Mr. John Taylor (Solihull): I am grateful to the Under-Secretary of State for Health for taking this debate. I respect her and her office. I come with an all-party mandate from Solihull and, whereas there may be the odd political remark in what I am going to say, I have no party political axe to grind either now or in any subsequent developments. If she can help my constituents we will all be grateful to her. That is the spirit in which I approach this debate. At a recent meeting in Solihull involving all political parties we agreed that we are all in this together. In the same spirit, I acknowledge the presence of my hon. Friend the Member for Meriden (Mrs. Spelman) and the hon. Member for Birmingham, Hall Green (Mr. McCabe), who has wished me well in this debate.
The great, and so far unhappy, saga of Solihull hospital began for me in my earliest years in the House when, with many others, I pressed the case for what we then hoped would be a new district general hospital for Solihull. The regional health authority, as it then was, proved receptive and a splendid new hospital building costing £38 million was ultimately erected and opened in June 1994. We rejoicedbut later in 1994 the hospital applied unsuccessfully for trust status. That was not in itself a decisive alarm, but by the end of 1994 I was privately alerted to the fact that all was not well.
The origin of whatever miscalculations had been made may well lie in the NHS planning of the 1980s, which had anticipated that one of the five principal hospitals in Birmingham would close and a district general hospital in Solihull, to the east of the city, could well be justified, not least in the light of Solihull's expanding population and expanding economy. In the event, there was no such hospital closure in Birmingham.
I have documented the litany of events between 1995 and March 1997, but I will not recite it here in the limited time available to me in an Adjournment debate. March 1997 is, however, a significant date in that it was marked by a statement by the then Minister for Health pledging the future security of services at Solihull hospital, in particular accident and emergency services. I have given the current Minister a copy of that pledge.
Two months later I was to become, involuntarily, a member of the Opposition, following an election in which the Minister's party promised that it would do much better in health matters than my party had managed to do. It may surprise the House to know that I was prepared to believe that it might indeed do so. The economy was strong and it was in a position to make a fresh start with an overwhelming majority and an unchallengeable mandate. There was also a feeling, or mood, that health services might become more consumer led and less consultant or administrator led, anda welcome thoughtthat decision making would be more local.
However, the uncertainties at Solihull hospital would not go away, although for a time they were counter-balanced by optimism, and there was a period of abeyance that seemed to me to persist, though uneasily, until last year. There were recurrent assertions in accident and emergency that throughput figures in
I could waste the whole half hour if I repeated all the questions that I raised during the period1995 to the presentthat I am reviewing. However, neither the Library nor I can find the date of one question that I raised. It may not have passed muster with the Table Office. The question was about accident and emergency provision and is still pertinent. Should difficulties in staff recruitment be a valid determinant in establishing levels of service?
Whether or not that question was included on the Order Paper, it addressed another seemingly bogus argument with which we had to dealthat one could not provide the service because one could not get the staff. That too was self-fulfilling in its own way. We argued that it was surely the job of those in charge to address that argument the other way round. It should be their responsibility to ensure that the staff provide the service.
The next vexingly unconvincing argument was similar. Some greatly respected consultant would take a critical view of facilities or the level of staffing and pronounce that the situation was clinically unsafe. No one would quarrel with that, for understandable reasons. That judgment is potentially final. Our frustrated response to that would be, "Make it safe."
That is the background. I have endeavoured in this small compass to try at least to depict, if not re-create, the mood of uncertainty that attended the discussion of the security, or insecurity, of services at Solihull hospital, and the sort of arguments with which we had to contend, with mixed feelings of hope and exasperation.
Some things are clear. The population of Solihull is 205,000, but the daytime population is much greater. Solihull ceased to be a commuter town long ago. Approximately 9,000 people work at Land Rover. Solihull is a huge retail attraction, not least following its new Touchwood shopping centre with its many employees and its many shoppers from outside Solihull. It is estimated that on average, 60,000 shoppers visit it each day, and that 8 million have visited it since last September. Such is the prestige of Touchwood that Her Majesty the Queen will formally open it later this year.
