern, especially when people see health care becoming centralised in district general hospitals that might well be physically distant. That is certainly the case in my rural constituency in comparison with services in other parts of Devon and Cornwall. We have heard from other hon. Members about the particular challenges in such areas. One might need to travel by car for at least an hour to access a facility, so there are clearly problems in that regard when there is a lack of public transport, as the hon. Member for Stroud (Mr. Drew) said.

There is also an issue with the institutional feel of the larger hospitals. The hon. Member for Beverley and Holderness talked about his constituent feeling much happier in a community hospital than in a larger one. In larger hospitals, there is depersonalisation and perhaps slightly less of a relationship between patients and staff. That is not the fault of the staff in the larger hospitals; the pressure that they are under with the throughput of patients and dealing with increased numbers of people means that they might not be able to offer the support that people welcome in community hospitals.

Staff in community hospitals often live in the community that they serve and are well known there. A nurse who used to be a Liberal Democrat councillor on North Cornwall district council recently showed me around her community hospital. As I went around with her, it was obvious how many local people she had helped in her nursing career in that hospital, and that there was a sense of community in the hospital. This is about proximity, the special atmosphere in community hospitals and the strong relationship between staff and patients.

North Cornwall is served by excellent community hospitals, which are each seen as “our hospital” by the people in the towns and surrounding areas that they serve. That is evident from the passionate groups of friends who support them. Those groups raise money, offer support to the staff, who are under great pressure, and seek to preserve services. In Bodmin some years ago, there was a long campaign to secure a new community hospital, which was successful, and it still has great support in the town.

There were recently huge meetings in Bude, which is perhaps the part of my constituency that is most remote from district general hospitals. I spoke at one of those meetings last year about health services in general in the area. There was a well attended public meeting on 2 January—a time of year when people might be expected not to turn out in the cold. It was about health services in general, but Stratton hospital is part of what people hold dear and of what they want to preserve and develop for the future. A great deal of positivity exists and community hospitals are a huge asset for areas such as mine.

There are great challenges ahead, however, and hon. Members have highlighted particular concerns in their areas. The lack of funding for social services is a problem in terms of the need to get people out of hospital quickly. I have been contacted by many constituents whose family members have been in hospital for far too long when they do not need to be. Such situations put an extra strain on hospitals, and this issue needs to be dealt with. We need closer co-operation between social services and the health sector, as well as democratic oversight to ensure that the process involves the community as much as possible, as other hon. Members have said.

Services have also been withdrawn in North Cornwall—minor injuries units have been closed overnight. Emergency dental services are also under threat. That is a particular problem, given that NHS dentists are hard to find generally, because if there is to be no emergency service there will be no care at all at times. A local doctor served as an anaesthetist at the Stratton hospital so that procedures could be carried out there, but he has retired and is yet to be replaced, so the work that he was able to do cannot continue.

There is a bright, new, independent sector treatment centre in my constituency. It was functioning under capacity and, although it looks modern and is quick, it is never ours in the way that a community hospital is. I have spoken to people who have been to it. They have perhaps done so under pressure, caused by waiting lists elsewhere, and have been given an artificial choice. That is a different issue from community hospitals, but I am trying to highlight the fact that community hospitals are part of their communities and some of the newer ways of providing care do not have the same feel.

The hospitals could offer so much more. I know that the current review of health services in Cornwall, which is being chaired by Professor Nick Bosanquet, will demonstrate that people want community hospitals to be developed further. I hope that the Government will strongly encourage and support PCTs to develop these resources—to expand rather than to contract.

If the next hon. Members to speak can keep their contributions to four minutes each, we will hopefully get them both in.

Thank you, Miss Begg. I, too, congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) on securing the debate.

I want to reinforce, rather than repeat, what other hon. Members have said. In most communities, community hospitals have had a very long history and tradition. The two in my area were both set up more than 100 years ago by public subscription or by endowment. They are owned by the community and are felt to be part of it, not least because the various leagues of friends have raised tens of thousands of pounds, over many years, to sustain the hospitals. The hospitals belong not to the national health service or to the Government, but to the communities. Those communities are rightly up in arms about seeing any threat whatever to the hospitals, given that the largest amount of money ever is being allocated to health services. Yet, those hospitals remain under threat.

