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10 May 2006 : Column 112WH—continued
As I am an inexperienced MP, the petition that we put together was my first one. I sent it to a number of doctors’ surgeries—about 20—as well as to a number of pharmacies in my area, because I thought that that would be a way of demonstrating the size of support to the Government. I am not sure what level of support I thought would be successful, but I was thinking in terms of a couple of hundred names, and that if there
were more than 1,000 I would be celebrating. However, 5,000 people responded. There is a massive amount of local support and concern.
I wrote to the Secretary of State. The Minister was kind enough to reply, saying that the merger was a local matter, that the Secretary of State would not intervene, and that I should raise any concerns with Essex SHA. In many ways I agree; it is a local matter, but I do not consider the SHA to be local. To me, local is Southend, Rochford and the wider cancer network. I find the strategic health authority somewhat out of touch in that regard, and in regard to other matters as well. I hesitate to go into more detail, but I do not think that it has a role as things progress. It certainly does not add value for my constituents. I want more people on the front line. However, I apologise, Mr. Atkinson, for going slightly off on a tangent, and I shall return to the subject of cancer.
The Minister has a role. When the Government’s cancer tsar last came to Southend and examined the problem it paid dividends. I do not demand, or even ask, that the Minister should come to Southend, although it would be very welcome. I am more concerned that she should review the matter. [Interruption.] My hon. Friends are asking whether she will come; she would be more than welcome.
What I said about the consultation being a sham involves a key point. When Ipswich left the Mid Anglia cancer network, the writing was on the wall. It was always going to be difficult to justify maintaining two smaller networks, if, indeed, it was Government policy and advice that 1 million-plus should be the population number. That has produced upwards leverage.
Following the Minister’s letter, I telephoned the strategic health authority to check that it had not been missed in the post in early May, prior to the debate, and it kindly faxed its response to me this morning. In fairness, its representatives are disappointed that I consider the consultation to have been a sham, but not nearly as disappointed as I feel about the whole consultation process.
I am not criticising a lack of activity in the consultation; there was lots of activity and lots of money was spent on it. However, I believe that the decision was taken well before the consultation. Several more seasoned—perhaps one could say more cynical—colleagues told me not to bother to get involved. They said, “We see this time and again; consultations take place but the decision has already been taken.” Furthermore, in the health sector locally there is some consultation overload. I was considering five or six NHS consultations in south Essex in January, so things are quite difficult. Also, in each case the questions being considered were mergers, and getting bigger. I cannot help thinking that there is an underlying philosophy that bigger is better, but I do not think that that is right. Both on the specific cancer issue and on other things, bigger may be considerably worse. We should reduce the size of some of our operating units.
I said that I would try to include some questions to make it clear what I want to achieve in raising the debate. The best thing would be for the Minister to say, “Ah, yes, there has been a terrible mistake and we shall sort it out.” I do not imagine in my wildest imagination
that that will happen, but a ray of hope for my constituents would be most appreciated. I should like to find out more about why change is needed. I think that I have demonstrated that the cost benefits will be marginal, that there are no demonstrable patient benefits and there will be much administrative disruption, and that there is much opposition.
I should be interested to know more about the 1 million figure and why there is no flexibility, when the cancer tsar showed flexibility in 2001-02. Has there been a policy change since then, or has more information, of which I am not aware, become available? As to the tabular information, I do not ask the Minister to provide anything in that exact format. However, something a little more solid statistically, which correlates population numbers, cancer incidence and survival rates would be helpful to enable us to go forward. If the Minister is right that bigger is better, why should the figure be 2 million? Perhaps it should be 4 million? We need a strong evidence base to enable us to proceed.
I hesitated before putting my questions, because the issue that they raise is, “What if the merger does go ahead?” I should like the Minister to confirm that what is happening is 100 per cent. about administration. The South Essex cancer network and the doctors in Southend would like a promise that there will be no patient movements south to north or north to south, other than in the three specialist cancer centres, without consultation.
I should also like more information about the consultation. I talked about the cancer centre suffering death by a thousand cuts, and one concern is that smaller changes will happen below the radar, and without the involvement of local community leaders and community groups, once we are part of a bigger cancer network.
Macmillan Cancer Relief raised the problem of the travel costs that would be involved should patient flows be significant. Bus routes are poor, and there are virtually no rail routes north and south—certainly not from my part of south Essex. The charity is concerned about the extra costs, and that is a valid concern, although time is also a great worry.
I said that I would not talk in detail about upper GI, but I have had several letters from people in Basildon asking why there is no options appraisal for upper GI in Basildon. I simply throw that issue out to the Minister, and she might want to comment on it. That might be helpful for members of the public in that part of the world.
In summary, the merger of the South Essex and Mid Anglia cancer networks is opposed locally and represents a threat to the longer-term future of the Southend cancer centre. The case for the merger is weak at best and fundamentally flawed at worst.
