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Mr. Graham Brady (Altrincham and Sale, West) (Con): I am grateful for the opportunity to raise the plight of Altrincham general hospital. I am sorry that it is the second occasion on which proposed closure of this well-used and much-loved hospital has prompted me to seek such a debate. I believe that the Adjournment debate that I secured on the subject in July 1999 was instrumental in saving the hospital. I hope very much that the same will prove true today.
Since 1870, when Altrincham general hospital was built through the generous support of local people, it has served the community well. In recent years its services have included intermediate care beds for the elderly, located in a convenient place where friends and relatives, who are frequently elderly and dependent on public transport, can easily visit in-patients. There is also a busy minor injuries unit, serving 11,000 patients a year, and a large number of clinics providing 20,000 out-patients with blood tests, diabetes services, cardiology, audiology and much more.
For 20 years or more, there have been questions over whether to refurbish the existing buildings or to build a new hospital for the people of Altrincham and Sale. Under the previous Government, a clear commitment had been given that no closure would take place unless and until a new hospital was in place. As recently as July this year, the local NHS was giving clear commitments that a review of community hospitals would not mean closure of Altrincham general hospital.
"I understand that my Chair has responded to a letter from Councillor Susan Fildes, as leader of Trafford Metropolitan Borough Council in an email of July 15, to advise that our board has no plans to close Altrincham General Hospital or individual wards."
That followed the statement from the primary care trust last November, when consultation was launched on how to invest in the community hospitals in Altrincham and Stretford. Leslie Robertson, the then chairman of the Trafford South primary care trust, said:
"This exercise is not about closing the hospital but developing our services on the site. We know that many people have a vital interest in the future development of services at Altrincham general hospital. We want them, as well as staff and other partners, to take a full and active role in the development of proposals for change. These options will then go forward to formal public consultation."
"We are delighted with the response from local people, staff and others. We know that both these hospitals are much valued by the local community and we are pleased to be working so closely with everyone to gather your ideas for change."
Just six weeks ago, I met the trust's chief executive to discuss concerns about local health care provision, including ways in which services at Altrincham general
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could be expanded. I left that meeting feeling optimistic and positive. I felt that Altrincham had a good, expanding future with investment, refurbishment and more services. It came as a sickening blow on 15 November when, faced with a public interest report regarding the trust's deficit, the board adopted an emergency proposal that included the closure of the hospital.
On Friday of last week, I had further discussions with David Cain and Professor Robert Tinston, who has been asked to conduct a rapid review, to be concluded by Christmas, of the options for health care provision in the area. I urged Professor Tinston to take a genuinely open-minded approach and to try to find a better solution than that proposed on 15 November.
What do I seek from the Minister? I do not want to be over-simplistic and I do not want to be drawn too far into the wider financial problems of some NHS trusts, including Trafford. It seems astonishing, however, that with all the extra money being pumped into the NHS, we face hospital closures and service cuts rather than expansion and improvement.
I have two straightforward objectives. First, the trust is consulting the public regarding its cost-saving proposals. I want to leave the Minister in no doubt whatever: my constituents and people elsewhere in south Trafford are united in their determination to keep our local hospital. A few days ago, I saw more than 3,000 people sign a petition to save Altrincham general in the space of just three hours. I have never before seen people queuing to sign a petition in that way. In the two weeks since the trust board proposed closure, 720 constituents have contacted me by post or e-mail to support the hospital.
If Ministers and NHS bosses are serious about consulting the public there is only one message that they can possibly take out of the consultation: my constituents are not mildly irritated by the proposed closure of Altrincham general; they are furious. They insist on keeping the excellent local facility that was built by the local community and for which our taxes now pay.
My second objective is to ask the Minister to intervene to ensure that the trust moves away from its knee-jerk panic response to its deficit. On calm reflection, there are many reasons why it would be counter-productive to close Altrincham general hospital. The figures speak for themselves. Tens of thousands of patients make use of a local health facility. Altrincham general is not just an asset for the community; it also brings a revenue stream into the trust, as the Minister well knows. Its closure could therefore exacerbate the problems of the deficit rather than help to solve them.
The problem with Altrincham hospital is not that it is inherently unviable, but that it needs a significant capital sum spent to update it. The trust and the health authority should be examining ways to secure the necessary capital and to increase the revenue streams coming through the hospital. The trust tells me that that primary care trust has approximately £2 million of capital funding available, which could be directed towards the project. The recent closure of St. Anne's hospital in Altrincham also raises the prospect of a
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significant capital receipt in due course, which could, and should, be spent within the community to ensure proper health provision in Altrincham and Sale.
I mentioned the 20,000 out-patients using clinics at Altrincham, but further possible services could be brought to Altrincham to increase the revenue flows. Perhaps the most obvious would be to use Altrincham as the location for a local breast care unit, for which there is a desperate need, as the Minister knows, following the recent closure of the unit at Trafford general. We were told that that closure was temporary, but in the current climate of the deficit at the trust, I am concerned that it might get lost in the midst of the wider problem.
