It is a great pleasure to serve under your chairmanship, Mrs. Humble. We know each other from our work on the Select Committee on Work and Pensions in years gone by.

I am particularly pleased to have this opportunity to review with the Minister the state of health care in Shropshire. I will mostly discuss the facilities in my constituency of Ludlow, but I will touch on the county’s wider health care economy. I am delighted to see so many colleagues from Shropshire here today. I will, of course, be pleased to accept their contributions, which may be more focused on the acute hospitals in their constituencies, whereas I will focus mostly on the community hospitals in mine.

I begin with a slight sense of déjà vu. One of the first Westminster Hall debates that I was fortunate to secure in the year following my election to this place was on the same topic of health care services in Shropshire. That debate was held on 25 January 2006, during the period in which I was helping to lead the campaign to save all three community hospitals in my constituency, which faced the real threat of closure because of severe financial deficits in the local health care economy.

I fear that we are in danger of coming full circle, because after a couple of years of getting NHS finances in Shropshire into balance, the county again faces a severe deficit. However, before I turn to those issues and look to the Minister for some answers, I would like to touch briefly on some positive achievements in Shropshire health care since those dark days.

I recall a cold, wet Saturday morning a couple of weeks before that debate in early 2006, when I led a march of more than 4,000 people from a rally in the castle grounds in Bridgnorth to the community hospital, which was threatened with closure. Within two years, Bridgnorth community hospital had been transformed, with the opening of a new wing re-establishing the maternity unit with additional out-patient services and clinics. The hospital’s manager, who oversaw that significant redevelopment, has just been promoted, and rightly so—Bridgnorth’s loss will be Wolverhampton’s gain. I place on the record my thanks to her and to the Bridgnorth general practitioners, particularly Dr. Pam Yuille, who campaigned so hard to ensure that that development went ahead. The town’s GP practice has also been relocated to a new purpose-built health centre adjacent to the hospital, with improved parking and access for the GPs to in-patient beds next door.

On the same day in January 2006, some 2,000 people marched through the streets of Bishops Castle to demand that Stone House community hospital should be saved. This was a much tougher fight for lots of reasons, not least because of divisions within the community that we resolved in part through the establishment of the Bishops Castle Stone House forum, which I was pleased to chair and through which Shropshire County primary care trust and all interested groups in the community could work together to support refurbishment of the hospital, which I am pleased to say is under way.

Shropshire County PCT, led by its responsive chief executive Jo Chambers, is investing some £1.2 million in that major refurbishment, the first phase of which took place in 2008-09, with an upgrade to the roof and new windows. In the completed project there will be a new main entrance and much-improved reception area, 16 in-patient beds, of which four will be en suite single rooms, and a significantly expanded out-patient and ambulatory care zone, which together will enable an extended range of GP, nurse and therapy-led clinics to be delivered locally.

The redevelopment will occur in two phases. The first phase, which commenced last month and will end in October, will mainly refurbish the in-patient areas and the second phase—from November, concluding in March 2010—will focus on out-patients and the ambulatory physiotherapy areas. During the refurbishment, existing services continue to be provided locally, which is critical given the physical isolation of this very rural population, which is served by the community hospital.

There will be 10 in-patient beds remaining available throughout the build period and out-patient clinics will be moved temporarily to the Bishops Castle GP practice, although physiotherapy will remain on the site. One of the 16 in-patient beds will be a bespoke palliative care patient room with an adjoining relatives’ room and shared access to a walled garden outside. This will become increasingly important as the ageing demographic of the area places greater demands on end-of-life care. I will return to that in a moment.

This has been a real community effort, with significant input to the design of the facilities by local GPs and hospital staff, and fundraising for equipment organised by the hospital’s league of friends and staff, who, with the PCT, have secured Department of Health-King’s Fund funding through the Enhancing the Healing Environment programme, which the Minister will be familiar with. I shall single out a local GP, Dr. Adrian Penney, who raised some £10,000 for this palliative care scheme by participating in the five peaks challenge last year. Those people are all to be congratulated, and those are the two main success stories in my part of Shropshire in recent years.

I congratulate the hon. Gentleman on securing the debate. Does he agree that the experiences that he has described are a role model for what could be done on my side of the border, right next to him, to carry on supporting the operations of Welshpool, Machynlleth, Llanidloes and Newtown hospitals, all of which have been threatened with closure at certain times? He has proved that a proper strategic initiative, led by him and supported by local people, supports local health services and is ultimately cheaper than shutting local services down and sending people to district hospitals.

I am grateful that the hon. Gentleman has joined today’s debate, not only because we share a border—some of his constituents will take advantage of the facilities in Bishops Castle, because it is adjacent—but because Shrewsbury hospital is the main acute centre for his constituents. We share a lot of health issues in Shropshire and across the border into Wales, but although he is right in saying that it is important that the local community get together and work with the local commissioner, I suspect that the Welsh Assembly plays an important role with regard to his constituents.

I would like to say well done to my hon. Friend on securing the debate. Acute hospitals have been mentioned. Given Shropshire’s growing population—on the Welsh border side of the county, on the eastern side and on the south-eastern side, where that affects his constituents—is it not vital that the acute hospitals retain their 24-hour, seven-days-a-week accident and emergency facilities, particularly the paediatric unit at the Princess Royal hospital? Does he agree that it should not just have a sign over the door showing that it is open 24 hours a day, seven days a week, but should deliver consultants and doctors throughout the night so that his constituents, and mine on the eastern side and in central parts of the county, are not rushed, under threat and by blue light, all the way over to Shrewsbury?

My hon. Friend makes an important point, particularly for his constituents, who have the benefit of the Princess Royal hospital, with its A and E unit.

I will mention some of the pressures that the whole county is placing on the two A and E units, because it is clear that there has been a significant increase in A and E usage and I would be interested to hear the Minister say whether that is a national problem or one that can be solved locally, perhaps through more efficient processes for helping people to get out of the acute hospitals, freeing up beds to help to address some of the problems in A and E.

Let me mention some of the difficulties. There are three primary challenges to health care in Shropshire, particularly in my part of the county, which I urge the Minister to address in his speech. Four years ago the financial deficits in Shropshire were centred on the acute hospital trust, which had racked up more than £34 million of deficits under its previous management. The current chief executive, Tom Taylor, and his team have done a good job in turning around the fortunes of Shrewsbury and Telford Hospital NHS Trust, which is working hard to achieve its goal of foundation trust status with the aim of submitting an application for that status by the end of the year.

Active financial disciplines have been introduced so that from peak losses of some £12 million annually, the trust is on track to generate in the current financial year its second successive surplus of £4 million from an income base of some £247 million—just over a third of the total spent in the county by the NHS. A consequence of restructuring the acute third of Shropshire’s health care economy has been to shift the financial deficit from the acute trust to the commissioners, primarily Shropshire County PCT, which will have a deficit of £11.5 million in the current year if no action is taken.

