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14 Dec 2006 : Column 360WH—continued
3.55 pm
Mr. Nigel Waterson (Eastbourne) (Con): I am pleased to have the opportunity of speaking in this debate. The Minister began and ended his speech by lecturing us on political leadership. I have two or three points to make on that subject.
First, the Labour party does not seem to be showing a great deal of leadership or even interest in the subject, as the Minister is now the sole Member on that side of the Chamber. Even his Whip seems to have deserted him. Secondly, I and all my hon. Friends have been drawn into giving political leadership on the NHS in our constituencies because people are worried and concerned, and it is not only patients and potential patients but local NHS staff.
Thirdly, I seem to spend a large part of my life coming to debates like this, attending meetings with the SHA—much good they do me—with my constituents, with the primary care trusts and the various other bodies that have arisen from the Balkanisation of the NHS in recent years, but I have the impression that far from showing political leadership, Ministers are hiding behind what they call local decision making.
I recently had a meeting with my campaign group and the chairman and non-executive directors of our local PCT. Although they are clearly concerned about issues, such as accessibility and others that have been touched on during the debate, they are restricted by what the NHS tweely calls the financial envelope within which they have to operate. I had a meeting with the SHA a few weeks ago, at which the Minister was present. The hon. Member for Hastings and Rye (Michael Jabez Foster)—Hastings and Eastbourne are part of the same hospital trust—asked whether, if the PCTs were happy to commission roughly speaking the services that we already have, what would happen. No real answer came from the SHA, but I suspect that if it is not part of the overall plan they would not be allowed to get away with it.
I stress that we are not being luddites in our various campaigns in the south of the country. We appreciate that day surgery is a massive change in practice. Indeed, my hospital in Eastbourne has one of the highest rates for day surgery and it intends to improve even on that. We appreciate that new drugs and treatments are making a substantial difference. Of course it has always been true and always will be that really serious cases will be referred—serious children’s conditions to Great Ormond Street hospital, or serious head injuries to Hurstwood park hospital, and so on. We are not trying to stand in the way of progress or change. However, it is important for all who take an interest in the matter, including the Minister, that there is a proper debate about changes in medical and clinical practices. I have yet to hear from the Minister what is the distinction between them. Perhaps it is a distinction without a difference.
The problem for me and my constituents, however, is that sensible debate has been irretrievably contaminated by financial issues. Those with an afternoon to spare could look through the agenda documents for the strategic health authority. Its last agenda states:
“the NHS across Surrey and Sussex will be overspending by£237 million ... in 2008/9, exclusive of historic debt if no action was taken.”
It is the action that is to be taken that is the real subject for debate.
Andy Burnham: The hon. Gentleman makes some fair points and is developing an interesting argument. Does he accept that there has always been overspending in the NHS, but that under the old financial system it was masked because of brokerage and other changes in how funds were passed around the system? Does he not believe it is right and responsible for somebody in my position to take action where those financial pressures are exposed by a new financial system?
Mr. Waterson: Clearly there must be some financial discipline in the system—I am not for a moment saying that there should not be. As we have been in Government before and have every expectation of being in Government again—[Interruption.] Soon, as my hon. Friend says—how could we say it differently?
It is no earthly good starting discussions with those of us from the south-east by saying, “You are overspending by £237 million, or you will be by 2008/2009 and everything flows from that.” We have already had some debate about the formula and I intervened on the Minister on that point. There should be an on going debate and the formula should not be set in concrete, as it is clearly not working in our area.
Gregory Barker: My hon. Friend and neighbour is making an excellent speech. Does he not think it would be helpful if the Minister’s clarity in drawing attention to the deficit in the health service brought about by the new financial systems was adopted throughout the argument? People might respect the Government a bit more if they were honest and said that changes are being brought about by a deficit thrown up by a new financial system. Instead, they are pretending that such urgent and rapid changes are being moved exclusively by clinical developments.
