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Translate and communicate effectively the vision that health reform policy can transform local health systems for the benefit of the patient
The Minister talked about hearing the voice of local clinicians. Let me tell him that we cannot hear the voice of staff in the NHS, because locally they have been forbidden to speak out. When ambulance drivers and paramedics were asked by the local trust whether they would do an interview with Sky TV to speak for the changes proposed by the trust, they refused to a man and woman because they do not believe that the proposed changes are safe or viable. From that moment on, they were banned from talking to the press at all. Indeed, some of those whom I met recently feared that they could not even talk to their local Member of Parliament because of that stricture. I would be grateful to the Minister if he would confirm in his winding-up speech that it is perfectly proper for local NHS staff members to talk to their MPs about their fears.
We all fear that there will be a salami slicing process with acute hospitals and that once they lose their A and E departments, the process of downgrading will continue. I have good reason to fear that because of what happened with a hospital that serves my constituencythe Princess Royal hospital in Haywards Heath. I am sorry that my hon. Friend the Member for Mid-Sussex (Mr. Soames) could not be here today because I know that he would strongly share these views. Just a year ago, a consultation process called Best Care, Best Place resulted in the loss of trauma cases from Haywards Heath to Brighton. The hospital is barely able to cope with the transfer of patients now and will be still less able to cope with the transfer of
tens of thousands given that A and E admissions and attendances are on the rise across the county.
There is no question of A and E services being downgraded or becoming a minor injuries unit. That is not going to happen.[Official Report, 16 March 2005; Vol. 432, c. 383.]
Of all the hospitals in West Sussex that are likely to be downgraded to become minor treatment centres, or whatever is to happenand we simply do not knowthe Princess Royal is most in the firing line because it is on the east of the county. That promise has been breached just one year later. How can we accept the assurances of Ministers and health officials about how we are to enter this brave new world of care closer to the home when we cannot even take assurances that were given on the Floor of the House just one year ago? Can the Minister understand just how angry people are given that they have received such assurances from Ministers and health officials and that those assurances were so flagrantly and cynically breached?
The Minister cannot allow the blame for the deficits to be landed at the door of local health authorities. There has been substantial Government mismanagement of the NHS that I could go on to discuss for some time, but will not. I shall, however, point out that the cost of endless reorganisation has to be laid at the Governments door. We have seen the abolition of GP fundholding, the creation of 330 primary care trusts and now the halving of that number. We have seen the abolition of health authorities to create 28 strategic health authorities and now the halving of that number. There has been enormous disruption in West Sussex. The latest reorganisations across the country have cost more than £320 million. I wonder what the local cost has been compared with the deficits that have grown up in the local trust.
People do not understand why money has to be spent on management consultants and endless reorganisations, yet they face the potential downgrading of much-loved local health care facilities. I beg the Minister to reconsider this issue and to understand just how strongly people feel. I beg him to consider that he has not properly set out the alternatives to the current structure of acute hospital provision and I should be grateful if he were to see me as he kindly promised.
Mr. Andrew Tyrie (Chichester) (Con): I respect the Minister for coming along on his own and valiantly trying to defend something that everyone knows is indefensible and that he probably would not have done. He inherited this policy from his Secretary of State. The absence of any of his Labour colleagues tells its own story about their level of commitment to what the Government are doing.
I pay tribute to the efforts of clinicians and staff at St. Richards hospital and others in West Sussex. They have had to put up with extraordinary disruption and have managed to maintain a high level of care despite the disruption caused by the announcements of the past 12 months from the Department of Health and the strategic health authority.
I found particularly reprehensible the Ministers suggestion that the Opposition are scaremongering. What are MPs supposed to do when documents such as Fit for the Future are published telling us that major trauma A and E departments in our constituencies are to be closed? Of course, our constituents will be extremely concerned about that. What are we supposed to do when we find that there is no evidence base for the suggestion that there might be improvements in health care as a result of such a publication? The Minister effectively admitted as much today when he told us that he and his Department have only just started to collect the evidence required to justify the proposed changes that have already been published. We know that this is policy making on the hoof and is about money, not clinical practice. Indeed, senior people in the NHS have told us as much. It is a charade to pretend otherwise, and it will not do the Minister any good if he has another go at trying to pretend that it is something to do with clinical practice.
We know what is going on: the Government are trying to save money by closing district general hospitals, replacing them with a smaller number of large critical care hospitals and perhaps creating new urgent care centres. We have no idea what urgent care centres are supposed to do or deliver. Nobody knows; the Government do not know. Neither do they know what savings those centres might generate. What we do know is that the policy will lead to a reconfiguration of health care in West Sussex, which will mean the hollowing out of virtually all trauma A and E provision in the county.
