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7.18 pm
Mrs. Jane Kennedy (Liverpool, Broadgreen): I shall raise some health service issues that are of interest in my constituency. I should like to address two aspects of our motion: the continuing deterioration of the national health service, especially as it relates to acute services, and the highest ever number of people awaiting treatment.
Debates on the NHS are usually pretty bad tempered, and show clear differences between the two sides, as Conservative Members defend the treatment that the Government have meted out to the health service in the past 18 years, and we raise the concerns of our constituents about the treatment that they have received from the health service. The contributions of the right hon. Member for Wealden (Sir G. Johnson Smith) and the hon. Members for Chipping Barnet (Sir S. Chapman) and for Croydon, North-East (Mr. Congdon) were thoughtful, and I do not disagree with much of what was said. I particularly enjoyed the speech of the hon. Member for Chipping Barnet, because he is obviously concerned about the closure of the accident and emergency department of the hospital in his constituency, and the effect that will have on his constituents. I am not sure whether he is retiring at the next election: I hope that he is staying on.
The Minister for Social Security and Disabled People (Mr. Alistair Burt):
No.
The Parliamentary Under-Secretary of State for Health (Mr. Simon Burns):
No, he is not retiring.
Mrs. Kennedy:
He is staying on. I beg the hon. Gentleman's pardon. Perhaps his electorate will retire him. He could learn a great deal from the experiences of my constituents with the closure of the accident and emergency unit at the Broadgreen hospital.
The Government's amendment repeatedly uses pious words. It says that the Government are
Patients in the accident and emergency department of the Royal Liverpool university hospital know that the health service is in crisis, because they are told regularly--not just in an isolated crisis--by nurses and medical staff that they must contact their Members of Parliament to effect a change. They know that it is an on-going crisis and not just momentary, and that the Government are failing to address it. Despite the thoughtfulness of the speeches of Conservative Members, they do their case no good if they dismiss our arguments and ignore the experiences of our constituents.
I have a tale of two hospitals. Part one is the story of Broadgreen hospital, which is now part of a merged trust. My hon. Friend the Member for Hemsworth (Mr. Trickett) expressed concern about merged trusts in the geographical area that serves his constituency. Broadgreen Hospital NHS trust was merged with the Royal Liverpool University Hospital NHS trust. At the time of the last general election, Broadgreen was a district general hospital and was directly managed by the health authority. In 1988, it was proud to announce the provision of 11 wards in the new Alexander wing, which were opened by Her Royal Highness Princess Alexandra. Now only six wards remain. That gives the House some idea of the effect of the health service reforms on my constituency.
Four NHS trusts operate on that hospital site: four different units managing independent health service trusts. That leads to chaos and bureaucracy, and it is visible to everyone who visits the site. What does it mean when wards are closed? When those five wards were closed, it was not just beds that were lost; teams of staff from each of those wards were disbanded, and posts were deleted from the establishment of medical and nursing staff.
It is to the great discredit of the current management that the decision just before Christmas to close a 20-bed ward in Broadgreen--this information has been widely published, so it is not new--was communicated to the staff on the ward at 3.30 pm on the Friday afternoon when the nurse in charge was on leave and was unaware that the decision was to be made. Nurses had to tell patients that they were to be transferred within the hour. I leave hon. Members to imagine the chaos. It greatly distressed the patients who were moved, and it caused their relatives great anxiety. An investigation was held and an apology given, but that does not change the fact that chaos was caused and we lost a further ward.
In 1988, that accident and emergency department was one of four directly managed units, as they were then called--the jargon has now changed--in the Merseyside region. In 1996, it was finally closed, despite fierce local opposition and fears that the remaining accident and emergency departments would be unable to cope. It is a pity that the hon. Member for Chipping Barnet is no longer present. My constituents were promised brand new, state-of-the-art accident and emergency departments at three other major hospitals across the region. We were assured over and again that they would be able to cope with patients who would previously have gone to Broadgreen, and that we had nothing to fear.
One improvement that followed the closure of that accident and emergency unit was the introduction of paramedics in ambulances. Merseyside was one of the first regions in the country to ensure that every ambulance that left the depot had a paramedic on board. The hon. Member for Chipping Barnet is right: that unquestionably reduces the number of deaths. Merseyside is to be applauded and congratulated.
We were also promised that alongside the closure of the accident and emergency unit at Broadgreen would be improvements in primary care. New primary treatment units were developed, one of which was close to the hospital. They were designed to deal with what we would parochially call the walking wounded--people who were not seriously ill but needed urgent medical treatment, and could face lengthy delays in the big accident and emergency departments. Those people could go to a primary treatment unit, where they would be treated by nurses and, if necessary, a GP would be on hand to examine a patient. Unfortunately, that experiment has not worked. Primary treatment units quickly changed their role, as patients continued to go to the major accident and emergency departments for the treatment of both major and minor injuries.
I said that this was a tale of two hospitals, and I now come to part two. The Royal Liverpool university hospital now has the long title of the Royal Liverpool university hospital, Liverpool and Broadgreen: it is two hospitals merged under one management unit. It is one of only eight teaching hospitals outside London, and is highly regarded within the medical profession: it leads the field in some specialties. A new accident and emergency department opened in August 1995. Shortly before it opened, the NHS trust issued a press release, which said:
As we were to have the biggest and best accident and emergency facilities in Europe, how is it that, just 18 months later, the BBC regional television news programme "Close Up North" presented a half-hour programme from that very accident and emergency department with nursing staff describing the conditions as "like Bosnia"?
