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Westminster Hall

Volume 455: debated on Tuesday 16 January 2007

Westminster Hall

Tuesday 16 January 2007

[Miss Anne Begg in the Chair]

Community Hospital Services

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?

Health Services (Teesside)

First of all, Miss Begg, may I ask you to convey my thanks to Mr. Speaker for permitting me the opportunity to raise this issue in the Chamber this morning? On countless occasions, I have occupied the Chair that you occupy now, Miss Begg, as Deputy Speaker here, but this is only the second time that I have availed myself of the opportunity to raise an issue from the Floor. In doing so, I am rather pleased and relieved that my hon. Friends the Members for Stockton, South (Ms Taylor) and for Hartlepool (Mr. Wright) are in attendance. Hartlepool is my home town. I managed to escape the rope—I do not know whether he will, but I wish him well. However, I thought that one or two other Members might have attended because although the issues I am raising relate directly to that area in the north-east, I shall make some comments on the general reorganisation of the health service.

Perhaps the easiest way to achieve my aims this morning is to approach the matter historically—rather than hysterically, which I am afraid is how far too many comments have been made in the past, without true regard for the facts. I suppose that I have been concerned about the hospitals involved ever since Frank Harsent was rejected as director, which goes back some years. We had some very troublesome exchanges when trying to mollify the acrimony between my home town of Hartlepool and my adopted town of Stockton. My hon. Friend the Member for Stockton, South will remember some of those episodes with tinges of regret, as do I.

The aspect of the saga that concerns us now, however, really started with a phone call that I received when in the USA in the early months of 2004 from Sue Coward who told me that during the by-election, in which my hon. Friend the Member for Hartlepool was thankfully elected, voters were being terrified by claims from the hyenas of the political savannah—the Liberal Democrats—that Hartlepool general hospital was under threat of closure. That was a downright lie, and they knew it, but as ever that did not stop them propagating inaccuracies.

I was so concerned that I phoned the chairman of the primary care trust, the leader of Stockton borough council and my contacts in Hartlepool and alerted them to it. That resulted in the Home Secretary, who was then a Health Minister, and the Prime Minister, issuing statements saying that Hartlepool general hospital was not under threat, which of course was true. Nevertheless, that campaign went ahead, but my hon. Friend won the day and the Liberal Democrats were discredited by their false accusations.

The outcome was that the Tees review conducted by Ken Jerrold under the chairmanship of Tony Waites was put on the shelf and almost allowed to gather dust. Professor Ara Darzi—a noble man, and I will not hear a word said against him—was given the task of making sense of it all. His remit was that first he should read Ken Jerrold’s review and then recommend measures to preserve Hartlepool general hospital. That was an astonishing instruction bearing in mind the fact that the hospital was not under threat of closure.

Professor Darzi set about his work with a will, and quickly produced a report that could have been submitted, but it was then thought by elders and betters that it might be a bit embarrassing if it was announced before the general election. At that time, my hon. Friend the Member for Hartlepool was already sitting with us on the green Benches and contributing effectively to our debates. There was a worry, though, because a general election was in the offing, so it was thought that it would be better if the report was published afterwards, but the later publication had to be justified, so the idea was proposed by a gentleman whom I shall not name to extend the terms of reference to include the James Cook university hospital and the Friarage hospital in Northallerton.

That was done, and finally we got the Darzi report, which was a magnificent piece of almost critical path analysis—it had arrows going left and right, and Departments going here, there, up, down and all around. It was beautiful, and to the uninitiated it looked convincing, but to the medical profession I am afraid that it was an outright disaster. Many have said that and many have acted on it: we lost an outstanding orthopaedic surgeon called Mr. Miller, who moved to Liverpool because he was unhappy with what was happening—although he still comes back to Teesside to get his hair cut. We lost an eminent paediatrician and gynaecologist who went south. I happen to know also that an anaesthetist with 30 years’ service at the hospital is looking to finish his professional career elsewhere. They are all excellent senior men disturbed by the Darzi proposals.

Staff at the James Cook university hospital south of the river were not disturbed at all. In professional, collective unanimity they said, “It’s not going to happen and we’re not going to participate.” The Darzi report as it was first presented was doomed to failure from the outset, because the medical profession would not have it. Now we are left with a residual concern manifesting itself in the pages of Hartlepool’s local press. It seems that there is still a fear that the hospital is under threat of closure. I state quite boldly that it is not under threat of closure and never has been, and—as people will hear from the words that I shall utter this morning, if I am allowed—it never will be until such time as it collapses into a pile of dust.

Agencies in Hartlepool are seeking to acquire the maternity and paediatric services at the University hospital of North Tees, which has an excellent maternity and paediatrics unit. It is a centre of excellence—so much so, in fact, that it was opened six and a half years ago by none other than my right hon. Friend the Prime Minister, accompanied by his good lady, Mrs. Blair. North Tees’s record is superb—indeed, it is second to none—because right next door, in the same building, are the emergency surgical services that are necessary to take care of cases that might go awry, when mother nature gets awkward. Hartlepool wants to take that unit, yet it does not have the emergency surgical services. There seems to be a hiccup—is that the word?—or at least a glitch in the logic being applied. To take a unit on which millions of pounds have been spent and convey it 12 or 13 miles to the north-east, where it will not have immediately to hand the necessary back-up services that it has at North Tees, is frankly madness.

If we consider the proposal in terms of demography, it is even screwier. Hartlepool is my home town, and my family still live down there. According to the figures for 2005, the population of Hartlepool is 90,000. That is a lot of people—or at least a lot of Hartlepudlians. They are formidable one by one, so 90,000 of them can be a real problem, although I am sure that my hon. Friend the Member for Hartlepool realises that. However, the same figures, from the Office for National Statistics, show that the population of Stockton is 186,700. In other words, it is more than twice the size. Yet we seek to remove the maternity unit from the larger area and take it to the smaller one. That is another glitch in logic.

My hon. Friend the Member for Stockton, South and I have also recognised already that because of the distances involved many of her constituents will not naturally and instinctively make a beeline for Hartlepool. There is nothing wrong with Hartlepool, by the way—I want to survive the rope as well. For some of those constituents, Hartlepool is a distance of between 19 and 21 miles. They will make a beeline for the James Cook university hospital of South Tees, south of the river. I have known the Minister for many years and hold her in high regard. She is an intelligent lady and will not need me to tell her that the James Cook university hospital is already in serious trouble, with saturation of medical cases, and has overspent to a mega degree. It is a wonderful hospital, by the way. It has saved my life a couple of times—much to the consternation of some of my Labour party colleagues—and I hope that it will continue to do so, but it has hugely overspent. However, the people from Stockton, South will make a beeline there simply because it is 15 miles closer than the hospital in Hartlepool

The whole idea of even considering moving the maternity and paediatrics unit from Stockton to Hartlepool beggars belief. I just cannot understand it. Hartlepool has never been under threat and it never will be. Why will it not be under threat? Let me try to put the matter in military terms. When our young men and women are in a firefight and get wounded in a foxhole, their first port of call is the person next to them—the person sharing the foxhole—or they shout for a stretcher bearer. That person comes along with their casualty pack, and might give the victim a shot of morphine, put on a tourniquet and bandage the wound up. That is primary health care.

The next step is to get the casualty removed from there to secondary care, which is usually a mobile army surgical hospital. As a matter of fact, I am going to visit one of those units tonight, here in London. It is a unit that has been used more than any other unit throughout the Iraq and Afghanistan campaigns. Those units perform wonderfully well and I pay all tribute to them. The casualty is moved from primary care to secondary, to the MASH. Having received attention there—successfully, I hope—they undergo CASEVAC, or casualty evacuation, to a tertiary hospital, probably in Frankfurt or in this country.

The health service is having to adjust its structure to a similar pattern—not identical, but similar. We are developing primary provision, through our paramedics in ambulances, our nurse practitioners in GPs’ surgeries, and GPs themselves. That must be the pattern throughout the country. The GPs, the nurse practitioners and the paramedics in the ambulances in the north-east perform so well already and will perform even better as we develop the service to its full potential. I suggest that they will provide the primary care and that Hartlepool university hospital will provide secondary care, as will the North Tees university hospital in Stockton.

However, our constituents who need more specialised attention currently have to go south of the river to the James Cook university hospital, increasing the congestion there, up to the Royal Victoria infirmary in Newcastle or down to Jimmy’s in Leeds. Those two hospitals will provide secondary care, so what are we going to do for tertiary care? Are we going to depend on the James Cook, the RVI or Jimmy’s too? That does not make sense at all. I suggest, as I have suggested many times before, that in seven, eight or nine years’ time, regardless of what happens tomorrow, we are going to need a tertiary hospital north of the River Tees to take care of the larger communities of Stockton and Hartlepool. There is no doubt in my mind about that. Mark my words: it will happen because it has to happen.

I have been talking for about the right amount of time, but I will take a couple of minutes more if I may. I would ask the Minister to take the advice that I offer to her Secretary of State. Tell her to ignore the dust storm that has raged for so long as a result of the Darzi report and to let that dust settle. If it settles in a manner that buries the report—without burying Professor Darzi, of course—I will be a happier man and the world will be a safer place. However, if the dust does not bury the report, I urge the Minister to advise the Secretary of State to put the issue of maternity and paediatrics on the highest shelf, out of anybody’s reach, and forget it. She should then take down the Tees review, so ably completed by Ken Jerrold, and praised so highly by every medical authority that read it that it took my breath away. She should look into that report to see what we can put in place to resolve the problem, if it still exists. I do not think that there is a problem; we should leave the issue of maternity and paediatrics as it is. Hartlepool has a pretty good maternity and paediatric service anyway; why would we want to add to it when we have only half the number of people?

Hartlepool’s advocates will say, “Hartlepool is not just Hartlepool—it includes Blackhall, Easington and Horden,” but Stockton has similar surrounding areas. Not only that, but the town has developed enormously to the south since the 2005 figures were published. It is now developing along the A66 towards Darlington. Its population is far larger than 186,700.

The Secretary of State should look carefully at the Tees review, which is much more sensible. Ken Jerrold was in place for years. Professor Darzi is a very bright man, but he had little time and a bowdlerised remit that had been changed for him. That was not his fault; other people changed it—I do not want to get too heavily into that, but it was not very wise.

The Tees review is valuable because its first priority is patient care and community need, which is where we should have started in the first place. Sadly, however, the Lib Dems changed the argument right from the start, saying that there was a threat that Hartlepool hospital would close. It has not and will not, regardless of what the hyenas say.

All Members involved have received a letter from Peter Carr of the strategic health authority, which states:

“You are aware that the Secretary of State for Health, in August 2006, asked the Independent Reconfiguration Panel to undertake a review of maternity and paediatric services in Teesside following representations made by local authority overview and scrutiny committees…..there is a possibility that the results of the Panel’s work and its advice to the Secretary of State could be published at the end of this week.”

I wonder whether we will hear something to that effect later in this debate. The letter continues:

“Whatever the Panel advice…it would be helpful for David Flory and I to meet with you to discuss the outcome.”

I have arranged for representatives of the strategic health authority to come to my office first thing on Friday morning, at 9 o’clock or half-past 9, to discuss the issues. My hon. Friend the Member for Stockton, South has agreed to be there, and I invite my hon. Friend the Member for Hartlepool to join us, although the authority would meet him separately anyway.

If the issue is not resolved in the sensible way, the electoral consequences in Stockton will make those in Hartlepool seem like nothing. Frankly, Stockton’s reaction will be indescribable. There are other things to be said, but I leave that to my hon. Friends. I thank hon. Members for listening.

I congratulate my hon. Friend the Member for Stockton, North (Frank Cook) on securing this debate. A couple of weeks before Christmas, I secured an Adjournment debate in the House on maternity and paediatric services in Hartlepool. During that, my hon. Friends the Members for Stockton, North and for Stockton, South (Ms Taylor) and I had a number of clashes, and I look forward to something similar today.

I do not want to talk about Professor Darzi and the independent reconfiguration panel’s look at maternity and paediatric services. They carried out a series of consultations. I was interviewed twice, and I understand that they provided their report to the Secretary of State for Health on 18 December. As my hon. Friend the Member for Stockton, North mentioned, it is anticipated that the report will be published some time this week.

In Hartlepool on Thursday, there was a meeting attended by members of the public and the chairman and chief executive of the North Tees and Hartlepool NHS trust, during which the first phase of Darzi’s recommendations was discussed. Patients and clinicians universally recognise that the first phase has been an immense success since it was introduced on 14 December, and there is no reason to suggest that all Darzi’s recommendations would not have similar success. I shall come to that.

I want to talk about the provision of health services in general. In all parts of the country, health services should be based on clinical safety, best practice and specific local considerations and wishes. The residents of Teesside deserve no different from those in other parts of the country; indeed, there is a strong argument that because of our legacy, the people in our area deserve better than average.