In an effort to find out what urgent care centres might do, I gave the SHA a detailed 18 or 20-page response to Fit for the Future in which I asked a large list of questions, none of which it has answered. Of course, it does not know the answers, and the Minister himself has admitted that he does not know them either. We do not know whether any of the proposed services can be brought in safely. We do not know whether a business case has been put together that accommodates the fact that counties such as West Sussex have large rural areas in which many elderly people live alone.
We do not know whether the new services that are to be created will generate demand and, if so, how it will be financed. We do not know whether the acute trust can reasonably remove the direct, indirect and overhead costs associated with service reduction without there being a risk to other parts of the systemwhether services can safely be closed down. We do not know whether or how GPs are to be trained to develop the specialist skills required to plug the gap.
The argument for specialisation, which suggests that we should go for critical care hospitals, itself argues against allowing GPs occasionally to perform some of the tasks that are currently dealt with in district general hospitals. Surely, the argument for specialisation points to the need to continue to provide such care in district
general hospitals, not to give it to someone whose main function is to do other worthy work, as is the case with GPs. The GPs in my area have made that point to me vigorously. So it is not only clinicians in hospitals who have made that point, but GPs themselves.
I repeat that I have received no answers to any of my questions. I do not ask the Minister to respond now. I shall write to him with the list of the questions and I would be grateful if he would have a go at answering them. The plain fact is that the evidence does not exist.
That leads me to one last major point: at policy level, the strategic handling of this issue has been nothing short of catastrophic. We had the publication of Fit for the Future, which was so mangled by the people who know most about itthe clinicians, the GPs and a good number of the health managersthat it has effectively been withdrawn. The consultation was apparently initiated by the strategic health authority, but halfway through it was taken over by the primary care trust. The PCTs have been merged, and there have been endless delays on the start of the consultation period, and we still do not know when that will begin. We also remain unsure about who will ultimately be taking this decision, the PCT or the SHA. If something as strategic as this will not be decided by a strategic health authority, we must ask what an SHA is for.
We must also consider the shocking ignorance of Ministers, including the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), about even the most basic questions involved in this reorganisation. For example, she told Mrs. Ellis, a constituent of mine who had written to her, that she should write to Steve Phoenix who, she said, was in charge of the consultation. He has been replaced by John Wilderspin. My constituent was told to write to Western Sussex PCT, but that has been abolished. My constituent was also told that the consultation would begin in the autumnthe letter from the Minister of State was dated 13 November. Yet she chaired a meeting at which this Minister and I heard the chief executive of the strategic health authority announce, in response to a question, a delay in the consultation until the end of the year, if not until 2007. That extraordinary ignorance about what is going onit is as if she does not care at all about the effects of these changesleads my constituents to be deeply sceptical and worried about the whole process.
I implore this Minister to do three things. First, he should not make changes until the evidence has been collected. The clear indication that he has given today is that such a process might only now be occurring. If so, it is deeply reprehensible.
Secondly, he should reconsider the increased weighting that was put into the additional need adjustmentthe deprivation formulaas a matter of urgency. Something has gone seriously wrong in the allocation of national health service funding across the country as a whole. The deprivation weighting has given huge increases to some areas where life expectancy is lower, but few people in the NHS believe that extra health spending in those areas, when channelled through hospitals, can tackle the problem of lower life expectancy. That is largely a problem of lifestyle and not of hospital care. The consequence is that a large amount of money is probably being wasted and inefficiently used, and because there is a limited
national pot, money is being taken from areas such as ours, which have increased need as a result of the ageing of the population.
Thirdly, the Government should show greater understanding of the consequences of what is happening. They should recognise that the expressions of concern in my constituency and by those of my colleagues is deep-seated and strongly held. Some 130,000 people have signed the petition onSt. Richards hospital, and that was collected in a few weeks. At short notice, 5,000 people turned up to a rally in Chichester on the issue. I assure the Minister that rallies are not often held in Chichester. No one could recall an occasion when 5,000 had come for a rally in the city.
The Minister suggested that Conservative Members were not showing leadership. If he were to reflect on that for a moment, he would understand that my constituents think that it is the Government, the Department of Health and the Secretary of State who are not showing leadership. We beg the Government to reconsider the decisions that have been taken and to think carefully about the funding formula in particular. If the Minister does so, he would not only do our area a service, but he might rescue some of the Governments electoral chances.
Gregory Barker (Bexhill and Battle) (Con): I, too, admire the chutzpah of the Minister in defending the indefensible this afternoon. He has done a good job at standing there in the total absence of any support from his Back Benchers. I understand why there are no Labour Members present, but I am slightly surprised that no Liberal Members, bar one, are here either. Perhaps that is because they have taken to heart the instructions of their former leader, David Steel, and they have all gone back to their constituencies to prepare for Christmas.