I agree with my hon. Friend about progress on reducing the deficit, but does he agree that a large part of that deficit resulted from the previous chief executive, who submitted a fake CV and had inappropriate qualifications for being a chief executive? When I tackled the then Secretary of State for Health about the matter, I was told that not everyone’s CV can be checked. I hope that my hon. Friend agrees that the Government have learned from what happened in Shropshire and that the CVs of those who apply to become chief executives of trusts will be better scrutinised.

My hon. Friend raises two important points. One is that due diligence when recruiting for senior health service posts has had to improve, and it has. Secondly, a more fundamental point is that under this Government NHS restructuring has given rise to the opportunity for administrative chaos, which unfortunately beset Shropshire in the Government’s earlier years. In 10 years, they have introduced nine complete reorganisations of how health care is administered in this country. With such dramatic changes at all levels in the health service, it is not surprising that there were management failures.

When some 300 PCTs were introduced more or less overnight, the Government had to find suitably qualified managers to manage each PCT and acute trust. They found that challenging, and one of the worst examples of poor recruitment occurred in Shropshire’s acute trust. That problem is behind us, and I hope that the Government have learned how to recruit and how to minimise reorganisation. I believe that reorganisation is off the agenda for the time being, which is very welcome.

On the specifics of the deficit, first, it is not yet crystal clear to me how the deficit has arisen, but we have been told by PCT management that some £4.5 million of the £11.5 million annual deficit relates to what it describes as legacy issues in the contract with the acute hospitals relating to underlying demand. I think that is code for difficulty in assessing the tariff introduced through payment by results in relation to the actual cost of the procedures performed, or difficulty in estimating the demand for service involved with moving from one system to another. It is not clear exactly what it means.

The second aspect, which is more identifiable, is that some £2 million of cost from new investments in key service developments—in upstream interventions and preventive services—has helped to contribute to the deficit.

The third aspect, and the one for which the Government have most responsibility, is the introduction of the national payment-by-results tariff, which directly increased the contract between the PCTs and the acutes by some £4.5 million for no additional activity. The deficit is being shunted from one side of the health care economy to the other. Is the movement of resources from one side to the other—from primary to secondary, or vice versa—indicative of a national problem? If it is local to Shropshire, will the Minister give some guidance on how it can be resolved and whether experience from other areas can be brought to bear?

Another significant issue relates to capacity constraints in the Shropshire health care economy, most of which result from Shropshire’s peculiar demographics. The Minister, who comes from an almost neighbouring constituency, will be familiar with the attractions of Shropshire as a place to live. We benefit from significant inward migration of retired people. The county has an above-average population of over-65s and an above-average and increasing population of over-85s. That is significantly above average in my constituency in the southern third of the county. At the last count, almost 25 per cent. of the population was over 65, and the proportion of over-85s is rising rapidly. That inevitably puts demands on our health service that commensurately affect other areas with less.

One of my concerns, which has been highlighted in material provided by some of the GPs who have contacted MPs in recent weeks, is that a lack of recognition of the demographic challenge in allocating funds from the Department of Health to providers around the country is giving rise to a significant shortfall in funding. Dr. Rummens, chairman of Shropshire’s local medical committee, wrote to me and other Shropshire MPs, suggesting that Shropshire County PCT is underfunded by 3.8 per cent., calculated using Government’s own fair shares formula, which is equivalent to some £15 million of relative underfunding. The Minister will recall from what I have just said that that is more than enough to cope with the deficit that has been identified in the PCT this year.

What is the Minister doing about the fair funding formula, and can he offer any encouragement to Shropshire that it may receive a better reflection of the challenges posed by the demographic circumstances when looking forward to funding formulae in the next comprehensive spending review? I realise that he is relatively new to his post and that he may not be in post when the allocations are made, but I look forward to his response.

To illustrate how capacity constraints are affecting Shropshire—this picks up a point made by my hon. Friend the Member for The Wrekin (Mark Pritchard)—demand for accident and emergency services reached unprecedented levels in 2008-09, with some 3.7 per cent. more emergency admissions during the year than during the previous year. There has been a 30 per cent. increase in ambulance transfers to the Princess Royal hospital in Telford, compared with a 6 per cent. increase in ambulance transfers to the Royal Shrewsbury hospital previously.

We recently had a briefing from the management of the acute hospital at one of the Shropshire MPs’ regular quarterly sessions, which the hon. Member for Montgomeryshire (Lembit Öpik) also attends. Their analysis suggested that clinicians felt that, at any one time, up to 60 patients in the two acute hospitals did not require the specialist care offered by those hospitals and could have been cared for in rehabilitation beds in community hospitals. There is a shortage of rehabilitation beds in the two major conurbations in the county—Shrewsbury and Telford—because their provision comes through the acute hospitals. The community hospitals are located in the smaller, outlying towns. There are three in my constituency, two of which I have mentioned already.

There has been pressure on the community hospitals to shrink the number of beds to find efficiency savings. There is pressure on the acute hospital to provide somewhere for patients to be released to once they have undergone treatment through A and E or regular admission. The solution that the acute hospital would like to put in place to deal with the problem of bed blocking and throughput through the hospital is to introduce a further 30 rehabilitation beds in Telford. I am sure that the hon. Member for Telford (David Wright), were he here, and my hon. Friend the Member for The Wrekin would welcome the addition of rehabilitation wards in their community, but so would we elsewhere in the county, because one problem that flows from the pressure on space is that it clogs up the admissions process throughout the system.

We have also been told by Dr. Rummens that we suffer in our acute hospitals from many of the same problems that we read occur elsewhere in the country, with patients being unable to be admitted through A and E, partly to ensure that the A and E departments meet their target waiting times, but partly because of the bed blocking problem elsewhere in the hospital, to which I have referred. In his letter of 7 May, he said that one of his colleagues, a GP in the Shrewsbury area, said:

“Last time I did a Shropdoc session there were 24 patients waiting to get into the Medical Emergency Centre, many of whom were waiting in ambulances that were not allowed to unload the patient”.

We read about that in national newspapers from time to time. I have never before heard a Shropshire GP giving hard evidence that it is happening in our county now. I think that the reason for it is, as I said, that there are not enough rehabilitation beds—step-down beds—in the county at times of intense pressure. Of course, the pressures at this time of year are somewhat less than they normally are in the winter. We have been told that Shropshire, mercifully, has not suffered a significant number of hospital admissions because of swine flu. That does not appear to be giving rise to the pressure. I think that it has more to do with the demographic factors to which I referred.

