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10 May 2006 : Column 118WH—continued
The anecdotal evidence confirms that the public are very much on our side. I spoke to around 1,000 people—some of whom I questioned and some of whom questioned me on this matter—in the run-up to the recent local elections, and they opposed the merger almost to a person. We have massive evidence that the groups that should have been and were consulted strongly oppose the merger. I hope that if we are to push forward with the change—if it is going to happen
anyway—we are all proved wrong, but I do not have any evidence to support that.
I see that the Minister is listening carefully. In a nutshell, it seems that the merger will bring disadvantages, disruption and little demonstrable benefit. It brings unquantified risk without proper weighing of the costs and could set back the steady improvements that we have been achieving in the South Essex cancer network. I accept that it could accelerate improvements in the north, but that is not what I am here to talk about. I am here to represent my constituents, and the Minister is perfectly aware of that.
If the merger is not handled well, it could impede the plans of South Essex and progress on treatments and outcomes, cutting cancer waiting times, delivery on top targets, improving patient information and care, and improving services to the community. It might also affect links with primary care networks, our excellent local GPs and the wonderful Macmillan nurse network in south Essex, to which we all pay tribute.
The Government and the SHA have failed to make any coherent or decisive case for the merger, certainly to the public. That is largely due to the consultation period of three months—I believe that it ended on 13 March—which was said by some to be a sham. I am a moderate man in my language, so one would not expect me to make that claim. The public were angry about the consultation. They felt that they had been steamrollered by the strategic health authority towards a decision that had already been taken, and that there was an element of deceit and pretence in the consultation. In some ways, I feel sorry for the SHA, because it tried to proceed professionally and comprehensively. I do not bad-mouth the SHA, but I heavily deprecate the Government. The SHA was unfortunate, because its consultation was judged against the backdrop of the recent consultation on the police mergers, which was a sham. I say that even though I am careful with my language.
There was evidence that views were not properly considered but simply cast aside. It is easy for us in the south, who were against the merger, to say that and to ignore those in the north, whose views are obviously valid as well. The Minister has to make a balanced decision on that, and will do. In any event, the consultation document was claimed to be a shambles. A powerful letter from the patient and public involvement in health forum for Basildon and Thurrock hospitals, addressed to the Secretary of State and dated 3 April, states:
“We made it very clear to the SHA that we had concerns that the documentation was not fair, honest, and was biased towards Bloomfield Hospital Chelmsford”.
“not fair, honest, and ...biased”
The results of the consultation—although not clear, at least as far as the south was concerned—were taken by the SHA, which steamed ahead in the opposite direction. It made few arguments, to me anyway, for the benefits of change to the south and gave me little in the way of estimates of costs. Those are not just the financial costs, but the human costs, the operational costs and the costs in terms of patient outcomes. The
problem for the SHA is that the Government have stopped listening to the people and the people perceive that. The SHA is judged against that backdrop and in the shadow the mistrust that the public hold for public bodies. However, that is not the fault of the SHA; I lay the blame for that at the Government’s door.
The merger proposal looks very much like part of the Government’s now not-so-secret regionalisation agenda, which is hitting local democracy and removing local accountability. Their agenda covers things as diverse as police, planning, health, economic development and so much else. It is a Big Brother agenda, the people have rumbled it and action will be taken at the polls to reverse it.
Experience shows that such mergers typically cost much more than was anticipated at the outset. They typically fail to deliver the anticipated benefits or results—not that I see net benefits for my constituents from the merger in any event. Such mergers disrupt and set back progress towards important delivery improvement targets. The plan must be carefully controlled if it goes ahead and we should ensure that we achieve the targets that we set out to achieve.
The Government seem to be obsessed with reorganisation for its own sake. Yet again, we see them shuffling the deckchairs on the NHS deck. They should focus on tackling improvements, such as removing postcode prescribing and making better treatments and drugs available—for example, temozolomide and Gliadel implants for brain cancers and Herceptin for certain stages of breast cancer—as well as spreading the good practice that we see in other countries.
I ask the Minister to rethink the proposal, even at this late stage. It is never too late to accept that the case for merger has not been made, as it certainly has not in this example.
3.19 pm
Mr. Mark Francois (Rayleigh) (Con): I commend my hon. Friend the Member for Rochford and Southend, East (James Duddridge) on securing this debate and on introducing it so ably and comprehensively. I also congratulate my hon. Friends the Members for Castle Point (Bob Spink) and for Southend, West (Mr. Amess) on their contributions. I understand that my hon. Friend the Member for Braintree (Mr. Newmark) may yet be hoping to catch your eye, Mr. Atkinson, so that he can have a few minutes before the winding-up speeches.