Solihull's population growth is generated by new housing development mainly in the south of the borough, the area that is most naturally served by the hospital. There is an enormous amount of traffic on the M42 within a mile of the hospital. The M42 in Solihull is, in effect, a confluence of the M6, M40, M5, M45 and M69 motorways and the Birmingham northern relief road. Although I do not want to depict it as a hazard, I must add that Solihull also has a rapidly expanding airportBirmingham International airport. It employs 6,500 people on site and had a throughput of 7.6 million passengers last calendar year, despite the events of 11 September. The National Exhibition Centre is also in Solihull and attracts further large numbers to the boroughto visit Cruft's dog show, for example, or the motor show. All that is visible, patent and obvious.
I hinted that I did not wish to tempt providence by anticipating a disaster in Solihull, but it could happen. Could Solihull cope? It is obvious to me, as their parliamentary representative, that my constituents should demand an appropriate hospital that includes a comprehensive accident and emergency service. They feel that they have earned and paid for one.
A new strategic health authority will be in place from 1 April, although it may not be fully fledged until October. That much we know, but real and poignant uncertainties surround the future. We are told that there will be a consultation on the range of services to be provided at Solihull hospital, with an emphasis on examining A and E provision. We are told that there would have been little point in the outgoing health authority setting that consultation in train, and that the new strategic health authority will start the consultation process when it is in placebut will it also assess the results?
Who makes decisions about the consultation processthe Minister, or someone, some body or some institution that has the Minister's authority? What is the role of the primary care trust in that context? We need clarity. What will be the terms of the consultation? By what criteria will its findings be measured and judged? Who will decide? Is it ultimately a matter for the Secretary of State? Above all, what is the future of accident and emergency provision in Solihull?
At the moment, we have patients waiting in ambulances and plenty of first-hand accounts of utterly unacceptable waiting times. The overwhelming majority of people in Solihull are law-abiding taxpayers who have normal fears and apprehensions about illness and injury. They want certainty that a good efficient hospital will be there for them in Solihull should they need it. I hope that the Minister will reassure us about that, and I will give her the credit if she does.
Mrs. Caroline Spelman (Meriden): I am grateful to my hon. Friend the Member for Solihull (Mr. Taylor) for giving me a small share of his time, and I will confine myself to asking specific questions. Does the Minister accept that any downgrading of accident and emergency provision at Solihull hospital will be seen by the people of Solihull as a broken promise? If the previous hospital management secured an agreement with the royal colleges that doctors could safely be rotated between Birmingham Heartlands and Solihull hospitals, what has changed?
I endorse my hon. Friend's view that an inability to staff the A and E department is a poor reason to close it. That is a supply-driven argument that does not reflect the true demand or wishes of the people. The Minister may say that the matter is local and should be decided locally, but does she accept that a perfectly reasonable local solution is under threat? It takes 38 minutes to get from the border of my constituency to Heartlands A and E at off-peak times. Does the Minister regard that as an acceptable journey time in the event of an emergency?
Is the Minister aware of the editorial in the British Medical Journal of 4 August last year? It said that the Royal College of Physicians and the NHS Confederation had together announced a working group to rethink accident and emergency provisions. The editor wrote that the preferred model would place accident and emergency departments within 10 minutes reach of those who need them.
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears) : I congratulate the hon. Member for Solihull (Mr. Taylor) on securing this important debate. Primarily, it raises issues about Solihull, but it also touches on broader issues about accident and emergency departments. I thank him personally for giving me notice of the issues that he intended to raise. If Ministers can respond to specific points rather than talking generally, it makes for a more focused debate.
The hon. Gentleman has a keen interest in the services that Solihull hospital provides. He has tabled parliamentary questions about it on several occasions, and he is keen to ensure that the highest possible standard of health service is available to his constituents. I assure him that the Government, too, are committed to ensuring that local people get services of the highest possible quality, and we want to provide services that are as close to people's homes as possible. Obviously, that is consequent on safety and viability, but striking the right balance between local access and high-quality services has always been a tension in the national health service, and we all continue to grapple with it.
At the outset, I acknowledge that local people want accident and emergency services to be as close to their homes as possible. The hon. Member for Meriden (Mrs. Spelman) quoted a journey time of 38 minutes, and the working group is examining a period of 10 minutes. People want access, but we must acknowledge that they also want extremely high quality. It is not easy to achieve consensus; that requires much local consultation and discussion on the detail of local services.