The importance of rehabilitation beds and the role that the community hospitals can play in providing a step down from acute care is my third and main point. It relates to the third community hospital in my constituency—the hospital at Ludlow. I should like to take the Minister back to that Saturday in January 2006 when, after marching in Bridgnorth in the morning, I sped across my constituency—well, I travelled across my constituency within the speed limit, of course, but quite rapidly, because I had to get from a morning march to an afternoon march in Ludlow. Some 4,000 people assembled in Castle square and marched through the town to a rally at St. Peter’s church, opposite the community hospital in Ludlow. That was in reaction to the threat, which was even more real in that case, posed to their hospital. Although we managed to save the hospital from closure, we could not prevent the closure of the mental health ward there.

The community has subsequently worked painstakingly with the PCT—particularly through the league of friends, which has been ably led by Mr. Peter Corfield as chairman, and the careful work of the two GP surgeries, led in this regard by Dr. Dorian Yahram and Dr. Graham Cook—to encourage the PCT to place the redevelopment of Ludlow community hospital at the top of its priority list. The hospital continues to work from a site that includes the listed administration block, which was formerly the Victorian poorhouse in the town. It is disparately set out on a constrained site, with buildings that were perhaps fit for purpose when they were constructed—in some cases in Victorian times and in other cases in the 1950s and ’60s. There is no doubt now in the PCT’s mind that Ludlow is its top priority for redevelopment.

We received considerable encouragement from the West Midlands strategic health authority, whose chairman Elisabeth Buggins and then chief executive Cynthia Bower, who has, of course, moved on to dizzier heights in the Department of Health, visited the hospital at my invitation 18 months ago and endorsed the proposals put together by Shropshire County PCT for a redevelopment to take health care facilities into the 21st century. The PCT and local clinicians on the ground were encouraged to develop a vision that would provide an innovative plan for integrated health care services as envisaged under the White Paper, “Our health, our care, our say: a new direction for community services”.

The plan that has been put together is innovative in a number of ways, not least in that it is built around co-location involving the two GP surgeries, both of which have their own constraints: one has no space at all—even its filing area is shared with a broom cupboard—and the other has also run out of capacity. They will be co-located with the hospital. A site has been identified and work has gone so far as to include the inevitable, as it is these days, bat survey to ensure that the development of the site does not disturb the resident bat population in the fine line of oak trees that borders the site. That illustrates the extent to which plans are well advanced. We had been given every encouragement by the PCT to believe that that was something that it wished to proceed with, and there had been every suggestion by the SHA that it was the SHA’s top priority project for a community hospital redevelopment in the west midlands. I was under the impression that those plans—the outline business case—had been presented by the SHA to the Department of Health. It seems as though the Department decided to put the onus on the SHA to take things forward.

The primary source of funding for the proposal, which has not been costed to the last quote at this point, because it was an outline business case, was a £30 million scheme. A sum of £30 million for a community the size of Ludlow was quite a big ask, and we in the community were somewhat concerned about where the funding would come from. We were therefore greatly relieved when the then Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), made an announcement in the House on 5 July 2006. The Hansard reference is volume 448, columns 816 to 832. In her statement on community hospitals, she announced the establishment of the community hospital redevelopment fund. She said that a £750 million fund would be available over a five-year period. If I may, I shall quote from her speech, because it has come to light that the prospects of using that fund, not only for the community of Ludlow but for the county’s PCT and the SHA overall, appear to have been stymied by the fund having been terminated, although that word has not yet been used by a Minister. I am looking to this Minister to give us some reassurance on the fund’s precise status. In her speech announcing the fund, the then Secretary of State said that the Government would make available

“up to £150 million of capital…in each of the next five years, starting this year—a total of up to £750 million—for the development of a new generation of community hospitals and services.”—[Official Report, 5 July 2006; Vol. 448, c. 816.]

That speech was given in 2006, so the words “starting this year” suggested that there might be some spending in 2006-07 and that there would certainly be some in 2007-08. We are now in the middle of 2009, and we had a reasonable expectation that some of the money, which had been specifically set aside from the Department’s capital budgets, would now be available.

In a parliamentary question in December 2008, I asked how much of the money had been spent, and I received a written answer saying that £248.1 million had been committed by the end of 2008—18 months after the scheme had been announced. Again, that gave those of us in Ludlow who were concerned about the issue some comfort that money was being allocated and spent, and there was evidence in the answer that I received that buildings were starting to come out of the ground all around the country.

Hon. Members can imagine our surprise, therefore, when Shropshire County PCT received a letter from West Midlands SHA on 1 May, stating:

“Andy Stubbing, Head of Capital and Revenue Investment Branches at the Department of Health, has said that ‘the Treasury is unlikely to agree further releases of funding for this programme.’ Instead SHAs will have to apply for funding through PFI schemes”—

private finance initiative schemes. That came as a bit of a bombshell to us: although we could look at PFI schemes, and a great deal of work is going on to consider LIFT—local improvement finance trust—and Express LIFT, as well as other schemes that the Department is encouraging, we were under the impression that the community hospital redevelopment fund was there precisely to fund the sort of projects that we had proposed with the blessing of the NHS hierarchy.

I raised the issue with the present Secretary of State during the Second Reading of the Health Bill on 8 June, which was his first working day in office. I did not therefore expect him to give me an instant answer, and he admitted that he could not do so, but he did agree to write to me. True to his word, he did so, which was helpful—or it appeared to be. Just before I received the Secretary of State’s letter, I received another from the Minister of State, Department of Health, the hon. Member for Lincoln (Gillian Merron). In her letter, which is dated 22 June, she said:

“I can however assure you that there are no plans to remove funding from the Community Hospital Programme.”

Being a relatively new Member, I took the view that a letter from a Minister of State saying that there were no plans to remove funding from the programme was quite a positive indication that there had perhaps been some mistake. The Minister of State’s letter appeared directly to contradict what the SHA had told the PCT, and that appeared to be good news.

I then received the Secretary of State’s letter, which is dated 22 and 23 June—I am not quite sure when it was sent. He made two points that are of interest. First, he referred to his predecessor’s original announcement, saying:

“The £750 million was assumed to be required across a period of five years or so, spanning the CSR 2007 years, 2008-09, 2009-10 and 2010-11, and subsequent years for which”

the Department of Health

“has yet to receive an indication of capital resources from HMT”—

Her Majesty’s Treasury. That is a slightly different way of describing what his predecessor had described as a £750 million programme starting in 2005-06. The current Secretary of State is suggesting that the programme is meant to run from 2008-09, whereas we know from his predecessor’s answer in Hansard that the money was already committed in 2007-08. The current Secretary of State is trying to introduce a bit of wriggle room to suggest that the programme is being backdated, rather than front-loaded, which is what was apparent from what had been said before.