People who design health services for my area need to be aware of, and take into account, the specific geographical, historic and demographic factors that demonstrate that in Teesside one size of health service provision does not fit all. On the Order Paper, the title of this debate is “Provision of health services on Teesside”. However, in many geographical, administrative and—most crucially—psychological respects, Teesside does not exist. Although the towns of Hartlepool, Stockton, Middlesbrough, Darlington and Redcar and Cleveland occupy a relatively small geographical area, they are very distinct and have proud and separate identities of their own.

It is significant that in many areas there was very little public support for Cleveland county council. Since its abolition and the establishment of unitary authorities in 1996, coupled with the election of a Labour Government the following year, all areas in the sub-region have improved. Co-operation takes place between the local authorities, but autonomy remains important because of local considerations. Centralisation has been avoided—perhaps health bureaucrats could take heed of that.

Hartlepool has a particularly distinct identity, although I would say that. It is compact and separated geographically from other parts of what is known as Teesside. In addition, in the past few decades population growth and migrant flows into the town have tended to come from south Durham—the former pit villages of Blackhall, Horden and Easington and the new town of Peterlee—rather than from the Teesside area.

There are many family ties between Hartlepool and south Durham, and as my hon. Friend the Member for Stockton, North said, the university hospital of Hartlepool not only serves Hartlepool’s population of 90,000 but is the major hospital centre for the 50,000 or so people from Easington and south Durham. My hon. Friend the Member for Easington (John Cummings) could not be here today—he is performing a duty similar to yours, Miss Begg, in another part of the House—but he suggested that I mention those issues on behalf of his constituents. When we have taken those issues into account, we need to consider taking health provision northwards, not only into my town but into Easington. That applies particularly in the new era of “choose and book”, in which family ties, which help patients who have had hospital treatment to recover, will be a major consideration.

It is unfortunate for health bureaucrats that population areas do not come in neat bundles subject to clear administrative boundaries. Professor Darzi rejected an option that I shall mention in a moment, but now that it appears that all of Darzi’s recommendations are up for grabs, I will say that there is a strong case for reconfiguring NHS trusts in the area to reflect local health considerations, with greater ties between Hartlepool and Easington, to tackle the acute health inequalities. I suspect that more people in my constituency would feel at ease with and have greater loyalty to a Hartlepool and South Durham NHS trust than to the current arrangements.

That distinctiveness and sense of geographical separation is heightened by the transport infrastructure in the area. As my hon. Friend the Member for Stockton, North said, Hartlepool and Stockton are about nine or 10 miles apart. That does not seem far, but it is actually much further than it appears. Public transport between the two towns and between the two hospitals is poor. In many ways, the A689 and A19 cut off Hartlepool from the rest of the Tees area, and the A19 is frequently crowded. If plans for economic expansion in the sub-region come to fruition, particularly the growth of Wynyard, the road—in particular the stretch between Wolviston and Norton—will become even more congested. That will not help achieve the objective of local and accessible health services.

In addition, car ownership in my constituency is about half the national average, which causes problems for people travelling to hospitals or visiting relatives and friends. I fully acknowledge that there are similar rates of car ownership in neighbouring constituencies. My hon. Friend the Member for Stockton, South told me last week that 40 per cent. of households in her constituency do not have access to a car. That makes my point that it is difficult for people throughout the Tees area to access hospital services in other towns. A distance of some nine or 10 miles does not seem far, but somebody who has to attend an appointment in a hospital outside their town, whether it be Hartlepool or Stockton, will find the journey time-consuming and stressful. It may require two or three bus changes. Some people sneer at that, but for some of my constituents an appointment at North Tees hospital might as well be on the moon.

I am not taking issue with what my hon. Friend is saying, but I want him to carry on to a much more pertinent aspect. I agree that there are travel problems, but why does he want more maternity, gynaecology, obstetrics and paediatrics services at his hospital, which already has them? Why does he want to take from Stockton to put in Hartlepool?

I said that I would not discuss specific Darzi recommendations but deal with health provision in demographic, geographic and industrial terms. The point that I tried to make in my Adjournment debate on 11 December—the point that I put to my hon. Friend then—was that Darzi had come up with a set of proposals that sustained all hospitals in the area, not only the University hospital of Hartlepool but the University hospital of North Tees and also James Cook. He did that by proposing a model of regional centres of excellence that takes into account the need in the modern age to recruit and retain staff to allow technical specialist teams to build up expertise, and to ensure that patients are served as well as can be expected.

It appears that my hon. Friend is suggesting that a centre of excellence should be taken from Stockton and given to Hartlepool. That seems nonsensical, because millions of pounds have been spent on Stockton, it has more people, and in any case it is already doing a good job for everybody. He wants more of those services in his own town, but that seems illogical.

A fundamental point is that members of the same political party oppose each other on this issue. Frankly, I believe that there is an inconsistency at the heart of Government policy on hospital and health reconfiguration. Ministers and strategic health authorities say that the provision of local health services is a matter for local consideration—Ministers do not want to get involved in a devolved NHS—and I accept that, but it is inconsistent with the push towards centralisation of technical services.

The result is a situation such as that in Teesside, where centralisation means that services that previously were provided on both the North Tees and the Hartlepool sites should now be provided on one site, for technical and clinical safety. Given that the local NHS takes into account the needs and wishes of the population and decides what the provision of services should be locally, how does one square the circle? I do not quite understand the inconsistency. We are all doing our job of standing up for our constituents, but in an era of increasing specialism and centralisation, how does the policy marry up with the idea that local people should be able to choose the nature of health provision? I do not believe that that has been fully resolved.

Teesside was one of the first areas in the world to experience the effects of heavy manufacturing industry. Until relatively recently, it was the home of many steel and iron works, engineering firms and shipbuilding yards. It still retains a position as a centre for chemical engineering. Indeed, Teesside, particularly the area of Seal Sands, which spans my constituency and that of my hon. Friend, remains the area with the highest concentration of heavy and chemical industry in western Europe. My constituency is also the site of a nuclear power station.

There are two distinct but separate reasons why that industrial consideration, both past and present, should have a powerful bearing on the provision of health services. First, the legacy of industrial illnesses remains acute and distressing. People in my constituency and surrounding areas still bear the scars, often literally, of industrial accidents and disease. There is a higher incidence of diseases such as asbestosis, vibration white finger and respiratory diseases, and many people’s quality of life is adversely affected as a result of working with hazardous materials and perhaps having been injured while at work.

Secondly, the concentration of industry results in a higher risk factor for my area than for many others. Only this month, a toxic leak at a chemical factory on Teesside—in my hon. Friend’s constituency, I believe—injured 37 people and produced burns, skin irritation and breathing difficulties for those who were affected. The majority of people injured at the scene were decontaminated on site by the North East ambulance service, but 17 people had to be taken to the nearby hospital to be treated. That incident shows the risks to Teesside in still being involved in heavy and complex industry, and demonstrates that my constituency and others nearby require a high level of hospital cover, perhaps higher than comparable areas, to help manage the risks properly.

However, the biggest factor in determining health service provision is undoubtedly deprivation and the links to ill health. Twenty-eight per cent. of all super-output areas in the Tees region are in the bottom 10 per cent. of deprivation in the country. In my constituency the figure is higher, at 40 per cent., and it is 55 per cent. in Middlesbrough. Easington, whose population accesses hospital services in my constituency and in Teesside, has an even higher level of deprivation: all but one of the super-output areas in the district of Easington are in the bottom 20 per cent. nationally.

Hartlepool and the wider area of Teesside face acute challenges when it comes to tackling the effects of decades of ill health. I mentioned in my Adjournment debate last month that life expectancy in my constituency is markedly lower than the English average. Hartlepool males live 2.8 years less than the national average, and females live 2.4 years less, but such statistics mask even wider differences. For example, the life expectancy of a man living in Stranton ward in Hartlepool is just 66 years. That is a difference of 13 years from the most affluent ward, which is also the one where life expectancy is best. Life expectancy is similarly bad for Middlehaven ward in Middlesbrough.

People in Hartlepool do not have a healthy diet, as hon. Members can probably tell. It has been estimated by Hartlepool primary care trust that, across the Teesside area, it has the lowest consumption of fruit, with only 34.4 per cent. of males and 45 per cent. of females eating any item of fruit, let alone five, most days.


The death rate from smoking-related diseases is higher in Hartlepool than the average. That is a direct result of the fact that 40 per cent. of Hartlepool adults are believed to smoke.

Death rates from heart disease, stroke and cancer are significantly higher than the national average. Indeed, in researching for this debate, I stumbled on an Adjournment debate initiated by my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) in 2003 about cancer rates in Teesside. Although the figures are slightly out of date, they remain pertinent and dramatic. If 100 is the national average cancer rate, the standardised mortality ratio for all cancers is 128 for Hartlepool PCT, 123 for North Tees PCT and 129 for Middlesbrough PCT.

For lung cancer among women, with 100 as the national average, the rate is 205 for North Tees, 162 for Middlesbrough and 169 for Hartlepool. More frightening is the fact that the rate for lung cancer for women under the age of 50—remember that this is only recorded deaths, not lung cancer contracted—is three and a half times the national average. That means that women in Teesside are three and a half times more likely to die from lung cancer.

Future demographic changes should also play a major role in shaping health provision. It makes sense that the shape of health services over the next 15 years should reflect what the population of an area looks like. I have in mind what my hon. Friend the Member for Stockton, North said about the growth of Stockton. However, the population of the Tees area is projected to fall, according to the Tees Valley joint strategy unit, by about 2.5 per cent. by 2021. According to the JSU’s forecast, that is largely because people of working age, particularly the younger end of the group, will take advantage of a prosperous economy in London, the south-east and other city regions and will migrate away from the Tees valley. Without appropriate Government intervention, the economic base of the Tees valley will not be as strong as it could be, but that is a whole other debate.

It is forecast that the demographic group of those aged 75 and over—the so-called older retired group—will increase in the Tees area by one third, from 46,300 in 2003 to 63,100 in 2021. The group will also make up a significantly larger proportion of the total population, from 18.4 per cent. in 2003 to more than 25 per cent. in 2021. The increase is vital to the design of public services in the next 15 years, because members of the older group tend to be more infirm and to make larger demands on services, particularly health services. The JSU concluded that

“the total provision of services would have to increase substantially simply to retain the current level of service to this section of the community”.

Yet in my constituency, health services in the community have in the past been poor—a consequence of the lack of investment over the past 40 years. The number of GPs is not what it should be for a town of Hartlepool’s size and for its demands on the health service. Department of Health statistics have stated that Hartlepool has 47.5 GPs per 100,000 weighted population, putting my constituency in the bottom 10 per cent. of primary care trusts with the fewest doctors. I know that the Labour Government have done something about that, making Hartlepool a spearhead PCT with additional funding to tackle the problem of recruitment and retention of doctors, but I am afraid that the theme is all too common in health. The Government are making progress, but we are trying to turn around decades of under-investment.

The underdevelopment of community health facilities over 40 years has meant that we as a town rely far too much on the hospital. The take-up of local health facilities is markedly low, with the consequence that people engage with the NHS only when something goes dramatically wrong with their health and they have to go to the hospital. Admissions to accident and emergency have increased by more than 40 per cent. over the past four years in Hartlepool, largely because it is the only health institution that my constituents and their families have been able to rely on for years.

The use of community facilities, even as they come on stream—which they are doing now—will be slow during the period of weaning ourselves off the local hospital. Last year, I opened an emergency care facility in Owton Rossmere in Hartlepool. That is exactly what the NHS of the 21st century should be doing: providing local specialised care within neighbourhoods. However, within weeks of its opening the facility was closed because of clinical concerns at the PCT about safety. That does not help to embed the vital trust among my constituents that community facilities are operational and work safely and effectively. If anything, the opening and rapid closure of the unit fuels the perception in my town that we should rely even more on the hospital for our health needs. That perception would be wrong and unfair.

Much positive work is being carried out in Hartlepool to try to redress the balance in accessing health in the acute or community sector. The modernisation building programme is encouraging, with work taking place at the Headland surgery, the Owton Rossmere health centre and the planned GP complex in the centre of town. Hartlepool PCT is having real success with such initiatives as its smoking cessation services and its teenage pregnancy reduction strategy. However, even with the record investment provided by the Government, we are still probably a decade or so away from establishing a true network of neighbourhood health facilities in Hartlepool that would enable my constituents to reduce their reliance on the hospital. It is wrong, in those circumstances, and completely contrary to Government policy on choice and on moving health locally, to move access to health care away from constituents before community facilities are up and running.

Provision of health services should be based on all criteria such as levels of ill health and deprivation, infrastructure and projected demographic changes. By any of those criteria, Hartlepool and the wider Tees area need further investment. The first consideration in the provision of health services should be what the people deserve and need. There has been uncertainty about health provision in my area for almost a decade. People are weary of the fight and cynical about whether bureaucrats take their views into consideration when shaping health services: 32,403 people signed my petition about the full implementation of Darzi’s recommendations, which I presented on the Floor of the House of Commons a month or so ago. More people signed that petition than voted for the three main parties in the 2005 general election in Hartlepool. I know that people in Stockton are similarly angry about the possible proposals.