2.56 pm
Mr. David Amess (Southend, West) (Con): I congratulate my hon. Friend the Member for Rochford and Southend, East (James Duddridge) on the way in which he introduced this debate and on his temperate language.
The Minister is genuine in her intention to do the best that she can for the health service, but how could
she possibly know the details of the services that we enjoy in Essex, when she depends on advice? I gently ask her, therefore, to put out of her mind for a moment the thought that she will hear mainly from Conservative Members this afternoon. Instead, I ask her to consider carefully the advice that she is being given, because it was wrong four years ago, and nothing whatever has changed the argument today. I also hope that she will accept my hon. Friend’s invitation to visit Southend, and I would be delighted to buy her a Rossi’s ice cream, which I can thoroughly recommend, on our newly refurbished pier. She will, however, be very proud of the services that we enjoy.
The Minister should know that there is great pride in cancer services in our part of Essex, and that is particularly clear from the support for local hospices. Last week, I was proud to accompany Vera and Ivan Heath, both of whom are 90. They have no children and little family, so they have decided to benefit others by giving their money to the local community now, rather than waiting until they die. I was honoured to be with Ivan at Little Haven hospice, which he presented with a cheque for £250,000. I was also honoured to accompany him to St. Luke’s hospice, which was opened by the late Princess Diana of Wales and the Duchess of Norfolk when I was the Member of Parliament for Basildon. Ivan gave St. Luke’s £50,000, which is a wonderful gesture.
On Fridays, I sometimes go round my colleagues’ constituencies. Last Friday, I was at Stock Brook Manor in the constituency of my hon. Friend the Member for Billericay (Mr. Baron). I enjoyed a charity golf day, which was organised by the Donovan family, and a whole number of celebrities attended. The event raised in excess of £60,000 for Little Haven hospice. I just want the Minister to appreciate, if she does not already, that there is an enormous amount of good will towards cancer services in Essex generally. In particular, we are very proud of the services at Southend hospital, which really is a true centre of excellence.
In the debate in February 2002, to which a different Minister replied, I applauded the cancer plan, and I do so now. It is right that cancer, an illness that affects one in three people in the UK, should be given the priority status that it already enjoys in the national health service. However, as I said in that debate,
“As we have a first-class service and that is what the Government want, why change it?”—[Official Report, 6 February 2002; Vol. 379, c. 1002.]
That is the issue, and it must not be clouded by anything else. We have a first-class service and it should not be changed, whatever briefing the Minister has been given.
Professor Richards decided that, given the high number of cases treated by the centre and the high proportion of elderly residents in the area, the benchmark figure of 1 million inhabitants ought not to apply to the South Essex cancer network. I represent the constituency with the most people between the ages of 100 and 112 in the UK. For the reasons that I mentioned, Professor Richards decided to support the arguments advanced by my colleagues and me.
The factors have not changed, so why, four years later, is the size of the network a reason for merging it with Mid Anglia? It seems absolutely implausible—
how can the argument have changed in four years? So far, Essex strategic health authority has been totally unable to provide me and my colleagues with any evidence to show that small centres are less effective in treating certain sorts of cancer than larger ones.
A press release issued by Essex strategic health authority on Tuesday, 21 February 2006—still within the period of the public consultation—made the case for large specialist surgical centres. It stated:
“National guidance recommends that the surgical part of treatment of gynaecological, upper GI, urological and head and neck cancers should be provided in centres serving at least one million people. The national guidance is known as Improving Outcomes.”
The recommendation to replace what the release calls “fragmented” services with other clinical set-ups is made without statistical evidence to back up the assertion that bigger is better.
The Essex strategic health authority consultation on the reconfiguration of cancer services was conducted from 12 December 2005 to 13 March 2006, after which it was decided that the changes proposed in the document—that is, the merger of the cancer networks and the relocation of specialist cancer operations—should go ahead. As my hon. Friend the Member for Rochford and Southend, East asked, what was the point of the consultation? Members of Parliament and our constituents have been treated like complete idiots and I, for one, will put up with it no longer.
If the strategic health authority had already made up its mind, what on earth was the point of going through the consultation? It was more of a gesture towards openness than real dialogue; it did not take into account the views of the south Essex hospitals, the South Essex cancer network, the 5,000 members of the public—who, as my hon. Friend mentioned, signed the petition—or the Members of Parliament and councillors who represent those people and all opposed the strategic health authority’s proposal.
The Minister values the work of the Health Committee, on which I am privileged to serve. She knows that it recently conducted an inquiry on the reorganisation of primary care trusts. Our report found that consultation was woefully inadequate, mainly because of the top-down nature of the process, which imposed change, even when it overrode the needs of local communities, to make financial savings.
I say to my hon. Friends that that is what the issue is all about. It has nothing to do with best practice. The argument, accepted four years ago, is even stronger today.
