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16 Jan 2007 : Column 242WH—continued
It does not need an Einstein to understand what is required. It is not about ensuring an easy transfer between two hospitals; the journey on the main roads between Hartlepool and North Tees hospitals from 8 am to 9.30 am and from 4.30 pm to 6 pm is seriously difficult. A misdiagnosis might not be problematic, but such a journey might have to be accommodated. A child who had received emergency surgery for appendicitis in North Tees hospital would have to be transferred to Hartlepool for post-operative care. We must understand the problem. For example, a mother
with three children may have to travel by bus to see one of them in hospital. Will she be able to see her child in Hartlepool as easily as in North Tees university hospital? I do not think so. We need to consider such services in the round.
The gynaecology service makes the same point. Someone with stomach pains could be suffering an ectopic pregnancy; that could be highly problematic. The last thing we should do is to split acute and elective surgery, as it would threaten peoples’ lives.
Of course, it is not only the consultants who would have problems. The overstretched ambulance service told me that, if it made the wrong diagnosis, the patient could be taken to the wrong hospital. Should the ambulance go to Hartlepool or North Tees? The wrong decision could have a serious outcome.
With the best grace that I can muster, I have to say that the Ara Darzi report, which splits the functions and suggests that we can transfer excellence effortlessly, is wrong. I am delighted that the independent reconfiguration panel has reconsidered it. I must tell the Minister and my hon. Friends that, if I am wrong and if I have misunderstood the information and evidence that I have been given, I will say so. I will accept the panel’s conclusions on how best to deliver the best medicine for the people whom I represent. I believe that I am honour-bound to do so.
My hon. Friends mentioned travelling. I have a large population in the south of my constituency—in Parkfield, Thornaby, Yarm, Hilton and Kirklevington. It probably takes people 20 minutes to get to Middlesbrough by bus, and it would take at least an hour and a half to get to Hartlepool. That is the operational distance. If it takes people 20 minutes to get to Middlesbrough, take it from me, they will not go to Hartlepool. If they do not travel to Hartlepool, we will have a split in elective and acute services and Hartlepool will find itself without sufficient throughput of patients. My people will not go to Hartlepool, and I am not making that up; it is a fact. The throughput will not be sufficient and that department will be vulnerable before it begins its life. I ask for someone to take that on board. It is not just because of the hour and a half journey time or because my constituents have to travel south before they travel north; people face two or three bus changes and may have buggies or young children. In addition, the cost will be three times that to go to North Tees hospital.
The conclusions regarding this issue are wrong because the report was set up with the wrong purpose: to save Hartlepool university hospital. There would never be a threat to that hospital. I would stand on the line protesting with my hon. Friend the Member for Hartlepool if I ever thought that there was a threat. The conclusions are wrong and I hope that I have made sufficient sense and that what I have said is taken on board—I said the same when giving evidence to the independent reconfiguration panel.
I end where I began by making the same statement very quickly all over again. My concern is for the delivery of competent medical services to the people whom I represent. That is what I shall fight for and that is what I believe should be delivered. I am not arguing for North Tees to have what Hartlepool does not. I am simply saying to hon. Members that the division
suggested by Ara Darzi is plain wrong and that all the evidence supplied by the consultants would support that statement.
12.2 pm
Dr. John Pugh (Southport) (LD): I congratulate the hon. Member for Stockton, North (Frank Cook) on triggering this debate and all hon. Members on speaking passionately in favour of their constituencies and the services within them. I will not venture too far into the details of the cases made as it would be too much like venturing on private grief and discord, which according to some hon. Members is entirely the fault of the Liberal Democrats and nothing to do with the Government, who are running the health service.
I am fond of the area and must confess that I visited Hartlepool because of recent by-elections.
Frank Cook: Did they let the hon. Gentleman escape?
I will concentrate on the generic features that an issue such as this throws up. I am a veteran of such issues. My local hospitals were reconfigured in 2002 when the Shields report, not the Darzi report, was implemented. The accident and emergency, paediatrics and maternity departments were moved, and there were marches, meetings, protests and gigantic petitions. I even had a hospital campaigner backed by Martin Bell stand against me in 2005.