The second thing that the Secretary of State said in his letter is also important:

“HMT approval for additional funding would be unlikely because of the current pressures on the Department’s capital settlement. However, that does not necessarily mean that ‘no more funds would be made available’”—

that is a quote from my letter to the Secretary of State—

“but that future access to the funds would be determined by HMT.”

There you have it. On 22 June, one Minister says that there are no plans to remove funding from the community hospital programme. Then, probably on 23 June, her boss says that future access to the funds will be determined by the Treasury. Either we have a community hospital redevelopment fund that has funding or we do not. The Minister would do the country a service if he could clarify whether there is any money in the pot and, if so, whether we can have access to it. If not, let us come clean and establish that there is no money, and those of us who are working hard to come up with schemes to improve health facilities in our constituencies can focus on that.

Will the hon. Gentleman confirm that the penultimate sentence in the letter from my right hon. Friend the Secretary of State says:

“However, that does not necessarily mean that ‘no more funds would be made available’, but that future access to the funds would be determined by HMT”?

In other words, there is funding, but there needs to be HMT approval for it. The hon. Gentleman is making a mystery of something that seems very straightforward.

I am grateful to the Minister for paying attention to what I was saying—that is precisely the sentence that I have just read out to him. Two years ago, the Secretary of State’s predecessor said that £750 million was available and that the capital would be spent at the rate of up to £150 million a year

“in each of the next five years, starting this year”.—[Official Report, 5 July 2006; Vol. 448, c. 816.]

That is where the problem lies: one Secretary of State has said that money is available, while a subsequent Secretary of State has said, “No, there isn’t.”

I had actually brought my remarks to a close. I look forward to the Minister picking up this issue in his winding-up speech.

rose—

Order. Three hon. Gentlemen are seeking to catch my eye. I advise them that I hope to call the Front-Bench spokespeople at 10.30 am. If hon. Members take that into account in their contributions, I hope to be able to fit everyone in.

It is pleasure to serve under you, Mrs. Humble, and I will be as brief as I can.

I congratulate my hon. Friend the Member for Ludlow (Mr. Dunne) on securing the debate. As he said, this is the second such debate—there really is a sense of déjà vu and continuity. At the time of the previous debate, we went to see the then Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), for a private meeting. We actually congratulated her on parts of her White Paper and pressed her—this was confirmed in letters—to stick to the proposals on community health. We strongly supported those proposals. Indeed, I led a march through Whitchurch while my hon. Friend was marching around his constituency on behalf of community hospitals.

Let me give one example of what we are talking about. Some 75 per cent. of diabetic patients in Shropshire are treated by GPs, while 75 per cent. of diabetic patients in Birmingham are treated in district general hospitals. Our doctors reckon that there would probably be about a 20 per cent. saving if their GP practices could be enhanced with more facilities.

The Government came up with a White Paper, and I do not want to embarrass the Minister, but the then Secretary of State made the following useful statement:

“community facilities that are needed for the long term must not be lost in response to short-term budgetary pressures. So we will expect primary care trusts to reconsider such proposals against the principles of the White Paper.”—[Official Report, 30 January 2006; Vol. 442, c. 24.]

We were assured at the time that funds would be there for such community projects.

There has been expansion of GP practice facilities in Market Drayton, and I have been heavily involved in the expansion at Oswestry, which is going ahead. I should like the Minister’s assurance that the funds that PCTs were assured of, for the GP practice extensions, will continue. I am not asking for any more money; those moneys were promised. I want to name two practices in particular. I took doctors from the Ellesmere and Wem practices to see the present Minister for Regional Economic Development and Co-ordination when she was a Health Minister, and she made all the right noises about community care. Three years further on I should like assurances that the funds are there for the PCT.

With respect to Ellesmere, the White Paper called for collaboration with the local authority. Before it was dissolved into the new unitary authority, the outgoing North Shropshire district council bought the ground. The population in my constituency is expanding, and, as my hon. Friend the Member for Ludlow has said, ageing, so I should like to know that the funds set aside at the time of the White Paper are available for the extensions. I think 18 practices across Shropshire have been allocated priority, but the two that I would pick out would be Ellesmere and Wem.

Will the Minister confirm how the NHS funding formula works? My hon. Friend touched on it, but as I see things there is a lag in Shropshire. We have an increasing population, because of people moving in, but it is also an ageing population, and I should like an explanation of the notion of distance from target. I understand that that is about an amount that an area is deemed to warrant, under a formula, but does not yet receive, on the understanding that the target figure is to be worked towards, over the years. For counties such as Shropshire the delay in reaching that fair-share allocation can represent a significant current shortfall. Combined with particular financial pressures in commissioning services, given the elderly population that I mentioned, in a large and thinly populated rural area, that can cause the PCT problems. I reiterate that I am not asking for more money—the moneys I am talking about have been allocated, but there seems to be a drag in the system.

To cheer the Minister up I shall move to some good news, which is that I am happy to have the jewel in the crown of Shropshire health care in my constituency. That is the Robert Jones and Agnes Hunt orthopaedic hospital, which is a shining example of how health care can be provided. I was chomping through my drearily healthy breakfast about a year ago when I saw a list of hospitals that had been rated by the Healthcare Commission. I was not surprised, but delighted, to see that the orthopaedic hospital came top, with a score of 92 out of 100, on a range of scores. It had a higher score than any other trust nationally on four questions, and it was the top scorer in six out of eight headline categories across the west midlands. The key thing is that it has got its costs down by about 10 per cent. in the past couple of years. Above all it has zero MRSA—there is no MRSA there, despite an enormous increase in its activity. It employs 1,200 people and £80 million goes to the local economy; it is the biggest organisation near Oswestry. It is a very successful organisation, and is critical for the local area.

In addition there is charity work, which I think is rare in the NHS—I should declare an interest for my involvement in the Institute of Orthopaedics. That has led to the building of the Leopold Muller centre. A couple of weeks ago I went round the Torch centre, which probably has the most sophisticated gait laboratory in western Europe, which deals with the treatment of children with acute spina bifida or muscular dystrophy. That is at the crossing point of medicine, mechanical engineering and physics. I do not entirely understand it, but I enormously admire the work that is done there. An application has been made for national designation for muscular dystrophy services, and I wonder whether the Minister can clarify when that may come through.

The trust has cleared its debts and is now pressing on to foundation status; that goes back to my meeting with the right hon. Member for Leicester, West. I hope that it will happen in the next 12 months. The process has been dragging on.

What seems to be the sticking point is the fact that there are probably only four top orthopaedic hospitals in the country that can do revision operations; they rework operations that may have gone wrong or may not have been quite so skilfully done in other hospitals. That is immensely complex and difficult work. About 1,000 such operations a year are done there. Only the Nuffield orthopaedic centre in Oxford, the Royal orthopaedic hospital at the Woodlands in Birmingham, the Royal National orthopaedic hospital at Stanmore in London, and Wrightington hospital, which happens to be in the Secretary of State’s patch, can carry out such operations.