It is a pleasure to see on the Conservative Front Bench my hon. Friend the Member for Billericay (Mr. Baron), who will reply for our party. This is very much an Essex production, from our perspective.
Some of us have been around this loop before. As my hon. Friend the Member for Rochford and Southend, East said in his introductory remarks, there was a campaign several years ago when the Government unfortunately came up with proposals to transfer some cancer operations away from Southend to as far afield as Ipswich. They caused tremendous disquiet in south-east Essex and local Members of Parliament chipped in and lobbied the cancer tsar and Ministers. As we heard, the cancer tsar came to Southend and considered the issue in detail. Importantly, as an expert, as the Government’s adviser on cancer, he
decided to leave well alone. He was not a politician but an expert on cancer. As a result of his review, there was transfer of some local operations—just a few—between Southend and Basildon hospitals, but in essence the operations remained in south Essex and the South Essex cancer network remained intact.
The Government’s adviser on cancer came to Southend, looked at things on the ground, as they say in modern parlance, and having done that, decided that it was best to leave well alone. I suggest to the Minister in all seriousness—this is not a partisan point—that that is a very powerful consideration in this context.
There is no debate about the quality of care for cancer patients at Southend. There are various problems in the national health service. The Minister has had many letters from me about problems with dentistry and, most recently, clinical dental technicians—I take the opportunity briefly to remind her of them—but no one is saying that there is a problem with clinical outcomes at Southend. It is not as if the service there is deficient.
Several of us had a meeting with the medical director of the Essex strategic health authority some weeks ago, and we pressed him repeatedly on this point. We asked him to provide clinical evidence that there was something wrong with the outcomes at Southend. As my hon. Friend the Member for Rochford and Southend, East said, we have still had no conclusive evidence from the Essex SHA or from anyone else that there are poor outcomes at Southend that would necessitate a merger. We do not believe that there is a compelling clinical rationale to undertake the move. If there is, we genuinely are not aware of it.
Moreover, it is important to note that the cancer tsar accepted the case for derogation below the 1 million figure. As I said in an intervention, that derogation was there from the start of the network. The matter was considered when the network was set up, and it was considered again by the cancer tsar a few years ago. Both times, the answer was that it was all right at 750,000 for all the reasons that have already been given. Now, suddenly, that is being overturned, and I do not believe that that is wise.
I too am a moderate man, but I shall say it: the consultation was a complete sham. In fact, because of the shape of my constituency, I have responded to seven NHS consultations in the past few months. Briefly, they were on proposals to merge the Essex SHA in a regional SHA, to abolish the Essex ambulance trust and make it a regional ambulance trust, to reduce the number of primary care trusts in Essex, to turn the two mental health trusts in Essex into foundation trusts—that I actually support—to relocate the non-cancer head and neck services to Broomfield, and lastly, this one to abolish the South Essex cancer network. For each of those seven consultations, the recommended option was adopted—every time. It is difficult indeed not to become cynical about such exercises when it seems, particularly in the NHS, that proposals are put out to consultation but the decisions have long been taken. The Government go through a consultation exercise only because it is a statutory requirement.
That is even more galling because the policy of the Department of Health is to encourage local decision making, to push such decisions down to local level. I am sure that we will hear that in the Minister’s summing-up speech. If the Government are going to do that, they should be consistent. If they are putting decision making at the local level so that when things get difficult Ministers can say, “It wasn’t my fault, guv”, the flip side is that they should listen to what local people say.
If there is local consultation and 5,000 people sign the petition and the local councils and many of the local medical professionals say, “We don’t want this,” that should be acknowledged. It is pointless to go through sham consultations if local people are ignored. I am afraid that that is exactly what has happened in this instance. If I sound angry about it, it is because I am.
We are worried about the thin end of the wedge argument, and we are worried that whatever may be said today, the issue will be revisited and reconsidered in a few years’ time, a few more operations will be moved away, it will be reconsidered again, and eventually the centre at Southend will be under threat. We are not making it up, because the centre was under threat some years ago. We are genuinely concerned about that, and it is partly why we are taking part in this debate.
I reiterate to the Minister that the network was given a specific derogation below the 1 million quota when it was set up. That derogation was reaffirmed by the Government’s own cancer tsar—not someone from Conservative central office, Labour party headquarters or the Liberal Democrats. The Government’s own cancer tsar considered it and reaffirmed the 1 million derogation, which it is now proposed to overturn. There is no compelling clinical evidence to back up that decision; it is done simply for administrative convenience to fit in with the figure of 1 million and make it neat. Local people were consulted, they said that they did not want it, and they were systematically ignored.
I believe that the Minister is a reasonable person. I have dealt with her before on other issues, and I mean this genuinely: she is a reasonable Minister and she is fair-minded. Not all her colleagues are, but she is. I make a genuine plea to her to reconsider the matter. If she wanted me to sum up the whole case, I would do it like this: Minister, it really ain’t broke down in Southend. Please, please don’t fix it.