Mr. Waterson: My hon. Friend makes an excellent point. There is, of course, a considerable overlap between his constituency and mine in terms of medical demand and age profile. Issues surrounding historic deficits could themselves lead to a debate. Why should historic deficits be hung around the neck of some trusts and primary care trusts when others have them written off, as has recently happened?
On the issue of over-performance, it puzzles me when I am told that our local hospital is over-performing. Perfectly fit people from my constituency do not volunteer to be treated at the hospital for no reason. I suggest that over-performing means they are actually having their medical needs met.
There are issues about the location and the setting for treatment, but that is for another important debate rather than for this afternoon. On getting from here to there, in my constituency there is a recent history of shutting one rehabilitation hospital without, at the time, having the community facilities in place to take up the slack.
We understand that there are possible threats in my area to paediatrics and A and E, but most importantly we keep coming back to maternity. Despite large numbers of 85-year-olds, we also have a healthily rising
birth rate—different groups of the population use the NHS. As recently as August 2004, a detailed clinical review carried out by the trust concluded that maternity facilities should remain on both sites—Eastbourne and Hastings. What has changed since then, in barely two years? The road communications are just as bad: 21 miles of poor roads between Eastbourne and Hastings. The population continues to rise with a lot of new house building—much of it imposed by Labour Ministers—and the requirements of the population in terms of maternity and other needs have increased.
So what has changed? All that seems to have changed is the financial envelope. If one of those maternity units were to close, would it really be safe for mothers and babies? A senior consultant gynaecologist and obstetrician who has recently left East Sussex NHS Hospitals trust has said in public that he thinks lives would be at risk as a result. I understand that the Royal College of Obstetricians and Gynaecologists has a gold standard of half an hour between deciding to perform a Caesarean operation and actually performing it. There is no way, short of using a helicopter, to get from one of those sites to the other, admit a patient and carry out an operation in half an hour.
As touched on earlier, Ministers tend to argue these points by assertion. In a debate I held on 31 October the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint)—the hon. Gentleman’s fellow Minister—talked about deliveries in Eastbourne and the Conquest hospital in Hastings. She said:
“The problem is that such units tend to have poorer outcomes.” —[Official Report, Westminster Hall, 31 October 2006; Vol. 451, c. 73WH.]
Where is the evidence for that? Dr. Vincent Argent, the consultant I have just referred to, pointed out in the recent Worthing report that Eastbourne and Conquest hospitals have
“perinatal statistics...in line with regional and national norms. There was no evidence that the units were or are unsafe (or would be, if the two sites are maintained).”
The British Journal of Obstetrics and Gynaecologists published evidence showing that smaller units can indeed be safe especially when there is proper national and regional networking of maternity units.
Some of the problems that have recently been highlighted about the safety of units in places such as Northwick Park, Wolverhampton, and St. Peter’s Ashford came from large or merged units. So can we have less assertion and more evidence?
On the process, the mantra that we have had from the SHA and from Ministers has always been that there will be full public consultation in due course on the options and that that will be listened to. That is, of course, reassuring and designed to be reassuring. However, the other day, the medical director of our hospital trust, Dr. David Scott, let the cat out of the bag when he made it clear in public that they were already planning for a one site solution for maternity from 1 August. The trust had not been consulted about postponing the public consultation, and when I spoke to Dr. Scott, he confirmed that they were planning for the eventuality of there being one site. He was quite
clear that that had always been the solution and plans had to be made based on that. I understand that recruitment and so on is proceeding on that basis.
What earthly point is there in telling people that there will be public consultation when one of the most important options has apparently been closed off? There are also some so-called temporary closures in the offing—particularly for paediatrics. One thing we know about the NHS is that temporary closures have a habit of becoming permanent and part of the status quo. I have some real concerns, which I hope that the Minister will take seriously, about the way that this process is operating. He has talked about political issues, but it would be fundamentally anti-democratic and bad for the whole system if my constituents felt that they were being invited to take part in a public consultation that may not now start until the end of January when some of the options have already been removed from the table.
