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31 Oct 2006 : Column 65WH—continued
Health Service (East Sussex)
1.25 pm
Mr. Nigel Waterson (Eastbourne) (Con): I am most grateful for this slightly extended opportunity to discuss NHS reconfiguration in my part of the world and for another opportunity to register the very strong feelings locally on possible reductions in core services, not only at my local district general hospital in Eastbourne but at the Conquest hospital in Hastings, both of which are part of the East Sussex Hospitals NHS Trust. It is important to place my remarks in context. Although they are directed mainly at the Eastbourne situation, they are broadly designed also to make the case for all the people in outlying areas who depend on and look to the Eastbourne DGH, and for people in Hastings, who, rightly, feel equally strongly about retaining services there, too.
Not long ago we had a march—marches are becoming quite common along the south coast—with more than 5,000 people. That is quite an achievement in Eastbourne, which is not a place given to protest marches. There was a march of a similar size in Hastings. We have had some 30,000 signatures on a petition and some 20,000 visits to our campaign website. I receive daily letters, e-mails and telephone calls to my constituency office from local people who are concerned about what may happen to their local health service. With all due respect to the Minister, whom I am delighted to see in her place, we have also gone to the top of the food chain and had a meeting recently with the Prime Minister, who undertook to take on board our concerns and look into the matter. Perhaps the Minister can report today on whether prime ministerial interest has had an effect on subsequent developments.
It is important to stress that this is a cross-party and cross-community campaign. It involves not only me as the local MP, but the local Labour party, the Liberal Democrats, the Greens and a range of Churches and other community organisations. It is also important to stress that although there has been speculation about services being moved from one site to the other, as between Eastbourne and Hastings, our attitude has not been one of “beggar my neighbour”. We believe that broadly the same core services should be available to the communities in both Eastbourne and Hastings, not least because there are 21 miles of indifferent road connections between the two. However, this is not a transport debate, so I shall not worry the Minister by going into that issue on this occasion.
I should like to say a few words about the process thus far. In my view, it has been thoroughly unsatisfactory, lacking transparency, worrying local people and sapping morale among NHS staff. It is high time that Ministers and NHS bosses came clean about who is really making the decisions, on what basis and even whether crucial decisions to downgrade services have in fact already been made.
In addition, at the same time as the various discussions and meetings of what are called stakeholders in the NHS have been taking place, there has been a plethora of rumours, briefings and counter-briefings, mostly emanating from different parts of the NHS structure locally. All that is taking
place against a background of turbulence and change in the organisation of the NHS itself. It might almost have been designed to occur now to ensure, first, new and inexperienced non-executive directors and, secondly, new chief executives who have no local roots—possibly hand-picked to deliver a particular agenda.
Perhaps I can leap ahead and speculate on some of the things that the Minister will say in response to the debate. I am sure, for example, that she will say that no decisions have yet been taken. I attended yet another stakeholder meeting the other day, which got fairly rowdy as local people, as much as elected politicians such as me, expressed considerable disbelief in the suggestion that no decisions had been made and that everything was up for grabs. What seems to be happening, to use, again, the quaint language that seems to permeate the NHS nowadays—perhaps it always did; I do not know—is that what are called emerging scenarios are being presented. They seem to include reducing maternity services to one site rather than two; possibly downgrading accident and emergency at one or other, or both, sites; and changes affecting paediatrics.
It is clear that several parallel processes are going on at the same time. From minutes of meetings that have been held at the local NHS hospitals trust, and various board meetings, it is clear that the scenario that has emerged is what is called a “one-site solution” to maternity services. There is thus considerable scepticism about the assertion, oft-repeated by local officials in the NHS, that no decisions have yet been taken.
The second thing that I suspect the Minister will say is something to the effect that the south-east of England is living beyond its means—according to the Government’s figures we have a deficit of about£130 million or £140 million across the south-east region—and that that more or less equates to our being overfunded compared with other parts of the country. I do not want to get too much into the funding formulae; however, I have two or three points to make. Even if the figures are taken as given, for the start of the discussion, the Minister will, I think, be the first to concede that in the hospitals trust and primary care trust in my area there have been manful attempts—mostly successful—to reduce the deficits, and that any that remain are dwarfed by some of the deficits further up country, particularly in places such as Surrey. Lumping us all together in the south-east as having a big deficit is an unfair approach.
