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Rosie Cooper (West Lancashire) (Lab): I am most grateful for the opportunity to raise this important subject in my first Adjournment debate. The health issues involved will have a major impact on my constituents. My personal commitment to, and involvement with, the health service has dominated more years of my life than I care to rememberlatterly, for nine years as chair of the Liverpool women's hospital. Indeed, health was the subject on which I made my maiden speech.
I care deeply about and believe absolutely in the national health service. Now, more than ever, that commitment has been reaffirmed because I no longer represent the aspirations of a single hospital but those of 74,112 peoplemy constituents. That brings with it a duty and a responsibility to fight to guarantee the best and safest health care services possible. I sought the debate on mergers in the Cheshire and Merseyside strategic health authority area because I believe that that guarantee is under threat from chief executives colluding over deals to merge trusts: namely the Southport and Ormskirk Hospital NHS Trust, the Aintree Hospitals NHS Trust, the Royal Liverpool and Broadgreen University Hospitals NHS Trust, and the Walton Centre.
Before I venture into specific issues, I want to revisit a document produced by the Department of Health in 2003. "Keeping the NHS Local: A New Direction of Travel" clearly states the Government's vision for health service reorganisation and how they will bring the voices of patients and the public to the heart of the debate. One of its key points is that the continued concentration of acute hospital services without sustaining local access to those services runs the danger of making services increasingly remote from many local communities. The mantra is no longer "Big is best", but "Small works too."
Three fundamental principles should underpin every thought on how health services are reorganised. Change should be developed with people, not for them. The focus should be on redesign, not relocation. The view of the whole system should be taken, which requires working in partnership, with genuine integration and joint planning of services.
Andrew Miller (Ellesmere Port and Neston) (Lab): I am grateful that my hon. Friend cited that part of the document. Given her knowledge of the north-west of England, does she agree that it is a little absurd for the health economy of Crewe to be co-located with that of Chester and Ellesmere Port? The distances are enormous. Proper patient liaison and customer focus will be impossible because of geography.
Rosie Cooper : I absolutely agree. I do not know whether the strategic health authority has lost its maps or its ability to measure distances. Perhaps its staff do not use local public transport in the way that many of my constituents do. It is an appalling idea.
The Labour Government have done much for the health service, reversing 18 years of Conservative neglect. People's trust and faith in the national health
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service has been restored and I am determined that their excellent work on health will not be undermined by unelected officials acting autocratically. However, I want to convey a stark message to the Minister. All the good work will be shattered unless we say no to merger in west Lancashire.
I resent the small cabal of health service executives, each of whom may have a personal vested interest in the merger. They fail to make decisions and suggestions in an open, honest and transparent way that listens to and involves local people. It could be suggested that they are more concerned with future jobs or handsome redundancy packages. Over the past few weeks, since I highlighted the fact that I was having the debate, I have been inundated with stories from local health service staff. They are further demoralised by stories of change and now merger. Many have asked how I can prevent the merger from happening, because it is being presented to employees as a fait accompli. Their chief executive says that it will happen.
The power lies with the people, in whose name and with whose money the NHS is paid for. When local people and health service staff lose their voice in such a way, health services just happen to them. Rather than being empowered and enabled, patients are marginalised and staff demoralised. We must also not forget that people in west Lancashire face the possibility of being merged into a single primary care trust, which will include 1.1 million people. That would further dilute their voice.
Dr. John Pugh (Southport) (LD): On behalf of my constituents, I share many of the hon. Lady's concerns. Does she agree that not only is there talk of conspiracy, but there is rampant confusion and a complete loss of confidence in the local health authorities?
Rosie Cooper : I do. I understand that the strategic health authority is currently issuing press releases on various subjects, and there may very well be all sorts of news stories, which I believe would be intended to confuse the public. People do not know which level of the health service they are dealing with and who is responsible for what.
The public are hearing on the grapevine that services will be reduced or transferred, in particular from Ormskirk, and that there will be future involvement of the private sector at Ormskirk, while wards, such as the rehabilitation ward at Ormskirk hospital, are threatened with closure. They are also hearing that the Liverpool women's hospital will take over maternity services and that Alder Hey will take over children's services. There is rumour upon rumour upon rumour. That is not the way to communicate with our employees, and it is certainly not the way to communicate with our constituents and hospital patients. Confusion reigns.