I am concerned, as I mentioned earlier, that communities in my area and hon. Friends in Parliament are fighting each other about the matter. I ask my right hon. Friend the Minister to try to discuss the inconsistency that I consider to be at the heart of Government health policy. When health policy and the provision of health services are meant to be shaped locally, and when communities are against each other, with completely conflicting points of view over that provision, what happens? What do we do? Frankly, I think that the Government need to listen to what all hon. Members in the area say and to ensure that health services are provided that match the needs and aspirations of all our people.

It is always a pleasure to participate in a debate chaired by you, Miss Begg. I want to say a big thank you to my hon. Friend the Member for Stockton, North (Frank Cook) for securing time for us to debate the Ara Darzi report.

My contribution will specifically and solely reference the Ara Darzi report. It will reference the concern that we all share that high-quality medical services should be delivered to our constituents. There has been an overwhelming amount of comment and angry debate about splitting the function of paediatrics, obstetrics and gynaecology in North Tees university hospital so that acute services are performed by one hospital and elective services by another, and about the claim in the Ara Darzi report that an excellent department can retain its excellence, even if it is transferred to another hospital. Those views are both heartily contested, including by me.

No consultant from paediatrics, gynaecology or maternity was ever consulted about the spilt in function. I should have thought that if a split were thought appropriate, the first people who would be spoken to would be the experts who deliver the service. Equally, there seems to be no understanding in the report of the fact that it takes time to build up a medical department of the excellence of these three departments. There is a need to attract competent, complementary staff who work together and respect and trust each other. That takes a long time. It has taken North Tees university hospital a long time to attract such competence and to gain the universal respect of the northern region. That cannot simply be transferred. It most certainly cannot be transferred when no medical consultant has been involved in splitting up the department.

It is not merely about people, but about the technical equipment that the hospital has secured over time with an expenditure of more than £7 million—it is probably nearer £10 million. That has ensured that the department has up-to-date, first-rate equipment of the best standard that can deliver the best to the people who require those services—my constituents and those of my colleagues. Such activity takes place over time, not instantly. There seems to be a belief that sheer will-power and a removal van can ensure the establishment of excellent departments of paediatrics, gynaecology and maternity in Hartlepool, but it would take longer and require more persuasive activity. It would also require further expenditure—probably of £10 million—to secure it. Ara Darzi’s plan was wrong in its conception because he did not ask the people who needed to be asked whether the split in function was feasible.

I am keen to tell the House that the same professor did a report on Darlington and Bishop Auckland hospitals. His recommendation was clear. The outcome of the inquiry was that elective and acute treatment should be kept together. What is so seriously different about North Tees university hospital and Hartlepool university hospital? My hon. Friend the Member for Stockton, North put his finger on it: the professor was given the mandate to save the hospital. It was a nonsensical mandate. There never was a threat––it was a nonsense put about by the Liberal Democrats during the by-election won by my hon. Friend the Member for Hartlepool (Mr. Wright). It persisted because local people passionately want to keep what they have and do not want it closed. Professor Ara Darzi responded to that nonsensical threat, which was whipped up in the press by the Liberal Democrats—and shame on them for doing so.

My concern today is to secure the best medical services for the people that we serve. If they have to travel for half an hour or even two hours for the best, then so be it. As politicians, we should have the guts and the courage to say so. It is time that we acknowledged the fact that there is not always enough money instantly to produce the best. For me, the absolute fact is that we have the best in North Tees university hospital, and I am not prepared to let it be split in two when such a split does not make sense.

I bring to the attention of the House the fact that one clinician has resigned and that others are considering their position. People are saying that the situation is insecure and that they are not prepared to accept it. They are also not prepared to do again the phenomenal work that it took to develop the department in the first place, as they will have to retrace their steps entirely if it is to be reproduced at Hartlepool university hospital. I do not accept that the argument is about the miserably low level of health achievement universal in the north-east, about which my hon. Friend the Member for Hartlepool spoke. I am not prepared to go down that route.

We should understand exactly what Ara Darzi’s report will mean for three departments of excellence. The paediatrics, obstetrics and gynaecology consultants said that they have a very high level of emergency work. They all believe that they should not be moved to an elective site. Are we serious in not taking the experts’ advice when designing appropriate medical services? If so, our constituents will look upon us with disdain. The obstetric consultants emphasised that theirs is essentially an emergency service. They said that it makes no clinical sense for the department to be moved to an elective site, as they usually deal with emergencies.

The paediatric consultants state that, if paediatric services are separated from the acute site, it will require a significant increase in investment to provide round-the-clock cover for paediatric surgery and trauma. A doubling of the staff employed in both hospitals will have to be accepted. They also say that both sites will need a paediatric anaesthetist, and they are scarce. The consultants say that it is difficult to get staff appropriately trained to deal with trauma and emergency operations and that total understanding and competence is required of all consultants and surgeons performing such operations. They also say that running costs will be significantly greater.

The consultants gave me examples. They said that the vast majority of women giving birth need consultant care. Although the majority of women deliver babies without complications, that is not synonymous with doctors having no input. They also say that there will be a high transfer rate between the midwife-led units at North Tees hospital and consultant-led units at Hartlepool hospital. On paediatrics, they said that many decisions can be made only by specialists—for instance, a child suffering from stomach pains may have appendicitis, but paediatric emergency services with surgery competence will be needed if a misdiagnosis is made.

It does not need an Einstein to understand what is required. It is not about ensuring an easy transfer between two hospitals; the journey on the main roads between Hartlepool and North Tees hospitals from 8 am to 9.30 am and from 4.30 pm to 6 pm is seriously difficult. A misdiagnosis might not be problematic, but such a journey might have to be accommodated. A child who had received emergency surgery for appendicitis in North Tees hospital would have to be transferred to Hartlepool for post-operative care. We must understand the problem. For example, a mother with three children may have to travel by bus to see one of them in hospital. Will she be able to see her child in Hartlepool as easily as in North Tees university hospital? I do not think so. We need to consider such services in the round.

The gynaecology service makes the same point. Someone with stomach pains could be suffering an ectopic pregnancy; that could be highly problematic. The last thing we should do is to split acute and elective surgery, as it would threaten peoples’ lives.

Of course, it is not only the consultants who would have problems. The overstretched ambulance service told me that, if it made the wrong diagnosis, the patient could be taken to the wrong hospital. Should the ambulance go to Hartlepool or North Tees? The wrong decision could have a serious outcome.

With the best grace that I can muster, I have to say that the Ara Darzi report, which splits the functions and suggests that we can transfer excellence effortlessly, is wrong. I am delighted that the independent reconfiguration panel has reconsidered it. I must tell the Minister and my hon. Friends that, if I am wrong and if I have misunderstood the information and evidence that I have been given, I will say so. I will accept the panel’s conclusions on how best to deliver the best medicine for the people whom I represent. I believe that I am honour-bound to do so.

My hon. Friends mentioned travelling. I have a large population in the south of my constituency—in Parkfield, Thornaby, Yarm, Hilton and Kirklevington. It probably takes people 20 minutes to get to Middlesbrough by bus, and it would take at least an hour and a half to get to Hartlepool. That is the operational distance. If it takes people 20 minutes to get to Middlesbrough, take it from me, they will not go to Hartlepool. If they do not travel to Hartlepool, we will have a split in elective and acute services and Hartlepool will find itself without sufficient throughput of patients. My people will not go to Hartlepool, and I am not making that up; it is a fact. The throughput will not be sufficient and that department will be vulnerable before it begins its life. I ask for someone to take that on board. It is not just because of the hour and a half journey time or because my constituents have to travel south before they travel north; people face two or three bus changes and may have buggies or young children. In addition, the cost will be three times that to go to North Tees hospital.

The conclusions regarding this issue are wrong because the report was set up with the wrong purpose: to save Hartlepool university hospital. There would never be a threat to that hospital. I would stand on the line protesting with my hon. Friend the Member for Hartlepool if I ever thought that there was a threat. The conclusions are wrong and I hope that I have made sufficient sense and that what I have said is taken on board—I said the same when giving evidence to the independent reconfiguration panel.

I end where I began by making the same statement very quickly all over again. My concern is for the delivery of competent medical services to the people whom I represent. That is what I shall fight for and that is what I believe should be delivered. I am not arguing for North Tees to have what Hartlepool does not. I am simply saying to hon. Members that the division suggested by Ara Darzi is plain wrong and that all the evidence supplied by the consultants would support that statement.

I congratulate the hon. Member for Stockton, North (Frank Cook) on triggering this debate and all hon. Members on speaking passionately in favour of their constituencies and the services within them. I will not venture too far into the details of the cases made as it would be too much like venturing on private grief and discord, which according to some hon. Members is entirely the fault of the Liberal Democrats and nothing to do with the Government, who are running the health service.

I am fond of the area and must confess that I visited Hartlepool because of recent by-elections.

They did.

I will concentrate on the generic features that an issue such as this throws up. I am a veteran of such issues. My local hospitals were reconfigured in 2002 when the Shields report, not the Darzi report, was implemented. The accident and emergency, paediatrics and maternity departments were moved, and there were marches, meetings, protests and gigantic petitions. I even had a hospital campaigner backed by Martin Bell stand against me in 2005.

Today’s events in Westminster Hall suggest that my experience in 2002 is now replicated across the land. The problems associated with this issue are a product of certain pressures and policies. The pressures are relatively well established: the working time directive, the new tougher financial regime, the drive to get hospital deficits down, changes in the hours for junior doctors, and the higher training needs specified by the royal colleges. The other factor is policies and there are some good policies based on the need to have centres for excellence, the drive to improve quality and the need to have services brought closer to the patient at a community level.

The problem is dealing with the pressures and the policies while getting the balance right. There are a variety of routes that can be followed to balance out the pressures and the policies. One mantra recited by the Government is to leave it to local decision making, which, we all understand, really means decisions by a local quango—a locally based set of appointees. Following a consultation that is often completely ignored and, in many cases, virtually an insult, quangos make their decision with all the aplomb and indifference of colonial governance. That is not genuine local decision making, but, time and time again, it is what the Government call local decision making—I have heard it said already this morning. In fact, decisions are not made by local people, but by local appointees who ultimately owe their careers to the health service, not to responding to what local people ask of them.

Answer No. 2 when dealing with the balancing out of pressures and policies is to have a report and implement it, whether it is a Jerrold report, Darzi report or, as was relevant to my constituency, a Shields report. The deficiency in that is that such reports tend disproportionately to reflect the interests of medical communities, which are more worried about litigation and the advice from the royal colleges than issues of access. The report carried out in my neck of the woods on configuring services contained a clause that suggested a configure services in a particular way that created enormous transport problems—there were not the roads or rail or bus services to support it. The report went on to say that that was not an issue for an NHS report. In other words, how people get to the services was outwith its concern. The same is true of many reports that I have seen that have attempted to reconfigure services: the transport issues are set aside for somebody else to deal with.

Reports take time and are normally a long time in the cooking before they see the light of day. During that time, the world changes and the advice changes––even advice from the royal colleges. Also, as has been alluded to today, they tend to be nipped in the bud by political tampering and do not turn out to be the honest pieces of work they ought to be. That is also unsatisfactory.

Answer No. 3, which was referred to by the hon. Member for Stockton, South (Ms Taylor), is to refer the issue to the independent reconfiguration panel, which, in principle, is a good idea. However, reference in most cases depends on the Secretary of State being compliant with it and, even when the report is done, it will not have the necessary coercive force.

The solution that we all advocate is genuine local decision making, but that needs to be based on two distinct pillars. We need to have a clear view of the entitlements and what the people of Teesside require in terms of service and access to service. The hon. Member for Stockton, North referred to the fact that people did not start by considering what people needed, but rather the more problematic question of what the services are and how they might be configured. We should also be clear and honest about what the people of Teesside and the country are prepared to pay for through taxation, because every service comes with a price tag.

We need more fairness and honesty from the Government on this issue. There are a range of concerns and three particularly affect Teesside, but they also affect most parts of the country. One issue is deficits, because they tend to affect how things turn out. There is no doubt that previous NHS methods of finance were sloppy and had broken down into a system of bailing each other out—a kind of financial pass-the-parcel. When the music stopped, and, clearly, it has now stopped, some trusts were left holding huge historic debts. Under new resource accountancy rules, that meant reduced revenue and led to a spiral of decline, added to which some trusts—I do not know what the situation is in Teesside—are saddled with substantial debts as a result of capital investment or private finance initiative schemes. Without fair funding, configuration cannot be done fairly and people will not be persuaded that clinical needs are the driving force. We have not got there yet and that is why these problems persist.

