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16 Jan 2007 : Column 235WH—continued
That distinctiveness and sense of geographical separation is heightened by the transport infrastructure in the area. As my hon. Friend the Member for Stockton, North said, Hartlepool and Stockton are about nine or 10 miles apart. That does not seem far, but it is actually much further than it appears. Public transport between the two towns and between the two hospitals is poor. In many ways, the A689 and A19 cut off Hartlepool from the rest of the Tees area, and the A19 is frequently crowded. If plans for economic expansion in the sub-region come to fruition, particularly the growth of Wynyard, the road—in particular the stretch between Wolviston and Norton—will become even more congested. That will not help achieve the objective of local and accessible health services.
In addition, car ownership in my constituency is about half the national average, which causes problems for people travelling to hospitals or visiting relatives and friends. I fully acknowledge that there are similar rates of car ownership in neighbouring constituencies. My hon. Friend the Member for Stockton, South told me last week that 40 per cent. of households in her constituency do not have access to a car. That makes my point that it is difficult for people throughout the Tees area to access hospital services in other towns. A distance of some nine or 10 miles does not seem far, but somebody who has to attend an appointment in a hospital outside their town, whether it be Hartlepool or Stockton, will find the journey time-consuming and stressful. It may require two or three bus changes. Some people sneer at that, but for some of my constituents an appointment at North Tees hospital might as well be on the moon.
Frank Cook: I am not taking issue with what my hon. Friend is saying, but I want him to carry on to a much more pertinent aspect. I agree that there are travel problems, but why does he want more maternity, gynaecology, obstetrics and paediatrics services at his hospital, which already has them? Why does he want to take from Stockton to put in Hartlepool?
Mr. Wright: I said that I would not discuss specific Darzi recommendations but deal with health provision in demographic, geographic and industrial terms. The point that I tried to make in my Adjournment debate on 11 December—the point that I put to my hon. Friend then—was that Darzi had come up with a set of proposals that sustained all hospitals in the area, not only the University hospital of Hartlepool but the University hospital of North Tees and also James Cook. He did that by proposing a model of regional centres of excellence that takes into account the need in the modern age to recruit and retain staff to allow technical specialist teams to build up expertise, and to ensure that patients are served as well as can be expected.
Frank Cook: It appears that my hon. Friend is suggesting that a centre of excellence should be taken from Stockton and given to Hartlepool. That seems nonsensical, because millions of pounds have been spent on Stockton, it has more people, and in any case it is already doing a good job for everybody. He wants more of those services in his own town, but that seems illogical.
Mr. Wright: A fundamental point is that members of the same political party oppose each other on this issue. Frankly, I believe that there is an inconsistency at the heart of Government policy on hospital and health reconfiguration. Ministers and strategic health authorities say that the provision of local health services is a matter for local consideration—Ministers do not want to get involved in a devolved NHS—and I accept that, but it is inconsistent with the push towards centralisation of technical services.
The result is a situation such as that in Teesside, where centralisation means that services that previously were provided on both the North Tees and the Hartlepool sites should now be provided on one site, for technical and clinical safety. Given that the local NHS takes into account the needs and wishes of the population and decides what the provision of services should be locally, how does one square the circle? I do not quite understand the inconsistency. We are all doing our job of standing up for our constituents, but in an era of increasing specialism and centralisation, how does the policy marry up with the idea that local people should be able to choose the nature of health provision? I do not believe that that has been fully resolved.
Teesside was one of the first areas in the world to experience the effects of heavy manufacturing industry. Until relatively recently, it was the home of many steel and iron works, engineering firms and shipbuilding yards. It still retains a position as a centre for chemical engineering. Indeed, Teesside, particularly the area of Seal Sands, which spans my constituency and that of my hon. Friend, remains the area with the highest concentration of heavy and chemical industry in western Europe. My constituency is also the site of a nuclear power station.
There are two distinct but separate reasons why that industrial consideration, both past and present, should have a powerful bearing on the provision of health services. First, the legacy of industrial illnesses remains acute and distressing. People in my constituency and surrounding areas still bear the scars, often literally, of industrial accidents and disease. There is a higher incidence of diseases such as asbestosis, vibration white finger and respiratory diseases, and many people’s quality of life is adversely affected as a result of working with hazardous materials and perhaps having been injured while at work.