The so-called historic deficits also present an issue. It seems very unfair that new management teams and sets of non-executive directors are saddled with historic deficit figures. I put it to the Prime Minister when we met him that a system could surely be arrived at that would fairly reflect the deficits and the way in which they should be treated in the current situation. Perhaps if the management of a particular trust could, in a period of 12 months, show that it could run its services in balance according to the current formula, it could be allowed to turn the historic deficit into some sort of mortgage, repayable over 20 or 30 years. That is merely a suggestion, but it might be a fair way to deal with
historic deficits and efficient local management. I also believe very strongly that the funding formula itself, which was, of course, changed in 1998, needs to be more transparent and more obviously fair. We have the highest proportion of over-85-year-olds in the country—indeed, one of my constituents recently celebrated his 110th birthday—and that is not fully reflected in the funding formulae.
I am sure, thirdly, that the Minister will say that the changes are designed to improve patient care. Again, there is a great deal of scepticism about that. As recently as August 2004 a thorough clinical review by the trust concluded that maternity services should remain on both sites. What has changed in those two years? The local population has continued to grow. The birth rate has risen. Two respected consultants have said publicly that lives would be at risk if one site were shut down. The only thing that has changed is the financial position. It appears that Ministers want to save money and that the south-east is being singled out for cuts.
The leading consultants in obstetrics and gynaecology whom I just mentioned have both now left the local trust. One of them told me the other day that the Royal College of Obstetricians and Gynaecologists has a half-hour standard between the decision to perform a caesarean operation and carrying it out. There is no way that that half-hour standard could be met if the patient had to be taken from Eastbourne to Hastings or vice versa. There have been various attempts locally to call the royal college in aid in relation to a one-site solution for maternity, but it turns out that none of its visits or reports had anything to do with reconfiguration. Indeed, an interesting side product of one of its visits was some statistics, showing that contrary to what people had been assuming, which was that Hastings with its higher levels of social deprivation would have a higher level of difficult births, The reverse is true:
“Eastbourne has the higher induction of labour rate, caesarean rate and admission to SCBU rate.”
That flies in the face of some of the assumptions that seem wrongly to have been made by those in authority. There is evidence, if anything, of greater need in Eastbourne.
Fourthly, the Minister will no doubt say that the decisions will not be based on money. I say look at the 2004 report, and I ask again what has changed since then. We have also been hearing a lot about the European working time directive, as if it had been parachuted into the situation to everyone’s shock and surprise. Whatever the implications of that directive and of related court cases, it is the Government’s responsibility to ensure that there is a proper supply of junior doctors—and of consultants and midwives. If one were running a commercial organisation one would have to go out and recruit more people. In the end perhaps it all just comes back to money after all.
Fifthly, the Minister will say—I have heard her say it before—that decisions will be made locally. With all respect to her, that beggars belief, because the financial envelope, as it is called, will be determined by Ministers. There seems to be some confusion about decision making. The Minister has said that she believes decisions will be made locally. The Prime Minister seems to think that they will be made by the
strategic health authority. The chairman of my hospitals trust seems to think that decisions will be made by Ministers. I put the matter the other day, at a meeting that the Minister kindly organised, to Candy Morris, the chief executive of the strategic health authority. She made it very clear that decisions will be made by primary care trusts. I have already explained that we have new PCTs in our area, with new management, new chief executives and new non-executive directors. I am rather dubious about their ability, or their willingness, at such an early stage of their careers or lives, to make such decisions.
The hon. Member for Hastings and Rye (Michael Jabez Foster) subsequently asked, at the same meeting, what would happen if the PCTs decided that they were quite happy with existing arrangements and were prepared to continue supporting and funding them. The answer was a bit vague, but the question throws into sharp relief the issue of how a strategic view of health provision and need will be arrived at if each individual PCT will be making the decisions. There seems to be some doubt as to whether they can and will be taken at that sort of level?
