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Mr. Michael Foster: Let me intervene to put the right hon. Lady's mind at rest on one point. The community hospitals serving Worcestershire have not been affected by the building of the new PFI hospital. Indeed, they are part of the strategy to allow acute treatment to occur in the new district general hospital. Patients can be treated there and move into community hospitals at a later date. In terms of the acute service reconfiguration, all the options under discussion included the building of a new hospital, because, quite frankly, it was 40 years overdue.
Mrs. Shephard: I am delighted to have that elucidation from the hon. Gentleman. He and his constituents are much more fortunate than my constituents and me. It is an extraordinary irony that people are being expected to travel 60 miles for community hospital care. What are we talking about? No replacement facilities have yet been provided, and even when they are provided, there will be no local community beds, as was originally promised. Instead, the health authority is
- "exploring options for providing such beds in nursing homes".
As if to rub the problem in, during the recent crisis at the new Norfolk and Norwich hospital—I emphasise that it was a beds shortage crisis—the chief executive of Norfolk health authority, Neil Wilson, made this bland announcement:
- "There are a number of community hospitals throughout Norfolk. Some patients who also need further care after being discharged from the Norfolk and Norwich are transferred to community hospitals to continue their recovery".
Liz Railton, the director of Cambridgeshire social services, is quoted in Public Finance this week as saying that the flagship hospital cannot rely on social services because the Government grant is inadequate. She says:
- "Social services spending is increasing rapidly, but neither central government nor councillors are matching the increase with their budget allocations. There is now . . . an annual £1 bn deficit between what is allocated in the spending round . . . and what local authorities budget for social services".
What about residential homes? Two years ago, I initiated a debate in the House on the implications for bed numbers in residential homes of the Government's approach to uniform standards in those homes. I said then that although everybody supported proper standards in residential homes, they have already had to contend with the impact of the working time directive, huge hikes in fuel costs and cuts in social services. I added that having to cope with the uncertainty and confusion surrounding the Government's new proposals would drive many out of business altogether, with a devastating effect on frail and elderly people, their families and in turn the NHS, which would have to cope with the result. Oh dear, that has proved to be all too true.
According to Laing and Buisson, also quoted in this week's Public Finance,
- "some 12,600 beds in care homes were lost in the fifth straight year of reduced capacity."
- "equivalent to more than 10 per cent. of the total number of NHS beds. If people whose care requirements can no longer be met stay longer in hospitals, bed blocking will get much worse."
We can add to those bleak facts the additional problems in rural areas—I look at the hon. Member for Dartford—where closures occurring under this Government mean more travelling for families and staff, less choice for residents and a greater concentration of jobs in towns. One is obliged to ask if Ministers meant things to turn out this way—or has their concern always been the slick headline rather than what is happening to people?
Mr. Brazier: I am most grateful to my right hon. Friend for giving way in the middle of her powerful case. Given that it costs between three and four times as much to fund an NHS bed as it does a typical bed in a nursing home, does not the experience of an area such as mine, which has lost 15 per cent. of its nursing home beds in just 12 months, show that it is possible for a really incompetent Government to raise spending and lower standards of care?
Mrs. Shephard: My hon. Friend's point is borne out by the comments of Liz Railton, who said:
- "The whole thing calls for a much more strategic approach, underpinned by financial planning".
By no group is that more clearly perceived than by GPs. I recently did a survey of GPs in my constituency to find out their views on hospital provision and bed blocking.
Their replies were very instructive for Ministers. Dr. Barton of the Campingland surgery in Swaffham replied:
- "We have never experienced so many 'Red Alerts' throughout the summer months, whereby we are implored to find solutions other than admission to hospital. The closure of beds was due to a lack of trained nursing staff."
- "While we welcome the new Norfolk and Norwich University Hospital, there will be fewer beds than at the existing hospital. We find it difficult to believe a lower number of beds will improve an already difficult situation."
Dr. Grace Barlow of the Necton surgery wrote in December:
- "Of great concern to us in General Practice at the moment"—
- "is the apparent shortage of acute beds within the local hospitals. Although we have in no sense moved into a 'winter pressures' situation, both the Queen Elizabeth Hospital, King's Lynn and the Norfolk and Norwich Hospital have been on red alert and closed to all but the most urgent cases on a number of occasions recently. Even when there has not been an official red alert, on a number of occasions when seeking a medical admission for a patient we have been told that there are no beds in the acute admission ward and the patient has had to wait in Casualty, often for a considerable number of hours.
Having now worked in the Health Service for over 25 years, l am deeply saddened by the erosion in the level of care that I can provide for my patients . . . I would be delighted for any pressure you can bring to bear in Parliament to rectify this situation."
- "We feel that bed blocking is the result of insufficient beds and is just part of the general difficulty of providing treatment in the secondary sector. There needs to be a system for discharge from acute hospitals into intermediate care—which would probably require additional hospitals, or the development of existing hospitals in this sector."
Most recently, the pressure of population increase locally has caused one surgery to announced the complete closure of its facilities in Brandon. That will affect many hundreds of my constituents in the nearby villages of Weeting and Hockwold. On 14 January, Mr. Tunstall of Weeting, in an interesting letter, wrote:
- "After watching our globe trotting Prime Minister in an interview with David Frost I thought I would take the opportunity of writing to you to express my concern about the general state of our country's facilities.
Mr. Blair and his colleagues certainly seem aloof and out of touch with the basic problems and wastage in this country including the Millennium Dome, Wembley Stadium, Railways, Education, NHS Structure, the Police Force"
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