There is haggling about the tariff. It was increased last year, but the operations are so complex and difficult that there is still a problem, and that might be a block in the quest for foundation status. What are the Minister’s proposals on that? It would, bluntly, be humiliating for the country if those operations had to be conducted abroad, which might be an option if the hospital could not afford to carry on doing them. It is the cutting edge of medicine. As before, I am not asking for more money. The trust has saved the NHS substantial sums by efficiency gains. We just ask that the correct sums should be paid for a quite small number of very difficult operations. I am very much in favour of foundation status. The orthopaedic hospital is a classic example of a smaller operation with a really tight team and a tremendous team spirit throughout the place, which really delivers.

In the past I have felt that there has been a bit of prejudice in the west midlands authorities against that world-class operation, tucked away in the north-west of the west midlands. I met an Australian on an aeroplane once—I shall not bore hon. Members by doing the accent—who said, “I have been to this amazing hospital; it’s entirely surrounded by sheep.” It is isolated, but it delivers the care that it does partly because that is the attraction for the people who work there. There has been a sea change. I pay tribute to Elisabeth Buggins, the chairman of the strategic health authority, who has been to the hospital a couple of times and understands its value. She supports its drive for foundation status. However, I should like an answer on the vexed question of the tariffs for revision operations. The orthopaedic hospital has a sports injury service. Three consultants work on sports injuries. What links does the Minister have with his colleagues working on the Olympics, with a view to making sure that the hospital could benefit from that?

To move on, rapidly, from good news to bad news, a ludicrous vexed area is the nonsense of redesignating the status of GP practices that can dispense medicines. The Shawbury practice raised that with me last summer. I do not see why the Government have brought in the new regulations, which are wholly damaging and negative. We saw them off in Shawbury, thanks to a spirited campaign. I probably had more letters about that last summer than about anything else. Sadly, the issue has moved on to Gobowen, a large village a couple of miles outside Oswestry. I had many letters from furious constituents who are used to going to the GP and getting their medicines at the same time. The pharmacists there have local knowledge and access to medical records. The system is wholly beneficial. However, under the new regulations, if another company puts in a bid for a pharmacy, and if the designation of the area is considered and the rurality is withdrawn, the doctors’ surgery can no longer dispense. In Gobowen the utter nonsense of the situation is that the company that put in the bid does not yet plan to build a pharmacy. That is a wholly negative development and it is nonsense. It is all to do with the designation of rurality.

I have been in constant communication with the Minister’s predecessors. I have a letter from the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope), who said that the question is decided by the PCT, and I got a letter from the PCT saying that it is required by national regulations first to determine the rurality of the area as defined under the pharmacy regulations. Then there is a ludicrous passage in which the PCT just repeats what it is made to do by central Government regulations, and says:

“The regulations also clearly state that the fact that an area is classified as ‘controlled’ (ie not rural in character), or that a decision is taken to remove such a classification, does not necessarily mean that it is urban.”

If you can understand that, Mrs. Humble, you are doing well.

Councillor Joyce Barrow has recently been elected the councillor for Morda, another village just outside Oswestry, which must be rural because it comes within Oswestry rural parish council, and it is likely to have its services removed. One of the excuses about Gobowen was that there are other services, such as a post office. However, the Government have removed the post office from Morda and there is really very little there. I have had a furious letter from the surgery saying that that will damage patient care. Will the Minister explain why the regulations were introduced? The PCT has said that it had no option but to implement them. [Interruption.] I should be grateful if the Minister would listen to me rather than to the hon. Member for Coventry, South (Mr. Cunningham).

It is causing real upset. Doctors tell me that it will damage patient care. I am all for freedom of choice. If someone wants to build a pharmacy, if they can compete, good for them, but why should we upset a system under which doctors have detailed knowledge of their patients and patients do not have to suffer the inconvenience of using a taxi or the infrequent bus service to go into town to get their medicines? I do not see any merit in what the Government are doing, and I would like to see things reviewed. I would like an answer from the Minister.

I congratulate my hon. Friend the Member for Ludlow (Mr. Dunne) on securing this important debate.

I pay tribute to the hard-working members of staff at the Royal Shrewsbury hospital—the doctors and nurses, the cleaning staff and all involved in providing care at that important health care facility in Shropshire. I pay tribute also to the chief executive and the chair of the Shrewsbury and Telford Hospital NHS Trust for their hard work, Mr. Taylor and Dr. Bamford respectively.

The most important thing that I want to get across in my truncated speech—we are running out of time—is that Shrewsbury is a border town. We live cheek by jowl with the Welsh community just across the border, which uses our hospital facilities. A political map of England will show that all the seats in that part of the country are held by Conservative or Liberal Democrat Members. Although I have repeatedly raised my concerns with Ministers on how English hospitals are losing out as a result of Welsh devolution, little progress has been made because the Government do not understand the grave consequences and are not prepared to act.

The Royal Shrewsbury hospital loses approximately £2 million a year because the Welsh Assembly has different ways of paying for treatment. That loss cannot be allowed to continue. I aim my remarks at my hon. Friend the Member for Guildford (Anne Milton), the shadow Minister for Health, who will doubtless soon be making decisions on the matter. When we finally get a Conservative Government, I hope that there will be some redress, so that my constituents do not continue losing out.

Not only the financial aspects, but issues to do with drugs and waiting times concern me. One of the most emotional and fraught experiences that I have had as an MP is trying to secure live-saving drugs for my constituents; they are not entitled to them, whereas people who live just a few miles across the border in Wales that use my hospital are automatically allowed those drugs. I feel passionately about the United Kingdom, and I believe that we are one country. Allowing such a postcode lottery to continue is doing untold damage to the Union.

I declare an interest in that the Royal Shrewsbury hospital saved my life on 13 April 1988, and the Gobowen hospital helped me to start walking again.

I challenge the hon. Gentleman: I believe that those Welsh patients provide a net contribution to the Royal Shrewsbury. If they went somewhere else—perhaps to Hereford or Aberystwyth—Shrewsbury might have to become smaller. He may criticise the benefits of devolution to my constituents, but I advise him to look at the figures again. On balance, the Royal Shrewsbury hospital gains a net benefit from my Montgomeryshire constituents going there for their health care.

I do not want to get engaged in cross-border parliamentary warfare, but if the hon. Gentleman speaks to the chief executive of the Royal Shrewsbury, as I have done, he will discover that the hospital has lost out. Of course we welcome Welsh patients coming across the border to use our hospital’s facilities, but the Welsh Assembly must start paying the same for medication as English authorities. That is what leads to the losses in English hospitals.

