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Mr. Steve Webb (Northavon) (LD): To some extent, I sympathise with the Minister. I notice that she responded to another half hour Adjournment debate earlier on health services in Hartlepool. She has to be an authority on all these matters. However, as she was brought up in south Gloucestershire for at least part of her childhoodI think that I am right in saying thatFrenchay hospital will be if not of greater interest then at least of considerable interest to her.
Frenchay hospital faces D-day on 14 March. On that day, the chairs and chief executives of the four primary care trusts serving Bristol, south Gloucestershire and north Somerset will gather, as will those of the two acute hospital trusts. Between them, they will decide where to go with the Bristol health services plan and, in particular, they will decide whether there will be a major acute hospital on the Frenchay site or on the Southmead site, perhaps with a community hospital on both sites.
In preparation for the debate, I rang the chief executive of North Bristol NHS Trust last night and asked her what I could say about the stage that the trust's decision making had reached. She said that no decision had been made, that the trust board would meet later in the month and that it would have a special meeting at which the decision would be made. I respect what she told me, but the worst kept secret in Bristol and south Gloucestershire is that North Bristol NHS Trust wants to site the acute hospital at Southmead rather than at Frenchay.
Thousands of my constituents and those of other hon. Members who represent south Gloucestershire are concerned that Frenchay hospital, a centre of excellence with a proud history, may be about to be "downgraded", to use the jargon. I will not say that it will be closed, because in the most likely scenario there will still be a community hospital on that site. However, it looks as though 24-hour accident and emergency and specialist advanced acute services will go.
I stress that it is not a question of the people of south Gloucestershire against the people of Bristol, because not only is North Bristol NHS Trust deciding what it wants to be its major site, but the Greater Bristol health communityto use those awful phrasesis deciding about provision over the whole area and has already decided that the Bristol Royal infirmary is a given. It is not a question of choosing between Frenchay or Southmead, but a matter of having the BRI plus one other.
The concerns of the people of south Gloucestershire will not be adequately addressed if the answer to the question of where the two major acute hospitals would be is that both would be in Bristol and none in south Gloucestershire, when the needs of the people of Bristol will be properly met by a high-quality acute hospital in the centre of Bristol. The needs of the people of south Gloucestershire would be properly met by a high-quality acute hospital in south Gloucestershire on the Frenchay site.
Although I disagree profoundly with the trust board and chief executive about their preference against the Frenchay site, I offer them some sympathy. The new
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chief executive has inherited a very large deficit, is in the process of trying to recover the organisation from a very messy financial situation and is dealing with payment by results, which is difficult for a relatively high-cost trust. It feels almost like permanent revolution in the health service so, to some extent, I sympathise with the pressures that the trust board and chief executive face.
Mr. Roger Berry (Kingswood) (Lab): The hon. Gentleman knows that I agree that Frenchay should be the site of the new so-called super-hospital serving south Gloucestershire and north Bristol. However, does he accept the view of clinicians in the Bristol area, which is that it is right to concentrate specialist acute services on fewer major hospital sites, while community services are expanded at the same time?
Mr. Webb : The hon. Gentleman, who is my constituency neighbour, will be trying later to catch your eye, Mr. Deputy Speaker. He makes an important point: the advice from clinicians is that the three major acute sites within the Greater Bristol and south Gloucestershire areas are proving difficult to sustain. One symptom of that has been the pulling back of the 24-hour accident and emergency service at Southmead; operating three full-time 24-hour accident and emergency sites with proper back-up was proving unsustainable. Although I am not convinced that the wider public fully accept that argument, it is clear that we are getting that message from the clinicians.
I accept that many of these decisions are devolved to some extent. However, the money comes from central Government, the process will be signed up by central Government and central Government certainly has an interest in the consultation process.