I came into this House in 1997, along with other hon. Members, partly because of the threat to community hospitals from the previous Government; there was also what now sounds like a rather hollow promise about having 10 days to save the NHS. Some 10 years later, many people feel that we are in the same position, except for the fact that millions of pounds have been spent. The situation could and should be much better.

Community hospitals can provide local services involving less travel, less cost and so on. They can provide day case surgery, and such provision should be increased. More emergency facilities can and should be provided to take the strain off the big accident and emergency centres in the district general hospitals. There are opportunities for more of the following: disease prevention clinics; health promotion; health education and dietary advice; regular health checks; prenatal and post-natal services; and mental health services. All those things are extremely important to people living in communities, particularly in rural areas, yet we seem to be back where we were 10 years ago.

No one really believes that the Government have any great strategy. They seem to be lurching from one crisis to another, and every time that happens people’s hospitals and facilities are threatened—things that people feel that they psychologically and physically own. Nothing else seems to come under threat, least of all large sums of money that are paid to primary care trust directors and so on.

Community hospitals have a special place in the hearts of people in the community. Hundreds will come to this place and stand outside this building having spent four, five or six hours in a bus and knowing that they will spend the same time returning—they will do so in their own time; they will not be getting paid for it—to say how much they support their hospitals and how much they want them to be maintained. I must warn the Government that back in 1997 the previous Government lost the election partly because of this sort of thing. This Government will not be forgiven by anyone if they persist in a policy that will continue to threaten my constituents’—and my—community hospital.

I am grateful to my hon. Friend the Member for South-East Cornwall (Mr. Breed) for his succinct and appropriate words. I entirely agree with them.

The Government’s document “Fit for the Future” talks about NHS services being delivered at the appropriate level—a kind of NHS subsidiarity. That implies that some services in acute hospitals will have to be delivered in more remote units, which is why acute hospitals in Haywards Heath and Eastbourne, which I mentioned, are threatened and why there will be a consequent benefit for Brighton. That is the bad bit as far as my constituents are concerned, and we are fighting it, because we do not believe the idea to be accurate and appropriate.

The rest of “Fit for the Future” talks about delivering services at the appropriate level in local communities. It says that many functions, including minor injuries treatment, minor operations, breast cancer screening and so on, can be delivered locally. I entirely agree. Such functions can be delivered locally in communities to avoid the sort of transport nightmares rightly mentioned by the hon. Member for Stroud (Mr. Drew) and my hon. Friend the Member for North Cornwall (Mr. Rogerson). We in my constituency are getting the bad bit, however, because the acute hospitals are being taken away from us to more remote places, but we are not getting the good bit of the community facilities delivered locally instead.

I am in favour of the direction of travel that the Government have set out—ensuring more community support in our local areas—but that is not happening. If we had more community hospitals and more local facilities, it would take pressure off the acute hospitals. If the Government’s policy is to have more localisation in respect of minor injuries treatment and minor operations, I simply do not understand why community hospitals across the country are closing, why there are restrictions on night-time services and why community dentists no longer exist. It does not make any sense. I am taking the Government at their word, so if this is their policy, let us have it.

Seaford in my constituency has a population of about 25,000. The Government’s document “Fit for the Future” says that a population of about 25,000 should be served by a facility that delivers the sorts of things that I have just mentioned, so let us have them. At the moment Seaford has almost nothing; it has some general practitioners and what is jokingly called a day hospital, which deals simply with mental health issues and a bit of physiotherapy in a completely clapped out and inappropriate building that is inaccessible to all and has no car parking facilities. That is not a facility fit for a town of 25,000 people.

If the Government’s policy is as they say it is, let us have a community hospital of some sort in Seaford. We should not be talking about closing community hospitals. The Government’s policy is that we should be opening them in towns such as Seaford and others across my constituency.