The Government also need to be clear about moving care into the community. They cannot just talk about it; the funding and the service actually has to be out there. Community-based care cannot simply be an aspiration to justify closing existing facilities. There was a case in my constituency where the blood service was moved out of the hospital to a clinic. That was called “moving it into the community”. It was moved into a clinic in the far south of the constituency, so 50 per cent. of my constituents now have further to go for a simple blood test. They would much prefer to have the service in the hospital, because it would be closer to the part of the community in which they live.

It is crucial for Teesside that we have clarity on neonatal safety. We had a recent debate in the House on maternity services and I listened carefully to what the Secretary of State said. She began by praising small, midwife-led units. Later, she extolled the virtues of high-tech ones. When asked what would be the optimum size of a maternity unit and what evidence the Government had for any view that they might take, she dodged the question. I remember that she was pressed on the issue by the hon. Member for South Cambridgeshire (Mr. Lansley).

I do not think there was any desire on the part of the Secretary of State to be mendacious, duplicitous or especially evasive in this context. She was talking about units being safe for different types of birth. Clearly, midwife-led units that are well run will be safe for unproblematic births; for more problematic or low-weight births, a more sophisticated unit will be required. What is required in a maternity unit has become extraordinarily vague. It would be helpful if the Government published the evidence on what is safe and for which type of unit and birth, and the standards required. They would thereby add the clarity that the debate needs. Unless the Government contribute more clarity to the process, what we are seeing today in Teesside will be replicated in other areas and heard about in debates throughout this Parliament.

I add my congratulations to the hon. Member for Stockton, North (Frank Cook). These debates have become a familiar scene. Ministers and shadow Ministers visit this Chamber fortnightly to deal with some part of the health service that is annoying hon. Members around the country. This debate has a particular sense of déjà vu about it. It is round 2 of the debate that the hon. Member for Hartlepool (Mr. Wright) started on 11 December, with the same protagonists from Hartlepool, Stockton, South and Stockton, North, although we have had perhaps rather less heated interjections from the hon. Gentleman this time. The time was extended from half an hour to one and a half hours and, with the added reference to the hyenas of the political savannah—the Liberal Democrats—I feel something of a bystander in all this.

Hon. Members have spoken about the relative merits of James Cook university hospital in South Tees, the university hospitals of North Tees and of Hartlepool, the Darzi report and the Tees report by Ken Jerrold. I add my tributes to the very dedicated staff at all three hospitals, who must be bemused by the political to-ings and fro-ings that have gone on over too many years when they all want to do is to get on with their job of looking after their patients to the best of their ability. I have not visited any of those hospitals, but all the speeches made by the hon. Members representing the constituencies where they are based were eerily familiar.

The hon. Member for Stockton, North talked about constant reviews. In my part of the world, we have had that, too. He spoke about reviews and their timing being to do with general elections. We had that in my part of the world in Sussex as well. He and other hon. Members talked about consultants voting with their feet and leaving, which is very worrying. We have that in our part of the world, too. He also made the bold claim that Hartlepool hospital is not under threat of closure and never will be. We used to think that about some of our hospitals in Sussex, too. Just two years ago, we were given cast-iron guarantees by the present Government that there would not be any more tampering or reconfiguration. Now, they are under the spotlight of reconfiguration, closure or downgrading after all, so my advice to the hon. Gentleman is not to hold his breath.

We heard a familiar story about millions of pounds being lavished on new facilities at hospitals, only for it to be proposed that they be transferred elsewhere. The James Cook university hospital, which the hon. Gentleman referred to, is already in trouble with saturation and deficits. We, too, have hospitals like that, which will supposedly have to grow to take up the slack.

The hon. Member for Hartlepool made similar comments, although obviously tailored rather more to his own constituency hospital in Hartlepool. He talked about demographics and mentioned the greater needs of the elderly population. I think he said that 15 per cent. of his constituents were over the age of 60. He has got it easy. In Worthing, in my constituency, 45 per cent. of the population are pensioners and 4.5 per cent. of that population are over the age of 85, with all the extra health requirements that the elderly population has. I am glad that he drew attention to that issue, because it is a case that we have made and that Ministers have not paid sufficient regard to on too many occasions.

The hon. Gentleman spoke about congested roads. Again, we have it worse in Sussex, in the most densely populated part of the country. He spoke alarmingly, but rightly, about the poor public health figures. They are not down to poor hospitals or good hospitals but to the complete failure of the Government’s public health policy. He gave shocking figures for the alarmingly increased chances of death from lung cancer in women under 50 in his constituency. He talked about 32,000 people signing a petition; some 300,000 people have signed petitions against reconfiguration in my county alone.

The hon. Member for Stockton, South (Ms Taylor) concentrated on the Ara Darzi report and some of the inconsistencies between earlier reports that it threw up. That was all eerily similar to what is going on in the health service up and down the country. For North Tees and Hartlepool hospitals, I could easily substitute Worthing and Southlands hospitals and the Royal Sussex county hospital at Brighton, in my part of the world. Every Sussex hospital is under the spotlight. The difference is perhaps that in our part of the world Ministers do not join the demonstrations outside those hospitals against their downgrading. I suspect there are problems elsewhere in other areas of the region that we are discussing. Tomorrow, the hon. Member for Middlesbrough, South and East Cleveland (Dr. Kumar) will talk about education funding in the same area.

What is common to all these discussions is that we believe that any decisions about major reconfiguration should be based on three main things. First, they should be based on sound clinical practice that should improve the standard of health care for local communities, not on financial expedients. The Government need to come clean and admit that many of the decisions are being made on the latter basis. Secondly, they should take the local community with them if there is to be any credibility to Government claims about local decision making being of the utmost importance. The NHS is owned not by Ministers, NHS bureaucrats or even the staff but by the people and the patients. That is why the NHS is there. There should be genuine consultation of local people, the consultants and the clinical staff—to which the hon. Member for Stockton, South referred—not the sham, preconceived consultations that we have often seen.

Thirdly, there is more to hospital services than bricks and mortar and places of treatment. This is about the quality of life, the effect on large employers, infrastructure and transport, convenience and incentives to business. Just yesterday in my town, Worthing, the chairman of the South East England Development Agency came to a press conference to say that he believes that the proposals for reconfiguration in Sussex will have a serious detrimental impact on investment in our region—the powerhouse of the United Kingdom economy—and will downgrade the quality of life. He went on the record and said that. There is much more to this argument than just short-term financial balancing of books.

I could go into great detail about the problems with maternity services. A lot of this is about the vagueness of the proposals on which the decisions are being made. Does a maternity unit need to have 3,000 births to be sustainable and viable? In our part of the country, we are told that there must be at least 4,000 births, but Worthing hospital, for example, will have about 3,000. The largest maternity unit in Germany deals with only 3,000 births. If the reconfiguration proposals for our area go ahead and everything goes to Brighton, it will be the largest maternity unit in the whole of Europe, not just in this country. That cannot be good for patient care. Why does big always have to mean best? There is no evidence on which those decisions are being based that says that maternity departments of 3,000 or 2,500 or even 2,000 provide a lower quality of care, or pose a higher risk of mortality, to mothers and babies.

Let us have genuine horses for courses. Let us have genuine local consultation and local decision making. Let us not have the divide and rule that is going on in the health service. We have seen it graphically this morning, with neighbouring Members from the same party arguing for different things. If it ain’t bust, don’t fix it, and if it really is down to short-term financial expedients, the Government should at least have the honesty to say so, so that we can have a transparent and honest debate. The Government are busy trying to avoid that.

I will not, because the hon. Lady went over her time and I have only one minute left. I want the Minister to have her fair share of time at the end.

Too many decisions are being made by health bureaucrats behind closed doors, and that is increasing people’s suspicions and cynicism about what is really driving reconfigurations and about who is in control. We owe it to patients and our constituents to ensure that decisions are based on evidence and on what is good for their communities. This issue will run and run, and I suspect that at least some of us will be back here in a couple of weeks for a similar debate about another area of the country that faces similar problems.

I congratulate my hon. Friend the Member for Stockton, North (Frank Cook) on securing the debate. Obviously, the future of health services in Teesside is a concern for all my hon. Friends who are present, and they have closely reflected their constituents’ concerns. I was pleased to hear that my hon. Friend also has a connection with Hartlepool.

The debate has reflected the fact that the decisions that we are discussing are difficult and controversial, and strong feelings are expressed on all sides at local level. It is important to stress, however, that there are many reasons why we must look to the future provision of health services, including changing demographics and the ability to provide higher-quality services. Within that, however, there is also the need to consult local people during debates on those issues.

My hon. Friend referred to the inaccuracies in the stories that the Liberal Democrats have put about regarding the provision of health services, and I should add that there has also been a certain disdain for the actions of local people. I do not know whether the party of the hon. Member for Southport (Dr. Pugh) has any members on the joint overview and scrutiny committees, but I am sure that any such members would be pleased to hear that they are considered local appointees who take decisions with no consideration for local feeling.

The Minister is perfectly well aware that overview and scrutiny committees do not make decisions about the reconfiguration of services.

The hon. Gentleman is incorrect. The reason why an independent review of local proposals is going on is that the joint overview and scrutiny committees made a referral. If that is not having an influence over the matter, I do not know what is. However, I am sure that committee members will be pleased to hear that he thinks that their contribution to the local situation is irrelevant and unimportant.

The hon. Member for East Worthing and Shoreham (Tim Loughton) must recognise that reconfigurations are often carried out to improve local services. I would be surprised if the policy of his Front-Bench colleagues was to expect the NHS never to have to change to reflect local changes in demography or medical advances. I do not think that we could expect the NHS never to change, and it would be bad news for the NHS if he said that the issues that I mentioned would never be a consideration.

It is important to pay tribute to staff in the region, and I join Opposition Members and my hon. Friends in doing so. The staff have worked extremely hard to make real changes in the provision of health services in their area by reducing waiting times and promoting higher-quality services. It is important to stress that that has been achieved in partnership by combining the achievements of staff at local level and the increased investment that the Government have been able to provide. Primary care trusts in Teesside, for example, have received more than £568 million this year, and that will rise to £626 million next year, although the Opposition have consistently opposed our extra investment.

Does the Minister accept that we are not only seeing phenomenal investments in our health services, but fighting for better services? Nobody, but nobody, should blame us for doing that. In 1992-93, we fought to ensure that the previous Conservative Administration did not close North Tees general hospital.

My hon. Friend is right. All my hon. Friends referred to the fact that their region has some of the most deprived health areas in England. My hon. Friend the Member for Stockton, North touched on the growing population served by the different trusts. My hon. Friend the Member for Hartlepool (Mr. Wright) highlighted some of the health problems that have arisen because of industrialisation and particularly because of contact with hazardous materials. It is very much part of the Government’s policy to try to reduce health inequalities through a mixture of extra investment and new opportunities for NHS staff.

Let me deal briefly with some of the issues around the current reconfiguration proposals. My hon. Friends clearly set out the background and history to some of the changes, and hon. Members have touched on the different reviews that have taken place, culminating in the Darzi review, which proposed a number of changes. Given the diversity of views and the changes in services that have been proposed, it is not necessarily surprising that the joint overview and scrutiny committees wish the issue to be referred to an independent scrutiny panel.

Let me touch on our vision for maternity services, because it is important for a number of the issues that hon. Members raised. We want there to be three main drivers for the provision of maternity services: the maternity standard of the national service framework for children, young people and maternity services; our 2005 manifesto commitment to improving choice in maternity services; and the White Paper “Our health, our care, our say”. The White Paper emphasised my hon. Friends’ point about the importance of getting services into the community, and they highlighted what happened previously, when there was a reliance on hospital services. The issue is how we ensure that we have good services in the community, and the hon. Member for Southport referred to the standard that we have set out, which, in a sense, pulls together the Government’s vision for maternity services over the next 10 years. Women should have easy access to supportive, high-quality maternity services that are designed around their individual needs and those of their babies.

All hon. Members said that it is important to consult clinicians, and I absolutely back that view, because it is important that we can do that. Following the review of maternity and paediatric services in Hartlepool and Teesside, two scrutiny bodies chose to refer the maternity and paediatric elements of the proposals to the Secretary of State. In response to the inquiry from my hon. Friend the Member for Stockton, North, let me say that the report on the issue will be published on 19 January. In view of that, it is not possible for me to comment further on the detailed points that have arisen, except to say that I agree that it is time that there was some certainty about services. The reviews have gone on for many years, and I am sure that local people and clinicians want that certainty.

Bank Penalty Charges

I think that everyone will be familiar with banks’ charging system. I do not know whether the Minister has been subject to any penalty charges, but the fines are incurred when there is a lack of funds in the account to cover payments out, such as direct debits, bounced cheques and exceeding the overdraft limit. What may not be realised is that every year about one in four bank customers suffers penalty charges, that a single charge can be anything up to £38—they average about £30—and that the charges can be applied on every occasion when someone goes over the overdraft limit, for every cheque or direct debit at that point. Last year the top six high street banks therefore pulled in an estimated £4.5 billion in such charges.

