Angela Eagle (Wallasey) (Lab): Since I applied for this Adjournment debate over the summer, the proposed closure of two wards at Victoria central hospital in Wallasey has turned into a real closure. I want to spend a little time outlining the background. As part of a welcome plan to modernise and improve services for older people in Wirral, the two local primary care trusts announced a £2.3 million reconfiguration of services for them in October last year. The focus of the plan was to reduce the need for unnecessary stays in hospital and to prevent avoidable admissions of older people to hospital if they could be dealt with better in a non-hospital setting.
Angela Eagle : I have supported from the beginning the philosophy behind the reconfiguration initiated by the PCTs. No one could possibly object to their aim of preventing avoidable hospital admissions. I have, however, always been very sceptical that such a great number of admissions could be prevented, and so quickly, that the two local wards, which comprise 52 rehabilitation beds, could be closed safely. I believed that the changed services had to prove that they were working well before it would be prudent even to consider closing the wards.
I am also extremely worried about the instability that is becoming increasingly evident in the private nursing home sector. There is an above average number of older people in Wirral, which historically has had a problem with the delayed discharge of patients from hospital. The social services and the NHS have begun to solve that problem by working in partnership, which I greatly support.
However, increases in property prices as a result of our economic success have led to a reduction in private nursing capacity because owners of private nursing homes have sold up to realise profits on their property assets and have left the private nursing care service altogether. Such instability of supply in a crucial area of social care makes it difficult to plan ahead coherently, especially if we want to ensure that there is no delay in discharging older people who have completed their medical care. I believed that that was another reason to value the beds in wards six and seven.
I expressed those views in my response to the PCT consultation, which closed this January. During the consultation, local staff and residents campaigning to keep wards six and seven open collected 18,000 signatures in a petition, which I was the first person to sign. The result of the consultation was that 70 per cent. of the 400 responses opposed the plan to close the wards.
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It is fair to say that there was overwhelming public opposition to the ward closures, but it is also fair to say that there was general support for developing a more community-based service for older people in which hospitalisation was the last and not the first resort.
I believe, however, that the consultation process was inherently flawed, simply because of the nature of the questions asked. The Minister will have seen the questions asked when he prepared for the debate. Moreover, what on earth is the point of having a consultation if the results are going to be put to one side when they are not convenient to the PCT's plans and intentions? We should have a proper consultation, or we should stop calling these exercises consultations and call them something else.
The PCTs did recognise the strength of local feeling to some extent, however, and did seek to give some welcome reassurance. They also delayed their final decision on closure to prove their view that the redesign of services would dramatically cut admissions of the elderly to hospital. That was a prudent course, which I supported; indeed, I had requested that a precautionary approach be taken on the issue. Initial signs were encouraging. Delayed discharges declined from an average of 55 people a week to just 11. At the same time, I led delegations of staff and local councillors to see the Minister who would take the final decision if no agreement could be reached locally. There was also a lobby of Parliament, which I addressed.
Meanwhile, I continued to support the primary care trust's innovative redesign of services, which included two particular elements to which I should like to draw attention. First, a primary care assessment unit was created at Arrowe Park. It provides screening, testing and assessment processes for older people who may need them. Such people may have been taken ill and appeared at a GP's surgery or accident and emergency without being admitted to hospital. Early experiences demonstrated that the new way of doing screening, testing and assessment was avoiding 60 per cent. of all previous hospital admissions.
Nobody in their right mind wishes to see an older person, who may have been ill, presenting at the GP, then having to be admitted to hospital merely for a diagnostic test and then getting stuck in hospital and being unable to get back out into the community. Clearly, the 60 per cent. fall in hospital admissions that I mentioned demonstrated that redesign was necessary and could deliver much greater efficiency; that is undeniable.
Secondly, I am particularly interested in the pilot "partners in practice" work that has been done in some local GP clinics in my constituency. It is not rocket science, but it involves looking at a GP's list, ascertaining whether patients have a chronic condition, checking the at-risk groupsfor example, those who have been admitted to hospital more than once in that yearand using community nursing and health visitor facilities simply to go out to see patients and find out whether they are able to manage their chronic condition, be it diabetes or heart disease, well enough to prevent admission to hospital. That has to be a way forward. I hope that over time it will be demonstrated that some admissions could have been avoided by more proactive, preventative work. None of this is about saying that those things ought not to be happening.