I shall make one further point, as I know that time is limited. I congratulated the hon. Member for Beverley and Holderness (Mr. Stuart) on his initiative in securing the debate. He talked about accountability in primary care trusts, which is a serious issue. I have long believed that there should be democratic accountability at local level for the NHS. County councils or some other body should be involved so that people can be turfed out of office when they are regarded as inappropriate. Such people should be the commissioners, rather than the unelected officials that do the job at present.

What is the consequence of the unelected officials being involved? Hon. Members may have seen a story in this weekend’s newspapers from my patch. A director of public health in the Eastbourne Downs PCT was appointed in 2002. He worked for three weeks before he had a row with a senior colleague. He was then put on gardening leave for two and a half years on full pay, at the end of which he was given a pay-off, in addition to his salary, of £243,000—he was paid £575,000 of public money for three weeks’ work. That is the sort of accountability that we have in the NHS and it is not working. I hope that the Minister will seriously examine that case, because the PCT that has now inherited that position says that all this was done within NHS guidelines. If that is the case, those guidelines are wrong and need to be changed.

My hon. Friend the Member for Lewes (Norman Baker) made a powerful point about the financial accountability of primary care trusts.

I add my congratulations to the hon. Member for Beverley and Holderness (Mr. Stuart) on securing this debate, and pay tribute to him for his work in setting up CHANT—Community Hospitals Acting Nationally Together—which is an important group that represents the interests of those who care about community hospitals. He has been assiduous in ensuring that its representations have been on an all-party basis, and I, for one, certainly appreciate that.

We have heard stories this morning about the threat facing community hospitals, and many of us have direct experience of that in our constituencies In Norfolk, the primary care trust has an historic deficit of some £50 million, which it has been burdened with since its creation at the beginning of October last year. We face the prospect of losing up to half the community hospital beds in the county, despite the fact that the number is about average for the rest of the country, and the possible closure of four or five of our community or cottage hospitals. The financial crisis facing our health service in many parts of the country seems to be inextricably linked to the threats hanging over so many community hospitals.

Does the hon. Gentleman share the view in Norfolk that community hospitals are just one area where the Government have over-promised and under-delivered? Does he also share the concerns of many people in rural areas such as his and mine who feel desperately let down by a Government who seem to have no idea about and no interest in the realities of rural daily life?

I share the hon. Gentleman’s concerns, which are real in a rural county with an elderly population who often struggle to get to more remote health centres.

It is worth mentioning that the financial crisis would have been an awful lot worse had we not had extra investment in the health service. The hon. Member for Beverley and Holderness distanced himself from his party’s position on that, but if we had had £35 billion less in the NHS and if the Conservatives had had their way, the position would be far bleaker. The public should be aware of that.

I will not give way because I have limited time.

I want to speak about the confused, mixed and misleading messages emerging from the Government on their attitude to community hospitals. The hon. Gentleman was right to draw a distinction between stated policy and what is happening on the ground. I shall start with the Labour Manifesto, which talked of

“a new generation of modern NHS community hospitals...These state of the art centres will provide diagnostics, day surgery and outpatients facilities closer to where people live and work.”

That is a wonderful vision, which we could all sign up to, but the manifesto did not say that at the same time the Government would sanction the closure of many existing community hospitals that provide care close to where people live. People could reasonably conclude that they were misled, but perhaps that is unduly cynical.

Taking the manifesto at its word, it is fair to assume that because it said nothing about closures the grand plan did not involve closing hospitals. If that is the case, one is led to the inevitable conclusion that the closures are an unplanned knee-jerk reaction to the financial crisis facing the NHS this year. Which is it? Were the closures planned and we were not told, or is it crisis management? It must be one or the other.

The confusion continued in January last year. In a White Paper, the Secretary of State gave a reassurance that decisions on the long-term future of existing community hospitals should not be made solely in response to short-term budgetary pressures. She stated that she had asked strategic health authorities help to police that and to stop PCTs closing hospitals for the wrong reasons. Yet in Norfolk, we understand that the strategic health authority, far from blocking closures, was putting private pressure on the PCT to close community hospitals. That was not very accountable to the public.

