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Burnley General Hospital
11 am
Kitty Ussher (Burnley) (Lab): I am grateful for this opportunity to debate the future of Burnley general hospital, and it is an honour to make my Westminster Hall debut under your chairmanship, Mr. Chope, albeit in Committee Room 10. I am also grateful to my hon. Friend the Member for Pendle (Mr. Prentice) for taking the trouble to be present, and I will be happy to listen to his contribution if he wishes to intervene.
The issue we are debating does not affect only Burnley. Burnley general hospital serves not only my constituency of about 90,000 members of the public, but also the wider north-east of Lancashire. My petition in support of the hospital, run in conjunction with the Burnley Express, attracted 10,000 signatures from my constituents, but if we add together all the names on all the petitions that have been organised in support of Burnley general hospital—those by myself, by the trade unions and by individual community activists throughout east Lancashire—the number rises to around 60,000.
"reject any proposals to close Burnley General Hospital or Burnley's Accident and Emergency Department",
"strongly oppose any options that would be detrimental to the health of Burnley and Padiham people."
Let me explain why we felt that was needed. A few years ago, the acute trusts at Burnley and Blackburn hospitals agreed to merge. I am told by those who were involved in the making of that decision—not least my predecessor as Member for Burnley, Peter Pike—that assurances were given at the time that this was a purely administrative merger, and that there would be no transfer of services between Burnley and Blackburn. However, towards the end of last year the new East Lancashire Hospitals NHS Trust published four proposals emerging from its initial work on a clinical services review, all of which appeared to lead to a significant downgrading of Burnley general hospital in favour of Blackburn. The impetus for that change appears to be that the trust had mismanaged its finances. In its last annual report—that of 2004–05—the chairperson of the trust, Christine Kirk said that
"in plain housekeeping terms we have been living beyond our means and we must strive to bring this situation under control".
My point is that is not the fault of my constituents that the trust has got itself into this mess, and so it is not my constituents who should suffer as it tries to get itself out of it.
One of the published options proposed shutting down Burnley general hospital, which understandably led to ridicule in my constituency—and beyond—not least because the hospital is currently in phase 5 of a private finance initiative redevelopment project. I have since been told by the management that that was never a real option, and I am strongly of the view that if that is the case it should never have been put on the table. Therefore, my first question for the Minister is, whether it was necessary under Cabinet Office guidance to publish options that nobody has any intention of taking seriously? That was insulting to the intelligence of my constituents.
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However, more worrying was the realisation that the two options that were being seriously considered would both lead to the removal of intensive care beds at Burnley general hospital, with people having to go to Blackburn instead. It would be an understatement to say that that has caused uproar; it has led to the launch of a "save our hospital" campaign, with the full support of the local newspaper, which ran it as its main story for a number of weeks.
My constituents fear that they are more likely to die if they have to travel further to receive intensive care services. If one of my constituents is in a serious condition—as a result of a heart attack or a road traffic accident, for example—it is surely simple common sense that a longer journey time to intensive care means that they are more likely to die. I would like to hear the Minister's view on that. Specifically, I would like to know his estimate of the additional length of time it will take for my constituents and those of my hon. Friends—in particular of my hon. Friend the Member for Pendle—to get to intensive care in Blackburn, instead of in Burnley. How much longer will they be on the road, and what will be the increased risk of mortality from that additional travel time?
Let me offer further examples. If one of my constituents has a complication during routine surgery at Burnley general hospital, or during childbirth at the maternity unit, they will be more likely to die if they have to be moved to Blackburn, instead of receiving intensive care support where they are undergoing the operation or giving birth. If one of my constituents arrives at the accident and emergency department at Burnley in an acute state, surely they are more likely to die if they then have to be transported to Blackburn, instead of receiving the intensive care that they need on site? What are the Minister's views on those examples?
There are also concerns that if the intensive care unit is lost, the whole of the accident and emergency facility will surely follow, that no complex surgery—routine or otherwise—could take place on the site for fear of complications, and that for the same reason the maternity unit would be unsustainable and the hospital itself would gradually become unviable. Losing the ICU in Burnley would also presumably lead to a reduction in intensive care beds throughout the sub-region, at a time when intensive care beds are already in high demand.