Secondly, the concentration of industry results in a higher risk factor for my area than for many others. Only this month, a toxic leak at a chemical factory on Teesside—in my hon. Friend’s constituency, I believe—injured 37 people and produced burns, skin irritation and breathing difficulties for those who were affected. The majority of people injured at the scene were decontaminated on site by the North East ambulance service, but 17 people had to be taken to the nearby hospital to be treated. That incident shows the risks to Teesside in still being involved in heavy and complex industry, and demonstrates that my constituency and others nearby require a high level of hospital cover, perhaps higher than comparable areas, to help manage the risks properly.
However, the biggest factor in determining health service provision is undoubtedly deprivation and the links to ill health. Twenty-eight per cent. of all
super-output areas in the Tees region are in the bottom 10 per cent. of deprivation in the country. In my constituency the figure is higher, at 40 per cent., and it is 55 per cent. in Middlesbrough. Easington, whose population accesses hospital services in my constituency and in Teesside, has an even higher level of deprivation: all but one of the super-output areas in the district of Easington are in the bottom 20 per cent. nationally.
Hartlepool and the wider area of Teesside face acute challenges when it comes to tackling the effects of decades of ill health. I mentioned in my Adjournment debate last month that life expectancy in my constituency is markedly lower than the English average. Hartlepool males live 2.8 years less than the national average, and females live 2.4 years less, but such statistics mask even wider differences. For example, the life expectancy of a man living in Stranton ward in Hartlepool is just 66 years. That is a difference of 13 years from the most affluent ward, which is also the one where life expectancy is best. Life expectancy is similarly bad for Middlehaven ward in Middlesbrough.
People in Hartlepool do not have a healthy diet, as hon. Members can probably tell. It has been estimated by Hartlepool primary care trust that, across the Teesside area, it has the lowest consumption of fruit, with only 34.4 per cent. of males and 45 per cent. of females eating any item of fruit, let alone five, most days.
Frank Cook: It has the best fish and chips.
The death rate from smoking-related diseases is higher in Hartlepool than the average. That is a direct result of the fact that 40 per cent. of Hartlepool adults are believed to smoke.
Death rates from heart disease, stroke and cancer are significantly higher than the national average. Indeed, in researching for this debate, I stumbled on an Adjournment debate initiated by my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) in 2003 about cancer rates in Teesside. Although the figures are slightly out of date, they remain pertinent and dramatic. If 100 is the national average cancer rate, the standardised mortality ratio for all cancers is 128 for Hartlepool PCT, 123 for North Tees PCT and 129 for Middlesbrough PCT.
For lung cancer among women, with 100 as the national average, the rate is 205 for North Tees, 162 for Middlesbrough and 169 for Hartlepool. More frightening is the fact that the rate for lung cancer for women under the age of 50—remember that this is only recorded deaths, not lung cancer contracted—is three and a half times the national average. That means that women in Teesside are three and a half times more likely to die from lung cancer.
Future demographic changes should also play a major role in shaping health provision. It makes sense that the shape of health services over the next 15 years should reflect what the population of an area looks like. I have in mind what my hon. Friend the Member for Stockton, North said about the growth of Stockton. However, the population of the Tees area is
projected to fall, according to the Tees Valley joint strategy unit, by about 2.5 per cent. by 2021. According to the JSU’s forecast, that is largely because people of working age, particularly the younger end of the group, will take advantage of a prosperous economy in London, the south-east and other city regions and will migrate away from the Tees valley. Without appropriate Government intervention, the economic base of the Tees valley will not be as strong as it could be, but that is a whole other debate.
It is forecast that the demographic group of those aged 75 and over—the so-called older retired group—will increase in the Tees area by one third, from 46,300 in 2003 to 63,100 in 2021. The group will also make up a significantly larger proportion of the total population, from 18.4 per cent. in 2003 to more than 25 per cent. in 2021. The increase is vital to the design of public services in the next 15 years, because members of the older group tend to be more infirm and to make larger demands on services, particularly health services. The JSU concluded that
“the total provision of services would have to increase substantially simply to retain the current level of service to this section of the community”.