Then in July last year, the Secretary of State was back offering more good news: £750 million was to be made available for public capital investment to realise the vision of creating the new generation of community hospitals. She stressed in her statement to Parliament that judgments on reconfigurations—the jargon for closures—were for local decision making. The simple maxim seems to be that dispersal of largesse for the provision of wonderful new state-of-the-art facilities is for the Labour Government, but decisions to close existing, much loved, cottage hospitals are taken locally—there is no interference from the Government on that. That is highly selective localism, based on saying “Centralise the good news, decentralise the bad news.”

The truth, of course, is that the whole programme is being driven from the centre. The chief executive of the NHS announces that there will be reconfigurations—there is no question of local areas deciding—and strategic health authorities are then required to apply pressure on local PCTs to force change. The funding comes from Whitehall, where the power lies in our over-centralised health service.

What has been happening over the past 12 months? We know of at least 16 community hospitals that have closed and, as we heard from the hon. Member for Beverley and Holderness, there are reports of a total of 140 being under threat or having already closed. That is a bleak picture.

It is worth restating the case for community hospitals, lest we forget just how important they are. They provide care close to people’s homes and the Government seem to support that vision. They provide an essential safety valve for acute hospitals to keep bed-blocking to a minimum. They gain particular value in areas with large elderly populations by offering rehabilitation, general medical care and respite to relieve carers. They offer end-of-life care, which my own family has experienced, and enjoy low infection rates for MRSA, Clostridium difficile and other infections. They are critical in rural areas where public transport is generally poor for people who must get to more remote general hospitals. It also seems to make sense in rural areas to concentrate professionals together rather than compelling them to travel long distances by car from house to house to deliver care in people’s homes.

My hon. Friend the hon. Member for South-East Cornwall (Mr. Breed) made the critical point that if a community hospital is closed, the NHS loses the active support of the local community. Local leagues of friends raise a lot of money, but they do not campaign to raise money for large, acute PFI hospitals. We squander that support at our peril.

Much has been said about the lack of genuine consultation when proposals are put forward for closure of community hospitals. Too often, local people are left with the sense that the process is a total sham. My plea today is for the Government to listen to what people are saying throughout the land. We value our local community facilities and want to retain them. We should have genuine local decisions on our local health services and genuine local accountability.

I want to end on what is hopefully a more positive note. When the Secretary of State announced the £750 million fund for new community hospitals last July, she mentioned an exciting new development at Wells-next-the-Sea in north Norfolk. There, a small community hospital that was faced with closure was saved when a dynamic group of local campaigners developed a plan for the creation of a new community charitable trust to take it over. That has now happened with the support of the Community Hospitals Association, and particularly Helen Tucker—I am pleased that she is here to listen to this debate. The trust provides services free to NHS patients and is developing a remarkable array of clinics, diagnostic work and physiotherapy—far more than was on offer when the hospital was run by the PCT. Out of a crisis, something positive and innovative is happening. I hope that that vision survives the dire financial situation in Norfolk, because there is a real risk that it will not.

The Liberal Democrats strongly support the development of such public benefit organisations and diversity of provision. They can play a positive role in the future of our health service. However, this debate must be a warning to the Government. We are at risk of losing valued local facilities because of short-term financial pressure and crises. We must not let that happen. If it does, the Government will be guilty of deceit on the British people. My hon. Friend the Member for South-East Cornwall said that the last Government lost power in large part because of their record on public services and what was happening around the country. The same could happen to this Government. These services are too precious to lose and the Government must listen to what people are saying.

I congratulate my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) on securing the debate. It is important and timely given that today a large number of people are travelling to Westminster to campaign in support of local health care facilities. I congratulate him also on his exceptional work with CHANT. Members from all parties have been impressed by that organisation and by what it has managed to achieve in a short period.

We have had a constructive debate so far. It has been one of the more consensual debates in which I have had the privilege of taking part, the only discordant note being set typically by the hon. Member for North Norfolk (Norman Lamb), who speaks for the Liberal Democrats. I gently remind him of our manifesto commitments on funding over the past three general elections. If he were to revisit the Conservative party’s manifesto on funding, he might benefit.