There is a rising sense of anger in my constituency. We do not have an acute hospital in Bexhill and Battle. The majority of my constituents are served by either the Conquest hospital in Hastings or the Eastbourne district general hospital in the constituency of my hon. Friend the Member for Eastbourne (Mr. Waterson). The others, in the north of my constituency, go across the border to the Kent and Sussex hospital, which is in Kent.
The situation at the Conquest hospital and Eastbourne district general hospital, which form the East Sussex Hospitals NHS Trust, is desperate. Despite what the trust has said formally, we know that plans are being made to reduce the maternity services to a single site, either at Eastbourne or at Hastings. We also know that it is preparing to downgrade accident and emergency on one of the sites. We will lose 24-hour accident and emergency provision at Hastings or at Eastbourne, which would be very serious. We also know that the SHA is applying pressure to pass a whole tranche of services out into the community.
So there are three concerns: the loss of one of the maternity units; the downgrading of accident and emergency; and the general push out into the
community of services, when there is no proven clinical or financial evidence that they would be better or more effectively administered in the community, and, more importantly, when in the short-term, there simply is not the ability to provide them in the community. Nobody in my constituency is saying that there should never be any change. But people want the case for change to be made on clinical grounds and on sound medical evidence based on proven research, and not on the basis of assertions from Ministers.
Nine months ago, I met the chief executive and the chairman of the trust at their office in the Conquest hospital in Hastings. They had just published a review discussing the overall configuration of health care in the area. The primary concern of the senior staff of the trust earlier this year was the long-term threat posed by the potential building of a new hospital at Pembury in Kent, some 30 miles to the north, which could happen some time in the next decade. They saw that as being the primary threat to services at the Conquest.
Just a few months later, however, the picture had changed completely. This had nothing to do with the publication of new research or with the bringing forth of new clinical evidence; it was entirely concerned with the financial crisis at the SHA, which cascaded down to my hospital trust and meant that, in 2005-06, the hospital will have run up a deficit of close to £5 million. At the instruction of the SHA, it will have to claw that back to a deficit of just over £3 million in 2006-07some £2 million-worth of cuts have to be made in the current 12 months.
That is not about moving care closer to the community, providing more effective care for patients in my area or raising health standards; it is about the cold, harsh reality that money has been lost elsewhere. My constituents are having to pay the very real health price and, as other colleagues have said, they already feel discriminated against by the unfair system that benefits constituencies in the north of the countryLabours friends in the northand discriminates against the older population, which is often very poor, along the south coast. The household income in east Sussex is the same as that in Hull. Pensioners, by and large, are not very prosperous and to talk of my area being affluent is absolute nonsense when so many people are over 85 and dependent on fixed incomes. The argument about affluence simply does not wash in my part of the country.
The case for not having just one maternity site in Eastbourne or Hastings has already been well made by my hon. Friend the Member for Eastbourne. If the site in Hastings, for example, were closed, people would be hard pushed to get from the east of my constituency near Ryefor example, Northiamacross to Eastbourne in less than 50 minutes. That is totally unacceptable. It is not bringing health care closer to the community, but moving it further away. It would make it not only more difficult from the health care point of view, but much more difficult for friends, relations and partners to visit at an important time in a womans life when she is dependent not just on medical support, but on the support of her family and partner.
I want to focus briefly on the loss of 24-hour accident and emergency care. There has been a great deal of misinformation about the clinical need to consolidate on one site when we know that that is not a
clinically driven argument, certainly over the next year. I have been passed a letter from a senior consultant who is practising at the accident and emergency department in Hastings. He said:
Most patients with multiple injuries are managed appropriately in district general hospitals throughout the UK. A large study comparing the outcome of trauma patients from a trauma centre and from general hospitals in the late 1980s and early 1990s showed no statistical difference in death or permanent injury. The only patients who need to be transferred urgently are those with serious head injuries, cardiac injury or major burns.
We receive on average 8 trauma alerts from the ambulance service each week of whom half turn out to have significant injuries. Of this latter group we would only need to transfer 1 per fortnight to a specialist centre.
It is extremely difficult to accurately identify those patients who would benefit from a trauma centre at the scene of an accident and therefore bypass the local hospital.
The recent GPs contract has resulted in far fewer acutely unwell patients being seen by GPs. Two thirds of emergency admissions now come through the emergency department
We have recently had GPs working in the emergency department to assess their impact. They are able to see patients with minor ailments but not able to assess trauma patients, review xrays or manage acutely unwell patients. The percentage of patients suitable to be seen by GPs is therefore in the order of 25 to 30 per cent. As a result of their contract GPs have been released from their 24 hour obligation and the result of this is that it now costs twice as much to employ a GP in the emergency department than an emergency medicine specialist.
You will see from the above that the clinical case for regional centres is not as clear as the SHA and DoH like to suggest. There are very few patients who would genuinely benefit from such an arrangement and many more who will suffer longer transfer, unnecessary delays, difficulty with relatives visiting and probably ... length of stay particularly if social service input is required.
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