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10 May 2006 : Column 124WH—continued
On the “where”, everybody would ideally want the specialised unit—in fact, every such unit—to be in their town. We know that that is not possible, so a decision must be made. There have been many complaints from the Members who represent Essex constituencies about how the decision was made and the calibre of that decision making. Such a decision should be made openly, in an unbiased fashion and on agreed criteria. Although I accept what hon. Members said about the strategic health authority’s decision-making process, I
note from its website that it publishes seemingly objective criteria, and one can consider the outcome.
I share the feeling about consultation in the NHS. It is normally dire, formal and pretty unproductive, and it normally results in what the authorities had already thought of. Perhaps someone can clarify the matter, but I see that one or two earlier options were dropped during the consultation process. The website states that option this or option that were considered during the informal process but were abandoned. It may have led to the inevitable result, but it was not simply a rubber-stamping process—unless, of course, that was the initial intention.
We know that the results of such a process will not be universally liked. However, there should be a degree of professional and public support. I am concerned that, as Essex Members have pointed out, the merger does not seem to have professional support, any more than it has the support of the public.
In areas other than Essex, such decisions are not so contentious, largely because they have centres of clinical excellence with form and an established reputation, and there are often clear candidates for specialisms. Even then, conflicts can sometimes be caused by regional loyalties. For instance, large centres of population or even centres of excellence might be on the periphery of a region, which can create additional travelling difficulties. In fact, change always creates difficulties. People do not normally welcome change in their local health facilities, and the matter is complicated if a degree of political rivalry is added.
The second problem that dogs the idea of centres of excellence is that of travel. It is recognised that although some treatments need to be undertaken in centres of excellence, many do not. Out-patient appointments, diagnostic processes, check-ups and even chemotherapy can take place elsewhere in the clinical network, and somewhere nearer home. That is justified; it is a serious attempt to minimise patient travel and the cost to patients and relatives. Patients like their relatives to be with them, because cancer is intrinsically an extremely stressful process, and they need the support of the family and the wider community.
Networks need to be designed properly, and consultation is part of the process. It should be genuine to get the fit absolutely right. Things can be blown apart if factors other than clinical matters are taken into consideration, such as administration or finance. I wonder how the Government’s drive for all NHS facilities to have a degree of financial independence and autonomy will fit with the drive for effective and decent clinical networks for cancer or for anything else.
The Government’s strategy is not wrong in principle, and the Minister will, I am sure, say that we should be alert to the commendable results in cancer treatment. I am not certain that they have the template right for Essex. I can pass no judgment on that. I have listened to what other hon. Members have said, but I am not in a position to judge. However, it is possible to get it right with adequate consultation and the adequate sharing of appropriate evidence. My fear is that administrative, financial and other considerations may prevent a good template from emerging for Essex.
3.38 pm
Mr. John Baron (Billericay) (Con): I, too, congratulate my hon. Friend the Member for Rochford and Southend, East (James Duddridge) on introducing the debate, on the comprehensive, thorough and incisive way in which he introduced it, and on his campaign to prevent the merger of the South Essex and Mid Anglia cancer networks. I also commend him for his excellent and heartfelt contribution. I hope that the Minister takes the time—I shall ensure that she has the time—to answer the points that have been raised.
We know that cancer networks have played an important role in developing cancer services since their inception 10 years ago, following the Calman Hine report commissioned by the last Conservative Administration. The proposed merger is important, as it would create a new organisation covering a population of approximately 1.4 million. I am sure that the Minister is aware of that. Although such a change relates primarily to the management and administrative arrangements for planning cancer services, I hope that from the heartfelt contributions to this debate she appreciates the real concern that the needs of south Essex will be overlooked by a larger and more remote network. She should not take that concern lightly.
In Essex as a whole we have had a spate of reorganisations of services, including those relating to PCTs, SHAs, the ambulance service and cancer networks. The common theme seems to have been a desire to create ever-larger, more regional organisations. The concern for many people, as expressed in the debate, is that those structures will become more remote and less responsive to the needs of local residents. I do not believe that that concern is fully appreciated by those making such decisions.
