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Tim Farron (Westmorland and Lonsdale) (LD): I am grateful for the opportunity to address the House on the future of the coronary care unit at Westmorland general hospital in Kendal in my constituency. The unit is under severe threat of closure. The board of the University Hospitals of Morecambe Bay NHS Trust recently launched a public consultation on the future of Westmorland general hospital. The trust presented four options, all of which would leave Westmorland general with acute medical services cut and reduced hospital beds, and three of those options would lead to the closure of the excellent coronary care unit.
It seems clear that the options presented, with the exception of the unspoken fifth optionto maintain the status quoall threaten patient safety in the south Lakeland area, so I seek the Ministers assistance in securing the future of Westmorland general hospital in the interests of local people and of the hundreds of thousands of tourists who pass through the area every year.
The trust states that the proposed closures are a result of a £6.3 million deficit in its budget and the subsequent need to achieve cost savings. I sympathise with the trust in that respect, but I am reminded of the Secretary of States repeated undertakings that, in the process of trusts moving to balance their books, there would be no threat to patient safety. For example, on 7 June, the Secretary of State said:
Ive always been clear that there should be no trade-off between high quality patient care and actions to improve financial management.
People in my constituency who have a suspected heart attack or another acute condition such as a stroke will normally be transported by ambulance to Westmorland general hospital in Kendal. Should emergency admissions close at Kendal, the next nearest hospitals are in Lancaster and Barrow. Closure of the Kendal unit would lead to a significant increase in travelling times for people with acute conditions before they can be stabilised in hospital. It has been said that paramedics could stabilise patients with acute conditions in a similar way to doctors in hospitals, but that argument is erroneous. As the Minister knows, paramedics have a limited protocol for the administration of clot-busting drugsin about 90 per cent. of cases, paramedics cannot administer life-saving clot busters and must concentrate on getting the patient to hospital safely and as soon as possible.
My constituency is large and rural. It includes parts of the Lake district and the Yorkshire dales and the rest of the south Lakeland area. The prospect of getting a patient with a suspected heart attack from Grasmere or Garsdale to Lancaster instead of to Kendal fills me and thousands of my constituents with incredulity and dread. I have spoken to many heart patients, health professionals and others who tell me that the additional journey time to Lancaster or Barrow would significantly threaten
patient safety. The Minister will be well aware of the golden hour within which patients with acute conditions must be stabilised in order to give them the best chance of survival. Three quarters of my constituency lies more than an hours drive to Lancaster or Barrow, and that does not include the length of time for an ambulance to get to a call-out in a remote rural area.
Although the local ambulance service is excellent, it already struggles to meet target call-out times and depends upon dozens of excellent first responder groups around south Cumbria to provide on-the-spot assistance to people with acute conditions in advance of the arrival of the ambulance. The coronary care unit at Westmorland general hospital is excellent and has committed, talented staff and a track record that is second to none in our area. As one might expect in a large trust area, each of the three hospitalsLancaster, Barrow and Westmorland generalhas a coronary care unit. Of the three, Westmorland general at Kendal has the record for the quickest door-to-needle time: the administration of clot-busting drugs to patients in the shortest and safest period following their arrival in hospital. In addition, 75 per cent. of patients reach Westmorland general hospital within acceptable time limits, which is the same figure as the hospital in Lancaster, but there is no doubt that that figure will drop significantly if patients are transported further in the event that the Kendal unit closes.
It hardly takes an expert in geography or transport movement to work out that the closure of the Kendal unit would make it impossible for people in south Lakeland to get to Lancaster within current target times. I cannot stress too strongly that the longer the time before the administration of crucial clot-busting drugs, which, in most cases, cannot be done in an ambulance and must be done at hospital, the greater the permanent damage to the heart and the greater risk to patient survival. That brings me to a crucial pointthe additional pressure that will be placed on the ambulance trust as a result of any reduction of services at Westmorland general hospital.
Earlier this year, the Secretary of State kindly met me and the hon. Members for Lancaster and Wyre (Mr. Wallace) and for Morecambe and Lunesdale (Geraldine Smith) to discuss NHS services in Morecambe bay. At that meeting, in response to a question on a separate matter, the Secretary of State remarked upon the senselessness of one part of the NHS making savings by shifting additional cost burdens on to another part of the NHS, yet that very situation will be encountered should emergency medical services be removed or reduced at Westmorland General hospital. The knock-on effect will be an increase in ambulance journeys across a county boundary and an increase in the pressure placed upon paramedics as they attempt to keep patients going for much longer periods of time on journeys of up to twice current lengths.
Just as the hospital trust has not released any details relating to the money that it hopes to save as a result of the various options to downgrade our hospital, neither has there been any assessment of the likely additional costs that our local ambulance trust will incur as a direct consequence of the downgrading. How can it be right to allow one NHS trust to move towards balancing
its budget by placing additional financial difficulties at the door of another trust at the expense of public safety?
Good use of public money is a major consideration in the Governments efforts to tackle the problem of NHS deficits. The Minister will therefore be concerned to hear that, just three years ago, a state-of-the-art cardiac catheterisation lab was built at Westmorland general hospital at a cost of more than £2 million. That lab would in all probability be forced to close were there not a coronary care unit on site to support its work. This is tangible evidence that Government investment in the NHS will be wiped away as a result of the trusts current proposals.