However, that does not remove the fact that there is a need within the Trafford and south Manchester area for a proper dedicated breast care unit that brings together all the services and facilities needed for patients suffering from that type of illness. Given the amount of space available at Altrincham general, it would be possible to have such a unit there rather than shoehorning it into other facilities, such as those at Wythenshawe hospital, which might be the alternative.
When the local NHS published its proposals to close Altrincham general, local people felt shocked, angry and betrayed. It is not a failing hospital, but a much-loved, well-used hospital which has dedicated staff and massive reserves of good will in the community. I hope that the Minister can reassure my constituents that the fate of their hospital will not be decided by a panic reaction to the trust's deficit and that, instead, real efforts will be made to find an imaginative solution to secure the long-term future of this vital institution.
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : I congratulate the hon. Member for Altrincham and Sale, West (Mr. Brady) on securing a debate on the future of Altrincham general hospital. He has taken an interest in it over a number of years, and I welcome that.
I want to separate three different lines of argument. The first is the future funding available to the global health economy. The second is how we take forward and build stronger services in the hon. Gentleman's constituency. The third relates to the process for making decisions about health services in his constituency in the future.
The starting point for the debate must be to reflect on how far we have come. I read, with some interest, the Hansard of the hon. Gentleman's Adjournment debate in 1999. He attacked remorselessly what he described as spin on investment and waiting lists. I hope he will now join me in congratulating the NHS in his area on the way in which local health professionals have gripped record investment and the opportunity offered by our reforms.
I looked at some of the figures late last night and, along with the rest of England, fewer people in Altrincham have to wait for treatment. In September, 336 people waited more than 13 weeks for their first out-patient appointment, compared with 968 in 1997. There is also some pretty impressive progress on in-patient
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treatment. In September, only 112 patients at the trust had to wait more than six months, compared with nearly 1,000 in 1997.
When we consider the number of people who have to wait more than nine months for in-patient treatment, we see some of the great strides that have been taken. In 1997, 380 people had been on a waiting list for more than nine months in the trust that serves the hon. Gentleman's constituency. As of September this year, no one was waiting more than nine months.
There is a similar story to tell about the improvements in access to health care in the case of primary care. In September, every patient in the Trafford South primary care trust area could be offered an appointment to see their GP within two working days. The result of the extra investment and of bringing down waiting lists is quite simple: more lives are being saved in the hon. Gentleman's constituency. Cancer mortality rates in the Trafford local authority area have fallen by around 15 per cent. in the period between 1995 to 1997 and 2001 to 2003. That is higher than the national average of about 13 per cent. Death rates from circulatory disease in the same period have fallen by around 28 per cent. The extra investment is not only delivering better front-line care but saving lives. Those are examples of how one community is benefiting in the same way as the rest of the country.
Mr. Brady : I am happy to respond to the Minister's invitation to congratulate local health care professionals. I also want to be able to congratulate him after the debate, which I will do if he gives some reassurance that we will keep our excellent local hospital and have a proper breast care unit in south Trafford to serve my constituents.
Mr. Byrne : I shall come on to that question directly. I am glad that the hon. Gentleman is able to join me in congratulating local NHS staff. It is, after all, their hard work and dedication, backed by the reform and extra resources secured by the Government, that have been harnessed to such good effect.
The debate is not about the past; it is about the future. The Government do not plan to sit on their laurels. We want to take the services provided by local health care in Altrincham much further, much faster. Let us start with the money. Further progress will be made. In the current financial year, Trafford South primary care trust is receiving an allocation of about £128 million, which is nearly 6 per cent. up on last year. By 200708, that will have increased to £164 million. With that level of funding, we fully expect the local health service to continue to improve and NHS organisations to deliver substantial changes for the better in front-line care.
The increase in money over the next two years is £36 million. That is four times the projected year-end deficit of Altrincham general hospital. Although about 25 per cent. of NHS trusts up and down the country are currently in deficit, when we set those deficits against the projected increases in funding, we see that they are a small part of the picture. The real question and the quite fantastic choice that confronts the local NHS in the hon. Gentleman's constituency is how it is going to spend that unprecedented increase in resources over the next couple of years. What should it spend on hospitals,
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primary care and community services? How best can it spend that extra £36 million to benefit his constituents? How much should be spent on, for example, Altrincham general hospital?
Let us consider the hospital in some detail. As the hon. Gentleman says, it was built in 1870. It is currently used by about 20,000 out-patients a year, across a range of specialties. There has been a fall of about 14 per cent. in out-patient activity at the hospital over the past three years. There is a nurse-led minor injuries unit that treats 10,000 people a year and a 26-bed rehabilitation unit for elderly patients. However, the beds are based in two Nightingale wards and there is no resident medical support for those patients. The doctors that support the service are based at Trafford general hospital. Last year, 242 patients were admitted to the ward. In-patient activity at Altrincham has declined by about 30 per cent. over the past three years. The hon. Gentleman will probably know this, but about three quarters of Altrincham residents receive their in-patient treatment at neighbouring trusts.