Yet in my constituency, health services in the community have in the past been poor—a consequence of the lack of investment over the past 40 years. The number of GPs is not what it should be for a town of Hartlepool’s size and for its demands on the health service. Department of Health statistics have stated that Hartlepool has 47.5 GPs per 100,000 weighted population, putting my constituency in the bottom 10 per cent. of primary care trusts with the fewest doctors. I know that the Labour Government have done something about that, making Hartlepool a spearhead PCT with additional funding to tackle the problem of recruitment and retention of doctors, but I am afraid that the theme is all too common in health. The Government are making progress, but we are trying to turn around decades of under-investment.
The underdevelopment of community health facilities over 40 years has meant that we as a town rely far too much on the hospital. The take-up of local health facilities is markedly low, with the consequence that people engage with the NHS only when something goes dramatically wrong with their health and they have to go to the hospital. Admissions to accident and emergency have increased by more than 40 per cent. over the past four years in Hartlepool, largely because it is the only health institution that my constituents and their families have been able to rely on for years.
The use of community facilities, even as they come on stream—which they are doing now—will be slow during the period of weaning ourselves off the local hospital. Last year, I opened an emergency care facility in Owton Rossmere in Hartlepool. That is exactly what the NHS of the 21st century should be doing: providing local specialised care within neighbourhoods. However, within weeks of its opening the facility was closed because of clinical concerns at the PCT about safety. That does not help to embed the vital trust among my constituents that community facilities are operational and work safely and effectively. If anything, the opening and rapid closure of the unit fuels the perception in my town that we should rely even more on the hospital for our health needs. That perception would be wrong and unfair.
Much positive work is being carried out in Hartlepool to try to redress the balance in accessing health in the acute or community sector. The modernisation building programme is encouraging, with work taking place at the Headland surgery, the Owton Rossmere health centre and the planned GP complex in the centre of town. Hartlepool PCT is having real success with such initiatives as its smoking cessation services and its teenage pregnancy reduction strategy. However, even with the record investment provided by the Government, we are still probably a decade or so away from establishing a true network of neighbourhood health facilities in Hartlepool that would enable my constituents to reduce their reliance on the hospital. It is wrong, in those circumstances, and completely contrary to Government policy on choice and on moving health locally, to move access to health care away from constituents before community facilities are up and running.
Provision of health services should be based on all criteria such as levels of ill health and deprivation, infrastructure and projected demographic changes. By any of those criteria, Hartlepool and the wider Tees area need further investment. The first consideration in the provision of health services should be what the people deserve and need. There has been uncertainty about health provision in my area for almost a decade. People are weary of the fight and cynical about whether bureaucrats take their views into consideration when shaping health services: 32,403 people signed my petition about the full implementation of Darzi’s recommendations, which I presented on the Floor of the House of Commons a month or so ago. More people signed that petition than voted for the three main parties in the 2005 general election in Hartlepool. I know that people in Stockton are similarly angry about the possible proposals.
I am concerned, as I mentioned earlier, that communities in my area and hon. Friends in Parliament are fighting each other about the matter. I ask my right hon. Friend the Minister to try to discuss the inconsistency that I consider to be at the heart of Government health policy. When health policy and the provision of health services are meant to be shaped locally, and when communities are against each other, with completely conflicting points of view over that provision, what happens? What do we do? Frankly, I think that the Government need to listen to what all hon. Members in the area say and to ensure that health services are provided that match the needs and aspirations of all our people.
11.46 am
Ms Dari Taylor (Stockton, South) (Lab): It is always a pleasure to participate in a debate chaired by you, Miss Begg. I want to say a big thank you to my hon. Friend the Member for Stockton, North (Frank Cook) for securing time for us to debate the Ara Darzi report.
My contribution will specifically and solely reference the Ara Darzi report. It will reference the concern that we all share that high-quality medical services should be delivered to our constituents. There has been an overwhelming amount of comment and angry debate about splitting the function of paediatrics, obstetrics and gynaecology in North Tees university hospital so that acute services are performed by one hospital and
elective services by another, and about the claim in the Ara Darzi report that an excellent department can retain its excellence, even if it is transferred to another hospital. Those views are both heartily contested, including by me.