I question whether there is a commitment to the Ormskirk site. When there is a positive story or actionsuch as in respect of the minor injuries unit at
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Ormskirkthere is little publicity to tell people about it. Is it any wonder, therefore, that when they need an accident and emergency service, they bypass Ormskirk and use the services at Southport unnecessarily? What is the long-term future of that minor injuries unit? Indeed, as my constituents ask me, what is the long-term future of the Ormskirk site?
It is the Government's intention that all hospital trusts are to become foundation hospitals by 2008. Monitor recently concluded an assessment of the possibility for individual trusts in the Cheshire and Merseyside strategic health authority area to move to foundation status by 2008. The financial position of Southport and Ormskirk trust makes it unlikely that it can achieve that. The ever-increasing historical debt is now of the order of £17 million. In discussions, I asked why that was not tackled in the past. I suppose that there has not been the appetite to deal with the problem head-on, as it would have been on top of the already unpopular measures in the Shield review. The proposed merger would be yet another step in letting people down.
An assumption is also being made that a merger is the solution to the debt problem. That is not the case. Merger would address the problem by running services across Merseysideacross the larger areato reduce costs. So patients would probably have to travel further for treatment and visitors would have to travel further to visit in-patients. If there were a Liverpool-centric merger, Southport and Ormskirk would have a very junior role to that of Liverpool, with its greater population and university teaching hospitals. Over time, that situation would only get worse as medicine continued its move towards providing more specialist services.
We need to concentrate our efforts on getting the financial situation resolved. If the debt and the cause of it are dealt with, Southport and Ormskirk could be viable. That, along with any relevant partnership working proposals, should be put to the SHA and the Department of Health. We would then be tackling real problems, keeping a voice and keeping health services as local as possible. That is the argument that we should be putting to McKinsey and Co. That should be its brief.
McKinsey has done some good work for the NHS, but we must guard against any natural bias in favour of mergers. I understand that mergers are one of the growth areas of its business. Merging trusts would not be the solution but the easy option. It would be tantamount to throwing up our hands and saying that there is nothing we can do. I cannot accept that as a solution, and my constituents will not.
Merging will not provide the solution to the challenges of Government policy either. It will not result in debt being reduced or services being enhanced, and it is not in the interests of the people of west Lancashire or those of any of the other people affected by the proposal who live in the constituencies represented by my hon. Friends from the region. We have only to look at the experiences of merged hospitals. The Pennine Acute Hospitals NHS Trust and Leeds Teaching Hospitals NHS Trust have been a disaster.
The arguments against merger in the case of Airedale NHS Trust in Bradford apply equally to Southport and Ormskirk Hospital NHS Trust, and no doubt to the other hospitals under threat of merger. Under a merger,
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there will be no improvement in clinical standards that could not be achieved by the hospitals remaining separate. A management merger would not achieve any significant improvement in access to services; it could even reduce accessibility. Mergers do not lead to a greater access to funds; in fact, they could prevent high-quality staff from joining the hospitals.
It has to be said clearly that mergers do not increase the capacity to meet Government-set targets. We need to concentrate our efforts on getting hospitals to concentrate on the patients and the financial situation. The Government say that services have to be good, safe, timely and convenient for patients. The merger idea, which comes from the three chief executives involved, without any consultation, does not meet those standards.
Where does patient choice come in the agenda? If hospitals across Liverpool, west Lancashire and the wider area are merged, where will people go to get patient choice? They will have to travel to Manchester, Preston and beyond, which very possibly will be too far. It would be nigh-on impossible for west Lancashire residents to make regular journeys to visit in-patient family members and friends, never mind receive treatment themselves. Ormskirk is 22 miles from the Broadgreen site, 18 miles from the Royal Liverpool university hospital and 11 miles from Aintree hospital. From Skelmersdale, it would be even further. We already ask people to travel further and further to access specialist services such as cancer services, and that is medically right, but should we ask them to do the same to access general services? Like the Government, I do not believe that we should.
In my constituency, there are below-average levels of car ownership. In west Lancashire, we have public transport difficulties in getting to Southport and Ormskirk hospitals. I know that because I have done it: it takes one hour and 20 minutes on a bus from Upholland to the hospital in Southport. To have to go even further would necessitate what amounts to a day trip, which is ridiculous in this age. Vulnerable groups are left reliant on a public transport system that is failing people in west Lancashire.
It is the same if we travel from Skelmersdale to the Broadgreen site. Theoretically, that should take two hours, but in practice it would probably take closer to two and a half. It involves three bus rides, two walks to make the changes and one train ride. That is just one waydouble it for a return trip. What if a person is ill? That is just one of the many examples of problems that my constituents would face in accessing health services if the new model were adopted.