In my constituency, for example, people were particularly vexed about the proposal to scrap Essex police and our local PCTs, and we campaigned accordingly. Given the importance of Southend hospital to the structure of the South Essex cancer network, my hon. Friends are rightly continuing to raise their concerns about the cancer reorganisation. They have made the case against the merger in detail, but I want to highlight one or two points in the hope that they will be addressed by the Minister when she winds up.
Will the Minister explain why a merger of cancer networks is so vital in the east of England at this time? As she heard from almost every contribution, South Essex cancer network has a good reputation—an excellent reputation, in fact—for planning and commissioning cancer services. Naturally, there is confusion about why arrangements are now being thrown up in the air. If the argument is about population size and the need for networks to correspond to areas of between about 1 million and2 million people, what does the Minister make of the point—made on several occasions—that was conceded by the cancer tsar Mike Richards four years ago when he said that due to its age profile and areas of relative deprivation, the cancer case load in south Essex at least makes up for the shortfall in population?
During the past four years, the population in south Essex has probably grown faster than most other areas, which raises the question of why we have to tinker with
the current arrangement at all when it works so well. If the Minister has formed a different opinion, perhaps she could explain to us on what evidence she has done so because it is not clear to my hon. Friends why that should be the case. They have made a powerful argument to keep things as they are.
What is more, the small population of the Mid Anglia cancer network seems to have been brought about by the withdrawal of Ipswich, a decision taken by Norfolk, Suffolk and Cambridgeshire SHA. It seems somewhat unfair, to put it mildly, that south Essex should effectively lose its cancer network on account of a decision taken by a different health authority, a point made by several of my hon. Friends.
Another concern is that current patient flows do not argue in favour of an enlarged network. Consultants in south Essex are not in the habit of referring patients to centres further afield, and I have seen no evidence of any sudden, recent, increased desire to do so. It simply does not exist. In those cases where patients will have to travel further for treatment as a result of the merger, what financial assistance is the Government going to provide for their travel costs, given that cancer treatment often involves a number of visits to hospitals or other centres? The point has been raised before, but the Minister would do well to dwell on it because, in some cases, we are talking about quite increased distances of travel. That should receive urgent consideration.
There is naturally a degree of confusion about the motivation for the change. It appears that the SHA is putting a desire for administrative neatness, and reorganisation for reorganisation’s sake, over and above the concerns of local people. I would reiterate one point to the Minister. The consultation on the merger appears to have been inadequate, lasting only a few months and ignoring strong opposition from my hon. Friends, councillors, hospitals and many residents, including the 5,000 who signed the petition. To many, it appears to have been a sham, designed to give a veneer of credibility to a decision that had already been made, without reference to people’s concerns. That comes on top of many other consultations, such as those on primary care trusts, strategic health authorities and police reorganisations, which have led to a growing view that people’s concerns are not addressed.
Mr. Baron: As my hon. Friend says, the feeling is that residents’ concerns are ignored.
As I mentioned, in my part of the county people were particularly vexed at the thought of losing their local PCTs. However, despite the concerns expressed by those PCTs, the local MPs—both Labour and Tory—and many residents, our views were ignored and the original proposal, chosen prior to the consultation, was taken up. Such fig-leaf consultations have sorely tested the patience of people in south Essex. The consultation that we are concerned with in this debate seems to be yet another example of that.
The SHA does not even have the support of the South Essex cancer network for the proposal. The network has argued that a merger runs the risk of compromising the clinical cohesiveness and ownership
in the region. Much progress has been made recently on implementing the national cancer plan and improving services in the community. The network is understandably wary of accommodating the challenges and difficulties of the Mid Anglia cancer network because the people who will suffer if it goes wrong will be the patients.
I would welcome the Minister’s explanation of why the merger is going ahead. She will notice that I have given her additional time to respond, in the hope that she will be generous, both in dealing with the concerns raised by my hon. Friends, and in taking their interventions.
3.46 pm
The Minister of State, Department of Health(Ms Rosie Winterton): I add my congratulations to those that have been offered to the hon. Member for Rochford and Southend, East (James Duddridge) on securing the debate. As hon. Members said, he put his case eloquently on behalf of his constituents. There were some extremely relevant contributions, including the remarks of the hon. Member for Southend, West (Mr. Amess) about the excellent work of the hospice movement.