I am raising the matter today because I believe that it is a major contributor to the UK’s debt crisis and to social exclusion. Perhaps most important of all, those bank penalty charges are more than inconvenient and unfair—they are illegal. The fact that they continue to be levied in such large sums leads one to conclude that the Office of Fair Trading is failing and the Government are turning a blind eye. What may be a minor inconvenience to a person on a good regular income becomes a spiral of debt to the bank for those who are less well-off.

At my travelling surgery this year, as I was researching the issue and becoming more aware of it, I started to ask constituents who came to me with other problems—such problems were often, I might add, caused by government, and delayed payment of pensions, tax credits or benefits, or delays with the Child Support Agency—about the bank charges that they might be facing. I have yet to find a single case of somebody in such circumstances who does not tell me that they had been hit by bank charges. The problems are often caused through no fault of their own, and result from Government inefficiency and late or non-existent benefit payments, which are payable to the people in question only because they are already hard up. They are then mugged by their bank not with just one charge, but with numerous charges, since one penalty causes another and another. The people involved, who are at the bottom of the income scale and who depend on support for one or another reason—it may be a pension or disability benefit—find it impossible to extricate themselves from the excess on the overdraft limit. They continue, therefore, to be hit by penalty charges.

Numerous constituents have experienced that snowball effect. They are hit by hundreds or thousands of pounds of bank penalty charges, either because of someone else’s mistake or because they have made a small error themselves, such as assuming that a cheque has been processed by the bank more quickly than it has. The worst hit are low-income families, single parents, the elderly, the disabled, people who are out of work, students and young people who are starting out—the very people whom the Government say they were elected to defend and whom they want to prioritise.

An example is when a late pension payment leads to a charge for a bounced direct debit. The pension payment finally arrives, but the pensioner is still over the limit because of the previous penalty charge, so another penalty charge is levied, and then another—charge after charge. A real example concerned Miss R., a student from St. Austell, who had an account with the Alliance and Leicester, but moved most of the money into another bank account, leaving just a few pounds behind, and instructing all the organisations with which she had a direct debit mandate to use the new account. An insurance company mistakenly issued a direct debit request on her old account and the Alliance and Leicester bounced it and charged Miss R. a penalty charge. She went overdrawn, which meant she then incurred another charge. In three months she had received £300 in penalties. Despite the fact that she wrote three times to explain that it was not her fault, Alliance and Leicester refused to refund her anything.

What of cases in which people are considered at fault? When I raise this issue I am often told that people should be more careful with their accounts. An example of such a person is Mrs. V., a working mum in Truro, whose husband paid a cheque into her account but did not realise that because of the bank’s clearing cycle it would take a few days to clear. Direct debits bounced, and in one month she was charged £380. As a result, she was over the limit the next month. More direct debits bounced: that was another £405. That comes to nearly £1,000 in just two months. In the end she was charged well over £1,000.

Victims of the punitive charges system are also made to feel that they have done something wrong. The partner of a nursery worker, Miss W., from Grampound in my constituency, came to my travelling surgery to tell me about their problems with tax credits. I looked into the matter and helped to sort out the tax credit problem, but in the meantime I asked whether they had been hit by bank charges. It turned out that the problem with bank charges was bigger than the tax credit problem that it resulted from. The couple accrued £500 in charges. We helped Miss W. to take the matter to court. As a result, Nationwide paid out in a matter of weeks, to pre-empt a court case. However, in an act of retribution, despite the repayment, Nationwide issued a letter giving Miss W. 30 days to close her account. It has now been closed, and that of course has caused her even greater stress and inconvenience.

Not everyone is willing or able to take their bank to court about such matters, or even knows that they can. The volunteers who help, such as the one who helped with Miss W.’s case, cannot help everyone. Since the announcement of the debate my phone has been ringing constantly and my e-mail inbox has been full with messages of support and information about other cases from around the UK.

This problem arises from the banks using poverty as a source of profit—a great deal of profit. The bank commission of BBC 2’s “The Money Programme”, which included eminent business academics and a former senior NatWest executive, concluded that the absolute maximum administrative cost to a bank of processing a bounced cheque—the most labour-intensive of the processes in question—is £4.50. For all other items, such as unauthorised overdrafts or bounced direct debits, the commission concluded that the absolute maximum, in this electronic age where everything is done automatically through a computer, is £2.50. However, the average charge is approximately £30. Some are as high as £38, and they are charged every time people make what the banks consider to be an unauthorised transaction. That is a substantial profit for the banks, which rake in some £4.5 billion, without even taking account of the similar examples that the Federation of Small Businesses found in business banking accounts.

Almost all of what is charged is profit, not costs. It is profit at the expense of hard-up customers. It is the biggest bank robbery in Britain, and it involves the banks robbing their own customers, especially their poorest ones. A common response when the practice is described is that there should be a law against it; but there is a law, or there are laws. First, under common law, disproportionate and punitive charges have always been illegal. In layman’s terms, if a consumer breaks the contract the other party—the bank, in this case—cannot impose a charge greater than the reasonable estimate of its loss. That common law has been unchanged for 100 years, and numerous cases in the higher courts have confirmed it. However, we can go further. The rights in question are protected by statutory instrument. The Unfair Terms in Consumer Contracts Regulations 1999 made that clear.

I am no lawyer, and it might be argued that my interpretation is wrong. I hope that the Minister can tell us what he believes Parliament intended the law to provide on this matter. However, it appears that the banks know perfectly well that they are acting against the law, contrary to what they told the Office of Fair Trading. Why do I say that they know? Because I have helped constituents to regain thousands of pounds by threatening to take the matter to court. So have others. My former constituency researcher, Bob Egerton, has helped dozens more on a voluntary basis, which has made him famous in The Sun as “Bob the Bankbuster”. If people want more information on that, they should go to, but there are similar sites that advise people on how to get their money back.

Every time court action is threatened, the banks refuse to defend themselves, and there is only one possible reason for that. They know that they will lose and that if they lose a test case they will forfeit this multi-billion pound source of illegal profit for ever. Millions of people still pay illegal charges because they believe that if the banks say that they are legitimate and show tariffs of what they intend to charge, they must be legitimate. The banks claim that the charges are legal, but they will not face the courts. They know that it is an illegal rip-off of trusting and often impoverished customers. They are mugging their customers, and the OFT and the Government are letting them get away with it. If a backstreet lender were doing the same, the OFT would close it down within weeks, so what is being done?

The OFT looked into penalty charges on credit cards, but that took two years. It decided that £12 is a fair charge, although I argue that that is still way in excess of what is fair, but it then took what it described as a “novel approach” to this issue. It got no undertakings, but issued a statement calling on the industry to comply as a matter of priority. In its letter to me of 3 January, it could say only:

“Most credit card companies have since reduced their charges by at least half”.

There has been no action to force repayments to people who have been ripped off in the past. Despite what the OFT says, given that it has the power to threaten sanctions against its consumer credit licences, I believe that it has the power to make banks do that.

When the OFT said that the same principles that apply to credit card charges apply to bank charges, the banks simply said that they did not agree. Instead of enforcing its view, the OFT is to review the issue for up to another six months before deciding whether to launch an investigation. Given that it took the OFT two years to investigate credit card charges, which are worth only £300 million a year compared with £4.5 billion in bank charges for the top six high street banks, it seems that the banks will be able to make even more illegal penal charges, worth almost £10 billion, before there is any likelihood of an outcome from the OFT. That is a novel approach indeed, especially given that it has taken firm action against at least three commercial companies regarding penalty charges in their contracts, all of which were reported in its 2002 case bulletin. Why not take the same approach with the big banks? What is the OFT afraid of?

For at least 18 months, consumers have been asking the OFT to look into this issue, and there is no reason why it could not have been investigated at the same time as credit cards. Even the OFT has said how similar the issues are. Given that the Government are effectively forcing people into the hands of big banks by encouraging them to receive benefit and pension payments through banks, and by closing post offices, there is an even bigger impetus and moral duty on the Government to make banking responsible and to ensure that those to whom they pay benefits are not landed with outrageous charges.

The first thing that I hope will come out this debate is that the OFT speeds up its investigation and moves from simply reviewing the matter to conducting a full investigation. I hope that it will then produce a fair maximum charge according to law.

I congratulate the hon. Gentleman on securing the debate. I am often contacted by constituents who are distressed at the level of bank charges levied on them. The worst cases are those in which multiple charges stem from one mistake. People try to cover the bank charge, end up missing other direct debits and go into a spiral of debt. Does he agree that we should at the very least be looking for banks to charge a maximum of one charge a month, rather than multiple charges, so that bank charges are not a cause of debt?

I share the hon. Gentleman’s concern and agree that his proposal would be a step in the right direction. The truth is that with modern electronic banking, there is basically no cost to banks because it is their decision whether to allow money to be drawn, and they can do that automatically.

The key issue is that banks should not make unreasonable charges. It is clearly unreasonable that charges can mount up to hundreds of pounds in a month, as in some of the examples I gave, possibly before customers are even aware that they are being charged. If the Minister or I called our banks in such circumstances and moaned at them, they would probably waive the charges, but most people do not know that they can do that. Also, they are customers whom the bank is not as keen to keep as they might be to keep a Member of Parliament or someone on a good salary. I have no doubt that if the Minister rang up—he has some responsibility for the banks—he could get his charges waived without a problem, but that is not the case for people at the lowest end of the scale. Also, people assume, not unreasonably, that the bank charges are legitimate. Why would they not do so, given that the banks tell them that they are?

Most importantly, if it is to take such a long time for the OFT to resolve the matter, and if the Government are to allow it to take so long, they ought to make it clear to the banks that now that the OFT has made a ruling—it has said that the same principle applies to bank charges as to credit card charges—they will expect banks to repay customers for any charges in excess of what is reasonable that have been levied since then. If that were made clear, these charges would end overnight, because the banks know that they will lose. Meanwhile, Ministers should step in.

In 2000, the Cruickshank report, which was a Government report, established that banks are fundamentally different from other companies because of their social responsibilities, to which I have referred, and called for them to be treated as such, particularly regarding their high excess profits. Yet the Government have singularly sat on the report and failed to implement it. Will the Minister clarify the position and what he believes the intention of Parliament to have been? Will he publicise the issue so that people know not to pay the charges?

The Government should start providing more consumer advice on how people can get these charges back rather than them having to rely on individuals such as Mr. Egerton. The Government could also chase the OFT for action, particularly to ensure that people get unfair charges back if the OFT concludes, as it should, that they should be stopped.

I reiterate that the penalty charges are crippling people on low incomes. I believe that they are clearly illegal, and that if there was any doubt about that the banks would have the courage to fight a single case in the courts, which they do not. The banks are dodging the courts and the Government appear to be turning a blind eye. I hope that the Minister can reassure me otherwise.

I congratulate the hon. Member for Truro and St. Austell (Matthew Taylor) on securing the debate, and thank him and his office for their courtesy in giving me advance notice of the issues that he intended to raise. He has raised important matters, and it is important that there is proper transparency and profile in those issues. I was pleased to be able to read, before the debate, the comments that he made on “The Westminster Hour”. His appearance on that programme gave publicity to today’s debate and gave some of these issues a wider profile. That information has enabled me to prepare to respond in detail to the points raised in his powerful speech.

As well as raising specific issues about bank charges, the hon. Gentleman makes a broad point with which I, and most people, agree. While banks play a fundamentally important role in the workings of our economy, and while it is important for the working of our economy to have a strong, healthy and profitable banking sector, banks also play an integral role in our society and lives. Banks are among our biggest companies, and like any company—perhaps more so—they have social obligations and responsibilities within society. Given their important role in the economy and society, they should be leaders in corporate social responsibility.

In recent years, we have worked closely with the banking industry and the British Bankers Association on a range of different policy issues that all pertain to that wider social role of the banking industry. A key Government priority in tackling financial inclusion has been to try to reduce the number of people in our society who have no bank account. When we established our financial inclusion taskforce, we calculated that 2.8 million people in our society have no bank account. The hon. Gentleman will know that not having a bank account can impose real costs, such as not being able to access affordable sources of credit or take advantage of discounted utility bills by using direct debits.

Our wider agenda is to tackle illegal lending and loan sharks. Our pilot schemes in Birmingham and Glasgow, which are about to be extended across the country, are all about trying to ensure that we tackle the problem of people being ripped off outside the mainstream banking industry. An important part of our broader work on financial inclusion has been encouraging the third sector credit unions to play a wider role in providing bank accounts for the lowest-income customers, and cracking down on illegal lending.

