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The hon. Gentleman is being generous, but let me be absolutely clear about this: in health service terms, there is a clear distinction between secondary and tertiary care. Let me cite a single example. Under Sir Ara Darzis proposal, it was suggested that there would be a centre of excellence for childrens and maternity services at Hartlepool. That will not happenit will be sited somewhere else. That is not tertiary care, but secondary care. Maternity care will not be provided in Hartlepool. One of the reasons why the IRP said thatit is straightforward and I understand itwas that it thought that patients would
go not to Hartlepool, but across to James Cook hospital, and it did not think that maintaining maternity services at Hartlepool hospital would be sensible.
Frank Cook: The hon. Gentleman seems insistent on reintroducing Professor Ara Darzi, although he was disposed of some time agonot as a personality, but in the form of his report. The Opposition must get their head around the problem. The hon. Gentlemans colleagues want a cardiologist on every corner. They seem to think that there should be every provision on every street so that people do not have to travel anywhere, but that is not possible in todays times and with todays needs. We should be providing for needs only where that is neededit is as easy as that. We cannot have specialist provision in every village.
Frank Cook: I am going on because I need to refer to the business of reconfiguration and poll tax, about which we heard from the Lib Dem spokesman, the hon. Member for North Norfolk (Norman Lamb). He complained that the Labour party did not mention reconfiguration in its manifesto, and said that if one googles those phrases, one finds that reconfiguration has been mixed with poll tax, as though that proved something. The only thing that it proves to me is that they have become mixed due to the kind of untruths [ Interruption. ] I do not want to say lies.
I noticed that the hon. Member for North Norfolk made no mention of the threat of closure in Hartlepool. The only time that there has been such a threat was when it was made at the time when the Liberal Democrats were fighting a by-election in which they were trying to ensure that my hon. Friend the Member for Hartlepool (Mr. Wright) did not arrive here. In fact, they failed, which just proves that even when they tell the right time, they are not believed.
I counsel some of my colleagues to be careful about how they use their arguments, for they might simply be doing damage by giving a hostage to fortune to those who would take their words and, as Kipling wrote, twist them like
knaves to make a trap for fools.
It is a privilege to speak again in a health debate after my right hon. Friend the Member for East Hampshire (Mr. Mates). He and I share a number of things in common, especially the fact that both our constituencies have been burdened since 1997 by several reviews of their local areas hospital services. In
Mid-Sussex alone, there have been four such reviews since 1997, each with a more ludicrous name than the last. The penultimate one, Best care, best place, took place in 2004, and 18 months on, the whole health service in West Sussex has been thrown into confusion by another paper, Creating an NHS fit for the future.
Those reports were subsequent to a document commissioned by the West Sussex health authority, which, in 2000, faced growing fragmentation in health care provision, escalating and disproportionate management costs, and rapidly accumulating debts. The authority turned to Michael Taylor, a senior executive at the Oxfordshire health authority, and asked him to report back to it. Taylor exposed a series of top-heavy management structures in expensive premises, and duplication, replication and wastefulness. No one paid any attention to his warnings and the wilful mismanagement of the NHS in West Sussex continued, leading to colossal debts of over £100 million.
We have discussed the subject before in similar debates, but the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham) has given no answer on the issue. Sadly, as many colleagues would agree, when the Best care, best place consultation began in November 2004, it was regarded as a total sham in my constituency and elsewhere. Regrettably, West Sussex county councils scrutiny committee failed to do its duty, and did not call it in. I want the Minister to understand that the management of the strategic health authority, and most specifically the primary care trust, represented the paper to my constituents and to me as the way ahead for the foreseeable future. Many of my constituents were deeply cynical about the Governments motive, but they went along with it.
On 7 June 2005, at my suggestion, Professor Sir George Alberti, the Department of Healths so-called accident and emergency tsar, came to a meeting in the boardroom of the Princess Royal hospital to discuss the changes put forward in Best care, best place, the penultimate reconfiguration that my constituents have been obliged to endure. In that meeting, he persuaded me, against my better judgment, that it was right to make the proposed changes to the accident and emergency services, and particularly to switch major trauma cases from Haywards Heath to a hospital in Brighton, because of the necessity of treating major traumas on a site where all the main services were present. I still believe that to be the case, but at the end of the meeting he made it absolutely plainI have it in the minutesthat
had he taken a blank piece of paper to design the services for the given location with the same geography, patient flows, he felt that the presented solution was the best fit and would have been the one that he came up with.
significant benefits to be gained from the reconfiguration,
Many of my friends, and colleagues of all parties, who attended that meeting were deeply cynical about what Sir George Alberti said, but I supported it. I must report to the House, however, that, not 18 months later, it is probable that a further significant upheaval will be proposed. There will be further substantial changes,
which may include the removal of an essential accident and emergency service at the Princess Royal hospital, to be replaced by a walk-in centre.