University Hospitals of Morecambe Bay NHS Trust serves a population of 320,000 people. Most trusts of that size are urban or suburban in nature and have one large hospital. In our area, we have two district general hospitals at Lancaster and Barrow and a major third hospital, Westmorland general, in Kendal. The cost of operating three hospitals as opposed to one is vastcomfortably more than the size of the trusts deficit, and perhaps more than twice that amount. The Minister will be aware that no meaningful element of the funding formula even remotely addresses the huge additional cost of operating health services in a rural area such as ours.
Let me reiterate how important it is that the Morecambe bay trust area retains three hospitals. There are 80,000 people in my constituency and, in addition, hundreds of thousands of tourists all year round, no doubt including many Members of this House from time to time. The overwhelming majority of those people live or stay in places where it is simply not possible to get to hospital in Lancaster or Barrow in a safe period of time. To each of those people, the threat to close Westmorland general hospital to acute admissions and, in particular, those with suspected strokes or heart attacks is a threat to their safety and an unacceptable escalation of risk. I ask the Minister to conduct an urgent review of funding for trusts covering rural areas to take account of their actual spending needs and to ensure that they are not forced into proposing unsafe options for local health care.
In each of the options presented by the hospitals trust, Westmorland general hospital loses beds, acute admissions wards and rehabilitation wards, as well as the capacity to deal with, for example, suspected stroke patients or patients with diabetic emergencies. In all but one of the options, it loses the excellent coronary care unit. In each case, that would threaten the safety of local people and tourists and cause additional anguish and distress for patients, particularly older people, who would have to be treated a long way from their homes, making it much more difficult, and sometimes impossible, for them to receive visitors.
What is more, there are no plans significantly to increase capacity at Barrow or Lancaster. Given that there is already huge pressure on beds and resources at both those hospitals, it is inevitable that the quality of provision will suffer as a result of these cuts. The unspoken fear is that that downgrading of services across our area, particularly at Kendal, threatens Westmorland general hospitals very survival. Some have made the disingenuous case that it is no place for emergency medical cases because of the Royal College
of Physicians general advice that consultants should not be on call at more than one hospital site. However, given that consultants are on site at Kendal almost every day anyway and that, in rural areas, proximity to the population is an even greater consideration when thinking about patient safety, it seems clear that the Royal College of Physicians would not wish to undermine the viability of vital emergency services in rural areas and that its advice is taken out of context in this respect.
I hope that the Minister will take urgent steps to prevent the downgrading of Westmorland general hospital, because the options proposed by the trust and their knock-on effects would be contrary to the Secretary of States promise that none of the savings being made by trusts should lead to patients suffering a reduction in service. In seeking ways to enable the trust to present acceptable options, she may wish to consider the fact that the local strategic health authority has announced a surplus of £33 million and that a small amount of that surplus could be used to take the pressure off Morecambe bay to prevent it from making damaging decisions that threaten patient safety.
In January, I joined more than 2,000 constituents in a march through Kendal in protest at the primary care trusts plans to close mental health wards at Westmorland general. That campaign was broadly successful, as adult mental health services have since been saved. My constituents and I are resolute in our support of our local hospital. We have not developed campaign fatigue since that victory and we are now engaged in another campaign to save local services.
I am truly grateful for the opportunity to speak, because the debate could not have come at a more crucial time for my constituency. The Minister will be pleased to hear that I have no appetite for point scoring, finger jabbing or making accusations. My purpose is to seek her help in preserving the future of emergency medical admissions at Westmorland general hospital.
A familiar and sobering sight in my constituency, especially in the summer months, is the helicopter air ambulance flying to rescue injured people on the fells and lift them to hospital for emergency treatment. I cannot help thinking that, if relatively small financial pressures are allowed to lead to the closure of Kendal hospital to acute medical admissions, those who meet calamity on the fells and are rescued by helicopter will be in a much less perilous position than residents of the lakes and dales and the rest of south Lakeland who suffer a heart attack or a stroke, whose lives will hang in the balance on a journey of an hour and a half along tourist-clogged country lanes to the nearest hospital.
The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing the debate. His speech reflected his strong feelings on the matter. I also pay tribute to all the national health service staff in Cumbria and Lancashire who have made great progress in improving the local NHS.
Before moving to the hon. Gentlemans specific points, it is worth taking a few moments to reflect on the changes in his constituency in recent years. I am sure
that he will join me in acknowledging the significant funding increases to the NHS. In the allocation round that covers 2003-06, Morecambe Bay primary care trust received a cash increase of £76.7 million or 28.7 per cent. Further cash increases of £66.2 million or 17.8 per cent. will follow over the two-year period to 2007-08.
Overall, the Cumbria and Lancashire strategic health authority has seen the benefit of extra funding since 1997, with 180 more consultants, 2,200 more nurses and 1,500 more health care assistants. That translates into, for example, reductions in waiting times. In the SHA, the number of people waiting more than 26 weeks for in-patient treatment has fallen to 16, and no one waits more than 13 weeks for out-patient treatment.