The background to D-day on 14 March is an almost endless round of engagements, public consultations, public meetings and so on. The public do not necessarily discern the difference between an engagement and a consultation, but they are different from each other, and have happened at different points in time. Last month, the Bristol health services plan published a consultation report on the help-us-to-decide process, running to no fewer than 153 pages. One could not say that there had not been a lot of public debate. However, interestingly and rather startlingly, I read in the report that just 351 written replies had been received. I have to say that that number is pathetic for a big local political issue.
Public meetings were held that were attended by a total of 1,600 people, so the report is based on fewer than 2,000 responses. As those in the Chamber will know, just over a year ago, I delivered my own survey to every household in my constituency, to which I obtained more than 8,000 replies. It worries me that there were just 350 or so written replies to the Bristol health services plan consultation. On the basis of the 8,000 replies that I received, I have some authority to say what my constituents think. Very clearly, although they welcome the promise of additional community facilities, they do not think that that should be the quid pro quo for losing Frenchay; they are not in two minds about that.
What is the answer to the following question? I am thinking of people in the outer reaches of my constituency, Chipping Sodbury and the Cotswold
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villages beyond. If serious and acute accident and emergency services are to go from Frenchay, how long would it take an ambulance in the rush hour to get from Hawkesbury Upton to Southmead? I am not convinced that the times are credible, although they would be if the ambulance were going to Frenchay. However, the people of Southmead, who obviously and understandably want an emergency unit near them, will still be far more accessible to the Bristol Royal infirmary. If we want to cover the whole area with high-quality accident and emergency access, I am not convinced that two in Bristol and none in south Gloucestershire is the answer.
The primary care trust of south Gloucestershire did its own survey. Professional pollsters rang more than 650 people in south Gloucestershire, Bristol and north Somerset. What was astonishing was not that the people of south Gloucestershire overwhelmingly wanted FrenchayI could have told the trust that for nothing; perhaps I shall take a cut next timebut that, on balance, the people of Bristol whom it rang wanted Frenchay as well, even though Southmead is in Bristol and Frenchay is not. This issue is not about Bristol against south Gloucestershire, but about how we can serve the needs of the whole area with what looks like being two acute hospitals, one of which is in Bristol in the middle. That is the question. Only the people of north Somerset marginally backed Southmead over Frenchay, although I assume that most of them would go into the centre of Bristol anyway so they would probably not care a huge amount.
In researching this debate, I came across something that shocked me. The North Bristol NHS Trust population projection is that by 2020, which is only seven years into the life of the new hospital, the Bristol population of pensioners, who are the people who will mainly demand access to the services, will rise by 2.5 per cent. and the south Gloucestershire population of pensioners will rise by 50 per cent. In terms of the provision of acute, high-tech, full accident and emergency services, how can it possibly make sense to shut south Gloucestershire's only hospital when the vast majority of the growth in population pressures will be in south Gloucestershire?
People advance many other arguments for the Frenchay site. The heliport is mentioned. It is not used often, but it is used. I do not know how people who need to be helicoptered in would cope with getting to Southmead, but I do not think that that would be practical. Many people feel that the environment of the Frenchay campus is more pleasant than Southmead. I should say that my children were born at Southmead and that my wife used to work there, so this is not about being anti-Southmead. I am simply saying that if there needs to be a major acute site to complement the BRI, there is much going for Frenchay.
The accident and emergency department at Frenchay is currently being upgraded, because the Southmead department is being used less. How many millions of pounds is that costing, and is it just for a few years before it gets shut again? What is going on there?
The North Bristol NHS Trust assumes that it will get permission to build thousands of houses at Frenchay; it will need to do that to make the sums add up. Will it get that permission? Bizarrely, it has merely taken a figure from the district auditor, but the council has not yet said
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for sure that the trust will get permission to build those houses. If that is what is needed to make the sums add up, and then the council comes back and says, "Well, actually, no, you can only build half that number," will the decision have to be revisited? Should that not have been sorted out before the decision was taken, rather than afterwards?