As I hope the Minister is aware, we are talking about a part of the United Kingdom that already suffers from serious infrastructure fatigue. The hon. Member for Staffordshire, Moorlands (Charlotte Atkins) spoke about the health service in her constituency, but what she describes sounds like Versailles compared to what we have in my constituency, and compared to the investment that has been made in health and wider infrastructure in Sussex. Mid-Sussex alone has a statutory duty to accommodate 7,000 new homes between 2006 and 2016, and that equates to about 45,000 extra people, yet there is talk of closing an accident and emergency department in a hospital not 5 miles from a major motorway. Gatwick airporta major international airportis up the road, and there is only one accident and emergency centre anywhere near it.
There is appalling traffic on the roads into Brighton, and the infrastructure and public transport system are entirely inadequate to support the change. That change was proposed despite the assurances that I was given on the Floor of the House in an Adjournment debate that I secured on 16 March 2005 by the Ministers predecessor, the right hon. Member for Barrow and Furness (Mr. Hutton), now Secretary of State for Work and Pensions, who stated :
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.]
I urge the Minister to repeat that assurance on the Floor of the House. The removal of a full accident and emergency service is not right for my constituency or for my constituents and, between us, we will not permit it to happen. The Support the Princess Royal hospital campaign commands enormous local support, and it is an all-party cross-community effort that has attracted nearly 60,000 signatures. People have signed a petition to the effect that they will not tolerate the removal of their A and E, as they believe that it would be wrong to end that service. They want to preserve proper maternity services for a growing population, so it is essential that the Government listen to the clearly expressed views of large numbers of local people who believe that the proposals are completely wrong.
The Keep Worthing and Southlands hospitals campaign has attracted more than 100,000 signatures, and the St. Richards campaign in Chichester has attracted 134,500 signatures. Will the Minister confirm that consultations will be held in good faith and that the strong views of local people will be accorded the respect that they deserve, as failure to do so would be a recipe for profound resentment and indignation? My hon. Friend the Member for Arundel and South Downs (Nick Herbert), who has played a detailed and effective part in that campaign, and I both accept that change is required. Changes can and should be made, provided that the infrastructure is in place. We will support those changes, but we do not support the removal of A and E and maternity services.
It is the perception in our local health service and, I believe, in many other local health services, that our magnificent, hard-working nurses are engaged in a
constant struggle to look after patients as a result of inadequate resources and facilities, yet local trusts appear to have limitless resources to hire more bureaucrats. Local people know that the local NHS operates in an Alice in Wonderland world of twisted targets and distorted figures, and I would not care to be the auditor who has to sign off NHS accounts. Doctors should play a far bigger role in patient care; it is they who should be in charge of that care, not managers. The proposals in the Fit for the Future document are not better for patient care, as they constitute an effort directed from London to resolve the appalling mismanagement which people failed to deal with or get to get to grips with in the past, and to absolve them of responsibility for the grotesque financial problems that have arisen as a result.
Finally, I have two important points to make. First, the accumulated historic deficits resulting from poor management over the years and a lack of grip, together with the merger of the Princess Royal hospital and the Royal Sussex county hospital in Brighton, inevitably led to a large overhanging debt. I have referred to that problem on many occasions in the House, and we need a better, more constructive and imaginative approach to deal with those debts, quite apart from the necessity of making sure that the hospital is run prudently and effectively. The trust management is doing its very best to meet those demanding targets, but the Minister should meet it half way, and I urge him to meet a delegation to discuss the matter. Secondly, the Government must review the funding formula in West Sussexa subject on which my hon. Friend the Member for Chichester (Mr. Tyrie) has consistently made a detailed case. I know that the Minister discussed the matter the other day with my hon. Friend the Member for Arundel and South Downs.
The Princess Royal hospital is a first-class establishment and it has a highly skilled and dedicated work force that plays a vital role in the local NHS, in an area with vastly expanding requirements and inadequate general health infrastructure. There should be more services at the PRH to utilise fully this excellent local hospital, which would be in the best interests of local people and patients. Everyone knows that the hospital does an exceptional job, and with the right support and without the dead hand of Government with their arbitrary targets, that outstanding hospital could do even more. That is what I want to see, and I know that local people in Sussex share my view.
Dr. Howard Stoate (Dartford) (Lab): I welcome todays debate, not just because it gives us an opportunity to discuss the process and nature of hospital reconfiguration, but because it provides us with the opportunity to consider the wider question of what kind of role the acute general hospital ought to play in the 21st-century NHS.