Today’s events in Westminster Hall suggest that my experience in 2002 is now replicated across the land. The problems associated with this issue are a product of certain pressures and policies. The pressures are relatively well established: the working time directive, the new tougher financial regime, the drive to get hospital deficits down, changes in the hours for junior doctors, and the higher training needs specified by the royal colleges. The other factor is policies and there are some good policies based on the need to have centres for excellence, the drive to improve quality and the need to have services brought closer to the patient at a community level.
The problem is dealing with the pressures and the policies while getting the balance right. There are a variety of routes that can be followed to balance out the pressures and the policies. One mantra recited by the Government is to leave it to local decision making, which, we all understand, really means decisions by a local quango—a locally based set of appointees. Following a consultation that is often completely ignored and, in many cases, virtually an insult, quangos make their decision with all the aplomb and indifference of colonial governance. That is not genuine local decision making, but, time and time again, it is what the Government call local decision making—I have heard it said already this morning. In fact, decisions are not made by local people, but by local appointees who ultimately owe their careers to the health service, not to responding to what local people ask of them.
Answer No. 2 when dealing with the balancing out of pressures and policies is to have a report and implement it, whether it is a Jerrold report, Darzi
report or, as was relevant to my constituency, a Shields report. The deficiency in that is that such reports tend disproportionately to reflect the interests of medical communities, which are more worried about litigation and the advice from the royal colleges than issues of access. The report carried out in my neck of the woods on configuring services contained a clause that suggested a configure services in a particular way that created enormous transport problems—there were not the roads or rail or bus services to support it. The report went on to say that that was not an issue for an NHS report. In other words, how people get to the services was outwith its concern. The same is true of many reports that I have seen that have attempted to reconfigure services: the transport issues are set aside for somebody else to deal with.
Reports take time and are normally a long time in the cooking before they see the light of day. During that time, the world changes and the advice changes——even advice from the royal colleges. Also, as has been alluded to today, they tend to be nipped in the bud by political tampering and do not turn out to be the honest pieces of work they ought to be. That is also unsatisfactory.
Answer No. 3, which was referred to by the hon. Member for Stockton, South (Ms Taylor), is to refer the issue to the independent reconfiguration panel, which, in principle, is a good idea. However, reference in most cases depends on the Secretary of State being compliant with it and, even when the report is done, it will not have the necessary coercive force.
The solution that we all advocate is genuine local decision making, but that needs to be based on two distinct pillars. We need to have a clear view of the entitlements and what the people of Teesside require in terms of service and access to service. The hon. Member for Stockton, North referred to the fact that people did not start by considering what people needed, but rather the more problematic question of what the services are and how they might be configured. We should also be clear and honest about what the people of Teesside and the country are prepared to pay for through taxation, because every service comes with a price tag.
We need more fairness and honesty from the Government on this issue. There are a range of concerns and three particularly affect Teesside, but they also affect most parts of the country. One issue is deficits, because they tend to affect how things turn out. There is no doubt that previous NHS methods of finance were sloppy and had broken down into a system of bailing each other out—a kind of financial pass-the-parcel. When the music stopped, and, clearly, it has now stopped, some trusts were left holding huge historic debts. Under new resource accountancy rules, that meant reduced revenue and led to a spiral of decline, added to which some trusts—I do not know what the situation is in Teesside—are saddled with substantial debts as a result of capital investment or private finance initiative schemes. Without fair funding, configuration cannot be done fairly and people will not be persuaded that clinical needs are the driving force. We have not got there yet and that is why these problems persist.
The Government also need to be clear about moving care into the community. They cannot just talk about it; the funding and the service actually has to be out there. Community-based care cannot simply be an aspiration to justify closing existing facilities. There was a case in my constituency where the blood service was moved out of the hospital to a clinic. That was called “moving it into the community”. It was moved into a clinic in the far south of the constituency, so 50 per cent. of my constituents now have further to go for a simple blood test. They would much prefer to have the service in the hospital, because it would be closer to the part of the community in which they live.