That is genuine progress, which has much to do with the dedication and commitment of local staff. However, alongside record investment, it is important that the health service continues to reform to deliver the NHS that we all want in the 21st century. As part of the programme of modernisation and reform, many NHS organisations are considering, with local stakeholders, changes to the way in which they organise their services. I am sure that the hon. Gentleman agrees that it is important for hospital and community services to adapt if we are to continue to meet patients needs and improve access to services.
The hon. Gentleman spoke specifically about the future of coronary care at Westmorland general hospital, which is part of the University Hospitals of Morecambe Bay NHS Trust. The trust admits acute surgical patients at Lancaster and Barrow and acute medical patients at all three sites, although more critical patients are transferred from Westmorland to Lancaster for treatment.
The coronary care unit at Kendal has four beds and provides care for patients with acute coronary problems. Last year, it treated 514 patients. Cardiac rehabilitation services are also provided there, as well as in Lancaster and Barrow.
I would not question the hard work of the local staff, but the trust has identified strong clinical and financial reasons why the current pattern of acute medical servicesincluding the cardiac care unitneeds to be reviewed. On the clinical front, the overriding consideration has to be patient safety. Consultant physicians at Westmorland have raised concerns about the admission of acute medical patients to the hospital and their management on several occasions. I realise that the hon. Gentleman questions this, but the Royal College of Physicians has issued guidance on the minimum resources, both human and capital, required to run such a unit. This guidance presents a real challenge to the trusts present pattern of service provision.
On the financial front, the trust ended the last financial year with a £6.3 million deficit, and needs to deliver cost savings of more than £11 million in this financial year. The trust has also identified the fact that it has higher than average costs for its emergency activity, in part due to the additional costs of providing a service over three sites.
These are genuine and pressing challenges for the trust, and it needs to take a rigorous look at how it provides its services. That is quite the right approach to take. Together with Morecambe Bay PCT, the trust has
reviewed the provision of its acute medical services across all three sites. The review aimed to improve the management of patient flows, the patient journey, operational management and bed usage, and was conducted in the context of national best practice and policy requirements.
The hon. Gentleman will be aware that the pre-consultation stage of the review has recently ended. That stage explained the background to the service review and gathered the views of the public, external stakeholders and staff. A hospital services review steering group, chaired by the trusts medical director, has assessed responses to the exercise. Four models for acute medical services have been identified and the public consultation document on the acute medical review will be published tomorrow. The formal consultation on the four models will run until 13 September.
I am aware that the hon. Gentlemans concern centres on the future of acute services at Westmorland general hospital, and especially on the coronary care unit. Under the four options identified following the service review, the number of medical beds at Westmorland could be as few as zero or as many as 50. The hon. Gentleman will also be aware that one of the options includes the retention of the coronary care unit at Westmorland general hospital.
The hon. Gentleman raised the issue of the possible closure of the laboratory. As I understand it, even if the coronary care unit were to close, the laboratory would not necessarily close. The review is looking into the overall provision of laboratory services in the area. He also described very graphically the impact that the possible closure of the coronary care unit in Kendal might have on the local ambulance service. I hope that I can assure him that the ambulance service is part of the acute service review steering group, and that the potential impact on the ambulance service of any changes to service provision, including to the coronary care unit, will be thoroughly explored.
It is important to stress that at this stage no decisions have been made on the service redesign, and none will be made until the outcomes of the formal consultation are known. Following the end of the consultation period, the local NHS is responsible for reaching a decision on how to proceed. The final decision will be considered by the local authoritys health overview and scrutiny committee, which has the right to refer any decision to the Secretary of State for Health if it contests a substantial change in health services on grounds of inadequate consultation or the merits of the proposal. I hope the hon. Gentleman will appreciate that as there is a possibility that the matter may ultimately be referred to the Secretary of State, it is not appropriate for me to comment on the proposals for future configuration of acute medical services provided by the trust.
The hon. Gentleman said that the strategic health authority had a £33 million surplus. That is not correct. It was an estimate of the financial position, but following a redistribution of resources, the money is no longer available.
The hon. Gentleman also commented on the way in which allocations are made to primary care trusts and, in particular, to rural areas. Funds are allocated to PCTs on the basis of the relative needs of their populations.
A weighted capitation formula is used to determine each PCTs share of the available resources to allow the commissioning of similar levels of health services for populations with similar needs. The components of the formula are used to weight each PCTs crude population according to the relative need for health care, and in the light of unavoidable geographical differences in the cost of providing health care.
The Advisory Committee on Resource Allocation has considered the rurality issue on a number of occasions. As a result, the allocation formula used in 2003-04 and in the 2006-08 allocations provides the best available measure of health need in all areas. In
calculating heath need in rural areas, it takes account of the effects of access, transport and poverty.
Let me end by congratulating the hon. Gentleman again, but also by encouraging him to continue to discuss what is best for services with the local NHS. I am sure that he and his constituents will make their views on the final proposals known through the consultation exercise. It is important that we have consultation procedures that are reviewed and managed properly, but there are local avenues as well.