The hon. Member for Castle Point (Bob Spink) talked about the success of staff in his area in meeting targets. I, too, want to thank and congratulate the dedicated and committed staff in the area, who have achieved massive changes to mortality rates, among other things, thanks to extra investment, which has led to increased staffing. Of course, increased investment is nothing without strong input from the staff and a willingness to embrace some of the changes.
I want to respond to several issues that were raised by, for example, the hon. Member for Rayleigh (Mr. Francois), particularly with respect to the comments made by Mike Richards, and the evidence on some of the changes that have been made. The hon. Member for Braintree (Mr. Newmark) asked how the changes would fit with other services. I hope to touch on that too. The hon. Member for Southport (John Pugh) acknowledged that specialist treatment is an important consideration in the wider debate, and talked about how to deal with the fact that not every service can be available in every hospital. Those are some of the issues that we must grasp. The hon. Member for Billericay (Mr. Baron) spoke from the Front Bench about travel costs—I shall refer to that—and about the point that was made by Mike Richards.
As I said, we approach the subject against a background of improvements in the treatment of cancer. That is clear when we consider the situation in Essex, where there is an increased number of cancer consultants, diagnostic radiography staff and therapeutic radiography staff. That has made real changes to the way in which cancer care is delivered. However, it is also important to recognise that many of the improvements took place because of the establishment of cancer networks, which started a number of years ago.
We have to be absolutely clear what we are talking about when we consider cancer networks. They are about professionals, patient representatives and other organisations, perhaps from the voluntary sector—
hon. Members referred to the work of Macmillan nurses in their areas—getting together and considering how services can best be delivered over a whole area. It is important that we take note of how that local delivery is considered to be best shaped. In my area, there are often intense arguments about whether a service should be moved from one trust to another, and local people often deeply resent services being changed, but we also have to recognise—this is a crucial part of the debate, and a number of hon. Members raised the point—the evidence on whether the population coverage for specialist treatments and centres makes a difference.
I challenge many of the assertions made by Opposition Members about there being no evidence. There is evidence from the improved outcomes guidance and other national guidance which shows that when it comes to treating some specialist cancers, it is important to have a larger population. We are talking not about just providing a convenient service, but about saving lives. The evidence is very clear: it is obvious that if people, particularly consultants, do not see a certain number of patients every year with those specialist cancers, they cannot be expected to have as great an expertise in them. There is very clear evidence, and we should accept that.
Hon. Members talked about south Essex and their constituents, but it is important that we think wider than that, because Members of Parliament have a responsibility for all members of the public, who are all possible patients, and who may be affected by decisions that we make.
James Duddridge: I agree that there is a case for saying that bigger is better for some very specialist cancers. There is some evidence for that, in terms of evaluating specifically upper GI, gynaecological, urological and head and neck cancers. I know that there is a debate about those. However, we are saying that absolutely no evidence has been put before us to show a statistical correlation between larger cancer networks and better clinical outcomes. We are talking about network sizes, not specific cancers. Those specific cancers relate to only 20 or 30 people; we are talking about 3,500 people who are affected in south Essex.
Ms Winterton: But we are talking about the ability of a network to plan for a specific population base, and that is where the statistics and the evidence come into it. I absolutely understand what the hon. Gentleman says about Southend cancer centre, and this is no slur at all on its ability—I will come to that—but we are talking about the ability of a wider cancer network to make plans.
I will not go into great detail on the reason for the consultation, because that has already been stated—it is the withdrawal of east Suffolk from the Mid Anglia cancer network. However, I want to address some of
the points that were made. It is worth noting that all other clinical networks in Essex—cardiac, neonatal, critical care, pathology and neurosciences—are configured on an Essex-wide basis. That is important in terms not only of achieving outcomes, but of providing a stable foundation for those who enter the medical profession. For example, it is important that networks can provide a proper population base and a high level of expertise to ensure that consultants who want to specialise in a chosen field develop professionally.
