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Road Links and Hospital Reorganisation

1.30 pm

Dr. John Pugh (Southport): I am pleased to initiate the debate and to see that the Parliamentary Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), is the Minister who will reply. I have much respect for her, which increased recently when I discovered that she is a member of the parliamentary tap dancing team. I feel that democracy is in safe hands when Ministers are prepared to make fools of themselves by tap dancing. I applaud that.

I want to analyse a problem with local and national dimensions: the taking forward of hospital reorganisation proposals without much thought being given to the road and transport infrastructure surrounding them. That problem, with its national and local aspect, goes to the heart of joined-up government.

I understand, as does the Minister, the motives for hospital reorganisation. It seems transparent that part of the motivation is financial, which is nothing to be ashamed of. We want to make the best use of resources, and because of economies of scale, hospitals must be reorganised at times. I also understand the strong imperatives concerning clinical demands. Much research has shown that if units and services are concentrated, their success rates are substantially improved. I do not disagree with that, and I see why hospital organisation sometimes has to happen. If it did not, we would be a country of cottage hospitals and only a few main city hospitals.

The Minister, and anyone who studies the issue, will accept, however, that there is a downside. The moment that hospital reorganisation is mentioned, local loyalties come into play. People do not want their services moved from the place where they are used to finding them to another area. There can be suspicion about the motives that might lie behind the reorganisation enterprise. We should be aware that the sole independent Member of Parliament got elected because of misgivings about hospital reorganisation. I express no view on whether those are justified, but simply point out that it is a contentious matter.

Hospital reorganisation, if it involves centralising facilities, often makes individuals more remote from the services that they require and seek. Their travelling times are appreciably lengthened, and their anxiety about what might befall them if they have to make such a journey, especially in an emergency, increases. There are strong arguments to reassure those people. I am told by ambulance services, and I believe them, that when a person is in an emergency situation, the most important thing is the, immediate help that they receive, which is often delivered by paramedics. Once they have got hold of a person, he or she is, in a sense, in safe hands, and travelling distance is not as critical to survival as that first service.

The record of cottage hospitals is not unblemished. They are quaint, pleasant and supported by the local community, but they have not had the clinical outcomes and success rates that some bigger, more anonymous institutions have had. I also accept that, as medicine develops, there is a need for expensive resources not to be distributed everywhere but to be concentrated in the hands of those who genuinely know how to use them. Expertise and equipment must be concentrated.

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I recognise that there is a counter-argument to mine. However, any case of this order is substantially weakened if routes, especially those for emergency services, are poor. The maternity service is not actually classified as an emergency service, but I imagine that if I were imminently expecting I would want to get to hospital as quickly as possible and by the shortest and most satisfactory route. Extending routes for such services gives rise to serious concerns.

Another set of anxieties relates to the fact that we have an increasingly ageing population. Evidently, many people in hospital will be of the older generation, but many of the visitors who come to give them the support that is necessary for their recovery also have to make the journey to the hospital. Those facilities, whether by public transport or other routes, are often poor. That is a problem not only in terms of difficulty and inconvenience but in a clinical sense. Without regular visits the patient can often lack the psychological support that is necessary for a complete and satisfactory recovery.

The Minister will probably readily assent to what I have said, because it is a sensible way of looking at things and I know that the Department of Health is mindful of all the factors surrounding any kind of hospital reorganisation, highlights them where necessary and does not shy away from them. However, it probably plays an insufficient role in relation to transport considerations.

I want to draw attention to an example in my constituency, which has undergone a process of hospital reorganisation. At one stage, there was a Southport and Formby district general hospital—one building serving one community. The Southport and Formby NHS trust was merged with the Ormskirk trust because they were thought, as individual trusts, to be too small and incapable of providing the full range of services. Southport is the larger town; Ormskirk is substantial, but more rurally placed in central Lancashire. Of course, Southport and Formby are on the coast.

A contentious review of facilities was carried out by Professor Shields, who suggested that paediatric and maternity services should go to Ormskirk and cardiac services to Southport. That is fine unless one has a baby that needs delivering in Southport or a heart attack in Ormskirk—and not only Ormskirk, as Professor Shields pointed out. Beyond Ormskirk, around Skelmersdale, there is an area served by the Ormskirk trust consisting of a highly deprived group of people who do not have their own transport and lack any easy means of getting to Southport should they wish to visit a cardiac patient there.

