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The Royal College of Surgeons has argued for acute hospitals to have catchment areas ideally of 500,000, but at least of 300,000. That is because of the need to ensure that consultants in the main surgical specialties are available to provide emergency cover. It is also argued that such a catchment area provides the necessary concentration of case load for training doctors and maintaining surgical expertise. However, we must also recognise that, in remote rural areas, distance can be a safety issue, especially in respect of accident and emergency provision. We need to take that concern seriously.
Dr. Stoate: The hon. Gentleman gives the impression that the reconfiguration of hospitals is a new idea. I have been in my constituency for more than 20 years and we have reconfigured our mental health services from 2,000 beds to approximately 150 and our acute beds from 1,000 to 400 in the past 15 years. In Darent valley hospital, we now have one of the most successful three-star hospitals in the country. Reconfigurations have been taking place long before the Government came to power.
Norman Lamb: The hon. Gentleman has simply not been listening. Perhaps that is because he is trying to do two jobs at the same time. If had listened, he would have noted that I made the point that reconfigurations have taken place throughout the existence of the NHS. The hon. Member for Pudsey made the point about hospitals closing under a previous Conservative Government.
The cancer plan in 2000 made the case for specialist centres. I understand that it defines the number of patients that should be seen in breast clinics to ensure a sufficiently diverse case load to maintain skill levels and quality of service. I understand that fully fledged obstetrics units cannot be run safely without accompanying fully fledged paediatric units. Liberal Democrats do not oppose reconfiguration for the sake of it. There are clearly good clinical grounds in many circumstances for reconfiguration. However, that does not mean that reconfigurations are always planned for the right reasons or carried out acceptably.
What is wrong with the Governments approach? It has two central flaws. First, the process has become inextricably caught up in the crisis that faces significant parts of the health service, where there is overwhelming political pressure to clear massive historic deficits. The East of England region is a case in point. Clinicians to whom I have spoken raised specific concerns with the strategic health authority about whether reconfigurations in that region are being driven by the crisis in financing.
Mr. Francois: Like me, the hon. Gentleman is an east of England Member of Parliament. He knows that more than 50 per cent. of all the operational deficits in the NHS are centred in the six counties of the east of England. Many primary care trusts in that region have consequently had their budgets top-sliced to move money from one to another to try to plug the gap. How can PCTs work with acute trusts to try to plan for the future when those such as mine, in the south-east Essex area, have had £12 million taken away at short notice, with no guarantee that they will get the money back?
Norman Lamb: The hon. Gentleman makes a good point. The figures that were published yesterday show that the top-slicing has plunged many more organisations into deficit and genuine financial difficulty, potentially affecting patient care.
Financial pressures within the NHS are being felt at both local and national levels, adding urgency to decisions about which services should be provided, where, how and by whom. At a local level, the presence of financial deficits in individual NHS organisations is forcing trusts to consider which services they can afford to provide and which must be cut.
At a national level, the anticipated end to large increases in funding for the NHS after 2008 is prompting the Department of Health to focus on how the delivery of health services across the system as a whole can be made more cost-effective.
Before Christmas, the Select Committee on Health made the link between deficits and reconfigurations in its report on deficits. It referred to evidence from the acute trust in Worcestershire. The trust stated that service reconfiguration was essential, but that it would not be enough. I quote:
the Trust Board has recognised that it will not be able to make the final steps to achieve recurrent financial balance without even more radical action. This will involve a comprehensive review of services across the three sites and serious questions about their sustainability.
I said earlier that I had spoken to a consultant in the East of England region, who said that his colleagues had raised concerns specifically with the strategic health authority about the dire financial situation in that region. He raised the related concern that that was driving the pressure to reconfigure. Let us be absolutely clear: reconfiguration decisions tainted by trusts suffering massive deficits cannot be justified.
The second flaw in the Governments approach is the extent to which the whole process is being centrally drivena point made in a number of interventions on the Secretary of State earlier. Consultations are a sham and in places there appears to be a hopeless lack of engagement with clinicians. Solutions that may well be ill thought out are imposed from above. Those who work in the service are often left with no confidence in the decision-making process.
The whole process got off to a pretty inauspicious start in September last year when the newly appointed chief executive of the NHS was reported in The Guardian as announcing that there would be up to 60 reconfigurations of NHS services, affecting every SHA in the land. That did not sound to me like an invitation for local trusts to consider their options for service delivery and to take their own decisions. It was the head of the NHS saying that there will be reconfigurations.
