Iain Wright (Hartlepool) (Lab): I am delighted to have secured this Adjournment debate. I see the future of health in Hartlepool alongside the town's economy fulfilling its potential and the putting in place of measures to eradicate crime and antisocial behaviour from our streets as the main improvements that I hope to achieve as the town's MP.
Although the debate is about the future of health services in Hartlepool, I should like to spend a few moments outlining the broad historical trends in health in the town. I am a huge believer in the concept that we do not know where we are going unless we know where we are coming from. Hartlepool suffers greatly from its legacy as a centre for heavy manufacturing industry and from decades of economic decline. Industries such as the steelworks and the docks have left their mark with diseases such as asbestosis and respiratory illness. We as a town have suffered from decades of economic decline as the traditional industries have died. Unemployment has savaged the local population, which is only now beginning to recover.
Although the past decade has brought improvements in Hartlepool's economy, we are starting our renaissance from a very low base. Car ownership, a key barometer of economic prosperity, is low40 per cent. of households in the town do not own a car, compared to 27 per cent. nationally. That should have, as I will show, a real bearing on where health services in the town are located. Despite recent improvements, we still have to contend with the health consequences of years of economic decline, poverty and social exclusion. This legacy means that Hartlepool people suffer more ill health and disability and higher death rates from cancer, heart disease and respiratory illness, and live shorter lives than people in most other parts of the country.
The facts are stark: I received these figures only yesterday, in response to a written parliamentary question. Life expectancy for Hartlepool men is 73.4 years, against a national figure of 75.9 years, while Hartlepool women are expected to live 78.4 years, against a national average of 80.5 years. We also lead unhealthy lives. Forty per cent. of people in the town smoke, and we have more than the national average number of cases of obesity caused by poor diet and excessive drinking.
The national health service is, arguably, the Labour party's greatest creation, and it has undoubtedly improved the health of people in Hartlepool. However, it is not improving as fast as that of people in other parts of the country, and health inequalities within the town remain profound. Half the people live in wards that are in the 5 per cent. most health deprived in the country. Stranton ward is 51st out of some 8,400 wards in the country for health deprivation and disability, while Elwick ward, the most affluent ward in the town, is still in the top 3,000 for poor health.
We should also take into account demographic changes. The population of the town is ageing: the number of people aged over 75 is expected to increase by 25 per cent. in the next 15 years. That is aggravated by a sharp fall in the birth rate in Hartlepool. The number
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of births has dropped by almost a fifth in a decade, which has exacerbated the decline that was particularly pronounced between the late 1970s and early 1980s.
This is the challenge for those who shape the future of health services in Hartlepool: a legacy of industrial decline and associated poverty; unhealthy lifestyles; high incidence of ill health; pronounced health inequalities; an ageing population and low birth rates, all of which result in profound pressure on health resources.
Our health has not been helped by a chronic lack of investment for decades in primary health care in Hartlepool. The unwillingness or reluctance of successive Governments to invest in this crucial first call when somebody is ill or in the prevention of illness has led to an undeveloped primary care sector, which has to contend with the most difficult problems. The possibility of attracting more money elsewhere, and the generally poor quality of surgery buildings has meant that we suffer from an acute shortage of general practitioners. Hartlepool is in the bottom 10 areas of the country for numbers of GPswe need about 12 more to reach the national average, and a similar increase in the number of community nurses. Meanwhile, GPs' average list size is 2,100, the highest in any PCT area in County Durham and the Tees valley.
The problem exacerbates itself. High patient numbers lead to extra work and more stress for GPs, which accelerates their wish to retire early or to leave the town. An estate audit in the town found that five of the 17 GP premises in Hartlepool are in poor condition, with only six meeting the criterion for satisfactory. There is an acute shortage of space in those surgeries, and that hinders their development and potential to offer a wider range of services. Most do not comply with the requirements of the Disability Discrimination Act 1995.
The acute shortage of community doctors over the years has led to an over-reliance on the local hospital. Hospitalisation rates far exceed the national average, and the hospital's accident and emergency service is stretched to its very limits as people use accident and emergency because they cannot get access to a local GP or community nurse. The number of accident and emergency attendances at Hartlepool hospital has increased by more than 9 per cent. in the past year alone.
