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I was in a brand new local improvement finance trust centreor LIFT centrein Leeds on Friday, talking about the dermatology service, which has been brought from the acute trust into the local community, where the consultant is working extremely closely with a GP with a special interest. They are treating far more patients at that level who would previously have had to go to hospital for an out-patient appointment. Much more is being done in the community, which also means that consultants time is used to much greater effect, because they do not see patients whom they perhaps do not need to. The new arrangement also
ensures that NHS resource is used more appropriately, through a more streamlined pathway. That is the evidence that is being gathered now on the change to services.
I met a group of patients who are benefiting from that service, all of whom said that the care provided by the LIFT centre was much more convenient and that it made sense for them. The old system, under which they had to have an out-patient appointment at the hospital, led to days off work and disruption, whereas they now have a much better service all round, working with specialists.
James Brokenshire (Hornchurch) (Con): The Minister highlighted the change in how services may be provided, and in particular the emphasis on primary care and the LIFT initiatives. Does he accept, however, that the proposed reconfigurations are due to take place in the near term, even though the primary care facilities might not be in place to meet the demand? Indeed, we have a number of LIFT buildings in my area that, sadly, lie empty, because no GPs have moved in to deliver the services and take up the demand.
Andy Burnham: The hon. Gentleman makes a reasonable and fair point, and I agree with him. Before such steps are considered, it is important that proper capacity should be developed on the ground. In areas where there have been substantial LIFT schemes, I would argue that there is that capacity. What is required is a change in culture and thinking, possibly with hospital-based consultants bringing services out to the patient and perhaps providing them to an even higher standard, because the patient will be treated closer to home, which is a good thing in itself. In many parts of the country, there is the potential to start to bring services out.
To pick up on something encouraging in what the hon. Gentleman said, the Conservative party has to move out of its position of knee-jerk opposition to change in the health service, which is not a sustainable intellectual position, given the change that is happening in medicine. In their heart of hearts, Opposition Members know that some of that stuff is being run for purely political reasons.
Gregory Barker (Bexhill and Battle) (Con): Does the Minister agree that the reason there is so much anger in my constituency and in so many others throughout the country is that people see the Government using the argument of clinical change and advance, which many accept, purely as a fig leaf to disguise savage cuts that have come out of the blue?
Andy Burnham: Not at all. That is a ridiculous point. The change is evidence-based and led by patient safety[Interruption.] I have heard the shadow Secretary of State for Health, the hon. Member for South Cambridgeshire, and his colleagues talk about A and E. To take the example of Hinchingbrooke hospital, according to last Saturdays Cambridge Evening News, it seems that it is sometimes quite acceptable to talk about health change in a local setting. For a large part of the year, the thing to do is spread rumours, provoke fear, raise the spectre of health change and scaremonger about the nature of change, but last Saturday he told his local paper:
I would like to see A & E
remain but slightly changed. Perhaps it should concentrate on self-referrals while more serious incidents are dealt with at Addenbrookes, for example.
Does the hon. Gentleman stand by that point? I am not saying that that is the right or wrong thing to do, but that was the day after he had issued a document raising the spectreindeed, that was scaremongeringof the closure of 29 A and E departments. The very next day, he went to his local paper and advocated what one might call the downgrading of Hinchingbrooke A and E department, for the benefit of his local hospital. This is quite astounding stuff.
Mr. Lansley: The Minister is completely wrong about that. The point in the document that we produced, which came out before the Department said that it would be quite a good idea for specialist care to be provided in specialist units, was straightforward. It was that although perhaps 3 per cent. of accident and emergency attendances which are caused by severe head injuries, strokes, ruptured aneurysms and myocardial infarction go to specialist centres, that does not mean that the other 97 per cent. of patients who attend accident and emergency should have those services removed. That is precisely what I said about Hinchingbrooke, but the finances and the deficits are driving the options for Hinchingbrooke, and that could close the whole unit down.
Andy Burnham: The hon. Gentlemans first point was extremely reasonable and I agree with him. In fact, that is exactly what Professor Sir George Alberti said only last week in the advice that he gave the Department about A and E change, and I welcome the fact that the hon. Gentleman has repeated it. However, on the day before he made that point, he issued a document[Interruption.] I think that I am right about this. I also think that he knows that I am right and that I am near the knuckle. He says one thing in his local paper about downgrading the local A and E department, but he was on the Today programme the day before, raising fears about 29 A and E departments being threatened with closure. I do not know whether my hon. Friend the Member for Ogmore agrees, but that is not an intellectually honest position.