Reconfiguration is needed to improve health outcomes. Changes are necessary whether or not there are NHS deficits. Indeed, in some cases the reason why trusts have run up deficits in the first place is because these decisions were not made earlier.
We must start judging the NHS by the number of people we make better and keep well, not by the number of beds.
That, to me, is perfect common sense. Much of the debate on reconfiguration tends to dwell, quite understandably, on the potential loss of local hospital services and the perceived reduction in the quality of local health care. That diverts attention from what ought to be our primary area of inquirywhy we continue to admit so many patients unnecessarily to hospital, and what we can do to prevent it.
As I have said on many occasions in the House, the vast majority of hospital admissions should be seen as a failure of health policy. Every day thousands of patients are admitted to hospital not because they are desperately ill or because they need the support that only a hospital can provide, but because we often do not have anywhere else to treat them. In most cases patients enter hospital as a direct consequence of our failure to spot potential problems, to prevent people from becoming ill in the first place, and to put in place effective care packages that would allow them to be treated properly at home.
One in four emergency admissions consists of people with chronic conditions who yo-yo in and out of hospital three or sometimes four times in a single year. That adds up to 1 million unnecessary hospital admissions each year, costing the NHS in excess of £2 billion. This catastrophic waste of money rarely does patients any particular good. Not only do patients not want to be in hospital, but in many cases they would make a quicker and more complete recovery in their own homes and certainly in their own communities, supported by an appropriate care package close to where they live.
Most policy makers and commentators understand that and sometimes even talk about the need to reduce unnecessary hospital admissions, yet progress is painfully slow, given the sensitive nature of reform. As we have heard this afternoon, too often the reason is thinly veiled political self-interest on the part of Members who understandably but, in my view, misguidedly try desperately to talk up their own area and their own interest, often to the detriment of the wider health service. We must try to redress that tendency.
We are making some progress. Patients are discharged back into the community far more quickly than they would have been a generation ago, thanks to the increased use of less invasive procedures and the huge increase in day surgery. Todays hospitals require far fewer beds, as we have heard in the debate, and patients requiring minor procedures are increasingly being treated elsewhere. However, I believe that the model of acute care that we had in place is no longer fit for purpose, and we need to rethink radically the way in which the acute system, and the district general hospital in particular, is operated.
We should start by asking which services must be provided at acute district hospital level. Although there is a range of services to which patients in each area need access, including trauma, accident and emergency, orthopaedics, paediatrics, obstetrics, gynaecology and many others, there is no reason why all these specialties should be provided at each and every acute hospital in a particular region.
Anne Main: I respect the hon. Gentlemans approach, but does he not acknowledge that when a consortium of GPs in my area opposes reconfiguration on the basis that it does not deliver the best health care, we should listen to the views of those GPs as well as his own views?
Dr. Stoate: As I am not an expert on the hon. Ladys constituency, I cannot possibly comment on what the local GPs want. I am making much wider points about the direction that the NHS should be taking.
The duplication of services is vastly costly, and makes it far more difficult for individual hospitals to build up the specialties and expertise that they need. Would Members rather be treated by a unit that dealt with 10 cancers in a year, or by one that dealt with 200 in a year? I think the answer is fairly obvious. Why, then, do we need specialist cancer services in each hospital? I am merely making the general point that if services are configured in a way that concentrates the most expertise where that expertise is best delivered, everybody will benefit. We will avoid duplication, staff can build up much more expertise, and ultimately patients will receive a far better service. Such an approach would enable us to rationalise the number of beds significantly, and to save each trust hundreds of thousands if not millions of pounds without jeopardising patient care in any way. After all, a stay in hospital does not come cheap: it can cost up to £500 a night for someone to stay in an acute unit.
There will obviously be some obstacles to the process that I wish to see. The way in which hospitals are financed and set up will have a bearing on the configuration that will be possible over the next few years, and I think we must look carefully at the way in which we establish and pay hospitals to ensure maximum flexibility. I make no secret of my belief that the payment by results system has sometimes presented an obstacle. It often makes reconfiguration quite difficult, because paying hospitals according to activity rather than results may give them an incentive to provide care that, in my opinion, would be far better provided elsewhere.
As the House knows, I am a GP who continues to practise a certain amount. GPs have been given control of their budgets under the practice-based commissioning scheme, and in theory they can control their use of secondary services to a large extent, but the reality is very different. Many patients still attend A and E units off their own bat, and are treated, admitted and referred to consultants without any consultation with their GPs. Most of that treatment may be justified and necessary, but it is not possible for the primary care sector to have any control over it.
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