Understandably, there was a lot of local opposition to the proposals. The previous MPs for Southport, Matthew Banks and Ronnie Fearn, were from different political parties but unanimous in their opposition. The reorganisation was also opposed in part or in total by the hon. Members for Crosby (Mrs. Curtis-Thomas)—Formby is in her constituency—and for West Lancashire (Mr. Pickthall), who is similarly affected, and by Sefton and West Lancashire councils.

There was a whole tranche of opposition across the board, but a key theme was transport. I accept that it was not the only issue. For example, a section of opinion took the view that it was fundamentally wrong for

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anybody born in Southport not to have the right for their children to be born in Southport, and others were worried about whether services would be enhanced or simply rearranged for purely financial reasons. The hospital trusts were firmly behind the proposals but they, every political representative in the area and Professor Shields, who wrote the report, recognised that transport was a core element in the problem. He stated almost at the beginning of the report:

Transport is an issue. There is a road link and it would be silly if I did not own that there is, but it is a poor road designed for agriculture. Tractors often bar the way and in the summer it is flooded with holiday traffic of one sort or another. An ambulance going against the tide would have problems.

At the time of Shields, palliatives were suggested. Suggestions were made about a helicopter being used to take people over the congested road on bank holidays and so on. People talked blithely of a better bus system, but we have seen little evidence of that. The helicopter concept is a poor solution for overcoming transport difficulties because it is expensive and is not used in the winter or at night. Nor is it practicable for people with spinal injuries and injuries of that ilk.

The problem remains. One would like to think that an easy solution is on the horizon and I am soliciting the Minister's support for a move towards a solution. In the past, the routine might have been to go to the Department responsible for transport, point to the general need and stress what was required for it to be sorted out in Westminster. For sound democratic reasons, transport is not dealt with in that way today. Many roads have been de-trunked and that has led to road schemes having to be developed within local transport plans. In the case that we are considering, a local transport plan would be decided by Lancashire county council. I am not suggesting that the council does not want to build a road, but it is not its main priority at the moment. It is considering—I solicit the Minister's support for this—the possibility of an Ormskirk bypass, which would improve the problem for people travelling from Skelmersdale to Southport, but I emphasise that the problem is not such a priority for Lancashire as it is for the hospital system.

I shall not detain the Minister excessively, but I want to solicit support for her Department to make representations to various people, including the Department for Transport, Local Government and the Regions, and the Government office for the north-west region. I implore her to use whatever persuasive skills she has with Lancashire county council. However, the Department of Health cannot justifiably walk away from the problem.

The Shields report said at paragraph 8.9.3 that accessibility of the appropriate hospital service would always remain a problem given the paucity of public transport and the congested and poor roads. I do not blame the Department of Health for congested and poor roads, but there is some mileage in the Department's putting its weight behind any proposal to improve the road structure.

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I shall add a few strings to that bow. There is a sound regeneration case for a better road and there is a sound operational need case for the hospital to have a better road because junior doctors could use it in times of crisis.

This is a fundamental request to the Minister on a matter that is important to my constituents. Local people have spotted a loophole in current Government arrangements. No doubt, had I been an important member of a Government party in the past and the Department of Health had reconfigured the hospitals in my area, I would sidle up to people or talk confidingly to transport Ministers and something would happen. However, that method is susceptible to serious abuse or miscalculation of priorities. If, after consultation, the Department decrees a national arrangement, the Department for Transport, Local Government and the Regions should have input into what is done about transport. If the Minister responds positively to that request, she will go up further in my estimation.

1.45 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears) : I genuinely congratulate the hon. Member for Southport (Dr. Pugh) on securing the debate. He has highlighted the need for a coherent approach to transport and health. The link is not made often enough, yet transport in its widest sense has a huge impact on people's health and well-being. Apart from transport between hospitals, it is also relevant because of pollution and congestion, which we all face every day.

I am grateful to the hon. Gentleman for his kind remarks about my extra-curricular activities. I understand that he has a degree in logic. That may not be as foolish as tap dancing, but I am sure that it is equally enjoyable.