I am sure that the Minister will seek to reassure me that decisions will not be taken on any political grounds. I stress that we in the campaign are not luddites. We understand that health provision must change to reflect medical advances and patient need, but life and death decisions for local communities such as that in Eastbourne must be based on clinical evidence and community need, not party politics. If they are not, there will be no limit to the anger of my constituents. I reiterate that we have a growing population, both a rising birth rate and a high proportion of over-85s at the other end of the scale, and an increasing need for the very core services that seem to be under threat.
We have heard a lot recently about so-called heat maps and meetings between Health Ministers and the chairman of the Labour party. Then, of course, we were reassured that the point of one such meeting was not what we thought and that it was simply a normal briefing. I am sure that the Minister will say something along those lines today. I hope that that is the case, but I shall leave the Chamber with one small anecdote. The other day, I was in the office of the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), having a constructive and productive meeting on osteoporosis and bone scanning. As my eyes wandered around his office, I noticed that over the desk where he sits there was a map of the country, which was broken down not by population, morbidity or death rates, but into blue, red and orange. I do not insinuate that that is one of the so-called heat maps that we have heard so much about; it may simply reflect his genuine interest in the psephological make-up of the United Kingdom. I really want to be reassured by the Minister, and to believe that these decisions will have nothing to do with politics, and so do my constituents.
1.42 pm
The Minister of State, Department of Health (Caroline Flint):
I congratulate the hon. Member for Eastbourne (Mr. Waterson) on securing the debate. I know that this matter is of great interest to him and his
constituents, and is of wider interest to other hon. Members who represent constituencies in East Sussex.
I take this opportunity to congratulate the staff in East Sussex for the hard work that they put into improving services. As in other parts of England, millions of people there are receiving high-quality and safe services every day, and are receiving treatment quicker than ever before. Also, there has been a willingness to consider what changes are needed to deal with the different demands on our health service compared with those 20 years ago. In East Sussex, for example, the community-based primary care trust’s falls team is now running clinics and exercise classes in Seaford, and will soon be doing so in Amberstone. The team is also running a “sloppy slipper” programme, which I am interested in. The programme has been used in other parts of the country, and has found that older people’s footwear contributes to unnecessary falls and, therefore, unnecessary discomfort, pain and admission to hospital. The programme involves going into residential care homes, in particular, and talking to staff and residents about their footwear. That rather common-sense approach contributes to people not having unnecessary falls.
Also in Eastbourne, the Firwood rehabilitation unit offers patients the choice of being treated there or at home. It also offers a full multi-disciplinary one-stop shop for many clients, and is gradually increasing the sessions available for different groups, such as people with multiple sclerosis.
The PCT also works with agencies such as social services, the local authority and voluntary agencies so that community initiatives can be delivered with a broader perspective. I understand that the William Daly centre, which is funded by health and social services and the local authority, provides day care and activities. There are also moves to involve the voluntary sector more widely. I am pleased that there is a willingness to discuss the different services that are needed for all the communities in East Sussex, including the hon. Gentleman’s.
Waiting times for in-patient treatment have fallen, and 98.8 per cent. of patients are now seen, diagnosed and treated within four hours of arriving at accident and emergency departments. In the hon. Gentleman’s constituency, Eastbourne Downs PCT, which has become part of the newly formed Sussex Downs and Weald PCT, has achieved those targets. No doubt, it will now want to work toward the 18-week maximum waiting time, which we hope to achieve in the next few years.
I am sure that it will interest the hon. Gentleman, as it does me, to know that although we are at record levels in terms of access to treatment, when the public are asked about what they would like to happen with waiting times, they certainly want them not to stay as they are, but to go down further. That is the public expectation, which fits with what the public was telling us through our White Paper, “Our health, our care, our say”, which committed the NHS to shifting more care into community settings and was based on what people were saying.
As technology advances and the recognition of the value of prevention takes hold more in our NHS, we have an opportunity to provide the sort of services that simply could not have been provided 20 years ago, such
as scans. For example, nurses are now able to perform procedures that they were not previously allowed to do and pharmacists play a role by providing services or working with others to provide necessary clinics. This summer, I worked with community matrons—I say worked, but really I was watching what they do in their expert fashion—and saw the difference that people in that sort of role can have in a community setting, through work with the hospitals in A and E clinics, and with respiratory nurses, social services and others to support people with long-term conditions. That sort of work helps such people to manage their conditions in their own homes, often with the support of their families, and to have better health.