Tim Loughton: The Minister can settle the issue on the record once and for all by allaying the fears of my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) and my other hon. Friends. Which of the 29 hospitals on the list that we flagged up are not in any danger of losing their A and E departments or of being downgraded? Let us go through the list now, so that we can all go home happy.
Hon. Members cheer, but I am not sure that they will be cheering in a minute, but let us see, shall we? The Royal Cornwall Hospitals NHS Trust is on the list that the Conservative party
produced of A and E services under threat, but let me read what the trust said. It has accused the Conservative party of scaremongering, following the claim that it was to lose its A and E department. The trust insisted that the claim was wrong and demanded that the statement be retracted. Opposition Members do not like thisit has all gone quiet over there, as they saybut a trust spokesman said:
There is no threat to either the A and E or casualty services provided by the Royal Cornwall Hospitals Trust. Neither the Trust nor the Primary Care Trust were contacted by the Conservative Party press office to check the accuracy of their research. We have made it quite clear to them today...that their statement should not have included reference to the Royal Cornwall Hospitals Trust and have asked for it to be retracted. Misrepresentative statements such as these are upsetting not only to our staff but also because of their potential to lead to unnecessary scaremongering and concern among our local community.
Mr. Lansley: The Royal Cornwall Hospitals NHS Trust interpreted our document as referring to the accident and emergency services in Truro. In fact, we were referring to Penzance. There were 10 documented press reports, including on the BBC, and material on its own website that pointed to the option for withdrawing emergency medicine in Penzance. It misunderstood what we were saying. That is all.
Andy Burnham: I used to be a health researcher for Labours health team in opposition. If I were the hon. Gentleman, I would think about the quality of his research. If we had put out stuff like that[Interruption.] It is shameful[Interruption.]
Mr. Eric Illsley (in the Chair): Order. The quality of the debate might improve if there were fewer sedentary interruptions and if we moved away from narrow arguments about individual hospital closures and went back to the wider debate.
Andy Burnham: The Calderdale and Huddersfield NHS Foundation Trust was mentioned in the document on maternity services. It states that Calderdale and Huddersfield rejected the claimactually, this is about A and E. Forgive me, Mr. Illsley.
These claims are absolutely untrue ... We have recently undergone a lengthy reconfiguration of services and central to
this was the retention of both A&E units at Huddersfield Royal Infirmary and Calderdale Royal Hospital...This was always the case and has not changed.
The hon. Member for East Worthing and Shoreham (Tim Loughton) was shouting 28 at me a moment ago. I have given two examples. I do not think that Mr. Illsley will bear with me if I read out further statements from NHS chief executives. Let us be clear: what is being done is designed to scaremonger, unsettle and get headlines. It is not reputable political campaigning.
Tim Loughton: This point is very important. The hon. Gentleman has given a wrong answer in a claim that he made about Cornwall. He has mentioned Calderdale and Huddersfield. That leaves 27 A and E departments for which we need answers. I am sure that all Opposition Members would allow the Minister more leeway if he went through the list and assured us that all the hospitals that concern us are safe. Are they?
Andy Burnham: They do not like it up em, as they say, Mr. Illsley. If the hon. Gentleman had been listening, he would have heard your request to move the debate on. He asked for another example, and I gave him one. Clearly, his figure does not bear much scrutiny. The figure of 29, which he put out in the press last week, has clearly gone. He can stand by his figure of 27 if he wants to.
Peter Bottomley: On a point of order, Mr. Illsley. The Minister indicated that the Chair has barred him from replying to the question of whether the service in Penzance was under threat. Will you confirm that he is free to confirm that it is or is not? If he wanted to, he could say that he did not know.
Mr. Eric Illsley (in the Chair): The Chair did not bar the Minister from confirming that, but encouraged him to widen the debate beyond issues relating to narrow documents. Such things would be discussed better in correspondence or another medium.
Incidentally, this time is not the Ministers, but that of the debate and the House. Obviously, a large number of Conservative Members wish to join the debate. Hopefully, hon. Members will take cognisance of that.