I end by saying that I had the pleasure of visiting, with a number of my hon. Friends, the Southend cancer centre at Southend hospital on 31 March. We were absolutely in awe of the quality of the services; the centre is meeting not only its targets for breast and cervical screening, but the national cancer waiting times: 100 per cent. of its patients receive their first appointment within two weeks and their first treatment 31 days after the decision to treat. I know that the Minister, when she replies to the debate, will congratulate the hard-working staff on their achievements.
Waiting times and clinical targets are, however, only half the story of cancer treatment. Macmillan Cancer
Relief has been making the case for a more comprehensive cancer plan than the one that the Government launched in 2000. The plan would provide for vital supportive and palliative aspects of cancer care as well as diagnosis and treatment. The additional investment in specialist palliative care at Southend cancer centre is already making a difference in that area, along with an agreed framework for implementing the National Institute for Health and Clinical Excellence guidance on supportive and palliative care and for establishing a network user partnership group and a network patient information project.
I could go on, but I hope that my hon. Friends will catch your eye, Mr. Atkinson. I ask the Minister again to consider very carefully the arguments that she is hearing this afternoon and to reflect again on the advice that she appears to be receiving at the moment.
3.6 pm
Bob Spink (Castle Point) (Con): I congratulate my hon. Friend the Member for Rochford and Southend, East (James Duddridge) on making a very measured, well thought out contribution and on leading the drive to save the cancer centre in south Essex. He has done a wonderful job and shown that he has a lot of energy. Whether or not he is successful is no measure of his abilities and potential in this place.
I declare an interest: my son is a neurosurgeon who practises in London, and often in south Essex, treating cancers and such like, and he will do so in the future.
South Essex cancer service is an excellent clinical network. I am a Conservative because I believe in cherishing what is good. That is why I am speaking in the debate and supporting my hon. Friend. At the start of the process, the question should have been, will merging South Essex cancer network with Mid Anglia cancer network help or hinder the continued improvement that we have seen in the South Essex service? For me as an MP, the question was, what will it mean for the people of Castle Point, whom I have a duty to represent, and for my area of south Essex? This is not mindless nimbyism. I have a duty to look after the interests of my constituents, and if I do not no one else will. That is why they send me to this place. I therefore hope that the Minister will forgive me if I speak from the viewpoint of south Essex, rather than the overall viewpoint. It is her duty to look after that, and I know she does so carefully.
What is wrong with our cancer service that requires it to be merged with Mid Anglia and what benefits will we get in return for the merger? What benefits will we get to match the costs and risks of that change? Let me set out some facts about what we are achieving in south Essex. Merging with the relatively not-so-high-achieving Mid Anglia will, some claim, weaken the South Essex cancer network and the service that it is able to provide for our constituents. Merging will certainly disrupt its excellent progress, although I accept that Mid Anglia has many good points and I am sure that excellent staff work in that service, too. I would not in any way bad-mouth them. It must be said, however, that South Essex is reputed to be one of the
best services in the country, notwithstanding its smaller size. In fact, its success might be a result of its size; we certainly have no evidence to convince us otherwise.
There are excellent staff at all levels at South Essex, and I pay tribute to them. They are hard working, dedicated, professional and very caring people, as I am sure the staff are at Mid Anglia cancer network.
South Essex is meeting national targets for screening, particularly for breast cancer and cervical cancer,as my hon. Friend the Member for Southend, West (Mr. Amess), whose speech I am delighted to follow, pointed out. However, we need dramatically to improve our screening in those areas and to continue to make advances. We are cutting waiting times from diagnosis to treatment, which is one of the most important factors in achieving successful outcomes. We need to make dramatic improvements, and we are doing that in south Essex, but those improvements might be jeopardised by the change and disruption of the merger.
Our patient outcomes are improving and are now much better than those in many cancer centres in the UK; they are said to be better than those in the mid-Anglia area. We have extremely good financial controls, management and peer reviews, and, added to all that, the convenience of access to a local service. My hon. Friend the Member for Rochford and Southend, East pointed out, at length, the natural flow of movement in the health economy, which is east to west—certainly not north to south. There are good reasons for that, not least the infrastructure and the difficulty that people have travelling north to south.
Those who were consulted in my area said that the merger plan was against the best interests of patients in south Essex and the excellent staff who work in that area. It certainly lacks clarity of purpose and any detail about defined, discernible, demonstrable benefits, or even a set of properly laid-out costs. It also lacks any schedule as to how those changes are to be achieved, and detail on what the timing and costs will be. I shall return to that point in a moment.
If we put all those considerations together, we see why the objection to the merger was both hostile and comprehensive, certainly in south Essex, if not the north of the county. The objectors included most of the relevant bodies of opinion, including the south Essex MPs—we have ample evidence of their interest this afternoon. Many excellent councillors and good councils supported our stand on this, as did the hospitals, patient groups, South Essex cancer network and, probably most importantly, the public. Their support is demonstrated in the petitions. Unlike my hon. Friend the Member for Rochford and Southend, East, that was not my first petition. The media certainly support our side of the argument on behalf of the public.
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