Its got to be done locally. The local NHS, the doctors and other front line staff sitting down with each other and with the local public, to work out what is the best and the safest way of providing healthcare to the people in their area.
Decisions about reconfigurations are the responsibility of the primary care trusts working together with the strategic health authorities. I want to say a few words about the role of the SHAs and about my experience in the East of England region. I suspect that if we asked average members of the public what the SHA does they would not have the faintest idea. Yet we have seen in the East of England region and across the country how they wield enormous power in a way that totally lacks transparency. Where does accountability lie for SHAs? It lies, of course, directly with the Secretary of State.
We have seen the influence of the SHA in Norfolk, where a new PCT was established in October. A lady called Hilary Daniels was appointed as the acting chief executive. Back in August, the person who had been appointed as the new chair of the PCT announced in a letter to staff the intention that Hilary Daniels, previously the chief executive of the West Norfolk PCT,
will hopefully become interim Chief Executive either until a substantive appointment is made or by the end of June, 2007.
was delighted that she is now able to bring forward
I have spoken to consultants in the East of England region who have raised concerns with me about the extent to which the SHA was involving clinicians in the development of its plans for the reconfiguration of acute hospital services. The truth, I am told, is that the level of engagement appears to be minimal. One comment from a clinician was that they were
utterly out of the loop.
I remind hon. Members of the Secretary of States comment in October about local health services sitting down with clinicians and the public. Here we have a clinician in the East of England region saying that clinicians are
utterly out of the loop.
Perhaps to provide some reassurance of genuine engagement, the SHA announced that there would be a major stakeholder event in January. The only problem was that it forgot to tell the stakeholders. I heard from another senior clinician that they heard about it only four days before the event was taking place. They passed on the information to the union, which had not heard about it either. What extraordinary incompetence from the SHA. The result is that the clinicians feel that they have no confidence in a process that ignores their concerns. Of course clinicians should not dictate the process, but surely they should at least be listened to.
Going back to the Secretary of States comments from October, the whole approach was supposed to involve centrally doctors and other front-line staff in
shaping the proposals. That is certainly not happening in the East of England region and I suspect that it is not happening elsewhere.
Dr. Pugh: In my neck of the woods, most reconfiguration proposals do not result from consultation with clinicians. Their main source is management consultants, as has empirically been shown to be the case in many other parts of the country as well.
Norman Lamb: I am grateful to my hon. Friend for that intervention. He reinforces my point that the description of the process that the Secretary of State gave us in October is very far from the truth about how it in fact operates.
I want to say a few words about how the public are being involved in the process. Does that match the Secretary of States impressive commitment? The evidence points in precisely the opposite direction. The Health and Social Care Act 2001 imposed a legal duty on health trusts to consult the local population, which was clearly a move in the right direction. The trusts are required to consult about significant changes to service provision and to consult the local authoritys overview and scrutiny committee. The committee, in turn, may refer a case to the Secretary of State if it considers that the public involvement process has been inadequate or if it believes that the proposed changes are not in the interests of the local area.
By the end of July 2006, 16 cases had been referred to the Secretary of State, 14 of them in the last year of that period. I understand that the Secretary of State has referred only two of those casesalthough I think that she said that one more had been referred in the past weekto the reconfiguration review panel. In only one case did the Secretary of State support the objections of the overview and scrutiny committee
Norman Lamb: If the Minister would like to intervene, or to respond at the end of the debate, I would be interested to hear more about that. None the less, it appears that the number of cases in which the view of the overview and scrutiny committee is supported represents only a tiny proportion of the total. The process rarely seems to lead to a change in the proposals. So much for the local NHS sitting down with the public to decide what is best for their area. It is a sham, and the Secretary of State knows it.
Can we be reassured that local primary care trusts are centrally involved in designing proposals for reconfiguration? Sadly not. They are not locally accountable in any sense. Their boards are appointed centrally by the NHS Appointments Commission and we know just what happens if they fail to toe the line: their chief executives get sacked, as we have seen in Norfolk. That is the reality. This is not local decision making. PCTs with centrally appointed boards are kept in line by strategic health authorities whose boards are also centrally appointed, and which are accountable only to the Secretary of State and operate in the shadows without any adequate transparency. Is that really the Governments idea of local decision making? Such a thing does not exist in reality.