We pay too much for car parking at our hospital. We have to pay £2 to leave our cars at the Royal Shrewsbury. When my daughter was being born there, I remember thinking that I would have to leave the labour ward and rush out to fill the meter, because parking tickets expire at midnight and one has to buy another ticket. We are the fourth-wealthiest economy in the world, yet we are charging people to leave their motor vehicles. Many come, not as I did for the birth of my daughter, for a relatively short period, but for much longer, as they have relatives with long-term illnesses at the hospital. For people on limited incomes, paying £2 a day is bad.

I remember that the windows of the maternity ward at the Royal Shrewsbury hospital have to be sealed for security reasons. It was sweltering when my daughter was born, but the hospital did not have air conditioning or fans. I hope that the Minister will do everything possible to ensure that the maternity services at the hospital have better ventilation or air conditioning, so that people have a more conducive atmosphere.

The league of friends at Royal Shrewsbury hospital is a group of volunteers that raise hundreds of thousands of pounds every year for the hospital. It runs tea and coffee shops, sells goods and runs events throughout Shropshire to raise funds to buy vital equipment. That equipment should be provided by the state through taxation, but as a result of the lack of Government funding, the league of friends, a local charity, is increasingly burdened with having to find ever more money. I ran the London marathon a few years ago. It nearly killed me, but I raised £9,000 for the league of friends. Should I be re-elected, I may do it again because of the tremendous benefits that the group is able to give the hospital.

My constituents in Shrewsbury have raised aspects of the problem of long-term care for the elderly, as did my hon. Friends the Members for Ludlow and for North Shropshire (Mr. Paterson). For many of my constituents, it is the biggest health care issue. Many of my constituents have had to sell their relatives’ homes in order to pay for their care. The BBC website says this morning that the Government are considering asking people in England to take out care insurance to pay for long-term care in their old age.

The question of long-term care is hugely important to my constituents. There are many senior citizens in Shrewsbury. We have an above-average population of senior citizens, and they are looking to this Government, or to the next Conservative Government, for some form of answer. It is unacceptable that people who have been thrifty and have saved should have to sell their assets and their homes to pay for long-term care.

I end by trying to indicate to the Minister the passion that everyone feels about health care services in Shropshire. We want a fair deal, and I look forward to hearing the Minister’s response.

I am aware of the time, Mrs. Humble. I have delegations arriving here from Welshpool, so I hope that the Minister will forgive me, on condition that I do not ask him any questions, if I leave a little early.

As has been said, my constituency neighbours Shropshire, and my Montgomeryshire constituents depend heavily on the health care services of the Royal Shrewsbury hospital and, particularly, the Gobowen hospital. I cannot praise enough the efforts of the staff at those facilities, not least because of my experience there. I also praise the efforts of Tom Taylor in putting into order accounts and finances that have gone dreadfully wrong.

I wish to add two further observations. First, it seems that the most effective way to provide the care that my constituents need is for the district general hospital in north Shrewsbury to do what only it can, but to allow convalescence in the other four hospitals—at Llanidloes, Newtown, Machynlleth and Welshpool. Bed spaces are cheaper there and a collective approach could make a huge difference.

Secondly, technology should enable us to do outreach work much more creatively and extensively. By using modern technology, some sophisticated diagnosis and treatment could once again be devolved back to those smaller hospitals. That, too, would reduce the pressure on the Royal Shrewsbury hospital. I have no doubt that technology will make a difference, but it would be better if we did that strategically.

Finally, I thank Tom Taylor for bringing things into order at the Royal Shrewsbury hospital. Unquestionably, his leadership has turned around by 180° the dreadful situation that his predecessor had left to fester. The hospital is a cross-border lifeline for my constituents, and I thank its staff and leadership for all that they do. I hope that, collectively, we can create a cohesive strategy embodying the work of the small, local hospitals and using modern technology to improve their reach and to save funds and lives.

I congratulate the hon. Member for Ludlow (Mr. Dunne), a former Work and Pensions Committee colleague, on securing this important debate. I have enjoyed listening to the description of the issues in his constituency and the constituencies of other Shropshire Members. I know Ludlow reasonably well: my wife lived there for some years when a child and my brother-in-law Josh was born there, which presumably explains why he is a Manchester United fan—I never quite worked that out. However, it is a wonderful part of the country and one that I am always pleased to visit.

The case laid out by the hon. Gentleman and other hon. Members demonstrates the stark contrast between Ministers’ rhetoric and the reality of the NHS in the 21st century. The rhetoric is about localism, but in reality we have the most over-centralised health service in the world. I am afraid that that is an issue for us all. Few MPs have a community hospital in their constituency, but I am one of them—the excellent Wharfedale hospital—and very few of those MPs have not had to spend considerable time supporting those facilities, and often campaigning against cuts, service reductions and, on too many occasions, the threat of closure.

The hon. Gentleman alluded to a 2006 statement made by the former Secretary of State for Health, the right hon. Member for Leicester, West (Ms Hewitt), and the commitment to dedicate £750 million to community hospitals. Three years on, however, not even half that has been invested in those important health facilities. That is of real concern to communities in Shropshire and in Yorkshire, and up and down the country. I shall read some of the words accompanying the announcement. The 2006 statement said:

“Developments in medical technology are making it possible to provide far more care in local communities, closer to where people live”.

Is that how people perceive the health service? I say not.

The statement continued:

“Services could include in-patient and out-patient facilities, diagnostic tests, specialist clinics, minor surgery, health and social care services for people with long term conditions, dentistry, rehabilitation and palliative care… we expect to see a strategic shift in how the NHS provides care, with a reduction of funding to support the provision of more convenient services in local communities.”—[Official Report, 5 July 2006; Vol. 448, c. 816-17.]

Those warm words simply do not represent the experiences of people throughout the country, which is that many services that could be provided more locally are not. They have to travel increasingly large distances. In my constituency, people have to travel the 11 miles from Otley to the large hospitals in Leeds such as Leeds general infirmary and St. James’s university hospital.

In more rural constituencies, such as those of the hon. Gentleman and my hon. Friend the Member for Montgomeryshire (Lembit Öpik), some people regularly have to travel large distances to access important services that are often an hour and a half’s drive away. That simply is not acceptable. We should be trying to make as many services as possible accessible locally.

I wish to make another important point that comes up every time we debate local health services. The modern NHS is not accountable. It takes marches of thousands of people in the streets of our towns and MPs organising petitions, protests and public meetings to get any sort of accountability in local health services. Whatever Ministers or civil servants say, local health managers are not accountable to local people. They are accountable in this bizarre chain to strategic health authorities, which, as we all know, are not only enormously wasteful, but the puppets of the Secretary of State. They oversee a wide area and ensure that his bidding on general policy is done in local areas. That is entirely inappropriate and wasteful.

