| Previous Section | Index | Home Page |
7.15 pm
Mr. Tim Boswell (Daventry) (Con): I am grateful both to the Minister and to my hon. Friend the Member for Banbury (Tony Baldry), my constituency neighbour, for allowing me a few minutes of their time. I congratulate my hon. Friend on securing this important debate.
Although the debate is badged as being about paediatric services, and he has spoken on that matter with considerable expertise and great effect, there are major implications for the viability of Horton general hospital in Banbury. This is a significant interest for about 25,000 of my constituents in south-west Northamptonshire, including the town of Brackley. In turn, that amounts to about 20 per cent. of the total caseload at the Horton hospital. Incidentally, Miss Horton was from my constituency.
I have lived just inside my constituency boundary for more than 35 years, and during the whole of that time Horton hospital has been, for all practical purposes, my hospital. All three of my children were born there, and on one occasion I had every reason to be extremely grateful for the hospital's paediatric services in coping with an emergency, the response to which was led by Dr. Bob Bell, that involved a member of my family.
I recognise the real dilemma for health Ministers in balancing the changing requirements of modern practice standards against the need to offer convenient local services, including a rapid response to emergency situations, and doing so with limited trained manpower and other resources. However, I emphasise the difficulty that is posed by any withdrawal, in whole or in part, of paediatric services at the Horton, not only for the town of Banbury and its population, but for the scattered rural settlements around it in a number of counties and constituencies.
Some villages in my constituency are about 10 miles from Banbury and 25 miles from both Oxford and any other alternative service in Northampton, for example. I know also of the intensity of local feeling at the perceived danger of progressively withdrawing services that lead on from paediatrics to other services, with the ultimate fear that the entire hospital might become unviable. I associate myself with the concerns expressed by my hon. Friend and endorse his call for some constructive thinking in order to find a practical solution to this problem.
7.18 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I am grateful to the hon. Member for Banbury (Tony Baldry) for raising a subject on which he has been campaigning for some time, and I congratulate him on securing this debate. I am grateful that he gave me some notice of the issues that he was to raise. I also congratulate the hon. Member for Daventry (Mr. Boswell) on putting the case on behalf of his constituents.
The hon. Member for Banbury began his speech with the sad story of Ian Luckett. It was a tragedy that resulted from people being insufficiently experienced and working under pressure. The hon. Gentleman used the story to demonstrate why decisions were taken to establish children's health services in his local area and to support his view of how services should be shaped in
the future. Let me put that awful story back to him. Surely what it shows also is that clinical safety has to be a prime consideration when we design hospital services. Surely it shows also that when we configure services, we must take a strategic view that takes account of changing clinical practice, changing populations and changing circumstances.The hon. Member for Daventry acknowledged that issue. The tragedy relayed by the hon. Member for Banbury happened in 1974, but the world has changed in the 30 years since. Technology, for example, has changed dramatically. When the tragedy happened, the personal computer had not even been invented, and many clinical tests and drugs that we employ today had not been dreamed of. Those changes alone required us to look critically at local service design. In 1974, junior doctors worked long and unsafe hours to accumulate the experience that they needed. Now we are driving down the hours that they work that so they can work more safely, but we still have to maintain the level of training that they receive. That means that we must change the way we work and look critically at the way in which hospital services are delivered. As for the working time directive, which imposes a tight time scale on those changes, we were not even in the European Union when that case was heard, never mind signed up to the type of change that we must plan for today.
I acknowledge the serious concerns expressed by the hon. Member for Banbury, and he is right to expect a certain level of service on behalf of his constituents. However, all I ask is that he keeps in mind the way the world changes, does not expect Banbury and Oxfordshire to be immune to those changes, and that he remains open minded about the way in which paediatric and other health services can best be delivered in his constituency, should change be proposed in the future. The Horton hospital, however, provides a substantial part of hospital care for patients in Oxfordshire. It copes with approximately 30,000 accident and emergency attendances a year out of the county total of 100,000. On average, 7,000 of those attendances are paediatric, and it delivers approximately 1,600 babies a year. Given that level of activity, the hospital's importance to the county is self-evident. I note, too, the comments of the hon. Member for Daventry about its importance to his constituents.
There has also been significant investment in Horton hospital over the past few years. The number of beds has risen from 200 in 1998 to 250 today, including 14 paediatric beds. The position of the primary care trusts—their view is shared by the Oxford Radcliffe hospitals NHS trust—is that the Horton is, and will remain, vital to the delivery of emergency and elective care in the county. The PCTs want locally based hospital care to continue and expand where appropriate, provided that the quality and safety of care are guaranteed. The NHS will continue to work to ensure that that happens and that necessary investment is made in the Horton. The chief executive of the Oxford Radcliffe hospitals NHS trust, in the letter of 3 March cited by the hon. Member for Banbury, explicitly states that
- "paediatricians wish to see as much provided in Banbury as possible".