The Secretary of State needs to understand that dissatisfaction with the whole process is growing out of control. It is not only her Cabinet colleagues who are objecting. There is widespread rejection of the way in which the matter is being handled, and of the motivation behind it. It is all too easy to use expressions such as, This is Labours poll tax, but that view is spreading. If we google the words reconfiguration and poll tax, we realise that that expression is being used more and more across the country. In December, The Guardian identified 50 campaigns around the country and talked about the most widespread unrest since the poll tax revolts of the 1980s.
I must express my severe doubt as to whether the Conservatives would do things any differently. Their motion talks about the need for a stronger local democratic voice, but the hon. Member for South Cambridgeshire (Mr. Lansley) did not tell us what that voice should be. I would be interested to hear more about what they are actually proposing in that regard. I suspect that, in reality, the process would be very much the same as the one that we have experienced under this Government.
We certainly need a democratic local voice to reclaim our health service from a centralised approach that ignores local opinion on major changes of this kind. This is a flawed process, and the Government need to think again. They need to do, in reality, what the Secretary of State claimed was happening in her interview with the BBC last October. She knows, and the Government know, that the reality is very different, and that the centralised approach that they are dictating simply is not working and is being rejected by members of the public across the land.
Our health, our care, our say set clear goals for the transfer of services to community settings. That is particularly welcome in a rural setting such as Staffordshire, Moorlands, where a round trip to the acute hospital can be more than 60 miles. In my primary care trust area, community matrons help people better to manage long-term conditions such as heart disease and diabetes, improving their health and quality of life as well as reducing hospital admissions. With an increasingly elderly population, falls are a huge concern and Leek Moorlands hospital now has an innovative falls programme to prevent falls and to help patients manage better after a fall. That saves lives, builds confidence and encourages independence,
keeping elderly people out of hospital and living in their own homes, where they want to be.
That is not all. My local community hospital, Leek Moorlands, has a minor injuries unit which is open every day from 8 until 8, with minimal waiting times. In addition, PhysioDirect offers telephone advice and treatment, without having to see a doctor first, for the whole range of neck, joint or muscular problems. There is also the deep vein thrombosis diagnostic service, which allows 200 patients from Staffordshire, Moorlands to be diagnosed and treated locally each year. That is a huge improvement for patients who would otherwise have to travel to Stoke-on-Trentagain, a round trip of about 25 miles.
All of that was initiated by my local primary care trust, which was going to be swallowed up by a gigantic Staffordshire-wide primary care trusta reconfiguration too far. Although the Shropshire and Staffordshire strategic health authority steadfastly refused to take on board public opinion, the expert external panel and Ministers listened and supported my local campaign and we kept a local primary care trust, which has delivered for local people. Therefore, the public consultation did work and local health bosses were forced to accept its result.
Effective consultation with patients and public is essential, not only for the reconfigurations that I have mentioned, but to ensure that redesigned services truly benefit patients. The chairman of my overview and scrutiny committee, Councillor Mahfooz Ahmad, has worked tirelessly with the local PCT to spearhead the campaign to establish a local health centre and GP surgery in Cheddleton in my constituencya fast-growing village with about 6,000 residents and no GP. The PCT is rightly responding by carrying out its own public consultation to ensure that there is a real demand for that service. I hope that we will soon see a GP practice in that village.
With all that happening, is it surprising that there is a huge impact on acute hospital services? The number of hospital beds nationally has decreased by a third in the past 20 years. That does not mean, however, that the amount of care has decreased; on the contrary, it has increased dramatically. We must judge the NHS by the number of people it keeps well and makes better, not by the number of beds. My local acute hospital, the University hospital of North Staffordshire, has buildings spread over three sites in an area of more than 90 acres. The age of the buildings ranges from less than 10 years to more than 150. That leads to huge problems and inefficiencies as services are split and patients have to be transported between different buildings and sites during their care.
Our fit-for-the-future project will rightly create a new state-of-the-art hospital. It will have fewer beds, but that is because out-patient appointments will take place in clinics and health centres closer to people's homes, and patients will return home or to community settings more quickly when their treatment is complete. Already, the central out-patients department is cutting its service by 20 per cent. because of fewer GP referrals.
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