I have painted a dark picture, and I am not exaggerating. However, amid the gloom, there is real success. This Government have recognised the health problems caused by deprivation and invested heavily in the NHS. Funding year on year in cash terms for the NHS in Hartlepool since 1997 has been close to 10 per cent. The Government's commitment to providing health services as locally as possible strengthens the case that primary care in Hartlepool needs to be developed.
Despite the massive resources invested in our health service by this Government, there is a strong case to say that we in Hartlepool remain underfunded. The primary care trust has a shortfall of some £2 million a year from its targeted allocation; the NHS trust has a projected deficit of some £6.5 million to overcome. I am grateful to this Government, and sincerely believe that no other Administration would have invested so heavily. However, I am in Parliament to stand up for the people of Hartlepool, and I believe that the Government need to provide substantial additional funding to both
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primary and acute care to tackle the decades of neglect in Hartlepool. Health professionals would not squander this money; there has been real success in recent years, as I shall mention shortly. Just think what could be achieved with appropriate funding.
Foremost among the successes are the achievements of the local hospital. For the third year in succession, the North Tees and Hartlepool NHS Trust has been given a three-star rating. That means that over a long period, it has consistently been one of the best performing trusts. Only 12 trusts in the country have received that accolade for three years.
The University hospital of Hartlepool has been named among the top 40 hospitals in the country, and its clean-hospitals policy has meant that, unlike hospitals in other parts of the country, it does not suffer from accusations of being unclean or of suffering from germs. In fact, it is among the top 10 cleanest hospitals in the country. The "general", as it is known locally, is genuinely thought of with pride and affection in the town.
I know from personal experience what a marvellous asset it is. All my four children were born there. My eldest son's life was saved there when he was treated quickly for meningitis, and my youngestonly two months old at the timewas admitted last Boxing day, suffering from pneumonia and bronchiolitis. All that success is due to the tremendous commitment of staff of all grades at the hospital, which is ably led by Bryan Hanson, the trust's chairman. Their loyalty and commitment to health care for the town is arguably unchallenged throughout the entire country. That is why I think it understandable that the proposals led by the strategic health authority to downgrade or close the hospital have led to concern and alarm in the town.
A dedicated campaign to save the hospital has been organised by John Bloom. John stood against me in the by-election, and I disagree with many of his policies. However, I do not doubt his sincerity and integrity on this matter. He, and others such as Peter Wolfe, have put this issue on the agenda and have not hijacked it, as others did, for short-term political gain.
Let me make my position absolutely clear: I am adamantly opposed to the closure or downgrading of the hospital. In my vision for future health care for Hartlepool, I see the hospital as the major site for acute services between Sunderland and Middlesbrough. I see the hospital going from strength to strength and improving its capacity to provide all the services it provides today such as accident and emergency services, general medicine, surgery and neurology, orthopaedics, rheumatology, obstetrics, gynaecology and paediatrics.
I have been greatly reassured by comments from the Secretary of State for Health and the Prime Minister that the hospital will be improved, not downgraded, and I see Professor Sir Ara Darzi's review as an opportunity to ensure that Hartlepool can realise its potential as a major health hub between the River Wear and the River Tees.
I do not believe that the co-location of the Hartlepool and North Tees hospitals on to a greenfield site between the two towns will be conducive to effective health care. That would go against the Government's policy of ensuring that health care should be as local as possible, and would hinder the effective recovery of patients.
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As I mentioned earlier, my son Billy was ill during Christmas, and my wife and I took turns to stay with him. He was visited by his grandparents and by other relatives. We are fortunate that we have a car. Further anguish could have been caused to us, over and above the fact that our two-month-old son was seriously ill, had we relied on public transport to an out-of-town hospital over Christmas, while ensuring that our other three children were being appropriately cared for. As I said earlier, car ownership is low in Hartlepool. The ease with which family and friends can visit has an important bearing on the recovery of a patient. That ease can be achieved only by having the hospital firmly secured in the town.