The hon. Member for Banbury was right to express concern about the impact of the working time directive, although I detected slight signs of his trying to have it both ways. He cited the tragic case of Dr. Watkins, who died after a 100-hour week, implying that that was why the recruitment of paediatricians was proving difficult. In another part of his speech, he held up the working time directive as a barrier to the implementation of safe paediatric services. The aim of the working time directive and Government policies is to hammer down doctors' working hours to ensure that in future doctors do not work 100 hours a week and that recruitment is made easier. We do not underestimate the impact of the working time directive, but it presents the NHS with a marvellous opportunity to change outdated working practices that do doctors and patients no favours. By introducing innovative ways of working that take away routine tasks from doctors in training and, at the same time, reduce the hours that they work, we shall enhance doctors' working lives and improve the quality of service to patients.
We must have effective systems in place to share emerging good practice and learn from others. A number of national pilot sites are currently testing new ways of providing services so that we can learn lessons from their experience. Every NHS trust has been asked to prepare an action plan detailing how they will ensure that junior doctors comply with the law on working time, and every strategic health authority has been asked to work with trusts to agree their action plans and ensure that they are realistic and deliverable. The North Oxford Paediatric Task Force is assessing the best way forward for the local health community, with special emphasis on paediatrics. Oxford Radcliffe hospitals NHS trust is also conducting a broader strategic review, and the two PCTs—North East Oxfordshire and Cherwell Vale—are looking at the future shape of hospital, intermediate and mental health services in north Oxfordshire.
Implementing the working time directive locally is the responsibility of trusts, but there are things the Department of Health, the medical profession and others can do to support them, which is why we have set up a national working time directive expert group with the Academy of Medical Royal Colleges, the joint consultants committee of the British Medical Association, the Royal College of Nursing and other key stakeholders.
We have also set up a national delivery board of NHS managers to ensure that strategic health authorities and trusts deliver working time directive compliance on the ground. They will spearhead trust efforts and ensure that help is directed to trusts that need it most. Currently the Oxford Radcliffe hospitals trust is 70 per cent. compliant with the WTD and there is a trust-wide assessment going on to get compliance to 100 per cent.
The hon. Gentleman is, however, right to highlight the particular problems of paediatrics and obstetrics with respect to the working time directive. Those are two acute specialties that do not easily lend themselves to cross-cover, owing to the particular skills and competencies attached to them. We recognise that they require particular and different solutions to those required for general acute services, and that is why we are working closely with the Royal College of Paediatrics and Child Health and the Royal College of Obstetrics and Gynaecology to deliver those solutions.
The RCPCH has already produced some models in its document "Old Problems, New Solutions". They examine the provision of emergency assessment services without the use of in-patient beds, and increased care in the community with particular emphasis on community paediatric teams that prevent admission and enable earlier discharge. The RCPCH also considered staff being used in new and different ways—for example, the growing and effective use of nurse practitioners in paediatrics and neonatal care. Redesign is another of the key tools to help achieve a reduction in the hours worked by doctors in training, and has the potential to provide new ways of delivering services that avoid the need for reconfiguration.
At various points in his speech the hon. Gentleman referred to staff numbers with respect to children's health services. More staff, working differently summarises the Government's approach to growing the NHS work force. That means making the most of the whole team, not just doctors. There has been a 17 per cent. increase in paediatric nurses between 1997 and 2002, and a 19 per cent. jump in the number of allied health professionals, most of whom work with children. We have also increased training places. In the same five-year period, training places for children's nursing have increased by 55 per cent. and for allied health professionals by 73 per cent.
In paediatrics, that means nearly 600 more consultants are working in the NHS today than were working there in 1997, and there are 253 more specialist registrars, the consultants of the future. NHS trusts are willing to fund extra specialist registrar training places in paediatrics, and between 2003–04 and 2004–05 trusts have the opportunity to fund up to 115 additional posts. Implementation of this initiative is progressing steadily. Central funding has been provided for 10 additional
specialist registrar posts in paediatric cardiology. We have also announced that additional national training numbers will be made available, subject to obtaining the appropriate educational approval, where trust action planning has calculated that they are needed for WTD compliance. To date, we have received some 200 bids for paediatric posts from trusts. The Oxford Radcliffe hospitals trust has bid for five of those places.On communications, I hear what the hon. Gentleman said about mixed messages. The decision about where training can take place is not a local NHS decision. Only the Royal College of Paediatrics and Child Health and the post-graduate deanery operating through regional specialist training committees can decide where such training can take place. I will, however, make sure that officials study his comments carefully and that they are passed to the local strategic health authority so that if any mixed messages have been given, they can be sorted out and appropriate advice taken before any decisions about service changes are made.
The developments that I have described are not just a numbers exercise. We are increasing staff. More importantly, outcomes are improving. The increased investment made by the Government has meant better care for patients, and that is as true in Banbury and Oxfordshire as everywhere else. The working time directive and paediatric recruitment are a serious challenge, but it is one that we do not underestimate and it is being met. I hope the hon. Gentleman will be at least partly reassured by what I have said, and by my undertaking to ensure that we reflect on his comments and that local service designers do likewise. If the hon. Gentlemen should wish to have further discussions with me at a later date as these matters progress, I should be happy to meet them.
- Adjourned accordingly at twenty-nine minutes past Seven o'clock.
| Index | Home Page |