A second facet of this issue is the capacity of the new hospital, wherever it is. North Bristol NHS Trust, which covers Frenchay and Southmead, is struggling to cope. In 200203, 460 operations were cancelled; in 200304, more than 400 were cancelled; and, in the first half of this year, there have been nearly 400 cancellations. Since then, the Norwalk virus has hit both sites, and has caused considerable problems. They are stretched to the limit. I am sure that all hon. Members receive letters about operations being cancelled. I received one recently, in which a lady wrote that her husband's operation was cancelled ostensibly because a space was needed for an urgent case, but she subsequently discovered that the real reason was a shortage of beds. She said that the consultants and theatres were free, but there were no beds.
I am concerned about what the capacity is now, but the grand plan for this acute hospital is not for more beds, but for fewer beds. The argument is that the demographics mean that another 100 beds would be needed, which seems low, but that length-of-stay improvementsgetting people out quickerwill save 336 beds. If that can be delivered without prejudicing patient experiences, it sounds great. However, premising new hospital build on the assumption of such vast improvements greatly worries me, because what happens if they are not delivered? Therefore, I wonder whether this is credible.
I will keep my remarks brief, as I want to leave a moment for my constituency neighbour, the hon. Member for Kingswood (Mr. Berry), to try to catch your eye, Mr. Deputy Speaker. People will lose faith in these consultation processes if they express overwhelming opinions and are ignored. The report of the Bristol health services plan consultation for January 2005 stated that the views of the public, staff and other stakeholders count and will be taken into account. The people of south Gloucestershire have spoken loud and clear. If they are not listened to, that will make a sham of the entire consultation process. I hope that the Minister is able to ensure that they are listened to.
My constituents in Kingswood use all three of the acute hospitals in the Bristol area. They use Frenchay, which is the closest, and they also use Southmead and the BRI. The reason for that is that none of those hospitals covers the full range of acute services. Unfortunately, some of my constituents occasionally start at the BRI, then go to Southmead and end up at Frenchay.
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There is a powerful clinical argument for reducing the number of acute hospitals in Bristol. The hon. Member for Northavon (Mr. Webb)I almost called him my hon. Friend, and he is a friendmade that point. Far too much money has gone into buildings, and not enough has gone into direct provision of health care. I support that part of the Bristol health services plan that is committed to moving to two specialist acute hospitals with improved community facilities. I am completely unhappy about the Cossham proposal, but this is not the time to talk about that.
The hon. Gentleman referred to the consultation exercise and the expressions of public opinion. The polling evidence suggests that 74 per cent. of people support the principle of having two acute hospitals in the area and improved community facilities. So three quarters of people support that principle, which means that one of the existing acute hospitals will become a community hospital and that we will be left with two acute hospitals.
I agree with the hon. Gentleman that a majority of people have expressed support for Frenchay. I will say no more than I support strongly the arguments for Frenchay that he has expressed, but the last thing that I want is inaction on this plan. We must make progress, and the basic principle that was put forward in the Bristol health services plan in relation to acute hospitals is absolutely right. I am glad that all three hon. Members in the Chamber with a direct interest in this matter agree on that.
I congratulate the hon. Member for Northavon (Mr. Webb) on securing this debate on the future of Frenchay hospital. I have listened to and appreciated the comments he has made today and I know how important the issue is to him and to my hon. Friends the Members for Kingswood (Mr. Berry) and for Bristol, North-West (Dr. Naysmith), who are both present. I had the opportunity to respond on this issue in March 2004 in an earlier debate. I should like briefly to pay tribute to all the staff in the local health economy, and I am sure hon. Members who are committed to the improvement of the NHS will join me in that.