Miss Begg, you would count me out of order if I were to discuss the patient’s passport. All I say is that over three general elections, we have pledged to match Labour’s funding. That was the point I hoped to make in order to benefit the hon. Member for North Norfolk.

On Friday I had the privilege of being granted an audience with the new chief executive and chairman of Wiltshire primary care trust. It is important to note what primary care trusts are, because in the current climate I am afraid that despite what they might feel about themselves, they often act as ectopic parts of the Department of Health. It is unfair of us to lay into primary care trusts and their staff, and to pin on them the blame that rests with Ministers. We have had a consensual debate up to now, but I shall destroy the consensus by trying to pin the blame for the closures—about which I feel strongly—on the Minister and not on the primary care trusts.

The Minister knows well that there are four community hospitals in my constituency. One has closed, and the other three are threatened with closure. A decision on them will be made on 30 January, and in addition it is likely that the mental health and maternity units in my constituency will also close on the same day. The issue is of profound importance to my constituents, and they are distraught that their hard work and effort to inform the debate has been ignored by those who are empowered with making decisions about the matter.

On 30 November 2001, during one of the first debates in which I took part in the House, the current Secretary of State for Work and Pensions, then a Minister in the Department of Health, said:

“There are no plans to close the hospitals that I have mentioned. They have served the hon. Gentleman’s constituents well for many years and are a valuable local component of the NHS in west Wiltshire. On the contrary, the local West Wiltshire primary care trust, which is now responsible for the running of the hospitals, is strongly committed to their future, and is seeking further to develop the services that the hospitals provide.”—[Official Report, 30 November 2001; Vol. 375, c. 1293.]

My word, things have changed, have they not?

What has happened in the intervening period? There has been extraordinary pressure from Ministers to sort out financial deficits. Jobs depend on it at the end of the day, and as the Secretary of State for Health has made clear, her job depends on it. That is what has happened between the remarks that the then Minister of State for Health made in 2001 and now, when all community hospitals in my constituency face likely closure.

Before shutting the hospitals we must engage in consultation that will tick a box. Indeed, principle three of the NHS plan says:

“The NHS will shape its services around the needs and preferences of individual patients, their families and their carers.”

Unfortunately, in many parts of the country the principle has been little short of a charade. It does none of us any good to be seen to be associated with such exercises. They engender in the public a culture of cynicism; politicians encourage the public to take part in consultation, but when decisions are made there is no obvious link between them and the public’s input. I fear that that is true in my constituency and in many throughout the country.

I like to be fair and to give the Government their due when I can, and they have used many fine words about localising health care. In January 2006, “Our Health, Our Care, Our Say: A New Direction for Community Health Services” made some fine statements. They have been touched upon already but bear quoting verbatim. They refer to much thinking in the Department of Health, if not to what is happening locally. Paragraph 6.42 says that

“community facilities should not be lost in response to short-term budgetary pressures”,

and paragraph 6.43 says that

“PCTs taking current decisions about the future of community hospitals will be required to demonstrate to their SHA that they have consulted locally and have considered options such as developing new pathways, new partnerships and new ownership possibilities,”

to which I think the hon. Member for North Norfolk referred.

The Community Hospitals Association points out, however, that on the ground, 80-odd community hospitals face the axe. That is not for want of support for the Labour Government, because the left-leaning think tank the Institute for Public Policy Research only 10 days ago produced a report, “The Future Hospital: The Progressive Case for Change”, which appeared to support community hospitals. The Care Services Improvement Partnership, in which the Department of Health is a partner, appears to agree, according to the partnership’s lavish website.

The Government have said that community hospitals should not close for short-term financial expediency, but that is precisely what has happened. We know, because closures correlate largely with areas in deficit, and those areas are disproportionately Conservative and Liberal Democrat seats. They have suffered badly from the Government’s rejigging of the funding formula and from their removal of end-of-year arbitrage. However, Ministers cling desperately to the ludicrous notion that somehow, health care managers gravitate towards constituencies with Liberal Democrat or Conservative Members of Parliament. That is at least the logical extension of the Secretary of State’s argument.