Mr. Brady : I do not dispute the Minister's figures, but I am sure that he knows that the reduction in in-patient activity is due to the fact that wards were closed by the trust in previous years and that the reduction in out-patient activity is not because of a reduction in demand, but because of the way in which patients are being channelled and directed to clinics at Trafford general which are less convenient and less local.
Mr. Byrne : The backlog maintenance costs at Altrincham general hospital amount to about £5.8 million. It is the trust's view that the hospital is not suitable for the provision of modern health care. Dr. Frank McKenna, the divisional clinical director of medicine in Trafford, said of Altrincham:
"The inpatient wards are no longer an acceptable standard for the treatment of our patients. We have a superb, modern rehabilitation unit at Trafford General which is not only more comfortable for patients, but is also safer. Transfer of the rehab beds from Altrincham General Hospital is long overdue and should be welcomed by patients or relatives who need this service."
More importantlythis is the real pointwhen we are putting more money into the NHS and writing cheques for £36 million, it is not unreasonable to say that we need that money to be spent well, in the way that best benefits the hon. Gentleman's constituents. We are happy to write a big cheque, but we are not happy to write a blank cheque. There is potentially a strong case for the alternative siting of services that are based at Altrincham general hospital. Under any scenario, however, I have to be assured that the out-patient services, clinics and minor injuries units currently based at the hospital will be provided in alternative accommodation in Altrincham.
It is important that any reforms are seen against the backdrop of our commitment to community hospitals. As the hon. Gentleman will know, we made a manifesto commitment to develop a new generation of modern NHS community hospitals and to bring on line 50 new or refurbished community hospitals over the next five years. Those need to be state-of-the-art centres because
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we made a big promise in our manifesto to cut waiting times from the scandalous year and a half that we inherited to just 18 weeks. That means that the new centres have to provide diagnostics, day surgery and out-patient facilities much closer to where people live and work. That is essential if we are to deliver our manifesto commitment.
We made that commitment because we know about the potential of community hospitals, which will help us to move care and diagnostic services outside acute hospitals and much closer to where patients livethey will provide care around the clock and around the corner. The Department is working out how to deliver that manifesto commitment in detail, and the outcomes of the major consultation exercise "Your health, your care, your say" will be fed into the process around the turn of the year. We are listening to the public to develop health services in a direction that is set by them.
What does all that mean for the hon. Gentleman? The third line of argument that I promised to discuss was the process by which decisions are made. He referred to commitments made earlier this year and cited a letter based on comments from Trafford Healthcare NHS Trust about investing in Altrincham general hospital. I am told that those plans, which were at a preliminary stage, must now be considered against the question of how to spend the extra £36 million in his constituency in a way that strengthens front-line care in Altrincham. The right approach is surely for the local health economy to have the opportunity to review the provision of services across not only his constituency but the whole of Trafford. It is vital to stress that, at this stage, any proposals to re-site services are only proposals for debate.
The local health economy accepts that it has to take the actions set out in the auditor's report. Greater Manchester strategic health authority has announced, and has informed local MPs, that it will take a lead in the process of outlining a way forward for the Trafford health system. That will build on the work carried out to date and will involve the local NHS, local politicians, patients and other stakeholders. That work has started and will continue over the next two months.
The SHA has commissioned Robert Tinston to undertake that work, and I am glad that the hon. Gentleman has met him. He is a former NHS manager and was the regional director of the north-west office of the Department of Health until 2002. He has been tasked with producing a report that will unpick different levels of support for different options. He will also set out options for further consideration and decision, as well as making recommendations about the way forward. His report will be used for further discussion with the SHA and with the NHS in Trafford and Greater Manchester as a precursor to any public consultation. Such consultation is, of course, statutory and will be undertaken by Trafford PCTs in spring next year.
Mr. Brady : I have a sense that the Minister is moving towards a conclusion and I am keen to press him on a couple of points. I think he has given a commitment that
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the closure of Altrincham general hospital is not a foregone conclusion and that it is possible to avoid it. I also think that he has given a commitment that the local NHS may choose to spend the money that he says is available in whatever way is deemed to be appropriate locally, including the possibility that it may keep Altrincham general hospital. If he is prepared to confirm both those things, I shall be very happy.
Mr. Byrne : It would be quite wrong for any Minister to prejudge the results of any consultation. Robert Tinston was given the job of coming up with options, of testing different degrees of local support and of making recommendations. That will form a working document, which must be subject to a consultation thereafter. I do not rule any option in or out at this stage. It would be wholly inappropriate to do so.
The hon. Gentleman referred to the importance of breast screening to his constituents. I am advised that the SHA has temporarily suspended the service at Trafford, and patients go to Withington hospital for diagnosis and to Wythenshawe hospital for treatment. A review of that service is being conducted, and it should be completed in the new year.
Important consultations will be carried out in the next three or four months. This is a time of extraordinary opportunity to strengthen front-line care yet again in the NHS. I am glad that the hon. Gentleman will, I am sure, bring this debate to his constituents' doorsteps in Altrincham.
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