We are considering a range of different services in different settings, which include nurse-led services, direct access services provided in hospital settings, services provided jointly by consultants and primary care clinicians, and services provided in community hospitals. One of the demonstration sites of our better health care closer to home initiative is a mastectomy service in Hartlepool. Women are admitted to hospital, have their operation and are discharged with 23 hours. They receive intensive support from community nurses while recovering from surgery at home.
In Ipswich, we are evaluating a virtual audiology service. Patients see an audiologist in a town centre clinic. The results of their test are passed to the ear,
nose and throat consultant at the local hospital, who reviews the results and carries out a virtual consultation on the patient. The results are passed on to the audiologist, who informs the patient. All that happens in a few days, and patients need not go to the hospital.
If we are to shift care, there will need to be high-quality services in locations convenient to users. The White Paper made it clear that we would support PCTs by investing in a new generation of community hospitals and services grounded in local communities and fostered by local partnerships.
will happen to the 97 per cent. of patients without Ischaemic Stroke, ST elevation MI who would not benefit from these specialist centres
mentioned by the Minister. He also asked what would happen to children with broken arms and legs, because they use A and E. He asked about those with heart failure, cardiac tamponade, cardiac arrhythmia, cardiac arrest, anaphylaxis, meningococcal sepsis, children who have inhaled foreign bodies and so on.
People with all those conditions come to the A and E in Ipswich. The consultant running that department is seriously worried that the downgrading of his A and E department would mean that the 97 per cent. of people not covered by the super-hospital improvements that the Minister put to us would seriously miss out. What does he say to that expert on the front line at the hospital that he has just named?
Andy Burnham: Have I made any proposals about Ipswich? Basically, that is a response to the Alberti report, and I think that that debate should be led clinically, not politically. If the issue is about changing services, it is right that there should be a debate among clinicians about the right way to provide emergency services in this day and age.
The question about where we would locate some of the more specialist centres and where we would have more localised A and E services is secondary. It is jumping the gun somewhat to say that any such statement has immediate implications for any particular A and E department. The debate should be clinically led.
A clinician of great standing and authority made proposals last week and helped further public understanding of the changes that we may need to make if we are to save lives. I do not know about the hon. Gentleman, but if any member of my family needed emergency care, I would want them to be in the best possible environment, not necessarily the closest. That is an important consideration as we discuss the issues.
In June 2006, we announced that up to £750 million of capital would be available over the next five years to develop a range of different models for new community hospitals and services. Bids for the first wave of tenders have been submitted by strategic health authorities, and announcements will be made shortly. As has been mentioned, we have already refurbished and replaced
nearly 3,000 GP premises and we will have built 750 new health centres by 2008. Even more NHS one-stop centres will open in the next couple of years.
Change is not new for the NHS. Lifestyles, society and medicine have radically changed in the past60 years. That has meant that the NHS has had to change and reform, and it will continue to have to do so to provide the very best of modern medicine to all citizens.
People are now eating more and exercising less, and the mortality rate from chronic liver disease is rising as a result. Treatment for lifestyle diseases has increased significantly. In the 1950s, most health care problems that led to hospital admission, such as heart failure and pneumonia, occurred in people in their 40s, 50s and 60s. Now, those conditions are most common in people in their 70s, 80s and 90s. Some 80 per cent. of NHS patients currently have a long-term condition.
Community matrons or specialist staff are providing many services, which would previously have required hospital care, better and more conveniently in peoples own homes. Up to half the 45 million out-patient appointments each year could be dealt with in the community, along with some minor surgery and treatments. By introducing community nurses, Dudley PCT, for example, has dramatically improved the care of patients with long-term conditions.
New drugs developed in the past 10 years have allowed us to treat new conditions. For example, thrombolytic agents have reduced mortality, complication rates and lengths of stay for acute heart conditions.
Mr. Gibb: The Minister has just said that we would all want the best rather than the nearest care for our families in an emergency. My constituents in Bognor Regis and Littlehampton have carefully considered that issue. Indeed, they are all thinking about it right now because of the consultation process that is going on in West Sussex. They have taken the view, almost to a man and womanindeed, I have not really met anyone who takes a differing viewthat they want the services for people in Littlehampton to continue at Worthing and those for people in Bognor Regis to continue at Chichester. They would prefer to have that care in those two hospitals, because they are happy with the quality. They do not want slightly improved care that would require them to travel an additional 20 miles. Given that we live in a democracy and that my constituents, together with those of my colleagues, fund those hospitals, should this matter not ultimately be for the people to decide, rather than left in the hands of clinicians?
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