Not merging would not preclude any partnership working across clinical specialisms, although that argument will be the excuse and the ruse used by people who just want to merge and get on with it. Those things could still happen, but the difference would be that Southport and Ormskirk would be a full partner and have a voice at the table. As the Minister will be aware, many other hospitals have partnership arrangements that offer the best service options for their local residents.
Partnership working should not be confined to Liverpool. Why did that only happen there? Services could be delivered by Wigan, Preston and Chorley
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hospitals. If we believe in in-patient choice, let us construct a creative, innovative and enabling set of partnerships and relationships that deliver the highest standards of health care for our communities and local residents.
Having heard the proposals in Gill Dolan's report on the future shape of health services, members of west Lancashire patient and public involvement forum have issued a press release in which they express many, if not all, of my concerns about securing a sustainable, accessible health service. I have to tell my hon. Friend the Minister that we need solutions that do not include merger. The agenda of those solutions can only be to provide the best possible local, accessible care in a patient-centred NHS.
The merger that my hon. Friend describes is not the only one on which the strategic health authority is working. It is also working to merge North Cheshire Hospitals NHS Trust and Whiston hospital. Such mergers are undertaken by stealth, without any community engagement. More than that, the SHA is skewing the evidence that it presents to McKinsey on the merger in order to achieve the outcome that it wants, saying that it must explore organisational configuration issues. It has misrepresented the results of a MORI poll on choice carried out by the primary care trust in Warrington, and totally ignores the needs of local people in favour of bureaucracy.
The centre of my constituency has a relatively low car ownership. It is a 20 mile-round trip to Whiston hospital. As the private finance initiative for Whiston is larger than its current needs, the inevitable result of any merger would be the transfer of services away from Warrington. Like my hon. Friend, we are not opposed to partnerships or to improving clinical standards. However, concentrating on a merger is diverting attention away from those matters and on to the bureaucratic issues that suit the health authority.
My hon. Friend the Minister has to get a grip on our SHA. It must be much more patient focused and concerned less with structures. As for the merger, I tell him clearly that my constituents do not want it, and I do not believe that the hospital board wants it. The proposal comes from the SHA and it needs to be stamped on at birth, because it is not in the interests of the people whom I represent.
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : Let me start by congratulating my hon. Friend the Member for West Lancashire (Rosie Cooper) on having secured the debate. May I begin by saying that she has displayed two of her great talents this afternoon? The first is her ability to fight on behalf of her constituents, and the second her deep experience of the national health service. She was not only vice-chair of Liverpool health authority between 1994 and 1996, but chair of Liverpool women's hospital between 1996 and 2005. I was also very glad to
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hear my hon. Friend the Member for Warrington, North (Helen Jones) intervene, not least because I was born in Warrington hospital. It is always a pleasure to hear it mentioned in this Chamber.
The starting point for this debate is simple. In the past few weeks, I have had the pleasure of visiting a number of hospitals in and around Liverpool, including Whiston and Alder Hey hospitals and Liverpool women's hospital. I have seen the transformation of the NHS in and around Liverpool, and I know that that is benefiting my hon. Friends' constituents. That has not happened by accident. It has happened because we have increased the funding of the NHS from around £35 billion to around £70 billion. Cheshire and Merseyside strategic health authority has benefited greatly from that investment, with 400 extra consultants since 1997, nearly 5,500 extra nurses and more than 3,800 health care assistants. That has made a huge difference to the quality of care in my hon. Friends' constituencies.
My hon. Friend the Member for West Lancashire has a PCT that sits in the Cumbria and Lancashire SHA area where, I am told, the number of people waiting more than six months for in-patient treatment has dropped by an extraordinary 95 per cent. since 1997, and the number of people waiting 13 weeks or more for out-patient treatment has dropped by an almost as impressive 86 per cent. The result of that, of course, is that people are living longer. The mortality rates in my hon. Friend's local authority area show that there have been extraordinary advances since 1997. The mortality rate from coronary heart disease has fallen by more than a quarter, and the death rate from cancer has fallen by 8 per cent. We should congratulate front-line NHS staff on those achievements and the way in which they have gripped and exploited our investment and reforms.
Andrew Miller : Will my hon. Friend the Minister accept from me, as I have received acute services under the current structures, that there is integration across boundariesbetween the Countess of Chester and Broadgreen hospitals, the ambulance trust and my GP, in my caseand that it is superb? That is within current structures. There is an old adage: "If it ain't broke, don't fix it."