The local and transport planners interact with the national health service in the design of new hospitals and the reconfiguration of existing facilities. The Government set the overall framework in which service enhancements and developments take place, and provide the crucial resources that the NHS needs to facilitate those changes. As the hon. Gentleman accepts, the NHS can never stand still. As technology develops and public expectations increase, services are in a constant state of flux.

People who work in the NHS feel that they are experiencing constant change. That is not necessarily a bad thing because we want to improve the quality of local services. The need to combine quality with access is a challenge, and it is difficult to strike the right balance. In an increasingly complex health system, having every service on everybody's doorstep is no longer a practical proposition. Equally, we must guard against the creation of a huge monolithic organisation, which would be in danger of losing its connection with the local community. It is a difficult balance to strike, but we try to do so all the time.

Local health planners—whether at regional office, trust, or in future, primary care trust level—must strike the right balance between the convenience of local services and the requirement to concentrate services for reasons of excellence, safety and quality. Many needs can and should be met locally. The NHS tends to concentrate on the hospital, the secondary centre or the

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tertiary specialist centre. However, 90 per cent. of people's interaction with the NHS takes place at primary care level, and increasingly at intermediate care level, so that people can be cared for closer to home. The NHS should work in different ways and is doing so throughout the country as clinical networks provide services closer to people's homes. That may be a future direction for change.

We must take advantage of new technological developments and one of the most exciting is telemedicine. If hospitals are located in different sites and clinicians are treating people from different communities, it is more economical, gives higher quality and fulfils safety requirements for consultants to communicate directly with each other via telemedicine. I can tell the hon. Gentleman that telemedicine is being considered in his two local hospitals. A broadband microwave link has been established between the hospitals so that consultants on one site can assist with treatment at the other. I am told that there is a direct line of sight between the two units, which apparently makes this an ideal location for a pilot scheme to begin to get more people involved in that kind of telemedicine. This may well help. It will not reduce the need for people to travel, but perhaps not as many people will have to travel quite so often if they are able to use the new technology in this way. Clearly there are also worries about changes in configuring services where travelling does present difficulties.

Dr. Pugh : Clearly, in the case of surgical practice, telemedicine can be of some avail. However, in the maternity service, for example, even if a patient wants a medically assisted—not just midwife—delivery for their baby, telemedicine can play no part. They will essentially have to make the journey, and on a narrow and fairly unattractive road.

Ms Blears : I did not say for one moment that there are not certain specialties in which travelling is essential.

However, the requirements for people to travel all the time can be reduced as clinicians change the way in which they practice their specialties. I accept entirely that there are services where travel is a necessity and that people will worry about that. The right strategy is for the health service to work not just with local authorities that are responsible for developing unitary development plans, but with regional authorities that are responsible for transport links across the region. At national level, they can try to work with the Department for Transport, Local Government and the Regions to make sure that our national strategy takes health issues on board.

The Department of Health has a responsibility to work at all those levels to try to make sure that connections are made in a very practical way. We need to try to keep people out of hospital as much as we possibly can because that certainly obviates the need for them to travel. Much more emphasis on preventive work and on supporting people in their own homes is a top priority.

Equally, we need to get people out of hospital as quickly as we can. If people are subject to delayed discharge and remain in hospital in acute wards when they no longer need to, there are all the attendant problems that the hon. Gentleman has raised about

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visitors having to travel in order to support them and to help with their recovery. If we can get people discharged from acute hospitals into intermediate care settings closer to home and then back into their own homes with support, the need for travel will be reduced quite dramatically.

As the hon. Gentleman will know we have allocated £300 million nationally to tackle the problem of delayed discharge and we hope that many more people will be cared for at home rather than lingering in an inappropriate acute hospital setting.

The hon. Gentleman also acknowledged the need for staff to travel as well as patients. The NHS employs over 1 million people. Its infrastructure of buildings is probably the most diverse in western Europe. It operates 24 hours a day, 365 days a year, and nurses doctors therapists and other health care professionals need to get to work and to leave work, often in the middle of the night when public transport may not be available. Road facilities are equally as important to staff.

Whenever we carry out major hospital reconfigurations or build new hospitals, we have to take into account travelling times by public transport and private transport and try to make sure that there is proper car parking, cycle parks and essential access to bus routes in local communities. Planning policy guidance 13 takes into account the need for good transport links in hospital development.