We have also worked closely with the banks to try to ensure that we tackle customers’ inability to access banking services in the poorest communities. Just before Christmas, my right hon. Friend the Member for West Dunbartonshire (John McFall), who is Chair of the Treasury Committee, and I announced an agreement with the banks to provide automatic teller machines—ATMs—in the poorest communities of our country, where it is often hard for people to access banking services.

We have been working hard on other areas. As part of the implementation of the Cruickshank review, the payments system task force was established in 2004 to try to speed up the provision of banking services for customers. The length of time that it has taken to clear cheques has been an important and characteristic feature of my ministerial postbag—I am sure that the same applies in respect of the hon. Gentleman’s postbag. We announced an agreement on those areas before Christmas.

I am aware that penalty charges in the mainstream banking system, particularly current account charges, such as overdraft fees, and the problems they can pose to those in financial difficulty have received significant attention. The Treasury Committee also raised that issue in its recent report on financial inclusion.

The hon. Gentleman noted that the Office of Fair Trading has been closely engaged in this area, and he will know that we established an independent regime for competition inquiries—the OFT and the new Competition Commission. The banking industry often makes points to me that are directly opposed to the ones he has made about the scrutiny role that the OFT plays in its affairs, although I listened carefully to what he said.

The OFT carried out an investigation into penalty charges in the credit card sector and set a £12 administrative threshold for intervention by the competition authorities. As a result, credit card issuers have agreed to reduce their default charges, the majority agreeing to do so by almost half. That investigation was conducted under the principle of the Unfair Terms in Consumer Contracts Regulations 1999, which specify that financial service companies should recoup only the administrative costs of dealing with default. That was the basis upon which the OFT made that ruling, which was not popular in some circles in the industry but has been broadly welcomed.

The OFT recently said it believes that the same principles of fairness and transparency that it applied to credit card default charges are likely to be applicable to bank account default charges. Following the credit card investigation in which it acted, it has instigated an exercise to determine the facts in respect of the banking sector and then to decide what proportionate and appropriate action it should take.

The OFT is independent of Government; we do not direct it in or set the pace of its inquiries. In many cases, it is for the OFT to propose and implement remedies. The fact that those individual, case-by-case decisions are being made at arm’s length from Ministers is one of the strengths in terms of protecting consumers. In my experience of contact with the banking industry, the OFT inquiry is very serious—it is certainly being taken seriously by the banks. The OFT has collected the information and it has an established track record of acting when it believes that actions are being taken that are potentially outside the law. It would be wrong for me to comment on this particular case, because it is a matter for the OFT. If I were to second-guess an inquiry—the inquiry of an independent competition agency—when it is being conducted, it would be an error on my part. I would like to express my strong support, and that of the Government, for the principles of fairness and transparency, which the OFT applies in general. It applied such principles to credit cards and is now planning to apply them to banks.

The hon. Gentleman also mentioned that some customers are challenging default charges in the courts. It is up to individuals whether they challenge the decisions of a private institution in the courts. The OFT is holding a more general inquiry into the particular kind of cases that he mentioned. It would not be appropriate for me to comment on the particulars of those legal cases, especially while the OFT inquiry is ongoing. As I said, we are very supportive of the general principles that the OFT is seeking to apply.

The penalty charges that result from late payments by Government agencies and cause people to go overdrawn through no fault of their own have been mentioned. In 2006, the Department for Work and Pensions made more than 680 million payments, of which fewer than 21,000—or 0.0003 per cent.—were reported as late or missing by recipients. In the negligible minority of cases where payments are late because of an error on the part of the Department, the Government’s policy is to refund any penalty charges that might arise to the individual concerned.

I want to press the Minister a little further, because, as he will know, the intentions of Parliament can be interpreted partly by the comments that are made in it. While he cannot comment on specific legal cases, it is evident that banks are avoiding court cases, presumably because they feel that they would lose them. Will he confirm that the intention behind the regulations was, as the OFT has stated, the same as the principle that applies to credit cards: only the administrative costs should be charged?

I am happy to confirm, as the hon. Gentleman says, that the principles that apply to credit cards apply equally to the banking industry. It is for the OFT to get the facts and to judge whether it thinks those principles and the law require it to act. It is not for me to do so. It is clear that the principles that applied to credit cards also apply to the banking industry.

I have a short amount of time left, so I should like to make one further point to the hon. Gentleman. As a result of the Cruickshank report, there is now a regular review of the banking code—the voluntary, good practice code for UK financial institutions, to which all the major banks signed up and which was first established in 1991.

Mike Young, a former senior Bank of England official, is conducting the triennial review of the banking code this year. As part of that, he has written to stakeholders to seek views on possible changes to the code. He has asked stakeholders to consider the following:

“Are the requirements about how lenders deal with people who get into financial difficulties clear enough?”

He is examining whether or not the banking code requirements, to which banks sign up voluntarily, are sufficiently clear and onerous to ensure proper protection for some of the people the hon. Gentleman mentioned.

The Treasury will make a submission to the review, as it always has done on such matters, part of which will address those issues. I encourage the hon. Gentleman, and all other hon. Members who have concerns, to make a contribution to that ongoing review of the banking code. I am sure that Mike Young would be happy to meet the hon. Gentleman as part of his independent review. I would be happy to write to Mr. Young about this debate and to send him a copy of Hansard.

Whether we are talking about the work of the OFT, our response to the Treasury Committee, the work of the payments task force or the review of the banking code, we are determined to ensure a fair deal for customers, particularly those who are potentially most disadvantaged by financial exclusion and the problems of late payment, which the hon. Gentleman has raised today. The OFT is examining charging, so I cannot comment further on that, but I am grateful to him for having raised this debate and for bringing transparency to these issues.

Sunbed Salons

I am grateful for the opportunity to raise matters of concern about automated or unstaffed coin-operated tanning salons. My interest arises from my work with children—in a previous life, I worked for Save the Children—and children’s issues are close to my heart.

The purpose of this debate is to make a case for further regulation of the sunbed industry, particularly unstaffed salons which raise a wide variety of public health concerns. I want to concentrate my remarks on the misuse of unstaffed tanning salons by children, often girls in their teens.

Shortly after my election to Parliament, concerned parents in the constituency informed me about the availability of sunbeds to under-16s. There was an unstaffed automated tanning salon a short distance from my former constituency office on the High street in Swansea. Parents were aware that their teenage daughters had been using the salon, so I asked a member of my staff to monitor the situation at lunch times, and they saw schoolchildren using the facility. After some research, I discovered that while advice was available on the use of sunbeds by under-16s, it was not backed up by regulation. I have spoken to many children in Swansea, East who said: “Miss, it’s cool to have a tan.” They said they want to emulate celebrities and their sporting idols who have tans.

I congratulate my hon. Friend on securing this important debate. Does she agree that the media have a responsibility in the matter because young people who see pictures of celebrities in newspapers may try to imitate them without perhaps understanding the risks?

I agree with my hon. Friend. Young people find it difficult to distinguish between fake tan and the tan obtained from using a sunbed, but they want to emulate stars who should explain how they get their tans. We must work with young people to eradicate the idea that it is healthy to have a tan. One of my major concerns is that young people equate health with having a tan. They aspire to be fashionable, but they may, in pursuit of a tan, lie to their parents, use facilities that they should not use and claim that they are using fake tan when they are not. Hon. Members know that no one under the age of 16 should use a sunbed. However, in towns and cities throughout the United Kingdom it is easy for them to do so. I believe it is morally wrong that children are gaining access to such equipment.

Let me make a distinction. When I refer to coin-operated salons, I mean companies that accept cash or card payment in a box mounted on the wall and tend not to have staff to assist and provide advice about safe tanning techniques. They are not regulated by the Sunbed Association, which is a self-regulatory body in the UK. I met the association to discuss shared concerns, and it informed me that it has more than 1,200 members and refuses membership to unstaffed salon companies as they do not meet the association’s code of practice. Staffing is fundamental to membership of the organisation.

The unstaffed side of the industry is growing. People like the convenience of no appointments and pay-as-you-go. I agree that they are convenient, but they raise public health concerns that must be addressed. A qualified member of staff can do more than just be there and take money. They can advise on skin type, length of tanning session, how to tan safely and, importantly, the wearing of goggles. They are also a reassuring presence in case of emergency. Anyone—children, people with health problems and even people who are intoxicated—can gain easy access to salons, ignore guidelines and damage their health. It is wrong if no trained staff are available to provide information on safe tanning, to be available in an emergency, such as an assault on a customer, or to prevent inappropriate use. Unaccompanied women should not be encouraged to enter unstaffed premises where they could be vulnerable to attack or sexual assault. Such salons are cheap to use. One unstaffed company in south Wales has been offering deals of 25p per minute and others have offered January sales. Such prices are cheaper than that of smoking, and children can easily afford sessions for the price of their school lunch. They can cover the cost of a sunbed session during their lunch break, and that is wrong.

I have tabled a number of questions on the issue and the Minister has been receptive to my concerns. I am grateful to her and her officials for meeting me to discuss them. I have also met a number of cancer charities, particularly Cancer Research UK, which is supportive of my campaign. The matter was discussed at its sunbed symposium in September 2006, which I attended.

I have been lobbied from both sides of the argument, and I have not ignored representations from people who disagree with me. I tried to find common ground, even when that was difficult. I met Consol Suncentres, the largest unstaffed tanning company in the UK. I welcomed the opportunity to meet it and hear its views. There are many opinions on the safety of sunbeds, but we all agreed that it is wrong for children under the age of 16 to have access to sunbeds, whether staffed or unstaffed. What Consol and I cannot agree on is how to prevent under-16s from gaining access to sunbeds. I have advised it that I am keen to have further regulation, but it does not recognise the problem.

I welcome recent initiatives by the company to prevent under-age use of its facilities, but I was disappointed when it informed me at a meeting in June that it was the responsibility of parents to stop children accessing such facilities. That is an irresponsible attitude. Until the whole industry agrees that protecting the health of young people is the highest priority, its attitude will remain a major stumbling block.

The need to introduce more responsible sunbed use in coin-operated, unstaffed salons was the basis of my early-day motion, which received cross-party support and was signed by 155 hon. Members. I was pleased to hear about the parliamentary seminar, which was hosted by my hon. Friend the Member for Norwich, North (Dr. Gibson), to discuss sunbed-related issues, and I was disappointed that I could not attend because of Select Committee business overseas. I was informed of the discussion and I am sure that it was helpful to the ongoing debate. I thank my hon. Friend the Member for Rhondda (Chris Bryant) for speaking in support of my work at the seminar.

Following the success of my early-day motion, I hope that the Minister recognises the strength of feeling about the matter. The law protects children from buying alcohol and cigarettes, and from gambling. The same protection should apply to the use of sunbeds.

I agree with my hon. Friend. A young, 15-year-old girl in Merseyside was addicted to sunbeds, and the story was on TV. The health dangers were explained to her over and again; her parents told her that it was dangerous and wrong to use them, but she continued to do so. Unless we act and provide protection, those young people will not listen and will endanger their lives.

I thank my hon. Friend for her comments. It is true that it is our duty to protect young people. If society does not look after them, they may not realise the long-term dangers. It is up to us to educate them and provide information.

I would welcome further work between the Minister and other Departments to consider introducing a licensing scheme for sunbed outlets throughout the country. Such a scheme exists in some cities, but a consistent approach is needed, led by the Government.

Back in 1995 when the health and safety guidelines were drawn up, the automated, unstaffed sunbed centre did not exist on our high streets, but there has since been an explosion of them, which is why we must look again at the issue. Regulations have not kept up with developments in the industry, and public health is suffering. Unstaffed, coin-operated salons should not be worried about a licensing system, and I call on them to work with me on this campaign.

I have been accused of trying to prevent choice and to stop people using sunbeds, and wanting to ban them all. That is not so. I do not wish to stop adults over 16 accessing sunbeds, but perhaps with the recent change in the age restriction on the sale of tobacco we should consider 18. I wish only to prevent children from being able to walk into unstaffed salons and use them unchallenged. There has been a public outcry about young people accessing gambling machines in amusement arcades. Sunbed abuse is just as damaging and as harmful to young people’s long-term well-being.

I have heard arguments that under-16 year olds will continue to access the salons despite the introduction of an age ban, but that was said about cigarettes and alcohol. The success of the “Think 21” campaign demonstrates clearly that an effective voluntary system can challenge any under-age young person attempting to purchase alcohol or tobacco. The same should be true of the sunbed industry. It is imperative that a member of staff is present to challenge any under-age young person attempting to access the premises.

One company in my constituency has been displaying a notice that says:

“We do not accept responsibility for people under the age of 16 on these premises.”

It is an example of shoddy practice that must be exposed. In other words, the notice is saying, “It is not our fault; blame someone else.” Companies must take responsibility for their services. If they offer a service to the public, they should have a minimum set of standards, which is why licensing is needed.