Some important questions are raised by this debate and they will, no doubt, be raised by the consultation exercise. There are also some important issues for the local communities to address. We need to look at what we are doing for the future and think about how the services can best be configured to meet the health needs of the populationnot just now, but in future, too. That is difficult. I am sure that the hon. Gentleman agrees and that we all recognise that hospital and community services need to change if they are to continue to fulfil patients' needs and improve access. Services cannot remain static for ever; they need to be responsive to needs, and if they remain static they do not serve the
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future needs of the population, which means patients. Let us be clear that we are talking about patients and the services that they receive.
This Government are committed to investment. There has been a large-scale investment in the South Gloucestershire primary care trust area, increasing from 6.6 per cent. to 7.2 per cent. between 200203 and 200506. That is a real-terms cash increase, leading to some £50 million extra going into the health economy. We also believe in modernising things and personalising the offering of services by getting closer to patients. However, we also need to consider how the specialist services are delivered, because that is important. It is worthwhile saying that for some services people want to go only to a specialised centre. If someone were the victim of a terrible road traffic accident, for example, they would want to go to a place where all the specialised work could be done.
I shall talk about local issues in a moment, and Frenchay hospital in particular, but we need to acknowledge the pressures and the fact that we have to increase the capacity and raise clinical standards, and that we need this radical re-examination. As I said when we debated the matter in March last year, the quality of the building stock at both the hospitals in north BristolFrenchay and Southmeadneeds to be addressed. I am sure that the hon. Gentleman will agree with that.
There are two major hospitals, both with accident and emergency services, plus the Bristol Royal infirmary in the centre of Bristol. Those hospitals are between four and seven miles apart. I do not want to enter into the debate about distances, because that is something for the local health economy to weigh up, but even going from Hawkesbury Upton to Frenchay is quite a long stretch, if my memory serves me right. The distances for people in rural areas are always going to be further and the truth is that these hospitals are clustered in the Bristol area, as I am sure the hon. Gentleman agrees. The services are duplicated and fragmented across the two sites in the north Bristol trust and across Bristol as a whole. That hampers clinical excellence and hinders close working with primary and social care services. There is a debate to be had about what the hon. Gentleman did not mention, which is how we get services closer to people. Not all those services will be provided through hospitals; indeed, some are better provided not in a hospital, but more locally.
The current situation means that there are difficulties, some of which the hon. Gentleman has mentioned, in complying with national standards for clinical services, particularly for emergency patients. I was interested to hear the remarks that my hon. Friend the Member for Kingswood made about patients being transferred, even for A and E, between the sites, including children, cancer patients, cardiac patients and those requiring specialist care.
I trust that all hon. Members present agree that the status quo cannot remain and that more needs to be done. We have an opportunity to improve services, not spoil them. That way, the health and community services in the area can move forward into the
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21st century, as we go to hospital only when we need to, rather than automatically in many instances, and the system is less focused on hospitals than in the past.
I realise that some of those in the public debate, including patients, have not caught up with some of the changes where they have occurred. I know that from talking to people where a service that was previously provided in a district general hospital is now provided in a community setting. I saw an instance of that on a visit to Luton not very long ago. People are enormously welcoming of the fact that they now have a service for which they previously had to cross town, to go to the Luton and Dunstable hospital, but which is now provided in a walk-in centre in their neighbourhoods.
Those are the sorts of things that offer scope for modernisation and change. Biggest is not always best. We need to recognise that patients want more, not fewer, local services. We need to focus on redesign, not only relocation. We are talking about a complex series of changes that can and do improve services for the patients. That is the only reason for the change: to get a better offering.
Of course, centralising some services in larger hospitals works, but equally it is not always the answer, which depends on the service. The NHS needs to make innovative changes to open up access and widen patient choice. It needs to be able to deliver the care that patients need throughout communities when they need it. That opens up new roles and duties for staff and more options for change being discussed with patients.
I noted the hon. Gentleman's remarks about the consultation with patients. I also note that he was not a formal respondee, unlike a number of hon. Members in the area, but he obviously conducted the survey. I also note that six different options are still being considered, so it is not the case that there is one simple preferred model or even a couple of preferred models. Rather, a range of options is being considered.