No consultant from paediatrics, gynaecology or maternity was ever consulted about the spilt in function. I should have thought that if a split were thought appropriate, the first people who would be spoken to would be the experts who deliver the service. Equally, there seems to be no understanding in the report of the fact that it takes time to build up a medical department of the excellence of these three departments. There is a need to attract competent, complementary staff who work together and respect and trust each other. That takes a long time. It has taken North Tees university hospital a long time to attract such competence and to gain the universal respect of the northern region. That cannot simply be transferred. It most certainly cannot be transferred when no medical consultant has been involved in splitting up the department.
It is not merely about people, but about the technical equipment that the hospital has secured over time with an expenditure of more than £7 million—it is probably nearer £10 million. That has ensured that the department has up-to-date, first-rate equipment of the best standard that can deliver the best to the people who require those services—my constituents and those of my colleagues. Such activity takes place over time, not instantly. There seems to be a belief that sheer will-power and a removal van can ensure the establishment of excellent departments of paediatrics, gynaecology and maternity in Hartlepool, but it would take longer and require more persuasive activity. It would also require further expenditure—probably of £10 million—to secure it. Ara Darzi’s plan was wrong in its conception because he did not ask the people who needed to be asked whether the split in function was feasible.
I am keen to tell the House that the same professor did a report on Darlington and Bishop Auckland hospitals. His recommendation was clear. The outcome of the inquiry was that elective and acute treatment should be kept together. What is so seriously different about North Tees university hospital and Hartlepool university hospital? My hon. Friend the Member for Stockton, North put his finger on it: the professor was given the mandate to save the hospital. It was a nonsensical mandate. There never was a threat——it was a nonsense put about by the Liberal Democrats during the by-election won by my hon. Friend the Member for Hartlepool (Mr. Wright). It persisted because local people passionately want to keep what they have and do not want it closed. Professor Ara Darzi responded to that nonsensical threat, which was whipped up in the press by the Liberal Democrats—and shame on them for doing so.
My concern today is to secure the best medical services for the people that we serve. If they have to travel for half an hour or even two hours for the best, then so be it. As politicians, we should have the guts and the courage to say so. It is time that we acknowledged the fact that there is not always enough
money instantly to produce the best. For me, the absolute fact is that we have the best in North Tees university hospital, and I am not prepared to let it be split in two when such a split does not make sense.
I bring to the attention of the House the fact that one clinician has resigned and that others are considering their position. People are saying that the situation is insecure and that they are not prepared to accept it. They are also not prepared to do again the phenomenal work that it took to develop the department in the first place, as they will have to retrace their steps entirely if it is to be reproduced at Hartlepool university hospital. I do not accept that the argument is about the miserably low level of health achievement universal in the north-east, about which my hon. Friend the Member for Hartlepool spoke. I am not prepared to go down that route.
We should understand exactly what Ara Darzi’s report will mean for three departments of excellence. The paediatrics, obstetrics and gynaecology consultants said that they have a very high level of emergency work. They all believe that they should not be moved to an elective site. Are we serious in not taking the experts’ advice when designing appropriate medical services? If so, our constituents will look upon us with disdain. The obstetric consultants emphasised that theirs is essentially an emergency service. They said that it makes no clinical sense for the department to be moved to an elective site, as they usually deal with emergencies.
The paediatric consultants state that, if paediatric services are separated from the acute site, it will require a significant increase in investment to provide round-the-clock cover for paediatric surgery and trauma. A doubling of the staff employed in both hospitals will have to be accepted. They also say that both sites will need a paediatric anaesthetist, and they are scarce. The consultants say that it is difficult to get staff appropriately trained to deal with trauma and emergency operations and that total understanding and competence is required of all consultants and surgeons performing such operations. They also say that running costs will be significantly greater.
The consultants gave me examples. They said that the vast majority of women giving birth need consultant care. Although the majority of women deliver babies without complications, that is not synonymous with doctors having no input. They also say that there will be a high transfer rate between the midwife-led units at North Tees hospital and consultant-led units at Hartlepool hospital. On paediatrics, they said that many decisions can be made only by specialists—for instance, a child suffering from stomach pains may have appendicitis, but paediatric emergency services with surgery competence will be needed if a misdiagnosis is made.
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