Consol says that the education of children is the responsibility of parents, but if parents discover their children using unstaffed salons, or if a passer-by notices a child in an unstaffed salon and reports it, nothing is done. There is no complaint mechanism to deal with such circumstances, and nobody is prosecuted or fined. Action is taken only if there is a fault with the equipment or if an incident occurs. That is unacceptable.

In conclusion, there is a strong case for regulation, probably in the form of licensing. It is unacceptable in this day and age for unstaffed operators to pretend that there is no problem with under-16s accessing their salons. There is growing public awareness about the health and well-being of our young people. It does not make sense that we can protect them from alcohol, cigarettes, pornography and gambling, but that we cannot recognise the dangers to their long-term health from sunbed abuse.

I urge the Minister to be bold, as she has been with tobacco. I hope she agrees that it is always better to fake than bake, and I ask her to take the necessary steps to protect our children’s health.

I congratulate my hon. Friend the Member for Swansea, East (Mrs. James) on securing the debate. I also welcome the presence of my hon. Friends the Members for Halifax (Mrs. Riordan) and for West Lancashire (Rosie Cooper), and the earlier attendance of my hon. Friend the Member for Dundee, West (Mr. McGovern), who has had to leave the Chamber. I thank them for attending and for showing their support.

I thank my hon. Friend the Member for Swansea, East for her participation in discussions with officials in the Department of Health. They have been assisted by her information and experience locally, and by what she has gained from people contacting her, given the high profile that she has lent the issue. I must admit that one difficulty is securing the necessary data and information about the extent of the problem. We know, at least anecdotally, that coin-operated facilities in particular tend to be located in some of our more deprived communities. It is clear that they do not offer the beauty parlour experience that one might have in more affluent areas, where sunbeds under supervision sit alongside nail bars, facial services and everything else.

My hon. Friend has outlined today and shared with me in private meetings some of the ways in which the facility is open to abuse. The questions are about how much abuse takes place and who is responsible for trying to reduce the amount of misuse of coin-operated facilities.

The issue is important, and as she said, about 150 MPs from all parties signed her early-day motion. We continue to try to address the subject. Although my hon. Friend rightly draws attention to the public health concerns, it is an issue not only for the Department of Health but for the Department for Work and Pensions, to which the Health and Safety Executive is accountable; for the Department of Trade and Industry; and for the Department for Communities and Local Government, which leads on licensing matters. It does not sit with only one Department.

We share with my hon. Friend and others concern about the increase in the incidence of skin cancer and the importance of prevention. The popularity of tanned skin has raised the potential risks of getting skin cancer. However, the debate is not about people enjoying the sunshine but about the extent to which they do. That is important. There are benefits to sunshine through vitamin D, as we all know, but it is the extent to which people expose their skin, either naturally or artificially, which poses dangers for their future health. The trouble is that overexposure to natural sunlight or to sunbeds without protection does not manifest straight away. The problem is one of how we measure the impact of exposure on something that may manifest as skin cancer only some years later. It is a challenging area.

The Government discourage the cosmetic use of sunbeds, whether coin-operated or otherwise, particularly by young people. For adults, the key issue is that sunbed use is the result of an informed choice. However, for young people with skin at greater risk of damage from cosmetic tanning, and possibly an inadequate understanding of the potential harm, it is an issue not only for parents, as Consol said, but for the industry and for the Government.

For that reason, the Department of Health, along with other UK health organisations, has funded Cancer Research UK to run SunSmart, the national skin cancer prevention and sun protection campaign. The campaign includes raising public and professional awareness of skin cancer by providing information about it, including how it manifests and its early detection, and by providing guidance on preventive measures to reduce the risk of its occurring. The campaign raises awareness through support for health promotion events, the provision of printed resources, media briefings and the SunSmart website. It has proved a valuable addition to the exploration of concerns about skin cancer.

A key message of the campaign is to take care not to burn, whether in the sun or on sunbeds. We must reinforce that message as much as possible, and the website has a special section covering sunbeds. It highlights the fact that sunbeds, far from being cosmetic friends, cause premature skin ageing and blemishing at a younger age once the tan has faded. When discussing prevention among young people, that is an important message to get across, because unfortunately, the more serious problem of skin cancer may not appear until later in life. Focusing on the more immediate outcomes of over-use of sunbeds is an important way of getting the message across.

The campaign also makes the point that sunbeds should not be used by people who are particularly vulnerable. They include people with fairer skins, and specifically people under 16 years old, as my hon. Friend admirably pointed out. The Health and Safety Executive has also issued guidelines on the use of sunbeds for operators and customers. The guidelines are available on its website.

The guidance was developed in consultation with the Department of Health and leading experts. We have been trying to encourage self-regulation and the following of guidance. I noted my hon. Friend’s point about the Sunbed Association’s code and the basis on which it admits members to its organisation, because we want to ensure that anybody who operates sunbeds, whether coin-operated or otherwise, takes up the Health and Safety Executive’s guidance. There is a clear split of opinion among the sunbed industry on the subject, and that influences the debate.

Cancer Research UK has supported the guidance by working with representatives of the industry, particularly the Sunbed Association, to try to improve information for staff and customers. That includes displaying information about the use of sunbeds and the risks to customers’ health, and discouraging the use of sunbeds by young people under 16. There are issues with how one can meaningfully do so if there are no staff present to reinforce whatever written information is provided in an outlet.

As my hon. Friend rightly says, coin-operated sunbeds are often in establishments that do not use full-time staff. Last year, as a result of my discussions with her, I made a commitment to initiate cross-Government discussions to explore the options for regulating coin-operated sunbeds. She has taken part in those discussions, which have allowed us to exchange information in order to get a better understanding of the issues involved. We have considered licensing arrangements—local authorities have powers to license in this area—and we will discuss further the guidance currently provided by the Health and Safety Executive.

A sunbed symposium was held last autumn, which raised several issues including matters of data and information. I understand that the Chartered Institute of Environmental Health plans to follow up the survey results that it has pulled together with a fuller report. More information, from whatever source, would be very helpful for our future discussions on the provision of coin-operated sunbeds in communities and the way in which they are used by individuals.

There are a number of factors to consider, such as the different types of regulatory provision and their impact. I am aware that a Regulation of Sunbed Parlours Bill is being considered in Scotland. We are keeping a watchful eye on that and we are interested in the evidence base being considered as that Bill goes through the Scottish Parliament. There are common issues, although not necessarily identical ones, and clearly there is an opportunity for us to learn from the experiences of other parts of the UK, within our devolved island.

In the meantime, we continue to have discussions. I will be meeting my noble Friend Lord McKenzie of Luton, who has just taken responsibility for this area of health and safety within the Department for Work and Pensions, and that meeting will follow on from the one my hon. Friend the Member for Swansea, East had with Lord Hunt of Kings Heath, who has recently joined my Department.

This debate is timely, and it is opportune for me to explore the guidance with my colleague in the DWP, determine whether there are areas that we can tackle and think about strengthening the guidance and other routes that we may take. I welcome my hon. Friend’s campaign in this area, and I am sure that, along with me, she will seek to engage Departments that have a role to play in ensuring the best possible public health outcomes, particularly for those most vulnerable in our communities, such as those under the age of 16.

Sitting suspended.

Induced Car Crashes

I am very pleased to have the opportunity to present this debate on the Government’s prosecuting policy on induced car accidents.

An induced car accident happens when fraudsters who wish to claim from an insurance company drive motor vehicles to busy road junctions where they perform unexpected, unnecessary and dangerous emergency stops designed to cause innocent members of the public to crash into them. There are several favoured methods. Some disconnect the brake lights of their vehicle and then brake sharply in moving traffic once a victim is positioned behind. Others pull on to roundabouts from busy slip roads, then brake sharply once six to 10 feet over the line.

By forcing victims to crash into them from behind, under current insurance law, fraudsters can rely on a virtually automatic admission of liability by the victim’s insurers. They then submit multiple insurance claims—for personal injury, loss of earnings and so on—on behalf of the driver and multiple fake passengers, who are members of the criminal gang. If undetected, a single crash can net as much as £30,000 for the gang.

What is the scale of the problem? Research by the Insurance Fraud Bureau indicates that since 1999 over 22,500 fraudulent motor accidents have taken place throughout the country. The scam was first detected in the north of England, and insurers are now aware of gangs operating in many large UK cities and towns. Recently, there has been prolific growth in such activity in London and the south east. In 2003, insurers were aware of just four criminal gangs operating in the UK, but by November 2006, that had grown to 40, with an average of three new gangs being detected per month. Industry experience has shown that, once well established, such gangs can potentially induce 300 to 400 accidents per year. The problem is huge and growing.

I congratulate my hon. Friend on securing the debate. Does he agree that fraud is never a victimless crime—particularly insurance fraud—because we all pay through the premiums resulting from the fraudulent claims? Furthermore, does he share my concern that induced accidents are a serious threat to public safety and that innocent people could become embroiled in an accident resulting in serious injury or loss of life? That element stamps this as a real menace that must be tackled by the Government, the police and insurers in partnership.

I am pleased that my hon. Friend raised that point. The threat to public safety is the single biggest problem. Of course, there are other issues, such as rising motor insurance premiums. I know that he has taken a big interest in the matter, as the chairman of the all-party group on insurance and financial services. He is right: the very serious and growing threat to public safety is the single biggest issue. Serious injuries such as broken limbs and crushed rib cages can occur, and have done. If the fraud is allowed to continue, there will almost certainly be fatalities and a growing injury rate.

Some evidence suggests that women driving alone and those on the school run with children are targeted by fraudsters because they think that they are more likely to admit liability. As my hon. Friend said, these crimes are forcing insurance premiums to rise, which is paid for by innocent motorists, and insurers estimate that the fraud is now yielding at least £200 million a year for organised criminals. The phenomenon is growing so quickly, however, that that could be a significant underestimate. We are talking about many hundreds of millions of pounds.

That links directly to the third issue: cash generated from the fraud is fuelling the growth of organised crime. Norwich Union referred to that in its 2005 fraud report, “Shedding Light on Hidden Crime”. Insurers believe that the proceeds from induced car accidents are being used routinely to fund other forms of organised crime, including drugs and people trafficking, benefits and credit card fraud and money laundering. It might even be funding terrorism. Induced accident fraud started among predominantly Muslim gangs in the north of England, but has now spread so widely that criminals from all backgrounds are involved.

It remains the case, however, that the gangs that started the earliest and so acquired the most expertise have been the most successful in perpetrating the fraud. That is reflected geographically in the figures for the number of staged accidents. The Insurance Fraud Bureau has estimated that since 1999 there have been 22,605 staged or induced accidents, and has broken them down city by city. Blackburn comes top, with 1,710 staged accidents since 1999—7.5 per cent. of the total. Bradford and Birmingham come next, followed by Oldham. Those four cities alone account for more than a quarter of all such crashes. Bolton, Manchester, Liverpool and Preston come next and bring the total to more than 42 per cent.—some 9,500 crashes. The Serious Organised Crime Agency monitors terrorists’ finances. I hope that the Solicitor-General can tell us that the agency is aware of those figures, which indicate a significant concentration in a small number of northern cities where Asian gangs—they are predominantly Muslim—started this fraud.

I shall examine the reasons for the quick growth of the fraud. Before 2006, the police were generally unable to investigate these organised gangs. Typical cited reasons for not doing so are limited resources or the low prioritisation of fraud in the national policing plan—no targets were set. This fraud has been an extremely profitable and almost risk-free activity, so it would have been extraordinary if it had been ignored by organised crime. Since 2006, with the growing focus on fraud as a national issue, police forces in the south of England have begun to investigate more cases of such fraud. In notable cases, prosecutions are ongoing. To date, however, no police force in the north of England, where this problem started and is most prolific, has investigated a single case. Consequently, the vast majority of the 40 known gangs operating in the UK are not under investigation.

I remind hon. Members that it took six to seven years to generate more than 22,000 crashes. The Insurance Fraud Bureau believes that at the current rate of growth, a further 20,000 crashes will be generated over the next 18 months. Another reason for the growth is that the crime is so profitable and easy that it is now being franchised. Insurers have obtained intelligence that they believe indicates that the largest and most prolific gang in the north-east is effectively selling franchises to other gangs, providing support, set-up and driver training. I am given to understand that requests to investigate the gang have been refused routinely by the relevant police authorities.

I shall examine the implications for the policing and prosecuting authorities. It is a national problem requiring a structured national response. In my view, any significant delay represents an unacceptable risk to public safety. Without the consistent threat of prosecution across the UK, experience has shown that the problem will continue to grow. Police targets are set on the basis of harm caused to individuals and society by a particular crime. That approach makes a strong case for making the prosecution of induced accident fraud an immediate priority—it poses a direct risk to public safety, funds organised crime and possibly terrorism, and impacts on society through higher motor insurance premiums and the rate at which the problem is growing.