On 6 January 1997, Liverpool health authority put out another press release:
The press release continued:
Shortly after that television programme, which was screened across the north-west of England, I received a letter from a member of staff at the Royal Liverpool hospital, who wrote:
If they were only isolated incidents, I would be more than happy to raise them on a case-by-case basis with the local trust, the local health authority and, if necessary,
in a particularly bad case, with the Minister concerned. Unfortunately, they are not isolated incidents. It is an on-going and regular problem. It is so serious that the outpost of the NHS executive in the North West region commissioned a report on accident and emergency units in the region. I quoted from the introduction earlier and I wish to quote some more of its findings, particularly as they relate to a matter that was raised by the hon. Member for Croydon, North-East--community care and moving patients into primary care beds.
In page 5 of his report to Alan Langlands on emergency care in the North West region, published last August, Robert Tinston found:
"committed to"
and express their
"support for",
and it
"welcomes the Government's commitment to a growing budget".
Why do the Government stress their commitment three times in a relatively short amendment to the motion? I believe that it is a fundamental question of trust. Do the British people believe what the Conservatives say about the health service? If they do not, does that mean that the Government have lost the public's confidence over their handling of the health service? I believe that, because of their experiences of health service treatment, and especially the experience of their elderly relatives, the public no longer have confidence in the Government and do not trust them with the NHS.
"The Royal's newly extended unit, due to open at the end of next month, will be one of the largest and best equipped in Europe".
It is strange how that echoes the words of the hon. Member for Chipping Barnet. The press release said that the unit would have
"80 nursing staff compared to the present complement of 50.
That is a superb facility. If I were critically ill and needed resuscitation, I would want to be taken straight to that unit, because I would receive the best treatment available in the north-west. It would have a 30-bed short-stay assessment unit, 13 major treatment cubicles, a large minor injuries unit capable of treating 100,000 new patients a year and staff accommodation, including bedrooms for on-call doctors so that fully qualified medical staff were available at all times.
10 senior and middle grade medical staff, one more than the current level.
Six resuscitation bays with state-of-the-art equipment, including four with built-in x-ray."
"The Royal Liverpool and Broadgreen University Hospitals are currently facing considerable pressures resulting from an unprecedented increased number of patients who are presenting for admission. These problems have meant there are prolonged waiting times for admission to the hospital and also that some patients are having to be cared for in emergency designated patient areas."
It then listed four measures taken early in January in an attempt to address the problems. Sadly, the Secretary of State has suggested that it is another case of BSE--blame somebody else--and that, if accident and emergency departments or hospitals are unable to cope, it must be because they are badly managed units or trusts.
"All these measures have been implemented without an increase in the staff establishment and thus we recognise the great contribution that all our staff are making to the position. Nurses in the Training, Quality, Specialist Nursing and other departments have all volunteered to help in the care of emergency admissions."
That is to be applauded, although the authority states that, as a consequence,
"courses may have to be temporarily suspended. Medical Staff have reconfigured on call duty and are particularly hard pressed and elective surgery remains deferred."
Elective surgery had already been deferred for several months, and it remains deferred to date.
"The recent publicity about the Royal Liverpool Hospital . . . featured on BBC North West has prompted me to speak up. I have worked for the last ten years at the hospital and I have never seen staff morale so low . . . There have always been patients having to wait for long periods in A & E. This is nothing new but the closure of the A & E at Broadgreen has made it much worse. Surely what has happened could have been predicted?"
It was predicted repeatedly, by medical staff, patients, the community health councils and others. The letter continued:
"I used to be proud to work at the hospital but no more. We are not providing safe patient care any more with patients being moved in the middle of the night because heir beds are needed."
The letter ended with a challenge:
"The politicians need to call for an enquiry to expose and sort this mess out for the sake of the patients and the staff."
The right hon. Member for Wealden described such comments as bitching. I took offence at that and raised the matter with him. He also referred to scaremongering. The hon. Member for Chipping Barnet said that one of his constituents had to wait an unacceptable time for admission to hospital.
"A separate and independent pattern of emergency admissions could be observed".
He was talking about patients with non-specific illnesses that were quite difficult to diagnose who might have to wait some time before their treatment could be determined. He continued:
"Increases are particularly high in Liverpool and Sefton but scarcely significant at all in Wirral, Manchester and Salford. The pattern appears to related to the interaction between NHS Primary and Secondary Care and the Social Services Department and independent continuing care providers."
The report continued:
"Across the North West in December through to February 1995/96 approximately, 600 beds were blocked by people awaiting assessment and a nursing home place at any one time. Many Providers have stated that they expect this figure to increase in 1996/97, as they have indicated that certain Social Services have changed their eligibility criteria and/or their administrative arrangements in order to reduce their expenditure to stay within financial constraints."
Here we go again. It is another case of "blame somebody else". This time, it is the fault of the inefficient, ineffective local authority which is deliberately going our of its way to use, in the words of the hon. Member for Croydon, North-East, "expensive" care provided by the local authority rather than the cheaper care provided by the unit. In my experience, that is not the case. It may be that the hon. Gentleman can quote examples, but I can quote back at him cases where local authorities have made great efforts to make residential homes more efficient and effective and to reduce the unit costs without exploiting the nursing and domiciliary staff who provide care within a residential setting.
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