Since the publication of these preliminary options, I have been deluged with letters from desperately worried constituents. I cannot walk through the town without being stopped by somebody who fears for what will happen as a result of the proposals, and I share their concerns. People honestly believe—and I think they are right—that they would be more likely to die if these proposals were carried out than under the existing situation.
Therefore, we protested. We met the trust managers and handed over the petition here in Westminster. We turned up in droves at their board meetings. We organised a fantastic march through the centre of town on a Saturday shortly before Christmas, which culminated in mulled wine—non-alcoholic, of course, for health reasons—in the central square. A similar march took place in Pendle.
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That worked. As a result of our pressure, the management said that there would now be a new proposal for emergency care, dubbed the "fifth option", which would focus on
"the retention of both planned and unscheduled care in some specialities at the two main hospitals in the towns"—
those at Blackburn and Burnley. The trust's press release went on to say that the new proposal
"comes in response to fears expressed by some local people about possible changes to critical care services at Burnley General Hospital".
I wish to put on record a big thank you to all those who joined our campaign. Making that effort was worth while.
We have come far, and we now need to put in place the final piece of the jigsaw. On Friday this week, a steering group consisting of all the relevant primary care trusts will decide which options will go out to formal statutory consultation. It is imperative that the option that is put forward as the preferred option is new option 5.
We are a proud town with a strong history and a great hospital, and we need to keep intensive care beds at Burnley general hospital for those cases where to travel further would mean an unacceptable risk to life. Access to intensive care—and, indeed, accident and emergency in general—is a bit like the emergency exit in an aeroplane; we hope to goodness that we will not need to use it, but we blooming well want to make sure that it is nearby just in case we do. That is our main criterion against which the formal proposals will be judged when they emerge in a few days' time.
However, it is not the only criterion. I have a 10-point checklist against which the proposals will be judged when they are finally published. I will draw my remarks to a conclusion by stating them, so if any of my hon. Friends wish to intervene, now is the time to do so; I am very glad that they are present to add their voices to mine. My first, and most important, question is, will there be intensive care beds in Burnley? Also, how many intensive care beds will there be in east Lancashire as a whole? Secondly, will accident and emergency services remain in Burnley? Thirdly, what will we specialise in? Will Blackburn people come to Burnley to be treated, and if so, in which areas? Fourthly, what will happen to Burnley's fantastic Edith Watson maternity unit where so many of my constituents and their children were born—including my own daughter, last year? Fifthly, how many more lives would be saved, or lost, as a result of the proposals? Sixthly, what would the trust do to help my constituents travel between Blackburn and Burnley—for example, to visit relatives? Seventhly, would additional ambulances be provided to compensate? Eighthly, what are the medical experts saying, particularly those who specialise in intensive care? Ninthly, what is being done to encourage more young doctors and nurses to apply to work in Burnley, so that we can bring the expertise of the future into our town? Finally, and very importantly, what will happen to the medical equipment that has been donated to Burnley general hospital by the fundraising efforts of successive mayors and mayoresses and the contributions of so many of my hard-working constituents?
The answers to those 10 questions will determine whether my constituents believe they are better or worse off as a result of the proposed changes. I hope that the
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Minister will be able to reassure us on each of those points, and I thank my colleagues for their patience and courtesy in listening to my contribution this morning.
11.9 am
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : I congratulate my hon. Friend the Member for Burnley (Kitty Ussher) on securing the debate. Since she arrived in the House, she has taken a close interest in health services in her local community. She has helped to lead local campaigns for strong health services and has persistently lobbied Ministers, both in the House and behind the scenes, not just because she is an excellent local MP but because she is a user of local hospital services. I was privileged to meet baby Lizzie recently, and Burnley should be proud of her.
I, too, put on record my thanks to the Burnley Express for the way in which it has helped to keep the issue in the local headlines and at the centre of local conversation. Over the past few months it has proved, once again, that it is a real voice for the local community.