It is madness that where a town has an underdeveloped and relatively under-resourced primary care sector and a subsequent over-reliance on the three-star acute hospital, some senior bureaucrats wish to remove or to limit what the hospital does, against the wishes of the people. That is akin to a person having one healthy, muscular leg and the other one in plaster, and opting to amputate the healthy leg before the other one has healedthe person would soon fall over.
That is not so say that I want the hospital, and everything that it does to be preserved in aspicnever to change. Clinical improvements mean that procedures that previously required a major operation and recuperation in hospital for many weeks can be done as day surgery. Developments such as triage in accident and emergency treatment have meant that more people are seen more quickly and with suitable prioritisation. I want that trend to continue, so that fewer people stay in hospital and that they do so for shorter periods and recuperate in the familiar, comfortable surroundings of their homes. That will mean that a faster turnover of patients can take place at the hospital, which will help to produce shorter waiting lists and greater capacity for acute care.
I also want to mention the successes of Hartlepool primary care trust, because its objectives are a major vehicle with which to achieve my vision for health care in the future. It was formed only in 2001 and had initial managerial difficulties, but it has come a long way in a short period to reverse the lack of investment in primary care over the decades. The chairman, Professor Gerald Wistow, and the chief executive, Angela Hawkes, are putting in place the vision where people are treated as locally as possible, ill health is tackled and, as far as is possible, prevented, and state-of-the-art health buildings are located in all our estates and neighbourhoods.
The success of the PCT in a few years of existence is astonishing. In terms of smoking cessation, Hartlepool PCT's clinics have helped to produce a doubling in the number of successful quitters. Thanks to the PCT and its work in implementing its teenage pregnancy strategy, Hartlepool has enjoyed the biggest decrease in the under-18s conception rate in the north-east. Work is progressing to bring more GPs to the town, often from the international doctor market. Crucially, the PCT is investing, through the development of local improvement finance trust schemes, in new medical buildings in the heart of our estates in Owton, Rossmere, the town centre and on the headland.
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Those schemes are the foundation of the future of health in Hartlepool: 21st century neighbourhood health centres on each estate providing high-quality primary care and health advice to the local population, undertaking minor surgical procedures and being the first point of call for urgent cases, thereby relieving the pressure on the local hospital. For example, people in Owton go to their neighbourhood health centre for treatment rather than the accident and emergency department of the local hospital.
I am a passionate believer in the Government's policy of ensuring that health care is as local as possible. Given our historical health legacy, the PCT, in conjunction with the local strategic partnership, which I chair, understands Hartlepool's needs and is able to commission services to meet them. That is why I find it odd, and somewhat against Government thinking, that the local strategic health authority is pushing PCTs in its area to commit quickly to strategic commissioning, where commissioning for all Tees valley PCTs will be pooled under a Middlesbrough PCT. I am all for making savings and efficiencies through joint procurement of services, but there is a massive difference between procurement and commissioning. I cannot understand what possible benefit the people of Hartlepool will receive from allowing decisions about their health to be taken in Middlesbrough as opposed to in their own town.
One of the true success stories in Hartlepool in recent years has been the ability of different organisations to put aside institutional jealousy and place the needs of Hartlepool residents first. We are lucky in that the geographical boundaries of the PCT are coterminous with those of the local authority. More important is the desire to work together to improve the town's health. Joint commissioning has taken place, with joint appointments such as that of Peter Price as director of public health. Pooled budgets between the council and the PCT are already in place and, from next April, those organisations will jointly commission children's and older people's services.
That is the future of health care in Hartlepool: teams of doctors, nurses, social workers and home carers from a variety of agencies sharing information and using the same systems and procedures to tailor health care to residents' individual needs and requirements.It seems a shame that years of painful negotiation and hard work to secure partnership by those local agencies could be threatened by a blunt diktat issued on Christmas eve by the strategic health authority.
I want the partnering approach to be extended throughout the health network in Hartlepool. I want Housing Hartlepool to be part of that network to ensure that housing does not contribute to health problems. I want schools to teach children the benefits of healthy eating and I want supermarkets in the town to play a role in promoting fruit and vegetables and the benefits of a balanced diet.