I also want to give some reassurance. Essex SHA is not planning to close the cancer centre in Southend. Indeed, the position is quite the opposite, and the SHA is committed to supporting a thriving cancer centre in Southend. That includes the provision of out-patient care, diagnostic tests, chemotherapy, radiotherapy, palliative care and some specialist surgery. The only services to be moved from Southend to Chelmsford will be those for people with head and neck cancers. That move has the overwhelming support of senior clinical staff and will affect approximately 20 to 30 people a year in Southend. It will mean that patients who must have surgery for those less common cancers will have access under one roof to consultants and surgeons who are experts in oral and maxillofacial surgery, ear, nose and throat, and plastic surgery. Ultimately, it makes sense for those services to be together, because those cancers might require other treatments, such as plastic surgery. There is also the question of whether people will have to travel and whether their expenses would be covered. That is addressed by the hospital costs travel scheme, and people below a certain income level would qualify for that. Those are the only changes that will be made.
It is important to stress that there are no plans to downgrade services at Southend hospital. Indeed, as many hon. Members said, services have increased, and the hospital is now a cancer centre for south Essex, providing neurological and gynaecological cancer surgery services. Yesterday, I met Dr. Paul Watson, the medical director of Essex SHA, who assured me that there are no plans to reduce any other services currently offered at Southend hospital, and I understand that he has said that publicly.
Finally, the issue of Mike Richards’s last visit to the area was raised. There was no derogation that he would have given in those circumstances, although he obviously gave some advice. I shall not ask him to overturn a decision that has been made on very reasonable grounds, and I stress again that we are talking about saving lives in many instances. However, I shall ask him to look at the operational framework, which is due to be introduced in October, so that we can reassure hon. Members that the changes have fitted in exactly with what I have said.
I hope that that gives hon. Members some comfort. As I said, I am not asking Mike Richards to overturn the decision, but I would like him to look at the operational plans to ensure that the decision will improve services in the local area, and I would like them to be reassured of that.
Identity Card Scheme
4 pm
Jo Swinson (East Dunbartonshire) (LD): I am glad to have secured this debate on an important matter, especially as the Identity Cards Bill received Royal Assent on 30 March.
ID cards are a controversial topic. The Government were defeated five times in the other place before the legislation finally passed after the Government’s concession to delay the scheme until 2009. Public support for ID cards is falling sharply, from about80 per cent. in 2003 to just under 50 per cent. today.
The public are concerned about the introduction of identity cards for many reasons. There are real fears about the erosion of civil liberties and much confusion about what problem ID cards are supposed to solve. The suggestion that they will somehow prevent terrorism stands up to no scrutiny when the 9/11 and Madrid bombers held valid ID and the Home Office admitted that ID cards would have done nothing to prevent the7 July bombings last year in London.
Today I would like to focus on another cause of concern, which is the cost of the ID card scheme. The debate is set against the backdrop of a six-month countdown that started when the Bill received Royal Assent, and as each day passes until 30 September we come closer to the date on which the Government will have to reveal to Parliament the estimated likely cost of the identity card scheme over the next 10 years. How that will work in practice with 30 September falling on a Saturday during recess, I am yet to discover, but I am sure that many of my party colleagues are looking forward to receiving the report. It will hopefully contain more information about the cost of the scheme and with any luck we might get some information from the Minister today.
Back in 2002 initial Government proposals suggested that an entitlement card scheme would cost £1.3 billion over a period of 13 years, which would include the three years that it would take to set up the necessary systems and the 10 years in which the first cards would be valid. In November 2003, the then Home Secretary made a statement in the House in which he stated that the cost of an ID card would be £35. That changed again and by April 2005 the Government estimated that the cost of an ID card would be £15 with a fee of £85 for a joint passport and ID card application. However, that figure changed once again after the Identity Cards Bill was introduced after the general election a year ago.
The previous Minister, now Minister of State in the Department of Health, the hon. Member for Leigh (Andy Burnham), stated in the Identity Cards Bill debate on 13 February that the cost of a stand-alone ID card would be £30 and the cost of a biometric passport £63, so the combined cost would be £93. It could be argued that the number is only valid for the first year of the scheme, which will not be up and running until 2009.
Mark Williams (Ceredigion) (LD) rose—
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