3.27 pm
Mr. Brooks Newmark (Braintree) (Con): I, too, congratulate my hon. Friend the Member for Rochford and Southend, East (James Duddridge) on securing the debate. It covers cancer services in Essex, as well as the proposed change. During the Opposition-day debate on cancer services, the Health Secretary said that the decision on the future of cancer networks in Essex would be made locally. The emphasis on “locally” is what interests me. Do not my hon. Friends agree that the reason for the proposed change is the imposition of national requirements? One of the biggest challenges faced by my primary care trust in Braintree is the
interference of central Government, often in the provision of services that really matter to my constituents.
Witham, Braintree and Halstead primary care trust has received a five-star rating for vital cancer services such as cervical screening. However, it received that rating for the local services that it provides, not because of national impositions. It is not only acute and specialised services that are important in effective treatment of cancer; the early detection and easy access to primary services are essential, too. That is why I emphasise that localism and local services are important.
Although the consultation said that the amalgamation would affect only a small number of complex surgical cases, what guarantees do we have that routine services will not be compromised by the proposed changes? Now that the Minister is in front of me, I should like to make a quick aside. People in my constituency are battling to secure the future of a new community hospital in Braintree, yet the Government still make strategic changes a priority over the improvement of basic local services. My constituents want a community hospital, they have been promised one by the Government, and they are still waiting for the Government to support that.
My genuine concern is about meeting local needs. In a press release, I read with interest that the strategic health authority on 29 March said:
“The board of Essex strategic health authority today agreed a recommendation to create a new cancer network”—
“covering south-east, south-west, mid and north-east Essex. It was one of four key decisions about cancer services made by board members”.
“Speaking after the meeting, Dr. Paul Watson—
the strategic health authority medical director—
said: ‘The main aim in making these decisions is to ensure that Essex cancer patients have access to high quality services that meet national requirements’”,
not local requirements. Local people want local services to meet local requirements. They do not want a national diktat.
I share the concern of my hon. Friend the Member for Billericay (Mr. Baron), who has said that cancer survival rates in this country are worse than those in Albania. That is a shocking statistic. While we must acknowledge that more people are being diagnosed with cancer, waiting times for surgery and radiotherapy have been getting longer. That is of tremendous concern to me. How will the merger improve survival rates, diagnosis and early detection? Any restructuring should ideally be about such things.
I have always been supportive of the Schumpeter principle that small is beautiful. On the proposed merger of the cancer networks that co-ordinate treatment in south Essex and mid-Anglia, my hon. Friend the Member for Rochford and Southend, East has said:
“It is important that south Essex keeps its cancer network as it is.”
Our shadow Health Minister, my hon. Friend the Member for Eddisbury (Mr. O'Brien), said that my hon. Friend the Member for Rochford and Southend, East made a cogent case on behalf of south Essex MPs about the cancer network and the appropriate size of the South Essex cancer care centre, considering local conditions. He added that he hoped that people at both national and local decision-making levels have taken due account of that strong and well made case. In that context, I find it difficult to understand why the Government are pursuing a merger that is unpopular, unnecessary and likely to be ineffective in meeting local patients’ needs.
3.32 pm
John Pugh (Southport) (LD): I congratulate the hon. Member for Rochford and Southend, East (James Duddridge) on securing the debate and on having introduced it in a reasoned and sensible fashion.
I labour under the disadvantage of not being familiar with Essex’s facilities, geography or history. Therefore, I shall confine myself to making some general remarks about cancer provision and the difficulties of locating it. In my youth, cancer was considered to be a certain death sentence and was discussed in hushed tones of horror. Now it is seen as treatable, curable and liveable with. There is no secret to that: there have been advances in knowledge, both scientific and among the public, and there has been early screening and detection, more sophisticated treatment and skilled intervention. For that reason, people will travel far to exercise their right to the best clinical outcome. The “best” often means the most specialised, because such units, by and large, have the best outcomes.
I shall draw a parallel with my constituency, although it does not resemble Essex in any way. There is sincere and justified outrage in it about accident and emergency facilities not being available for children, but my constituents travel, not with joy but with a degree of equanimity, to places such as Clatterbridge hospital. They go through Liverpool, cross the Mersey and through the Wirral because they know that Clatterbridge hospital has specialised, effective and very skilled treatment.
The National Institute for Health and Clinical Excellence argues that centres of excellence should have catchment areas that contain about 1 million people, though I note in passing the remarks made about the derogation; I assume that the Minister is in a position to respond to that. When people come up against that fact they immediately come up against two problems in any area. Where will the centres of excellence be? What can be done to minimise travel for all concerned?
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