In this demanding age, a one-size-fits-all approach is wrong, particularly for health care. The agencies in the town need suitable flexibility, and shared systems and procedures, to enable them to offer a personalised
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service as close to the home of the person concerned as possible, with the minimum of duplication from organisation to organisation.
The future of health services in Hartlepool is the realisation of our town's vision of care; it is services that are as local as possible, with an emphasis on a service to patients based on their individual needs; it is a multi-agency approach with a massively sophisticated health network; it is an adequately funded primary care sector, in conjunction with a responsive and fully funded acute sector, which allows community based health to be at the centre of the health service in Hartlepool while freeing the acute trust to undertake its valuable role. Only by realising that vision will we truly reverse decades of ill health in Hartlepool.
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson) : It is with pleasure that I respond to my hon. Friend's debate and congratulate him on securing it; I know that the subject is a matter of huge importance to him and his constituents.
I want to say a few words in response to his remarks about public health. Although I shall not say a lot on those topics, because I need to focus on the specific issues that my hon. Friend raised about hospitals and primary care trusts, that should not suggestand I can tell that this goes for him toothat we give a low priority to public health, prevention and the Government agenda, which makes health care, and health itself, a top priority.
I concur with my hon. Friend's remarks about the importance of tackling health inequalities and obesity, and about the need to avoid over-reliance on hospital services by securing good services in a community setting. I am, in addition, pleased to congratulate the PCT and others involved on the drop in smoking brought about through the quitting smoking services, as well as on the teenage pregnancy figures that he mentioned. All those things are terribly important and we need to tackle them if we are to crack the issue of health care and health in the longer term.
To deal with some of the more specific issues, Hartlepool PCT, as my hon. Friend acknowledged, has received large allocations of £93.6 million in 200304, £102.5 million in 200405 and £112 million in 200506. Those amount to a cash increase of £26 million, or 30 per cent., over three years. That compares closely to the overall national average. It is slightly less, but by only a small amountthe figure is 30.27 per cent. compared to the national figure of 30.83 per cent.
The next round of allocations will be announced imminently, and I am sure that my hon. Friend will take a keen interest in that. That is in the context of record increases throughout the country, which means that there has been a big cash injection to enable many of the issues that he raised to be addressed.
I turn to the Tees service review and then the work of the PCT. To respond to my hon. Friend's point about where decisions are made, at the end of the day 75 per cent. or more of the money is received by the PCT. It is up to the PCT to commission locally the services that it feels are most appropriate for the people of Hartlepool. In that setting, responsibility has also been given to the strategic health authorities for running the NHS and
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running health in their areas, alongside the PCTs. In that context, my hon. Friend will remember the remarks that my right hon. Friend the Secretary of State for Health made last summer:
In looking at how the services are developed for the future, the Department and all the strategic health authorities have a responsibility to ensure that the NHS not only provides high-quality care today, but will be able to provide it in 10 years' time. The service is not static; developments occur all the time, and possibilities for new treatments and new ways of doing things evolve, which is to the benefit of patients. We must ensure that our health service generally, and in Hartlepool specifically, continues to evolve in such a way that, as patients, we all get the best service possible.
The current review of services in the area north of the Tees is designed to ensure that. There are three elements to any possible change. First, primary care is the key to the future of the NHS, as I said. It is now possible to provide a wider range of care, including minor surgery, X-ray and other tests. I note my hon. Friend's remarks about high-quality facilities in all the communities around Hartlepool and the importance of providing services away from acute hospitals, which I have seen elsewhere and which are more convenient and often much more effective in a community setting.
The reason for the change is that providing services in primary care makes services more local for local people, who will be able to receive treatment and care in local surgeries and other facilities close to their homes. There are a number of benefits to that. I note my hon. Friend's remarks about car ownership levels and the importance of travelling. The changes can mean a lot less travelling and less pressure on the hospitals, and therefore shorter waiting times for those who genuinely need a hospital service that cannot be provided in a community setting. In line with recent announcements, it is also important that the care of those with long-term conditions be managed closer to home too. There will be better prevention of ill health by targeting people at risk, which is an aspiration that he and I share.