It is crucial for Teesside that we have clarity on neonatal safety. We had a recent debate in the House on maternity services and I listened carefully to what the Secretary of State said. She began by praising small, midwife-led units. Later, she extolled the virtues of high-tech ones. When asked what would be the optimum size of a maternity unit and what evidence the Government had for any view that they might take, she dodged the question. I remember that she was pressed on the issue by the hon. Member for South Cambridgeshire (Mr. Lansley).
I do not think there was any desire on the part of the Secretary of State to be mendacious, duplicitous or especially evasive in this context. She was talking about units being safe for different types of birth. Clearly, midwife-led units that are well run will be safe for unproblematic births; for more problematic or low-weight births, a more sophisticated unit will be required. What is required in a maternity unit has become extraordinarily vague. It would be helpful if the Government published the evidence on what is safe and for which type of unit and birth, and the standards required. They would thereby add the clarity that the debate needs. Unless the Government contribute more clarity to the process, what we are seeing today in Teesside will be replicated in other areas and heard about in debates throughout this Parliament.
12.11 pm
Tim Loughton (East Worthing and Shoreham) (Con): I add my congratulations to the hon. Member for Stockton, North (Frank Cook). These debates have become a familiar scene. Ministers and shadow Ministers visit this Chamber fortnightly to deal with some part of the health service that is annoying hon. Members around the country. This debate has a particular sense of déjà vu about it. It is round 2 of the debate that the hon. Member for Hartlepool (Mr. Wright) started on 11 December, with the same protagonists from Hartlepool, Stockton, South and Stockton, North, although we have had perhaps rather less heated interjections from the hon. Gentleman this time. The time was extended from half an hour to one and a half hours and, with the added reference to the hyenas of the political savannah—the Liberal Democrats—I feel something of a bystander in all this.
Hon. Members have spoken about the relative merits of James Cook university hospital in South Tees, the university hospitals of North Tees and of Hartlepool, the Darzi report and the Tees report by Ken Jerrold. I add my tributes to the very dedicated staff at all three hospitals, who must be bemused by the political to-ings and fro-ings that have gone on over too many years
when they all want to do is to get on with their job of looking after their patients to the best of their ability. I have not visited any of those hospitals, but all the speeches made by the hon. Members representing the constituencies where they are based were eerily familiar.
The hon. Member for Stockton, North talked about constant reviews. In my part of the world, we have had that, too. He spoke about reviews and their timing being to do with general elections. We had that in my part of the world in Sussex as well. He and other hon. Members talked about consultants voting with their feet and leaving, which is very worrying. We have that in our part of the world, too. He also made the bold claim that Hartlepool hospital is not under threat of closure and never will be. We used to think that about some of our hospitals in Sussex, too. Just two years ago, we were given cast-iron guarantees by the present Government that there would not be any more tampering or reconfiguration. Now, they are under the spotlight of reconfiguration, closure or downgrading after all, so my advice to the hon. Gentleman is not to hold his breath.
We heard a familiar story about millions of pounds being lavished on new facilities at hospitals, only for it to be proposed that they be transferred elsewhere. The James Cook university hospital, which the hon. Gentleman referred to, is already in trouble with saturation and deficits. We, too, have hospitals like that, which will supposedly have to grow to take up the slack.
The hon. Member for Hartlepool made similar comments, although obviously tailored rather more to his own constituency hospital in Hartlepool. He talked about demographics and mentioned the greater needs of the elderly population. I think he said that 15 per cent. of his constituents were over the age of 60. He has got it easy. In Worthing, in my constituency, 45 per cent. of the population are pensioners and 4.5 per cent. of that population are over the age of 85, with all the extra health requirements that the elderly population has. I am glad that he drew attention to that issue, because it is a case that we have made and that Ministers have not paid sufficient regard to on too many occasions.