The starting point for this debate is the transformation of the NHS in and around Burnley. As a result of our funding policy, the NHS nationally is in receipt of record resources, and so is the NHS in my hon. Friend's constituency. Funding overall in the NHS has increased almost twofold; it is up to £70 billion, and by 2007–08 that will have increased to about £92 billion. That is an enormous increase in spending. Indeed, if the NHS were a national economy, it would be something like the world's 33rd largest. That is a record of investment in which the Government can take great pride.
The money has been extremely well spent. It has bought extra staff and shorter waiting times, and the result is that there have been great advances against the big killer diseases that we suffer from. This morning, I looked at the statistics for Cumbria and Lancashire: since 1997, about 150 more consultants, 3,000 more nurses and more than 1,800 health care consultants have arrived on the scene. The result of that investment, the new staff and the new ways in which they work is that waiting times have come down, and not a little, but massively. In 1998, nearly 300,000 people waited more than 13 weeks for an out-patient appointment. By December last year, that figure was down to just 171. In March 1997, about 165,000 people were waiting between six and eight months for an in-patient appointment; that has come down to just 35.
Hon. Friends who have been in the House much longer than I will remember the days when they received many, many letters from constituents complaining about long waits. I hope that that flow of letters has dried up. The result of the reduced waiting times is that more people now live longer.
This morning, I also looked at the death rate for an indicative disease, coronary heart disease, which, of course, is one of Britain's biggest killers. The mortality rate for that disease in Burnley came down by 32.8 per cent.—nearly a third—between 1997 and the last year for which we have statistics, which is 2003; that is a massive decline in the death rate from one of Britain's biggest killer diseases. That did not happen by accident; it happened through the sheer hard work of NHS staff, backed by the new tools with which they have been equipped.
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It is especially comforting that my hon. Friend's primary care trust has shown an enormous commitment to tackling many of the issues that the Government have seen fit to prioritise, such as cancer, coronary heart disease, choosing health, better services for the elderly, mental health, and diabetes. More than £5 million is being spent on those services. To take a couple of local examples of great results in delivering better health care to my hon. Friend's constituents, the pulmonary rehabilitation service introduced in June last year has already delivered a 4.5 per cent. reduction in emergency medical admissions to hospital. The PCT is planning to recruit some 21 community matrons; there are already 11, and they are playing a vital role in making sure that more health care is managed in the community, so that people do not need to come into hospital for the help that they need.
That investment is set to go on. My hon. Friend's PCT received about £241 million in 2003–04. By 2006–07, that will have increased to £340 million and in 2007–08 it will go up to £371 million. That is an enormous increase in the cash available to the NHS in my hon. Friend's constituency. It is worth mentioning that much of the investment to date has benefited Burnley general hospital; £30 million is re-providing new medical accommodation, and providing a new renal dialysis unit and a new entrance for the hospital. The hospital is, of course, the centrepiece of this morning's debate.
The starting point for my hon. Friend's comments was whether there were Cabinet Office guidelines for how debates such as ours are conducted. I much regret the false alarm caused by the way in which the trust went about beginning the consultation. We recently recognised that problem explicitly in the White Paper on social care and health; in it, we set out that we would do far more to support local organisations by consulting in a manner that we think effective. As my hon. Friend knows, in that White Paper, we pioneered a new way of writing White Papers. We benefited from unprecedented levels of public engagement, and the process was extremely successful. We found that the public want debates about the local NHS and have intelligent views about it, and can structure what are often difficult decisions. We want to make sure that the learning that we acquired through writing that White Paper is made available to local communities.
Mr. Gordon Prentice (Pendle) (Lab): The Minister referred to the White Paper on social care and health. There is a reference in it to "fully fledged" accident and emergency departments. I invite him to tell hon. Members what the Government mean by that phrase, and to say whether that is what Burnley general hospital will have.
Mr. Byrne : I am grateful to my hon. Friend for that intervention, and I will address that remark in a moment.
The challenge for health chiefs in Burnley and Pendle, against a backdrop of a 20 per cent. increase in cash over the next two years and of record investment, is how to update their hospital for the 21st century. To answer that question, the steering group was set up to oversee the identification of options, and it identified a number of important criteria against which options would be developed.
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The first criterion was the need to expand and invest in community-based care that would increase the amount of planned emergency and long-term condition management that could take place in the community. In our consultation on the White Paper, the public said overwhelmingly that if care could be provided not just round the clock, but round the corner, that is where they would like it.