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However, there is the ongoing issue of the wards. When I took a delegation of staff and patients' representatives to see the Minister, Lord Warner, he was receptive to our arguments about taking action too quickly, but in the end decided to back the primary care trust's decision on the wards. I was informed of that in a letter dated 8 September, and I am extremely disappointed that that decision has been confirmed at a national level.
However, we got something out of our campaign. As the Minister made clear in a letter to me, as a result of our representations he had also taken the precautionary approach and insisted on some guarantees from the strategic health authority as a condition of the closure. They were, first, that health authorities must admit any older person who at any time needs admission to hospital as determined by the national four-hour accident and emergency target. That is a welcome and powerful requirement, which will keep the health authorities on their toes in the months ahead.
Secondly, he required that the facilities at Victoria central hospital be maintained over the winter periodmothballed, essentiallyso that they can be reopened if there is a sudden reversal of the favourable trends on which their closure depends. That is another guarantee that we are not going to have precipitate, quick action that will deprive us of 52 beds that we might subsequently discover we need. I welcome the reassurance that the mothballing of the wards has given us over the winter period.
Thirdly, the Minister announced that there should be a monthly monitoring group to keep a very close check on hospital activity figures and ensure that the guarantees are honoured. Following that decision, I called upon the primary care trust to empower a citizens jury with which to share the information generated by the monitoring group. The idea was that a non-aligned group of local citizens would check that no problems were emerging as a result of the changes to services.
I am pleased to be able to confirm today that the primary care trusts have agreed to my request and have approached Wirral senior citizens forum to perform that important and innovative role. It is an independent organisation, which, I am sure, will be only too ready to alert us if there is evidence of any problems or bed shortages developing as a result of the reconfigurations. I look forward to the forum's independent monitoring, which will provide protection as our services change and develop, and I thank the PCT for agreeing to my suggestion to empower the citizens jury.
In the aftermath of the decision, I visited the wards to talk to staff and patients. I emphasised that the campaign has never been about saving jobs. All staff have been given a welcome undertaking that they will be redeployed within the local health service. That has been organised following full consultation with staff organisations and no outstanding concerns or worries have been raised with me or appear to be developing at Victoria central hospital.
Since the decision was taken, there has been a gradual emptying of the two wards. My information is that 30 patients have been discharged in the normal way and that no changes were made to the way in which they
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were treated; 21 have gone home; eight have gone into residential or nursing care; and one is in temporary residence.
I wonder whether my hon. Friend has an update of the latest situation concerning the guarantees that Lord Warner gave to me in his letter. Has the decline in delayed discharges been maintained? Since the announcement, I have not been contacted by any constituent about any problems with timely access to hospital beds or for elderly patients, but does the Minister have the latest information and can he give it to me today? In short, does he have any evidence that the loss of the wards is causing problems in the local system?
Secondly, could my hon. Friend comment on whether it would be possible to consider how the instability in the private nursing sector can be addressed? I am particularly interested in working with the co-operative movement to expand its mutually owned models of nursing care. They not only give greater stability and quality of care, but improve on some of the extremely low wage levels that are all too often a feature of the private nursing home sector. In my view, that is a much better way forward than a completely marketised muddle in the private sector. Will the Department consider how it could assist us in developing such a process?
Will my hon. Friend the Minister confirm that the future of Victoria central hospital is bright? There have been many welcome developments on the site in recent years, not least the opening of a brand new building for a well-used walk-in centre. It is extremely convenient for my constituents who, instead of sometimes having to travel many miles on two buses to Arrowe Park hospital or Clatterbridge hospital on the peninsula, or even across the river to the Liverpool hospitals, can have treatment for minor accidents and so on and general health checks in the walk-in centre.
The award-winning Wallasey heart centre has opened. I am pleased to say that it is cutting in half the number of deaths from coronary heart disease in my constituency and making an incredibly positive contribution to the health outcomes of many of my constituents.
I hope that my hon. Friend can reassure me on the points that I have raised. I also hope that he will undertake to keep an eye on the monitoring figures himself so that we can reopen the wards if they are needed, especially during the winter. Finally, will he reflect on the problematic nature of primary care trust consultations that have been highlighted by this case?
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : I start by congratulating my hon. Friend the Member for Wallasey (Angela Eagle) on securing the debate and I would like to begin my reply to her eloquent speech with a few words of praise.
First, I want to praise the Liverpool Daily Post and Liverpool Echo, which have consistently and factually kept this issue at the forefront of the local community for its readership. The way in which they have framed the debate has again shown that they are a real and effective voice for the local community.