The Secretary of State appears to have washed her hands of the problem. However, “Shifting the Balance of Power Within the NHS: Securing Delivery” states:

“PCTs will be accountable…to the Secretary of State through Strategic Health Authorities.”

Apparently it means that there is accountability upwards but no responsibility downwards, which is a rather despotic state of affairs.

Let us explode some myths. First, on the cost of community hospitals, it costs £2,500 a week to keep a patient in an acute hospital, and about £900 a week to keep someone in a community hospital. When one achieves the right case mix, community hospitals are cost-effective. Secondly, staff have not been discussed, apart from by the hon. Member for Stroud (Mr. Drew). He was right to say that consultants may spend a lot of time travelling between hospitals, and that it is dead time. I have been to Berkeley hospital, and it was clear from speaking to doctors there that they love it and that they are energised by practising in community hospitals. I am not convinced that it is all down time; they put in a lot more than is accounted for.

Many people who work in community hospitals would work nowhere else. There is a myth that, somehow, nurses will be redeployed in the community after the closure of a hospital. However, I know many people who work in community hospitals. They are there for special reasons and they are special people. When we close community hospitals, I suspect that many such people will be lost to the national health service.

Will the Minister update us on the situation regarding unbundling the tariff? It is vital to the future of community health services, and to community hospitals in particular. What stage has he reached with facilitating changing patterns in community hospital ownership? We have a moral responsibility to understand that although the NHS has owned such hospitals since 1948, they are nevertheless a part of the community. They were often given over by communities, and they are undoubtedly supported all the way along the line by leagues of friends and by others.

Will the Minister also update us on the estate impairment charge, which is an accounting trick? My right hon. Friend the Member for North-West Hampshire (Sir George Young) raised that issue in November 2005, and he was right to do so, but we do not seem to be any further forward. Will the Minister comment on the content of new generation community hospitals? My hon. Friend the Member for Banbury (Tony Baldry) inquired about that in November 2005 and got an unsatisfactory response; it would be nice to have an update on it. Will the Minister also describe how the capital fund of £750 million, which was announced for new generation community hospitals, will be deployed? We should know that right now.

This is a bad news story, and I hope that at the end of the day the Minister will be able to pull a few irons from the fire. Will he please listen to local communities? Their views are simply not in doubt. We need a halt to the wholesale closures that are happening for reasons of short-term financial expediency, and which do not take into account the proper design of community health care facilities.

I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) on securing the debate, and I would also like to welcome the lobby of Parliament that is happening this afternoon. Representatives of that lobby will be meeting my right hon. Friend the Secretary of State.

I welcome the debate because it allows us to make two points very clear. First, there is a strong, bright future for community hospitals in a modernised national health service. An unprecedented programme of investment in community hospital estates and infrastructure is currently under way throughout the country. Secondly, although that is the principal policy direction, the future of community hospitals is essentially a matter for local people and local decision making. Decisions about how services are provided locally and how services should be provided should be taken by primary care trusts and practice-based commissioners. They are decisions for local people to make, and there would be objections from Opposition Members if the situation were any different.

If there is common ground in this debate, I hope it is that we should all be in the business of saving lives rather than buildings. We should be securing better services for our constituents. To oppose all change to the health service and to describe all change as cuts is to fail the health service and our constituents. Such a response to change in the health service possibly stands in the way of both human progress and progress in matters of health. We should recognise that, as society changes, health services may need to change to keep pace.

When the manifesto was written, were these closures envisaged, or have they come into the Government’s plans only since the general election?

I shall take the hon. Gentleman’s point head on because I believe he is confused about it. There is a difference between campaigning for every brick and bit of cement in the current estate and saying that there is a role for community hospitals, but ones that are modern, appropriate places in which health care can be delivered. They should be places into which we can bring services out of an acute setting because they can be safely delivered in a high quality community hospital environment. He needs to make a distinction between the principle of community hospitals playing a role close to local communities, and campaigning to retain every piece of existing estate within the NHS by saying that there can be no change.