The second element is the need for all emergency services to work together more effectively. At present, there is often confusion about the best thing to do. People end up in an accident and emergency department just because they know that it is there and that it is open, but it may not be the best place for them in all circumstances. The right service may be advice from NHS Direct, or out-of-hours service in primary care or a minor injuries clinic. People need rapid access to the emergency service best able to meet their need. In that connection, I am pleased to report that the out-of-hours service in the Tees valley area has been operating smoothly since April 2004.
The third element is ensuring that local hospitals are strong and modern, and can give the best possible services available to all people north and south of the Tees. I acknowledge that change is always uncomfortable to contemplate and not always popular. People sometimes like to keep things as they are, which
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is most true of well loved local services such as local hospitals. It is absolutely understandable that the Hartlepool "save the hospital" petition was signed by some 30,000 people.
The job of the SHAworking with all its partners in health and social careis to look ahead and put forward changes that will save tomorrow's hospitals by making sensible changes today. The hospital services have been changing for some time and they are still changing. As I have already said, some services that used to be provided in a hospital can now be provided in primary care. Other services need to be provided in fewer places so that specialist staff and facilities can be available to provide the best possible care. Some examples of such services are those for cancer treatment, emergency surgery and the most serious accidents. I am not talking about average attendance at accident and emergency, but really serious road traffic accidents and other dramatic accidents.
The decisions to create strong, modern hospitals have already been taken in other parts of County Durham and the Tees valley area. For instance, people living south of the Tees are already served by the James Cook university hospital, which opened in 2003. The purpose of the Tees review is to establish arrangements in the area north of the Tees that will provide the best and most sustainable services for the 21st century. The Department of Health invited Professor Sir Ara Darzi to work with the SHA on the review to ensure the highest quality outcome. The professor was asked to consider how the fullest possible range of services can be maintained at Hartlepool hospital in light of the work that has already been undertaken during the Tees services review and the wider context of the proposed provision of primary and secondary care services, both north and south of the Tees.
Two additional areas were identified relatively recently as needing examination, which is why we have agreed to look at the work of the Hambleton and Richmondshire PCT and the South Tees hospital trust in relation to the Friarage hospital, and consider the impact of the centralisation of specialist services at, and the capacity of, the James Cook university hospital on other hospitals in the area.
The original time scales were not realistic, so the review has been extended and it must be allowed to be carried out thoroughly and should report when it is ready. It is important that we provide people with safe, sustainable services that are local, where that is possible. I know that my hon. Friend will share that ambition. The local health service, with the assistance of Professor Darzi's review, is looking at how best we can do that. The professor is visiting Teesside in March and I understand that my hon. Friend is likely to meet him again then. Professor Darzi is likely to submit his final report in the following months and, as he is still reviewing the situation, I am sure that hon. Members will understand that I cannot make any commitments that pre-empt the outcome of the work that he is doing.
In the remaining minutes, may I turn to GP recruiting and the work that has been done on that? The good news is that, in September 2001, there were 49 GPs in the PCT area and the latest figure is 52, which is a 6 per cent. increase. I am aware that there are still seven vacancies and the PCT has employed eight salaried GPs to provide capacity where it has not been possible to attract
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principal GPs to practices. The PCT has been working with the strategic health authority to develop the international recruitment of GPs. Under the national initiatives, new GPs in Hartlepool will receive the higher rate golden hello payment, which can be up to £12,000. The PCT is also looking to develop modern primary care centres providing access to integrated health and social care teams, including all the specialist workers that my hon. Friend mentioned. It is also planning to use a range of other primary care skills to help deliver that. In addition, the PCT has recruited two GPs from Spain and one from Austria.
Nationally, there are more GPs in the NHS than ever before, which reflects the Government's record investment in primary care and commitment to expanding the GP workforce. In June 2004, there were 31,215 GPs working for the NHS, which is an increase of 11.3 per cent. since October 1997. There are a range of initiatives to secure ongoing, positive developments in that direction.
We know that people are concerned about health in Hartlepool and I reassure my hon. Friend that the Department of Health is, too. The strategic health authority and the local NHS organisations are also concerned. That is why so much has been invested in health and why we will keep on investing in health in Hartlepool, which we want to be modern and sustainable for the future.