The hon. Gentleman spoke about congested roads. Again, we have it worse in Sussex, in the most densely populated part of the country. He spoke alarmingly, but rightly, about the poor public health figures. They are not down to poor hospitals or good hospitals but to the complete failure of the Government’s public health policy. He gave shocking figures for the alarmingly increased chances of death from lung cancer in women under 50 in his constituency. He talked about 32,000 people signing a petition; some 300,000 people have signed petitions against reconfiguration in my county alone.
The hon. Member for Stockton, South (Ms Taylor) concentrated on the Ara Darzi report and some of the inconsistencies between earlier reports that it threw up. That was all eerily similar to what is going on in the health service up and down the country. For North Tees and Hartlepool hospitals, I could easily substitute Worthing and Southlands hospitals and the Royal Sussex county hospital at Brighton, in my part of the world. Every Sussex hospital is under the spotlight.
The difference is perhaps that in our part of the world Ministers do not join the demonstrations outside those hospitals against their downgrading. I suspect there are problems elsewhere in other areas of the region that we are discussing. Tomorrow, the hon. Member for Middlesbrough, South and East Cleveland (Dr. Kumar) will talk about education funding in the same area.
What is common to all these discussions is that we believe that any decisions about major reconfiguration should be based on three main things. First, they should be based on sound clinical practice that should improve the standard of health care for local communities, not on financial expedients. The Government need to come clean and admit that many of the decisions are being made on the latter basis. Secondly, they should take the local community with them if there is to be any credibility to Government claims about local decision making being of the utmost importance. The NHS is owned not by Ministers, NHS bureaucrats or even the staff but by the people and the patients. That is why the NHS is there. There should be genuine consultation of local people, the consultants and the clinical staff—to which the hon. Member for Stockton, South referred—not the sham, preconceived consultations that we have often seen.
Thirdly, there is more to hospital services than bricks and mortar and places of treatment. This is about the quality of life, the effect on large employers, infrastructure and transport, convenience and incentives to business. Just yesterday in my town, Worthing, the chairman of the South East England Development Agency came to a press conference to say that he believes that the proposals for reconfiguration in Sussex will have a serious detrimental impact on investment in our region—the powerhouse of the United Kingdom economy—and will downgrade the quality of life. He went on the record and said that. There is much more to this argument than just short-term financial balancing of books.
I could go into great detail about the problems with maternity services. A lot of this is about the vagueness of the proposals on which the decisions are being made. Does a maternity unit need to have 3,000 births to be sustainable and viable? In our part of the country, we are told that there must be at least 4,000 births, but Worthing hospital, for example, will have about 3,000. The largest maternity unit in Germany deals with only 3,000 births. If the reconfiguration proposals for our area go ahead and everything goes to Brighton, it will be the largest maternity unit in the whole of Europe, not just in this country. That cannot be good for patient care. Why does big always have to mean best? There is no evidence on which those decisions are being based that says that maternity departments of 3,000 or 2,500 or even 2,000 provide a lower quality of care, or pose a higher risk of mortality, to mothers and babies.
Let us have genuine horses for courses. Let us have genuine local consultation and local decision making. Let us not have the divide and rule that is going on in the health service. We have seen it graphically this morning, with neighbouring Members from the same party arguing for different things. If it ain’t bust, don’t fix it, and if it really is down to short-term financial expedients, the Government should at least have the
honesty to say so, so that we can have a transparent and honest debate. The Government are busy trying to avoid that.
Ms Taylor: Will the hon. Gentleman give way?
Tim Loughton: I will not, because the hon. Lady went over her time and I have only one minute left. I want the Minister to have her fair share of time at the end.
Too many decisions are being made by health bureaucrats behind closed doors, and that is increasing people’s suspicions and cynicism about what is really driving reconfigurations and about who is in control. We owe it to patients and our constituents to ensure that decisions are based on evidence and on what is good for their communities. This issue will run and run, and I suspect that at least some of us will be back here in a couple of weeks for a similar debate about another area of the country that faces similar problems.
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