What should be a people’s health service has fallen into the hands of managers who do not see themselves as accountable. I have seen many examples in the health service in my constituency of a paternalist attitude. The managers say, “We know best. We know what our priorities are. We will deliver them and make decisions with little or no consultation.” When there is consultation, it is usually inadequate and often simply a fig leaf, enabling them to rubber-stamp a decision already made.

There are campaigns throughout the country not only on community hospitals, but on other important health facilities and health centres. It takes such people power to bring any kind of accountability. When will the Government address that clear democratic deficit? If they did so, they would not have to listen time and again to MPs complaining that even we find it difficult to influence decisions on behalf of our constituents, except through such petitions, marches and protests.

The Liberal Democrats will enter the next election with a policy to replace PCTs with partially elected health boards. We can debate whether that is a good idea, but it acknowledges a problem that cannot be ignored and needs policy solutions. We have put one on the table to be discussed: involve local people in decisions so that they can kick out, through elections, hospital trust managers making unpopular decisions and PCT bosses making unpopular local strategic decisions. Without that accountability, all the warm words about localism and accountability are not only just words, but rather insulting to the many people who take part in marches and sign petitions.

The sad reality is that the health service is unaccountable and desperately over-centralised, and does not respond to the needs and demands of local people. Until that changes we cannot make the best use of the energy of our health professionals and managers who are passionate about the care that they provide. Health services are so tightly controlled from Whitehall and the Departments. That must change if we are ever to give the NHS back to the communities, where health service decisions should be made.

I congratulate my hon. Friend the Member for Ludlow (Mr. Dunne) on securing this debate. He has clearly spent a lot of time participating in marches around his constituency. He talked about 4,000 people marching in protest at the threats to Bridgenorth hospital, and he mentioned Bishops Castle community hospital. It was encouraging to hear him talk in such glowing terms about the community effort that has gone into the design of not only services but buildings. Clearly, a lesson in best practice can be learned about designing services that are responsive to local people’s needs and that make people feel that the NHS is responding to their concerns.

My hon. Friend mentioned Ludlow community hospital and the closure of the mental health ward. As a shadow spokesman with responsibilities for mental health, I caution against the loss of mental health beds. The closure of such beds has resulted in a rise in the prison population. Whether people are in prison or in mental health hospitals, they must receive the care and services that they need.

My hon. Friend told a very frustrating story about how the hospital and the local people were encouraged to redevelop services. Both the PCT and the strategic health authority described Ludlow as a top priority. Mention was made of the community hospital redevelopment fund. Despite the Minister’s intervention, I am still not clear whether or not the fund is there. That shows the confusion about some of the Government’s announcements. The Minister shakes his head. Either we are all being very dim or he is not paying attention, and I suggest that it is the latter.

Will the hon. Lady give way?

The Minister will have a chance to address the points when he replies to the debate. [Interruption.] Okay, I will give way.

I should be grateful if the hon. Lady did not make personal asides and then stop me from intervening, because it is discourteous. As I have said already, the fund is available, and it needs the consent of both the Department of Health and the Treasury. It is very simple and straightforward, and there is nothing obscure about it.

I certainly did not mean any discourtesy to the Minister. I was driven by frustration over the lack of clarity. By implication, I do not think that we are all being very dim either. None the less, we need more clarity. The Minister has not explained why the money is not being spent at the rate at which it was originally intended to be spent.

As for community hospitals, I certainly have one in my constituency. Cranleigh village hospital is extremely important. I am often unconvinced by both the modelling and the drivers of such hospitals, which relate, I am convinced, to short-term budgetary pressures, rather than to clinical improvements. The Government’s White Paper, “Our health, our care, our say: a new direction for community services” made it absolutely clear that decisions should be made on the basis of improving clinical outcomes. Yet, all too often, the drivers are the financial pressures.

My hon. Friend the Member for Ludlow also raised the issue of financial deficits and the yo-yoing between PCTs and acute trusts. That is confusing not only for local people but for the trusts, and we need to have some clarity about where those deficits lie. In my PCT, I have had considerable difficulty discovering why, with a 5.2 per cent. increase in funding, the PCT has to save £60 million. I cannot make sense of the figures.

Will the Minister reassure us that there will be no more reorganisation of services in the lifetime of this Government? As he is new to his brief, I refer him to the Health Committee’s report on reorganisation, which makes it clear that reorganisation causes chaos, a fall in due diligence—we heard about the chief executive who got his job with a fake CV—loss of focus and management failures. Moreover, will the Minister explain the deficits and what attempts the Government are making to ensure that we know exactly where such deficits lie?

My hon. Friend also raised the issue of demographics and our increasingly older population. Again, as the Minister is new to his brief, I refer him to an excellent Health Committee report, in which I was involved, about financial deficits and to the work of Professor Sheila Asantha, who considered the issue of funding. In particular, she examined whether rural areas were getting sufficient funding to deliver the required services, particularly as they tend to be more difficult and expensive to provide in those areas.

My hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) spoke in glowing terms about the expertise in Oswestry and the need to harness and invest in that expertise. We have pockets of superb practice in this country. We must ensure that we do not have clumsy funding formulae and tariffs that put such services under threat. He also eloquently described the anger that many GPs feel over the dispensing problems in rural areas. In this debate, we have had a run around every single issue relating to NHS services that faces many hon. Members. I know that my hon. Friend is not alone in his concern about GP dispensing.

The hon. Member for Montgomeryshire (Lembit Öpik) and my hon. Friend the Member for North Shropshire (Mr. Paterson) praised the Royal Shrewsbury hospital. My hon. Friend always describes his local services and workers in glowing terms. As someone who worked in the NHS for 25 years, I can say how much staff appreciate being mentioned in such terms. He also mentioned some very complex cross-border issues, such as waiting times and availability of drugs. Even in this Chamber today, we saw the issue bubble up as the heat began to rise. I dare say that my hon. Friend and the hon. Gentleman could have gone on for some time and taken the complex issue further.

I recently spoke at a league of friends conference. There is no doubt that the organisation does a tremendous job in raising money. Sometimes it helps to fund equipment and services, which are right on the border of what the state and chargeable provision should provide.

The Government are publishing a Green Paper on social care and long-term care. I do not want to take up any more of the Minister’s time, because there are a number of points on which we should like to hear some clarity. Moreover, I should like to give my hon. Friends and other hon. Members the opportunity to intervene on the Minister if they do not get the full clarity that they would like.

As I said, I have worked in the NHS for 25 years, and I came to the House because I did not think that enough people with front-line experience of the NHS were working in Parliament. There is no doubt in my mind that there is a disconnect between what the Government believe is happening and what is actually happening on the ground. So often, we see the frustration of hon. Members as they try to describe what is happening in their constituencies. They often say that what the Government say is happening is just not taking place. There is a yawning gap between some of the modelling behind the Department of Health and what works on the ground. We saw that in the White Paper, which explicitly says that changes should not be made because of short-term budgetary pressures, but that is exactly why changes are made.