Mr. Stephen McCabe (Birmingham, Hall Green): I am extremely grateful to my hon. Friend for permitting me to intervene. She knows that my constituents use some of the facilities at Solihull hospital, and they want two assurances from her. First, will she give a categorical assurance that there is no threat to Solihull hospital? Secondly, will she assure me that any changes that the trust contemplates will be subject to a full, transparent and above-board consultation process?
Ms Blears : I am delighted to give my hon. Friend those assurances. The Government, the health authority and the community see a vibrant future for Solihull hospital. Any changes to the services will be subject to the same rigour that has always been required. If there is a requirement for public consultation, it will be open, transparent and inclusive.
We want to make the consultation process more real to local people. Instead of presenting local people with a fait accompli, we want to get them involved in drawing up options at the outset. That will allow them to be part of the decision-making process. In the past, local people felt that they entered the process right at the end, and if they had not had the chance to influence policy making at the outset, they were often forced into a position of opposition and defending a situation. We want that change to be introduced.
The hon. Member for Solihull set out the background of the hospital and trust. He was right that the merger with Birmingham Heartlands hospital in April 1996 brought financial and managerial stability to Solihull hospital. Savings were made at that time, such as efficiency savings that managed to turn the financial situation around, and the merger was beneficial. Since then, there have been several dramatic new service developments in areas such as renal dialysis, ophthalmology, oncology and dermatology. Activity levels at the hospital have increased year on year. The trust is performing very well with regard to waiting times. It has been successful with the fourth wave booked admissions bid, which means that patients will be able to book their admissions at a time that is convenient to them. I hope that that will lead to a significant reduction in appointments that are not kept, which means that we will save money, which can be invested in services.
There have been several improvements to the physical environment, including better facilities for obstetrics, gynaecology, day surgery and endoscopy, as well as MRI and CT scanning, dermatology, the out-patients department, pre-operative assessment, and the mortuary facility. That goes to show that there has been significant investment in the hospital, so that it can provide a wide range of services for local people.
Some of the investments resulted from Government expenditure, some from efficiencies as a consequence of the merger, and some from publicly raised funds. It is also the case that much of the progress has been made because of the hard work of the trust's staff, and we should acknowledge their contribution.
Since the merger, there has been no major change to the A and E service but the trust has long expressed concerns about the clinical safety of maintaining a 24-hour A&E department at the hospital. The removal of training accreditation from certain posts has contributed to recruitment difficulties, and concern has also been expressed about the case mix of patients who are presenting at the hospital, which is of relevance to the training of doctors. The relevant factors include the supply of doctors, their training needs and their working practices. I am sure that hon. Members will agree that all of those are essential to the delivery of high-quality health care.
Clinical quality requires a minimum work load, so that doctors can build up experience. In an acute hospital without a minimum work load, doctors cannot be properly trained and senior doctors cannot maintain the expertise that they need to ensure the best treatment and care for patients. That situation has been developing for a long time, and it involves two issues:
Therefore, there is tension in that situation, and I am delighted that extra attention is now being paid to looking at the future of A and E services, by examining, for instance, whether we can use new technology such as tele-medicine. It is important to take a fresh look at how we provide A and E services, to see whether we can provide as much as possible in local communities, while maintaining a balance by continuing to provide excellence. Most people accept that it is not possible to have top-quality specialist care on everybody's doorstep; that is common sense. Therefore, getting that balance right is a key issue. We must look afresh at emergency care.
As hon. Members may be aware, in November 2001, we published a document called "Reforming Emergency Care: First Steps to a New Approach". It was worked on by all of the royal colleges, nurses, consultants, paramedics, the ambulance serviceby everyone who is employed in emergency care. The document sets out a new strategy for joining up all of the elements of emergency care, because the issue is not only about A and E departments; it is about primary care. It is about whether people who currently come to A and E departments could be dealt with more appropriately, and faster and better, by primary care, community mental health units and a range of other partners. It is also about whether we can use the ambulance service more effectively. One ambulance service is sending consultants out in their vehicles, which enables them to make rapid decisions about diagnosis and admissions in patients' homes. As a result, emergency admissions to A and E departments are falling dramatically.
