Robert Key (Salisbury) (Con): I start from a slightly different perspective. Perhaps I should have a text: "veniuntque abeuntque pueri, sed semper maneo", or "the boys come and go, but I always stay the same". I am perhaps the longest-serving Member for Wiltshire. I first attended Salisbury hospital in 1952 to have my tonsils out when it was a Nissen hut camp outside the city, on the hill. I have long-held and pretty fond memories of the health service.

I should also declare that I am going to be extremely nice about the health service in South Wiltshire, as I shall shortly be testing it myself. I have an operation booked with the excellent national health service to look after my problem. I shall be throwing away my walking stick and leaping around Westminster shortly. Having said that, I am going to take a slightly different approach to the problems. The crisis that we face in Wiltshire is caused by the crisis management of debt and projected debt and by the unclear boundaries between health service provision and social service provision. That, as far as the south of the county is concerned, is the biggest problem.

It is also an issue of accountability. Over the past six months or so, we have seen the closure of the Amblescroft unit for elderly, mentally ill people, the Greencroft centre as a day centre for disturbed people with a wide range of problems, as well as the community nursing plan service and the hospital alternatives team. We have seen the closure of the Shelwork factory run by Action for Blind People and the Shaw Trust centre for people who are visually impaired and disabled. We have seen a lot of such closures.

At the heart of that has been the great distress caused to the people and families involved. A lot of lessons have been learned. When I have raised such issues, I have received nothing but courtesy from Ministers. When I raised the closure of Amblescroft and the Greencroft centre at oral questions on 7 March, the Secretary of State immediately said that she would look at the specific cases. She did, she got back to me and I received a charming letter from the Minister who is with us today, in which she also pursued those points. It all came back to the problems of accountability. The Secretary of State and the Minister both rightly said that a lot of money was being spent and that decision making on individual projects and expenditure must be matters for local decision.

There is a problem. County councillors faced with picking up the bill, as the national health service will not pay for what it previously paid for, are liable to surcharge. They cannot just go on running up debt ad nauseam. They have not only the electors breathing down their back, but the district auditor. That is a problem for them.

The primary care trust, the acute trust and the mental health trust all have executive and non-executive directors. They have to take responsibility as they are remunerated—not very generously, but they are remunerated—but they are blushing violets. It has been with the greatest difficulty that I have persuaded people to realise that a lot of people in the community are appointed by the NHS Appointments Commission to look after the interests of local people. Nobody knows who they are and when things go wrong they keep their heads down. That is wrong.

I have tried to encourage the non-executive directors of our local health trusts in Salisbury and South Wiltshire to put their heads above the parapet and to explain what is going on. I challenged one of them, who I know very well, and said, "You know what is going on. Surely you can come out and say that when Amblescroft closes no one will be out on the street, because you will have to pick up the pieces." The reply was "Oh no, we have been told not to say anything, because that would indicate liability. We have been instructed to say nothing to anybody." That is a shame, as it inhibits accountability. It is wrong, and it should not happen.

When we consider what has been going wrong in Salisbury, we should remember that a tremendous amount has been going right in South Wiltshire. The health service is in good heart. We have moved on from the Nissen hut era, I am delighted to say. We have been through a number of different sites and have seen rationalisation and massive delay. The one thing that has characterised the health service in South Wiltshire has been change after change. It has normally been a question of administrative change and financial procedures. Often, clinical procedures and policies for the treatment of people have changed. Occasionally, as in the crisis of the past few months, we have seen the chief executive of our primary care trust—an excellent public servant—trying to persuade us that the problem is solved because they have found a new and clinically better way to treat people that, surprise surprise, will cost less in the long run.

That does not help the people who write to their Members of Parliament in terms such as this:

"I am aware that you have been involved in trying to resolve the issues of care funding . . . My mother was resident"

at Amblescroft

"until she unfortunately died . . . She was one of the twelve people earmarked as requiring just 'social care' and as such would potentially have received no direct funding for her nursing care if she had been moved to a nursing home as was being proposed. When I point out that she was epileptic, doubly incontinent, bed ridden, had high blood pressure, high cholesterol and enlarged blood vessels in her brain making her liable to a stroke, was prone to infections and I was asked if they should put 'do not resuscitate' on her notes as she was so frail, you will be able to see that she had requirements for nursing care not social care."

That illustrates my problem with the boundaries between health and social care.

Another note from a constituent on 17 March reads:

"I am so frightened, the Greencroft centre has been my haven for a number of years, it has worked alongside my medication in keeping me as stable as possible. I suffer from Borderline Personality Disorder, Clinical Depression and Epilepsy. I also have eating problems and self harm as a coping mechanism to deal with extreme trauma! Since the devastating news that the Greencroft centre is closing, my illness has become worse. I get shaky and panicky, wondering how on earth I will cope after the 30th of April. I live alone and I am so scared."

It is at the edges that it really feels bad when things go wrong. It is not the robust clinical directors, who can run our magnificent hospital and make the best possible use of every penny that the taxpayer provides under whatever Government, who suffer. It is the people who are not going for straightforward surgery who suffer. It is the people who have problems with their mind who suffer. Perhaps they have mental health problems. Sometimes they are not in that category. However, it is always the people at the edges who suffer. That is why we must be particularly careful. I believe that there is a future, and we must ensure that it comes to pass when we get through the current crisis.

I congratulate my hon. Friend the Member for North Wiltshire (Mr. Gray) on raising this issue. He has put it in passionate terms as it affects his constituency. My constituency is not seeing the closure of cottage hospitals. We have none; we have no cottage hospital-type facility. I wish we did. It has been suggested that the Amblescroft unit, which has closed, would make an ideal community unit as a sort of halfway house. We should not be seeing the closure of the hospital alternative scheme and the community nursing, and that is without consultation with the GPs, incidentally.

There is a tremendous future, but it is no good pretending that everything is fine or that money alone will solve the problem. The issue is all about the sort of management that we want to see. Of course, that must be extremely efficient, but not to the point of harsh delivery and harsh, sudden decisions that have huge consequences for a small number of vulnerable people in our communities.

The health service in South Wiltshire is strong. It has always been good and will get better because of the people who work in it. They include consultants who are attracted by the quality of life and therefore do not wish to move on to further their careers in London teaching hospitals or even Southampton. They want to stay where they are to serve the people of South Wiltshire. That is why the number of consultants in Salisbury has doubled in the 23 years for which I have been the Member of Parliament. It is why the morale among all the people in the heath service, whether clinicians, porters, cleaners or administrators, is so high.

The one thing that dashes everyone's hopes is management by crisis, which we have been seeing recently. I hope that before too long we will be through that phase and back on track towards ever better health services for the people of Wiltshire.