The Government cannot make grand statements and get press coverage for the £750 million that they are spending on the community hospital fund only for it to disappear before our eyes. We do not see the withdrawal of such funds plastered all over the press, but we see the announcement of them everywhere. We need clarity on the matter. Although the Minister intervened on me, I still do not believe that we have that clarity. I look forward to the Minister’s comments and to him being able to reassure my hon. Friends that health services, particularly those in rural areas, are safe in the Government’s hands.

I have 10 minutes left in which to reply. The hon. Member for Guildford (Anne Milton) said that she was going to give me some of her time, but she has given me only about 30 seconds.

Ten minutes.

I have 10 minutes overall in which to reply, and the hon. Lady took nine minutes and 30 seconds to respond. She is entitled to that time, but she should not then say that she is allocating some of her time to allow me to respond more fully. The hon. Member for Ludlow (Mr. Dunne), whom I congratulate on securing this debate, took 35 minutes to set out his case, and the hon. Members for North Shropshire (Mr. Paterson) and for Shrewsbury and Atcham (Daniel Kawczynski) raised a series of important issues on which I should have liked more time to respond, but they will have to forgive me if I am unable to do so in detail on some of them. I am happy to respond to the gestures of the hon. Member for North Shropshire and write to the hon. Gentlemen.

Let me say that I am concerned about the representations that were made in respect of Ludlow community hospital. Before I respond specifically to those, I pay tribute, as Ministers always should, to the hard work and dedication shown by health service staff throughout Shropshire in providing a high-quality health service for patients.

Funding overall for the NHS has tripled since 1997. Between 2004 and 2010-11, funding to Shropshire County PCT will increase from £230.5 million to £436.6 million. That represents an increase of more than £200 million in only seven years. Back in 1997, it was not uncommon for people to have to wait 18 months or even two years for an operation in the NHS. However, because of our reforms and increased investment in the Shropshire County PCT area, 92 per cent. of admitted patients and 98 per cent. of non-admitted patients are currently seen and begin their treatment within 18 weeks of referral. That demonstrates the dramatic effect that the Government’s policies have had on waiting times.

In addition, we are establishing new GP health centres in Shropshire, which will be based in Shrewsbury. They will open in September and can be used by some of the hon. Members’ constituents. The Market Drayton primary care centre, which opened in 2005, provides GP services for some 15,000 patients and other health services for the wider community. The hon. Member for Ludlow mentioned Bridgnorth hospital, which has been transformed, and the new services coming from the £1.2 million spent at Bishops Castle. Those are just a few examples of how the extra funding provided by the Government, combined with the dedication of health service staff, have made some real improvements for the local population.

However, the hon. Gentleman also spoke about the local financial deficit. The financial situation is indeed challenging, but the SHA and the PCT have assured us that they are confident that a balanced financial position will be achieved by the year’s end. Revenue allocations for 2009 to 2011 are based on, and calculated using, the most up-to-date population data from the Office for National Statistics. There is always a lag of a few years, but that is not all that long. Allocations seek to reflect the Department for Communities and Local Government’s growth areas and growth points and the increasing numbers of retirees. Shropshire County PCT will receive a revenue allocation of £412.6 million in 2009-10 and £436.6 million in 2010-11. As I said, that represents an increase of £45.6 million or 11.7 per cent. in funding.

In the time I have left, I shall turn to Ludlow community hospital. I appreciate how important the issue is to the hon. Member for Ludlow and his constituents, and I am aware of the petition on the No. 10 website posted by Friends of Ludlow Hospital. Community services provide essential care to many vulnerable people, families and communities, from health promotion to end-of-life care. Such care is often provided by community nurses and therapists and in local centres and community hospitals, and it accounts for a substantial part of NHS funding—approximately £10 billion annually. The Government have developed a strategy for transforming community services, which has involved hundreds of clinicians and other stakeholders. The strategy will reduce inequalities, secure high-quality care and promote productivity and innovation.

The Government continue to ensure that we provide support for the community hospital programme. Investment in community services remains a high priority for us. The Government programme consists of two elements: £500 million for conventional infrastructure investment, which relates to proposals for new buildings, and £250 million for community ventures. We intended the latter to be innovative joint ventures with the private sector, involving many services and some infrastructure. Let me be clear: that funding was there if projects were proposed. That has happened in some years and 28 projects have secured elements of the funding.

The money has contributed to a range of services, including community hospitals, and more generally to other important and welcome community projects. I can confirm that the Department of Health will continue to consider schemes for community hospitals. They will be subject to the same approval process as all capital investment, thus ensuring that any further spending is affordable and that it provides value for money. For projects due to start in 2010-11, decisions will be subject to the strategies that PCTs produce for the development of their estates and the outcomes of the next spending review.

I appreciate the concerns about Ludlow community hospital. In 2007, Shropshire County PCT proposed a scheme for consideration as a community venture, requesting £20 million in capital investment. That was fine, but when it was examined, it was determined that the scheme would not stand up as a community venture project. The PCT worked to develop the scope of the venture but seems to have concluded eventually that staff conditions, particularly pensions, made the scheme impractical. The project therefore did not go ahead in the form that was originally proposed.

Subsequently, last May, a new idea was proposed. I have no problem with that. The new idea appears to be valued at around £30.4 million and the PCT has submitted the strategic outline to the SHA. The most important thing is to ensure that the Ludlow scheme is assessed and prioritised appropriately in the context of the regional health economy. The local NHS needs to compare the costs of, and benefits that will be delivered by, a proposed scheme against its other priorities. If the local NHS is to make the right decisions, the PCT will need to develop an outline business case, the purpose of which is to identify in more detail the preferred option for the delivery of the scheme.

There are a number of funding options—it is not true that the community hospitals scheme is the only option. The PCT needs to negotiate with the SHA about the priority that the latter has within its regional formulae.

I should point out to the Minister that the SHA had determined that the scheme was its No. 1 priority for the fund. That is what it wants help with.

The hon. Gentleman says, “for the fund,” but I must tell him that there are a number of potential sources of funding. Frankly, on the face it, the project looks good, but it needs to be within the overall allocations for the SHA. I was interested to note that Elisabeth Buggins, the chair of the SHA, gave active encouragement for the project, but I would also be interested to know where it stands in the SHA’s overall plans for the region. At the moment, if the project is asking for funding under only one category and does not have wider potential sources of funding, it stands less chance of going ahead.

We will see how the project develops. I hope that it progresses, that it gets into the SHA’s regional plans and that it is given the priority that the hon. Gentleman would like. It appears that Mrs. Buggins also wants that to happen. Let us wait and see whether the SHA gives it that priority.