The issue is also about joining up walk-in centres, and joining up NHS Direct so that it can take some of the telephone calls that are currently made to A and E departments. We are planning for every health community to appoint an emergency care leader, who can try to join together all of the parts of the network. A great deal of innovation is going on in terms of looking at the future of A and E departments, and I urge hon. Members to get involved in that endeavour.
The issue is also about reform and changing the way that we do things. The Government intend to put in extra investment to change the way that services are delivered so that patients receive a better standard of care.
Mrs. Spelman : The Minister encourages us to look at innovation. Does she accept that it was an innovative solution to rotate doctors through the two hospital sites, to satisfy the criteria of the colleges for their training? Is she also aware that, although A and E services might not have significantly altered since the merger, the loss of an emergency surgeon at Solihull was crucial with regard to what could be done in the A and E department?
Ms Blears : I am delighted that people have come up with different ways of providing services and training doctors. There is no single solution to all such matters, which is why I have advised the hon. Lady to get involved in all that is contained in "Reforming Emergency Care". I urge her to read the document and
The hon. Member for Solihull asked important questions about whose responsibility it is to make decisions and what the process is for that. I shall not say simply that that is a matter for local consideration, but, primarily, it is. We should aim to achieve consensus in a local community if we can. The primary care trusts, which will have a major role in examining reconfigurations in their communities, will be key to the process. They are the bodies with which local people will be involved and they will be able to look at the local community's needs. The primary care trusts will be able to decide what services are appropriate for the people that they represent. That is what I mean by getting people involved right at the start of the process. The primary care trust, which will have the majority of the budget and be commissioning services for local people, will be the driving force behind changing services locally.
Of course, if a major change is not agreed, it can be referred to Ministers, as at present. That power currently lies with community health councils. If the NHS Reform and Health Care Professions Bill, currently in the other place, is enacted, that power will be transferred to the local authority overview and scrutiny committee. I have given an undertaking that the power to refer configurations to Ministers will be no less rigorous under the new system than it is under the existing one. There will be that right to refer. It is very important that local government, with democratically elected members, can take a view on such issues right across the community and that there can be the links between local government and the health service that have, perhaps, been lacking in the past.
The Government are in the process of setting up the independent reconfigurations panel, an independent body to offer advice to Ministers on contested and controversial reconfigurations. The panel is likely to be operating by the autumn, but if the matters under discussion were referred to it in advance of that, it might be in a position to offer some advice to Ministers. It is a very good development, which will be able to work up some consistency around configurations. It will examine not hard and fast rules or a rigid framework, but the way in which reconfigurations should go through. At the end of the day, decisions will remain the legal responsibility of Ministers. That situation will not change. I urge all hon. Members to get involved in that process, and I
Staffing and training issues are important, but they are not the only issues. Access is incredibly important to local people, and such matters will be weighed in the balance when decisions are being made.
Mr. John Taylor : Will the Minister kindly take into account and acknowledge now the point, which I have made, that the daytime population of Solihull is much more than its residential population, for the reasons that I have given?
Ms Blears : I am delighted to deal with that point. The hon. Gentleman mentioned new homes, the new Touchwood site retail development, the airport and 30,000 new jobs to come. Those are important developments, which are happening as a result of the strong and thriving economy under this Government. I am delighted that his area is doing extremely well and that local people are thriving to such an extent. Clearly, his point is important, as it is in seaside areas that have a great influx of tourists. We must be conscious of such variations in communities.
It would be wrong to speculate on the future because, by the process that I have just explained, decisions might end up being made by Ministers. I am aware of the previous pledge given, as a result of the merger, on maintaining a 24-hour service. I am not in a position to say that the position will never change, because Ministers have a legal duty to take into account any changes in the population, the area and the services provided. However, we are determined to ensure that people have access to high-quality health services in their local communities.
Whatever is decided, the overriding aim should be the delivery of high-quality treatment in a modern, up-to-date setting, in an NHS fit for the 21st century. The hon. Gentleman's constituents are entitled to that, as are people throughout the country. The primary care trusts have a new role, a new responsibility and new powers to drive that system, and I urge them to make sure that they consult local people as widely as they possibly can in drawing up options for the future. It is crucial that local people are able to participate in formulating options as well as deciding on them at the end of the day; if we can get some kind of consensus on that, so much the better.