Figures show that 38.2 per cent. of the community hospital estate was constructed prior to 1948, and although I accept the point of the hon. Member for Lewes (Norman Baker) that a sense of ownership has been created among those in local communities because they helped to build the facilities, those figures also show that some of the estate is in dire need of modernisation, and nothing should stand in the way of that.

As has been said, the hon. Member for Beverley and Holderness secured this debate, and I shall try to answer some of his points in the time that remains. He raised some fair points, and I do not dispute the strength of feeling in his local community about the ongoing consultation. I say to him that the Secretary of State did not refuse point blank to meet him, and I will happily give the hon. Gentleman a list of all his colleagues whom the Secretary of State has met during the past year. The consultation is ongoing and it is inappropriate for the Secretary of State to intervene in what is essentially a local process.

We keep hearing from the Opposition that the matter should be one for the local community, but when they do not get what they want, they say, “Politicians should intervene.” Let us allow the local decision-making process to take place. It is important to say that it is a question not of closing hospitals, as the hon. Gentleman described, but of changing the way in which they provide services to the local community. There is a big difference between the two points.

The hon. Gentleman ran two lines of argument against us, which were repeated by the hon. Member for Westbury (Dr. Murrison). Essentially, the hon. Member for Beverley and Holderness said that a politically driven process was going on, driven from the centre, using “heat maps”. However, he also made the point that Ministers are out campaigning against changes in the health service. I am afraid by making those two contradictory statements, all he has proved is that change is going on in the health service. I accept that point. If he is trying to allege that some areas are politically insulated from that change, he has disproved that with the very admission that people are out there making the case for their communities as part of the consultation. There is a major difference between people saying that the general direction of policy is right and their making a case for their own community.

My hon. Friend the Member for Stroud (Mr. Drew) made an excellent contribution. He asked about the definition of a community hospital, as did the hon. Member for Beverley and Holderness. That is an important point, and I would like to convey to all hon. Members attending this debate—I am pleased that so many have come—the fact that in the majority of cases, it is for the local community to define what they want. That is the point of our policy. We want local communities to bring proposals to us that describe a modern way of delivering community services, and we will then decide whether those proposals should receive backing. It is not a matter of rigidly prescribing that process at Department of Health level, so that every proposal emerging from a local community is batted away because it does not meet a rigid central definition.

The Minister seems to think that primary care trusts are the local community. The situation we have described throughout the country—and admittedly, to agree with the Minister, it exists in the constituencies of all political parties—is one where the primary care trust and the community are at completely opposite ends of the spectrum.

We announced the first four schemes paid for by the £750 million fund before Christmas. They combine a mix of brand new facilities and redeveloped existing facilities, such as the Gosport War Memorial hospital, which is in the constituency of the hon. Member for Gosport (Peter Viggers). Surely that is the point: not every piece of the existing community estate can or should be redeveloped to provide health care for the future. People have to open their minds to the provision of services in the best way possible to meet local circumstances.

The fund will pay for major improvements in community infrastructure across the country. It will create a new generation of community hospital facilities, and it is for local communities throughout the country to make their case to secure part of that fund. I accept the points made by Liberal Democrat Members about ownership and local communities’ wish to feel a part of such hospitals, but that is exactly what the community hospital fund makes possible. It encourages a strong partnership between local government and the NHS, and we want proposals from local communities that are not ticked off according to a prescriptive definition, but which meet local communities’ needs and are defined by them.

Exactly such a scheme has been approved. The Minehead community hospital is in a part of the country that hon. Members know well. It has been allocated a major amount of funding to transform it into something healthy and living. I do not believe that hon. Members feel that that is inappropriate. In fact, it provides the sort of local ownership that they are calling for the Government to provide.

I would like to finish by taking head on the point of the hon. Member for Westbury (Dr. Murrison) about the funding formula being politically driven. That is an absurd and outrageous allegation. Politicians would be accused of interfering if they went to every consultation and said “That is right” or “That is wrong”. Conservative Members are calling for an independent NHS. Do they really want Ministers to crawl over every proposal, or do they want no accountability?