The second criterion is that the patient experience for those going into hospital has to go forwards; it cannot go backwards. Ultimately, the debate must have a single test: is patient care being improved? Thirdly, hospitals need to develop into centres of excellence, supporting safe and high-quality treatment. Fourthly, redesigned hospitals and community facilities have to reduce waiting times; we made a big commitment to the British people in May to bring down waiting times from the scandal of one in 10 people waiting two years for treatment in 1997, to a maximum wait of just 18 weeks. Producing dramatic falls in waiting times has to be part of the criteria against which any new proposals are judged.
The independent steering group meets on Friday to agree options for public consultation and I shall take a watching brief on the development of those proposals going forward. I shall be able to answer some of the points that my hon. Friend the Member for Burnley has raised now, although not all of them, because we await Friday's decision on which options will go forward for consultation. However, I commit to write to her once those options are in the field and let her have my analysis of the answers to those questions, based on the two proposals that are put forward.
First, and most importantly, no option will propose the closure of Burnley hospital. Secondly, A and E will not be put in jeopardy. Thirdly, we expect at least one of the options to see high dependency beds staying at Burnley. I understand that under that option those high dependency beds will have the flexibility to step up to intensive care beds, although this will have to be confirmed on Friday. I also believe that one of the options—again, this is subject to the confirmation on Friday—will involve new investment in women's and children's services. If that option is proposed, the logic is that those services will be centred on the Edith Watson ward.
Those options are important because the number of cases that require intensive care in Burnley shows that there is a clear need. I asked officials this morning to dig out the number of high dependency cases and intensive care cases in Burnley last year. The answer is not inconsiderable: last year some 546 patients were admitted to high dependency units, with 191 admitted to intensive care, which is a little less than four a week.
Kitty Ussher : The Minister makes a powerful point. Given that there are 546 HDU cases and 191 ICU cases a year and that only one of the options proposes that there should be HDUs with the potential to flex up to
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ICUs, does he agree that that should be the preferred option? To phrase the question slightly differently, if the steering group and the hospital trust view that as the preferable option, should they not state that?
Mr. Byrne : When the trust puts up different options for consultation it is vital that it also makes clear to the public the number of cases that we are talking about, to inform the engagement that it undertakes with clinicians. My hon. Friend the Member for Pendle (Mr. Prentice) has made a good point in the past about the travel times between Burnley and—potentially—the new hospital in Blackburn. If the trust proposes that any option be preferred or not, it needs to explain the volumes for each kind of case and the implications of that if, for example, there are extra travel times.
The trust is doing that against a moving background. For example, our reforms of the ambulance service envisage a future in which more and more emergency care can be administered by ambulance professionals working on the site. That is what ambulance staff want to do and it has been shown to deliver a decline in mortality in many parts of the country. There is a moving background, but it is imperative that the trust sets out not only the volumes of different kinds of cases but the implications for, say, mortality under the different options.
I am sure that my answers will have provided my hon. Friend the Member for Burnley with some reassurance, although not complete reassurance, so I stress that decisions have not been made at this stage on the precise options for change. That decision will be made by the independent panel on Friday. The chief executive of the trust has kept hon. Members in touch with the development of some proposals and I expect that to continue.
I assure all hon. Members that there can be no faits accomplis, no cabals and no decisions made behind closed doors. The NHS is under statutory obligations in the way it conducts consultations with the public. The trust is clear that it must put out firm options to public consultation following the analysis of pre-consultation options. I am advised that the trust anticipates that the proposed start date for the 12-week period of public consultation will be in March.
In conclusion, I encourage hon. Members to stay closely engaged in the debate, if not to lead it. I am sure that there will be a rich discussion over the next 12 weeks in Burnley. I will remain closely involved in monitoring the situation and will be more than happy to meet delegations of my hon. Friend's constituents if she wishes to have me hear their views directly. I look forward to the consultation coming to a successful conclusion and, against the backdrop of a record increase in NHS resources, the development of option that immeasurably strengthens NHS services in my hon. Friend's constituency.
11.26 am
Sitting suspended until half-past Two o'clock.
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