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Secondly, I want to extend some praise for local campaigners whose passionate involvement in the campaign to keep the wards open is a credit to local community strength. Thirdly, I must congratulate my hon. Friends who represent the Wirral, in particular my hon. Friend the Member for Wallasey. She has previously raised this matter in meetings with my ministerial colleagues my right hon. Friend the Chancellor of the Duchy of Lancaster and Lord Warner. I know that her interventions have helped secure important guarantees from the local health community to address the understandable concerns of her constituents. She is a fighter who has won vital advances for her constituents.
I hope my hon. Friend will agree that at the heart of this debate is an honest difference of views about the next steps for improving care for older people across the Wirral, particularly in Wallasey. When Labour was elected in 1997, our job was to pick the national health service up off its knees and to power a shift from the inherited state of neglect to the world that we have today. As a result of our funding policy, the NHS is in receipt of record resources.
My hon. Friend's constituency sits in the Cheshire and Merseyside area. It has shared in the benefit of more than 400 more consultants since 1997, nearly 5,500 more nurses, and more than 3,800 more health care assistants. That has made a huge difference to the quality of care in Cheshire and Merseyside. The number of people waiting more than six months for in-patient treatment has dropped by 86 per cent. since 1997. The number of people waiting 13 weeks or more for out-patient treatment has dropped by 90 per cent. since 1998.
That means that more people live longer. For example, the mortality rate in the Wirral from coronary heart disease has fallen by nearly 20 per cent. Cancer mortality rates have reduced by more than 10 per cent. since 1997.
There has been enormous progress. As a former Chancellor might have said, money has been the root of some of that progress, but the truth is that more money alone is not the answer. Standards of care need to be transformed as well. In the context of this debate, that means there is a question of how we change the way we care for older people.
I want to present the Chamber with two sobering sets of facts about the imperative of strengthening care for older people. First, during this Adjournment debate about 100 people over the age of 65 will be admitted to accident and emergency, a number that resulted from figures from a year or two ago. In 200304, there were 1.6 million such emergency admissions.
Secondly, during the course of today, 8,000 older and frail people will fall. Of those falls, 70 per cent. will happen tonight. About 200 people will break a hip and 15 will die from their injuries. Nearly 1 million people over the age of 65 are treated by the NHS. About two-thirds of our hospital beds are occupied by older people at any one time. That is why care for older people is one of the most important things that the NHS does.
Providing care on the ward the way we did in the previous century and the one before that is not good enough any more. We can and must do better. Instead of forcing patients to come to the NHS, it is time that the NHS came to the patient. We want the NHS to change;
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we want it to be not just a hand that catches people when they fall, but a helping hand that supports them in different aspects of their life.
That is why this Department is investing £60 million in partnerships for older people to help councils and primary care trusts help older people to avoid emergency hospital visits and to live independently for longer. That is why we are investing £80 million, through local authorities, in telecare, to support an extra 160,000 older people living at home. Sometimes care at home is not the answer; sometimes nothing else but a good NHS hospital will do. Our job is not just to maintain but to strengthen the world's best safety net.
That brings me to the specific issue of wards six and seven at Victoria central hospital. Three facts are important for this debate. First, for the vast majority of patients on both wards, admission could have been avoided if suitable alternative arrangements were provided in the community at the right time. Secondly, nearly all patients on the wards at any one time were awaiting rehabilitation or transfer to a place in the community. Patients were never admitted directly to wards six and seven at the hospital. They were admitted to Arrowe Park initially and then transferred to VCH for rehabilitation later.
Thirdly, I am advised by Cheshire and Merseyside strategic health authority that in the 12 months to April this year, about 15,000 Wallasey residents were admitted to Arrowe Park. About 4,000, just over a quarter, were aged over 65, and of that 4,000, 159 elderly Wallasey residents4 per cent.received in-patient care in the 52 beds in wards six and seven at VCH. That is about 1 per cent. of the total Wallasey residents admitted to Arrowe Park.
Local community health professionals were required to make decisions. They took into account the fact that about 148,000 Wallasey residents attended the wide range of facilities such as out-patient and walk-in centres, day case, physiotherapy, occupational therapy and diagnostic facilities. Those facilities are there at present and they will be retained at the VCH site. That is why that site is so important to the future of the local community. That is the context in which decisions about wards six and seven were taken.