The trust, the PCT and the SHA have all subsequently been trying hard to stuff the cat back into the bag. Indeed, they have issued a statement saying that Dr Scott regrets any misunderstanding that might have arisen from his interview with the BBC. However, he could not have been clearer and he could not have been clearer in his direct conversation with me.
The working time directive and pressures on the hospital to plan to close one of its maternity sites all relate to financial pressures. Ultimately these issues are all about money. That is the impression I have formed and it is certainly the impression that my constituents have formed. I cannot stress too heavily to the Minister that that impression will undermine any public consultation and any decisions that have to be taken. People in my constituency simply do not believe that the options are still available and that this is driven by anything other than a desire to save money.
Mr. Eric Illsley (in the Chair): The winding up speeches will start at 5 o’clock and I intend to allow10 minutes each for the Front-Bench spokesmen and for the Minister. If anyone has a problem with that, they can approach the desk.
4.9 pm
Nick Herbert (Arundel and South Downs) (Con): I notice that the Minister recently won The Spectator award for the Minister to watch. We have had little choice about that this afternoon as he has been the only Minister that it has been possible to watch. I am sure that he will be acutely conscious that previous winners have included Estelle Morris and Christopher Leslie. We did not have to watch them for long.
The Minister knows, because I mentioned this to him when he kindly agreed to see me about this issue—we have not yet had that meeting, but I am sure that he will honour the generous promise that he gave me—that I am especially concerned, as all Opposition Members here are, about the reconfiguration of acute health care facilities in relation to my constituency, because it is comprehensively affected by what our local health authorities are proposing. The following are acute hospitals in West Sussex: the Princess Royal hospital at Haywards Heath, St. Richard’s hospital at Chichester, and Worthing and Southlands hospitals in
Worthing and Shoreham. None of them is in my constituency, but all of them serve my constituents and all are in the firing line when it comes to the potential downgrading of A and E and maternity facilities. They already face difficulties. Between the four trusts that serve my constituency, 1,000 jobs have been cut, or there has been an announcement that they will be cut, and 100 beds have been lost.
The principal concern that I want to articulate on behalf of my constituents, who are watching the progress of the proposals with enormous anxiety, is the travel distances and times that will be involved if they have to go to units that are much further away from them than the units are currently. Right in the middle of my constituency, in the downs, is a little village called Washington. There is even a place called the White house in Washington, to which I have been—that is almost certainly the first and last time that I will ever have tea in the White house in Washington. At the moment, the nearest hospital—Worthing hospital—is just 8 miles from Washington. Should Worthing be downgraded, the travel times involved in going to an A and E department could increase by 2.5 to 5 times, if patients have to travel as far as Portsmouth. I could make that argument across my constituency. People, particularly the elderly population, are extremely worried about the increase in travel times that they may have to face, not just for A and E services, but for other treatments that they need.
Someone came to my constituency surgery the week before last who was having cancer treatment in Brighton. She lives in the middle of my constituency and was already having to make a round trip of some 40 miles three or four times a week for treatment. That was taking hours out of her day and she was extremely worried about it. That is the prospect faced not just by a minority of people in my constituency but, potentially, by the majority if the acute facilities that I am talking about are moved away from them. Furthermore, people face a potential increase in travel times along roads that the Government have continually failed to upgrade. The A27 in particular does not resemble anything like a coastal highway; it is a coastal car park. People are worried about the travel times for ambulances should there be additional travel times to A and E facilities.