As I mentioned, our policy is for PCTs to make such decisions with the local NHS trust and the strategic health authority. They must decide the NHS locally. I happen to be blessed with a limited amount of historical knowledge about the area in question. That is unusual, as Ministers do not always know and certainly Whitehall and Westminster are not where decisions about the configuration of such matters are best taken.
Mr. Webb : The Minister is very gracious to give way. I quite agree that the decision should be made locally. The Minister talked about patient choice, but does she not understand why, if large amounts of public money are spent on consultation and the patients in south Gloucestershire loudly shout one thing but the outcome is entirely different, they should be rather embittered and feel that they were never going to be listened to in the first place?
Miss Johnson : If people are shouting for particular answers, as it were, not everybody is going to get what they want. There is bound to be an answer whereby some people are not satisfied with the outcome initially. Whether they would be dissatisfied with it in the longer term is another matter. I am sure that those who close to Frenchay are supporting Frenchay and those who are close to Southmead are supporting Southmead. That
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might mean that people in Filton are keener to go into Southmead and those in Yate or Thornbury are keen to support Frenchay. Obviously, those who are closer to the hospitals will want to support them in particular, and will feel a close identity with them.
We need to step beyond that. That is why local knowledge and expertise is drawn in. The primary decision making is not at the centre, because it is not appropriate for Ministers to decide on the direction of travel in relation to how services should be configured, for the reasons I mentioned. We have made that very clear. It is right that the local NHS should do it. I hope that the hon. Gentleman will continue to work with the local NHS to build a better future for residents in his area.
Whatever decisions are reached locally after full and public consultation will have been made after much consideration and open debate. The fact that a large number of members of the public have engaged in the formal consultation and in the hon. Gentleman's consultation indicates that people are alive to the issues, they are engaged with them and they want to have the debate.
We do not always do ourselves the best service by simply making it an argument about individual sites, rather than considering the broad needs of the population and how responses to them are best configured. We do not always necessarily take the argument about the advantages of more community provision to people as powerfully as we might. Where I have seen that delivered on the ground, it has brought huge improvements. Patients are probably its strongest advocates. No matter who advocated it in the first place, patients are strong advocates when it happens on the ground.
I hope hon. Members appreciate that it would not be appropriate for me to comment further on this case; there is to be a local process and I could pre-empt any future ministerial decision that might be necessary. I would like to assure hon. Members that the Department
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and Ministers will continue to work with the local NHS to review the progress of the local economy and to ensure that the difficulties that are faced continue to be managed.
I want to emphasise that this is an opportunity for positive change. It is a time of huge investment in services. There are major advantages for everybody in the Bristol area in getting this right. There is a major opportunity for better hospital and community sectors to emerge from the process and for securing the services for the future.
Mr. Webb : I would not want the Minister to think that it is simply a case of saying, "I want the local hospital because it is nearest to me." Obviously, as she says, everyone will say that. I have tried to bring to the debate the demographic pressures on south Gloucestershire, to which she has not responded, and the complementarity with the one that has to be in Bristol anyway. Are those not substantive arguments and not merely a case of, "I would like it in my back garden, please"?
Miss Johnson : Those arguments have been made and are being heard in the debate that is going on locally in the local health economy. I am sure that they are being registered. I am sure that there are other arguments, which the hon. Gentleman has not mentioned, that might cut in other directions. As I said, where change is being argued for, there will seldom be a result that everyone is happy with. However, we are clear about why this needs to happen and I think hon. Members are clear about the advantages of its proceeding.
All of those involved in the local decision making and in the consultation need to work together to ensure that the outcome for patients in Bristol is an NHS that is fit for the 21st century. It must be geared up to respond to all the improvements and changes that the NHS is already experiencing. We will see more of them in the years to come. That will lead to improved health care outcomes for all patients and their families.
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