In my view, a case could be made also for the immediate ring-fencing of police anti-fraud resources around the UK, as recommended by the Attorney-General in his excellent fraud review last year. Without that, we can reasonably expect a continued erosion of specialised police anti-fraud resources. In the past decade, available resources for combating fraud outside London have been halved. Last year, at the request of the Home Office, following representations from the insurance industry, an evidence-based threat assessment was submitted to the Home Office by the Association of British Insurers detailing and quantifying the threat to the UK of induced accidents and requesting urgent and co-ordinated action from law enforcement agencies.

That has been superseded by more recent research by the newly formed Insurance Fraud Bureau indicating that the problem is significantly larger than first thought. Details of that research were presented to the all-party group on insurance and financial services, chaired by my hon. Friend the Member for Ryedale, (Mr. Greenway) and subsequently shared with MPs from affected constituencies. I would like clarification from the Government on a number of questions. First, who in the Government is responsible for considering the implications of the research and deciding on an appropriate course of action? Secondly, is such consideration ongoing, and if so, when will a decision be reached? Thirdly, will the relevant Minister advise us on the action to be taken to combat the national problem of induced accidents and on how the Government intend to stop its prolific growth? Fourthly, will that Minister agree to meet with the Association of Chief Police Officers to discuss how to prioritise the arrest and prosecution of such gangs before the problem escalates out of all proportion?

Induced accident fraud is just one example of the wider problem of fraud. Its recent growth is connected to low awareness of fraud and the fact that it has not been a national policing priority. However, it is important to say that good work is now being done. I applaud both the growing efforts of our police in the south-east and the excellent work done by the Attorney-General’s fraud review team.

Almost overnight, our perception of the problem has changed. For example, the Attorney-General’s review concluded that fraud as a crime is perhaps second only to class A drugs in the harm that it does nationally. Induced accident fraud is only one of the many rapidly growing methods of fraud facing us, which include VAT fraud, benefit fraud, credit card fraud and corporate fraud. I welcome the Attorney-General’s review of fraud and support its recommendations, which once implemented will lay the foundations of a more fraud-resistant economy and society. I await the Government’s response to those recommendations and would welcome active steps to ensure that they are implemented as soon as possible. The Attorney-General’s report recognised that there are currently no up-to-date statistics on the extent and impact of fraud on the UK. I await with interest the ACPO study to measure that, which I believe is due to be published next month. Perhaps the Solicitor-General could tell us whether he has met the Attorney-General to discuss the recommendations of the fraud review and say what hope he has that the recommendations will be implemented.

I have focused most of my remarks in this debate on induced accident fraud, so I hope that the Solicitor-General will concentrate primarily on that in his reply. I hope that I have persuaded him of the seriousness of the issue. Induced accident fraud is one of the most startling forms of fraud. It targets innocent motorists in a disgraceful way, and is a significant and growing threat to public safety. It offers organised criminal gangs easy pickings that are nearly risk-free for the fraudsters. Although some police forces are now taking an interest, there is a long way to go. There are large parts of the country, particularly in the north of England, where the organised criminal gangs undertaking the fraud are unimpeded and uninvestigated, and can operate with virtually zero risk of prosecution. Finally, the proceeds of such crimes are used to finance more organised crime. This cannot continue.

I congratulate the hon. Member for South Norfolk (Mr. Bacon) on securing this debate on an issue that I agree demands greater public awareness. The insurance industry has been aware of it for some time, but only a relatively short time, in the sense that such fraud has grown quite spectacularly in recent months and years. I also welcome the hon. Member for Ryedale (Mr. Greenway), who has taken a keen interest in such issues.

The Government take seriously the increasing prevalence of induced car accidents and their effect on communities. Innocent road users—they are often mothers taking their children to school in the morning, who might be seen as easy victims, as the hon. Member for South Norfolk pointed out—face physical injury, emotional trauma and the shock of having an accident, perhaps in the middle of a busy roundabout, which is a favourite location for induced accidents. The victims of such fraud also face damage to their vehicle and the inconvenience of having to deal with the accident and their child, who might be very upset, as well as the loss of their no claims bonus and increased premiums. All that means that individuals can be quite badly affected by induced accidents. The general public are also at risk and need to be aware of the problem, because all of us who drive cars face increased insurance premiums as a result of the growing problem.

We are also aware that some of the money that is paid to the criminals might be diverted to other kinds of criminal activity. I do not have any evidence that it is diverted towards terrorism, but no doubt other criminals have used it for various purposes.

The way in which we address the problem must involve three key elements. First, there must be a response by the authorities, particularly the police and the Crown Prosecution Service. Secondly, the insurance companies must recognise, as they are doing, their responsibility to focus on claims that happen in the sorts of circumstances in which induced accidents may occur, ensuring that their investigators focus on particular incidents, gather the evidence and, if appropriate, refer the matter to the police. Thirdly, we need the public to be aware when they have accidents of the sorts of circumstances in which such incidents arise. Those concerned need to ask themselves whether they have had a real accident or whether, when they were trying to get on to that roundabout, the guy in front of them just pulled out and jammed on the brakes. The victim might not have seen any brake lights because the lights had been disconnected and because they were watching the cars coming from the right, round the roundabout. That is one of the ways in which such fraud is perpetrated.

The Solicitor-General is absolutely right to say that there needs to be attention by the authorities, the public and the insurance companies. That might eventually lead to a change in a technical aspect of insurance law, which has always assumed that the car hitting from behind is guilty. The insurance companies have done a great deal in recent years, appointing investigators, gathering evidence and secretly filming such incidents. However, does the Solicitor-General accept that even when the insurance companies have presented the prosecuting authorities with evidentially sound bundles, with pink ribbons around them, and said, “There, prosecute that”, they have found resistance? That is one of the problems.

I cannot accept that, because I do not have any evidence for it. However, the hon. Gentleman says so and no doubt he has been informed of that by the insurance companies. If he has evidence that that has occurred, I should be happy to look at it and talk to the CPS about why that might have occurred, or to the Home Office, if the police have felt unable to conduct such investigations. However, I entirely accept the view, which has been increasingly put to us in consultations with the Association of British Insurers and the insurance industry more generally, that induced accident fraud is a growing problem. It puts innocent individuals at risk and is a growing criminal issue that needs to be addressed.

I am concerned by the hon. Gentleman’s references to police in the north of England. I agree that some of the problems appear to have arisen initially in West Yorkshire. The issue came to our attention in early 2005, with a spate of accidents in West Yorkshire that followed a similar pattern. However, prosecutions are also taking place in a number of counties in the south of England. There is a growing awareness of the problem by the police, and I suspect that we shall see an increasing focus on it in the months to come.

Key actions for the police service, as set out in the recently published national community safety plan, include the need to have strategies to address all major threats, including fraud. The hon. Gentleman is quite right to say that fraud is currently not one of the key policing indicators. We always have to be careful about how many targets we set for public services. He will be aware of the criticisms that his party has made of the number of targets that are presented to public authorities. We need to hold discussions with the police about how they deal with such issues, and about where KPIs and other targets have a role. However, the national community safety plan includes references to fraud, and we have flagged up with the police the need to deal with it.

I welcome the hon. Gentleman’s comments about the fraud review, which the Attorney-General conducted recently, and the close work that has been undertaken between our Department and the insurance industry to examine some of the issues that it faces to do with fraud. The results of the review have been broadly welcomed by the insurance industry and I hope that that will make a significant change.

Another thing that will make significant change is yesterday’s introduction into law of the Fraud Act 2006. That is significant, not only because of some of the increased penalties—in one case doubling the penalty for fraud from five years on indictment to 10 years—but because it will make it easier to focus on the reality of the fraud rather than on the technical problems of implementing some of the fraud-related provisions of theft legislation. I hope that that new legislation, which I helped take through the House of Commons, will help to enable the police and prosecuting authorities to focus more effectively on such crime.

The Solicitor-General’s point about KPIs is well taken; there is a limit to how many targets we can have. Lately, Lord Browne of Madingley was in the news, saying that no organisation should have more than 10 targets—he was referring to BP, of course—and that if it has, it will be lucky to achieve six of them.

However, if police targets are set on the basis of harm, and if the Attorney-General’s view is that the harm caused by fraud is second only to that of class A drugs, surely there is a case for reviewing the national police priorities and considering whether fraud ought to be moved up, perhaps at the expense of something else? Fraud is a national policing priority in Scotland. Will the Solicitor-General consider the case for introducing fraud as a national policing priority?

For a considerable time, there have been all sorts of discussions about what the key policing indicators should be. Fraud has been discussed in that context; it was when I was at the Home Office some years ago. Such discussions with the police are always difficult, because they know that they are only able to focus on particular issues.

We want to ensure that fraud is dealt with as a key issue without it necessarily having to be one of the KPIs. However, we shall discuss the matter again with the police in due course. Let us ensure that we have the appropriate focus to deal with the problem of induced accidents. As I have already indicated in the national community safety plan, we regard that as important. It is a growing problem, and I welcome the fact that this debate has enabled me to raise its importance.

We have consulted the Association of British Insurers, which estimates that there could be as many as 10,000 induced accidents a year, costing us more than £200 million in insurance. Such fraud impacts on us all, as insurance fraud alone puts our car insurance premiums up by about 5 per cent. Under the Fraud Act 2006, police and prosecutors will be able to use modern and flexible statutory offences to help ensure that criminals who stage accidents to commit fraud are brought to justice. I am very pleased that such provisions became law yesterday.

The recently published fraud review suggests how the Government and industry can work together to fight fraud. The insurance industry is undertaking an identification of fraud and seeking to develop its means of dealing with the problem. The review team worked closely with the Association of British Insurers and its recommendations presented a range of proposals, from prevention through to investigation and prosecution.

It is important that there should be a sufficient criminal justice response to staged accident fraud. The police and the CPS fully appreciate the seriousness of staged traffic accidents, because of not only the criminal offences and sums of money involved but the real and serious danger to road users and the impact on the innocent motorists and passengers targeted by such criminals.

The CPS and the police are working closely together on such cases. When such serious allegations are made, the CPS is responsible for authorising the police to charge suspects. Advice from the CPS is increasingly sought by the police at the earliest stages of investigation; prompt action is being taken to restrain assets. Case management systems are now being set up from the outset to assist in the compilation and analysis of evidence and the conduct of court proceedings.

However, the CPS must review each case on its merits. We need the evidence and to ensure that it is in the public interest to prosecute. Cases of induced accident will normally be in the public interest, because they are an increasing problem with which the criminal justice system has to deal. Any conviction is likely to result in a substantial sentence that will include compensation and confiscation.

In December 2006, the CPS launched its public consultation on bad driving. Many of the responses are from members of the public who have been involved in traffic accidents. Their accounts of the incidents and their impact on them and their families highlight the significant consequences of even the most minor of unavoidable accidents, let alone more serious collisions and the induced accidents that we are discussing today.

We know that the various fraudsters involved in induced accidents get a significant amount of money. The average insurance bill for such accidents is £25,000 to £30,000, and the total cost to the industry in 2005 was estimated at in excess of £200 million. The issue is significant, and we need to address it. Induced or staged accidents are not just about insurance companies, fraud or the money, but collisions and injuries to individuals.

We must recognise not only the insurance industry’s problems, but the difficulty and pain inflicted on individuals whose lives are put at risk by such criminals. We need to raise public awareness and ensure that insurance companies are establishing appropriate ways of dealing with the issue. I agree with the hon. Member for South Norfolk that the insurance companies are now putting the appropriate responses in place and ensuring that their investigators are conscious of the need to deal with such issues. The companies are putting in place mechanisms to enable them to put together evidence.

I want to ensure that there is greater co-operation between the police, the CPS and insurance companies and a greater awareness among the public. If someone is the victim of what they think was an accident, they should think about whether it was that or something far worse. If that conjunction of elements can be brought together, we will have a fair chance of seriously coming to grips with a new but growing problem.

The Solicitor-General is generous in giving way. I am encouraged by some of his words; he is right in saying that the problem requires work and effort from everyone, including the public.

Lawyers have considered and tested the evidence for some such cases and found it to be sound and robust. They have considered the case robust, but there have been difficulties in persuading the CPS or the police to take it forward. Would the Solicitor-General be happy to consider those evidence bundles to establish whether the cases should go forward?

I hesitate to agree to investigate and take an individual view on what might be hundreds and hundreds of cases. We employ the CPS to consider evidence; the police assess evidence and put it together for the CPS. It is not for Ministers to try to usurp those roles. None the less, it is important that, when the evidence offers a realistic prospect for prosecution, such cases are properly considered, investigated and dealt with.

A chief constable has to take a view on the appropriate allocation of his officers’ time and effort and it would not be appropriate for me to say to particular chief constables, “You must allocate your police officers’ time in this way.” We must give some authority to chief constables and ensure that cases are dealt with properly. It is also essential that the public, the police and the CPS are aware of induced accidents and that, together with insurance companies, they all get their acts together to ensure that we deal with them.

Question put and agreed to.

Adjourned accordingly at one minute to Two o’clock.