The difficulty is that we never start from a clean sheet and have to look at the situation we are faced with. The hon. Gentleman's constituency has two good local hospitals but pretty poor road links. I understand that the proposal to upgrade the A570 is in fact the number two priority on Lancashire county council's transport plan, and I hope that even if it is not the top priority, being second will mean some action fairly soon.

I am more than happy to say that transport is a key issue in hospital configuration. The Department of Health should be saying to all the parties involved that transport needs to be a priority if we are to make sure that the hospital services are safe and accessible for local people. I am happy to give the hon. Gentleman the assurance that my Department has no intention of walking away from the situation. We will try to do everything that we can to get the road improved. It is a matter for Lancashire county council, and it is committed to putting it high up its agenda.

The two hospitals have struggled for safety reasons with the new requirements from the royal colleges for accreditation of junior doctors. Professor Shields's report has done us a great service in trying to ensure that the two hospitals are configured in a way that provides a wide range of services but maximises the safety and training requirements for the doctors involved. He recommended protocols on accident and emergency services at both Ormskirk and Southport to ensure that paediatric emergencies could be coped with safely and properly.

Ambulance services in the area have had some recent investment. Mersey ambulances received more than £1 million and Lancashire ambulances £330,000 to try to improve their response rate times. They both meet the national standards for responding to emergencies within eight minutes in 75 per cent. of cases, and are doing an

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excellent job. I am told that bus services have improved as well. I am sure that the hon. Gentleman will know more than I do, but I am told that the service between Southport and Formby has been reinstated and that scheduled services between Skelmersdale, Ormskirk and Southport have improved. It was suggested that a shuttle bus should be provided, but that would cost about £100,000. The trusts decided that it was not economical but that they would try to improve the bus services between the two hospitals. I know the road myself, as I go to Southport regularly, and there can be a bottleneck in the centre of town. The road should be improved dramatically.

I understand that the ambulance trusts are taking advice on how to improve services by placing their ambulances at appropriate points across the community, rather than being always in ambulance bases. That, too, might limit travelling time. As the hon. Gentleman said, care in the ambulance can sometimes be the key to a good outcome for patients. We have invested in 12 lead ECG machines on ambulances, together with telemedicine links to the hospital, so that we can have immediate diagnoses of people, particularly with heart attacks, and improve survival rates.

The situation outlined by the hon. Gentleman is full of challenges. Professor Shields did his best in his report to reconcile a series of competing interests. What impressed me most about the report was that he went out to experience the transport problems and drove the road himself. Not every consultant or expert that we call in is prepared to test out the system personally. Professor Shields's recommendations were robust and based on real evidence of the situation in the community, and they appear to have the support of all the parties in the area, which is a difficult balance to achieve when people are worried about local hospital services.

Dr. Pugh : I should be wrong if I did not state my exact position. I was opposed to the reconfiguration in the form that it took for reasons other than those of transport, but I recognise that transport was the

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problem that everybody, including Professor Shields, singled out as a fundamental flaw in the scheme. Professor Shields appears to say that the road should be built, but it is not within his remit to recommend that roads be built. The fact that he drove it and recorded that in his report shows that he expects not the Department of Health but someone to address the problem.

Ms Blears : I dispute the argument that Professor Shields decided that the road was a fundamental flaw. He decided that it was a substantial issue and problem. Nevertheless, his recommendations for reconfiguration took into account wider clinical and service quality issues, not only those of access. The hon. Gentleman, and most Members of Parliament, frequently face the difficulty of trying to reconcile such competing issues within their communities.

We can take several practical measures, as I have outlined. We can try to prevent people from having to go to hospital and get them out as quickly as possible after they have received appropriate care. We can try to care for people and ensure that diagnostic facilities, including test, X-ray and pathology services, are provided as close to home as possible so that the patient does not constantly have to travel to the service. That is fundamental.

If we are serious about designing a system around the needs of patients, we must examine those considerations rather than simply the bricks and mortar. We should consider the services and what suits patients and, if we use a little more imagination and creativity, we can design our services so that people are not faced with the difficult transport problems outlined by the hon. Gentleman. I am glad that he has brought them to our attention and I will do what I can in the Department of Health to try to ensure that the transport issues are addressed.

Once again, I congratulate the hon. Gentleman on raising those important matters on behalf of his constituents.

Question put and agreed to.

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