My hon. Friend asked whether there was news about what had happened since changes were made and guarantees were extended to her earlier this year. There are four or five bits of news that I want to bring to the attention of the House. First, I am happy to say that delayed discharge numbers have indeed declined. The number of patients whose discharge has been delayed pending availability of regular nursing home places is now consistently far lower compared to the peaks of around 60 in August last year. There are just 19 patients who are delayed in awaiting social services care. That is broadly in line with the assumptions that were made in the consultation document.
Secondly, the substantial reduction in delayed transfers of care and the beneficial impact of other investments at the hospital have produced a significant reduction in the number of patients who are admitted to the wrong type of ward as a consequence of the pressure on beds. The numbers have been reduced to single figures compared to the 50 or so on a regular basis 12 months ago.
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Thirdly, whereas previously a significant number of patients sent in by GPs as emergencies were temporarily accommodated on trolleys in the accident and emergency department, all those patients can now be admitted directly to the combined clinical decision unit and primary care assessment unit.
Fifthly, the trust and PCTs estimate that the deep vein thrombosis service saved approximately 2,000 bed days during the last financial year and the primary care assessment unit saved 1,500 bed days per annum, avoiding about 700 admissions. The work load at the walk-in centre at VCH has increased steadily over the last 12 months and it is assumed that about 4,000 bed days per annum are being saved because of that service. The services cover the vast majority of people aged over 65.
My hon. Friend asked me to reflect on ways to manage instability in the local care market. I am happy to take that on board and I will return to that point. In addition, I can give her a commitment to maintain a watching brief on the guarantees and the numbers in question so that we can ensure that at a very senior level the right decisions are being made locally.
None of the improvements in Wallasey happened by accident. They happened because of the new investment in the clinical decision unit of £1 million a year, because of investment in a new walk-in centre, more investment in intermediate care services and in primary care assessment centres, four new community matrons and the new 12-bed heart assessment unit.
In conclusion, I shall say a brief word about democracy, and specifically the involvement of local people in decisions about health services, which was an important part of my hon. Friend's analysis. Since 2003, every local authority with social services responsibilities has had an overview and scrutiny committee that has powers to review and scrutinise health services in its local area. Wirral metropolitan borough council's OSC made a valuable contribution to the arrangements that have been put in place. Its input, coupled with my hon. Friend's specific interventions, has brought about the guarantees from the SHA.
As my hon. Friend rightly mentions, the most important guarantee is the continued maintenance of facilities in wards six and seven throughout the winter period so that they can be reopened if there is any sudden reversal of the favourable trends on which their closure was initially proposed.
The truth is that health organisations cannot overlook the user perspective. In the past, consultations have left people feeling cold. They felt that their ideas
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were rejected without reason, and they felt that they were not really heard. Many of my hon. Friend's constituents held that view, and that is why we must find new ways of engaging people.
I congratulate my hon. Friend on the establishment of the citizen's jury in her constituency. That idea potentially has a national application, and it comes at an opportune moment. As she knows, the Department is engaged on a listening exercise known as "Your Health, Your Care, Your Say", which is in full swing around the country. I am glad to say that it reaches its climax in Birmingham in a week or two.
As part of that consultation exercise, several taskforces are looking at specific issues of local democracy. One taskforce, "Having My Say", focuses specifically on how better arrangements can be put in place to strengthen the voice of patients, users and the public in the way in which we plan and deliver health care. As the health and social care system changes, we must ensure that the new arrangements support patient voices, so that the health services that are delivered are fit for purpose. We must learn the lessons from Wallasey that my hon. Friend has so eloquently brought to the House.
I can tell her that the "Having My Say" taskforce will make recommendations to Ministers on how we can be confident that views, experiences and the interests of patients and the public are heard and responded to.
Angela Eagle : That is a very welcome announcement. I wonder whether the Minister would undertake to send the taskforce a copy of the Hansard debate, so that they can look in detail at the ways in which the consultation in Wallasey worked and did not work. There are many lessons to learn, and it would be good if the taskforce learned them in a timely fashion before it pronounces.
Mr. Byrne : Absolutely. I am grateful to my hon. Friend. I was about to say that I will personally ensure that the case of Wallasey is put before officials who are tasked with getting the next stage of reform right. I congratulate my hon. Friend on the tenacity and firepower that she has brought to campaigning on behalf of her constituents.
Over the next 10 years, this country's community of older residents will grow and grow. Alongside doubling our investment in the health service, we have allocated an extra £10 billion since 1997 to older people who have been on benefits. With those advances in wealth and in health, there is a real promise of a better life for older people who have given us and their community in Wallasey a lifetime of service. They deserve the best care possible, and with this Government running the national health service, they will get it.
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