We are constantly told that the reconfiguration is about bringing new facilities closer to people’s homes and delivering great centres of excellence in what the Minister called “regions”—in this case, in Brighton and Portsmouth. The point is that we have seen no credible or costed proposals for the services that are meant to be brought closer to communities. We have seen none. In a rearguard action, the Prime Minister started a few weeks ago to make the case for the changes and the documents by Sir George Alberti and Professor Boyle were published. Those documents amount to just seven and 12 pages respectively. They include many attractive photographs, anecdotal argument and diagrams, but no costings whatever. It is impossible to make a judgment on whether the proposed reconfiguration of health care will be financially sustainable or will save money, which is presumably what it is intended to do, when no costings have been provided either locally or nationally. There may well be a strong case for saying that bringing care closer to people’s homes will be more expensive.
A great mistake that the Government have made, to which my hon. Friend the Member for Eastbourne (Mr. Waterson) alluded, is that the reform proposals that they are now purporting to set out are in fact being elided with cost-cutting proposals. That is what this is really about. We all know that. It is about addressing local deficits. The trusts have been instructed to cut costs on a very short time scale, and that is the real purpose of the proposed downgrading.
Andy Burnham: The hon. Gentleman is digging his own grave with that point, because it is he and his colleagues who are seeking to put those two things together. They are seeking to put the deficits and the pressures that there are this year in some parts of the country together with the longer-term structural changes that are needed in some parts of the country to ensure that those health communities are fit for the future. That is precisely the point. For their own purposes, the hon. Gentleman and his colleagues are trying to weld those two things together to create an impression that this is all finance driven, rather than safety driven. If the hon. Gentleman feels able to throw away the Alberti report, claiming that it is glossy nonsense or whatever he was trying to say, that is a dangerous thing to do and will not serve his constituents.
Nick Herbert: The point that I made was that the Alberti document and the Boyle document are completely uncosted. We have seen no credible proposals from the Government, either on clinical grounds or on cost grounds, that demonstrate whether the proposals will deliver affordable health care locally, yet we are told that a reason for the changes is that there is a need to save money. The local trusts and the health authorities are clear that the reason why the proposals are being considered in relation to acute hospitals is to save money. The closure of major hospitals—at one point, it was even being considered that we would have no acute facilities in West Sussex at all; now, apparently, we have a reprieve and will possibly have one where there are currently three—is designed to save money, and the Minister should not pretend otherwise.
The Minister dismissively talked about people pulling out placards. Yes, 25,000 people have marched in West Sussex. Yes, 250,000 people have already signed petitions across West Sussex. That is a staggering number and it will increase. People are going out on cold evenings to hold 24-hour vigils because they are immensely concerned about what is going on. They are, quite rightly, subscribing to the notion of something that the Government constantly espouse—patient choice. The question that I put to the Minister is: if people are not to be allowed to choose to keep their local hospital, which is what they clearly want, what does patient choice mean?
Andy Burnham: Will the hon. Gentleman give way?
Nick Herbert: Just let me finish. If people are not to be allowed to choose their local hospital, which is what the NHS website proposes that they should be able to do, what does patient choice mean? Perhaps the Minister, instead of intervening on me, will answer that question when he winds up the debate.
The truth is that the consultation that we have been offered in West Sussex has been largely a sham. In April, members of the strategic health authority came up and spoke to West Sussex Members, but they made no mention of the proposed downgrading of acute hospitals. We now know from minutes of the board meeting that were leaked that, in fact, they had been proposing that downgrading since the beginning of the year. Not surprisingly, people are extremely suspicious about whether the objections that they are registering in their hundreds of thousands in West Sussex will make any difference to the Government’s thinking, because they fear that the die is cast.
What are the Government doing to make the consultation a real process? We know that they have delayed the process, but we also know that they are planning to recruit a director of communications each for the South East Coast and for the East of England strategic health authorities. For a salary of £90,000 a year, that person will have to
“Understand public perception and patient experience of health care services”.
That is all right, but the next job purpose is to
“Deliver appropriate and timely information to the Ministerial Briefing Unit.”
Is, then, the purpose of the director of communications to ensure that Ministers are armed more effectively with the facts? Another task is to
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