Mr. Byrne : I am grateful to my hon. Friend for that intervention. I hope that he is pleased by what my noble Friend Lord Warner writes to SHAs and hon. Members later today about our proposals to strengthen front-line services in and around his area.
The backdrop for today's debate is the funding increases that are to come. Although advances have been made, we want to go further. In the local PCT area of my hon. Friend the Member for West Lancashire, that means about £24 million more going into front-line health care in the next few years. The choices available to local health professionals are extraordinaryhow much extra should be spent on hospitals, primary care services and community care services? It is a long time since front-line professionals working in the NHS have had such a rich array of choices.
My hon. Friend was right to stress the importance of localism in advancing services in this country. That is precisely why my right hon. Friend the Secretary of
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State will produce a White Paper in the new year on how to strengthen services that are not just around the clock but around the corner. We do far too much work in acute hospitals, and we can do a great deal more to move that care closer to where people live.
As we put more money into the NHS, it is only right that we should ask its managers to manage their books effectively. That is why we have asked hospitals to go for foundation status; it is a badge of effectiveness. My hon. Friend well knows that because she was instrumental in getting Liverpool women's hospital foundation status recently. To facilitate that process, we asked a few areas to pilot the whole health community diagnostic project, which is our way of ensuring that financial management in the NHS is as strong as it should be. My hon. Friend's area was one of those that piloted that project. That was done simply to ensure that NHS managers do not have the luxury of ducking the kind of tough financial decisions that she talked about so eloquently, or the opportunity to do so.
The agenda of expanding hospital services is important, but it needs first-class financial management to go with it. The programme of expanding and improving acute hospitals would be much easier if Liverpool metropolitan borough council raised its game and started to work slightly more effectively with the NHS. My visits to Alder Hey, Liverpool women's and Whiston hospitals were instructive, and I was disappointed to hear of concerns that the council might have dragged its feet in taking decisions that were needed to expedite the arrival of those new, first-class facilities. The diagnostic project on finances in my hon. Friend's constituency is ongoing.
However, I must confirm that the Department of Health has not agreed how it will proceed from the outcome of the pilot involving Cheshire and Merseyside SHA. There is still work to be done exploring the options that should be made available. As part of that, I understand that NHS trusts in Liverpool, Sefton, Southport and west Lancashire have begun formal discussions to review the configuration of trusts in their area to determine whether the current organisational structure is best placed to provide services to meet patients' needs. I know that in my hon. Friend's area McKinsey was hired. After this afternoon's debate, I wonder why they did not hire herthey could perhaps have obtained a slightly better result for less money. However, that is a decision that has passed us by.
This year Cheshire and Merseyside SHA assures me that it has not predetermined the outcome of the work and that any conclusions will be pursued if they are demonstrably in the patients' interest. I shall hold the SHA to that assurance.
Mr. George Howarth (Knowsley, North and Sefton, East) (Lab): Does my hon. Friend agree that it would probably be helpful if the chief executive and chair of the
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SHA were to meet a group of Members of Parliament from the constituencies that are affected to discuss in frank terms what is happening?
Mr. Byrne : That is a first-class idea. The matter has been reviewed in some depth, and Ministers will need to see extremely good evidence to justify any change in the current configuration. The SHA must satisfy Ministers on three tests in particular. I should be grateful if my hon. Friends would, if they have the opportunity to meet the chief executive and chairman of the local SHA, remind them of those tests, which Ministers will treat as important and which will determine their stance. First, there must be consistency with the NHS plan and the White Paper on care close to home, which we shall publish at the turn of the year. Secondly, new proposals must unequivocally produce better standards of care. Thirdly, any proposals must be subject to a full public consultation. Managerial convenience is not one of the tests that the proposals must pass.
Mr. Byrne : Full public consultation is a statutory obligation, as the hon. Gentleman knows. The point about consultation will be underlined in the forthcoming White Paper on community care and care close to home. I shall keep a watching brief on the developments as they arise. I understand that all the local Members of Parliament have been sent details of the work in relation to enabling trusts to become foundation trusts. I should be grateful if they would let me know if they are not satisfied with the quality of the communications. I understand that arrangements have been made for the SHA's chief executive to meet Members of Parliament and so have an opportunity to raise issues.
Rosie Cooper : I appreciate the Minister's comment that extraordinarily sound reasons for change would be needed. Will he take on board the fact that the chief executive is telling everyone that it will happen?
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