In June, we announced that up to £750 million in capital will be available in the next five years to develop a range of different models for new community hospitals and services. We do not suggest that there is a one-size-fits-all approach, but think that every community has particular needs and challenges to address. What is appropriate in Eastbourne might be different from what is appropriate for other parts of Sussex or, for that matter, the rest of the country.
We have already refurbished or replaced 3,000 general practitioners’ premises, and will have built 750 new health centres by 2008. There will also be even more NHS one-stop centres and purpose-built facilities at which GP services are on the same site as pharmacies and social services. Providing that integrated approach is as important in urban settings as in rural areas, because it means that appropriate services can be provided and it brings together different health and other professionals, such as those in social services, to work in a more appropriate and accessible way to meet the needs of different communities.
It is also important to make better use of new and improved surgical techniques. For certain operations that would, years ago, have required a stay in hospital of a week to 10 days, that is often no longer the case, thank goodness. New drugs and more effective treatments are driving the changes in the NHS, but clinical issues and patient safety are paramount. That provides a challenge, particularly for clinicians, who will often be engaged in challenging discussions, and who recognise the need for change. However, they do not necessarily always agree, as a group, about the shape of those changes or where services should be. That is nothing to do with politicians; it is to do with clinicians recognising what is in the interests of patient safety and the delivery of treatment. As with any group of people, they may have different views on where treatment should be provided.
We are trying to address the changing shape of the NHS and how it can deliver. I shall give some examples of what is happening in East Sussex. I understand that the East Sussex trust has about 64 patients in acute beds who no longer need acute services but cannot be moved to other settings, presumably because they have not been developed. I am pleased to say that that figure has fallen from around 74 in May, although all parties involved accept that it is still too high. An active discussion is under way, and the then Surrey and Sussex SHA and the Commission for Social Care Inspection commissioned the Audit Commission in
spring this year to review the problems with delayed discharges and create a joint action plan to address it and promote better services for older people in East Sussex. Again, therefore, there is a recognition that more needs to be done.
In addition, the Chronic Obstructive Pulmonary Disease Service will provide and facilitate rapid response, prevention of admission, case management and pulmonary rehabilitation. That will help better to co-ordinate and manage community, primary and acute hospital care and improve the service to individuals. Yes, that will also reduce emergency admissions, but I am sure that the hon. Gentleman will agree that it is far better to have a better prevention service than it is for someone to reach such a critical point that they must be admitted to hospital.
Heart failure services are also working in partnership with primary, community and acute hospital care and paralleling the work that is being done on respiratory disease, which means that people will be prevented from dying too soon. It is fair to say that people with such conditions have often ended up in such an acute state that hospital has been the only option. Many of them will, I hope, have had the treatment that they needed, and their lives will have been saved, but it is clear from clinicians that doing more to prevent the onset of acute episodes would contribute to such people’s quality and length of life.
Likewise, on ambulance services, paramedics are now being trained to act as emergency care practitioners—generic practitioners who respond as part of the ambulance service and who can diagnose and treat a person or refer them to an appropriate professional service. Although I accept the hon. Gentleman’s point that timings for delivery to acute services by the ambulance service will have to be carefully considered, it is also important to recognise that emergency care practitioners can begin treatment at the point of contact, which will play an important part in giving people the best chance of survival.
Mr. Waterson: Does the Minister accept, however, that in my correspondence with her about reconfiguration, the chief executive of the ambulance service has expressed considerable concern about the extra strains that a so-called one-site solution to maternity, for example, would put on the service? Will she also comment on the royal college’s half-hour standard for caesarean operations?
Caroline Flint: I was coming to maternity services. The Government’s vision—again, this is based on what women have been saying—is that women should have a choice about where their child is delivered. Our ambition over the next few years is that we will be able not only to support high-quality maternity services in a hospital setting, but to give women the opportunity to use birthing units and have home births. Women are saying that they want those choices available to them, and reconfiguration gives local managers the chance to see whether local services are fit and able to deliver those choices and the care that goes with them in different locations.
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