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a stronger local democratic voice that will contribute to public confidence in the planning of acute NHS services.
I believe in that very strongly, and I have always done so. When the Conservatives were in government, I served on the Frenchay health authority. When a decision was made to remove elected local councillors from health authorities, because we knew too much about local matters, I disagreed. I welcomed the Governments introduction of overview and scrutiny committees, although there is insufficient local democratic accountability, as the Oppositionand I agree with themsuggest in their motion. It is self-evident that that accountability is insufficient to exercise control over financial matters, and local councils would never have been allowed to find themselves in the position in which, sadly, some trusts and PCTs have found themselves. Similarly, it is important that local communities engage in consultation about reconfiguration from the outset, and that proposals are not bounced on to them.
Like my hon. Friend the Member for Crawley (Laura Moffatt), I have experienced reconfiguration and I would like to explain why it improves health care. I agree with the hon. Member for South Cambridgeshire (Mr. Lansley) that we should listen to local professionals. Reconfiguration is the subject of the Bristol health services planwe are part way through the processthat has been developed precisely because local clinicians, doctors, nurses and other NHS staff have argued for years that it is needed. It is not the product of concern about financial or staffing pressures. That could hardly be the case, given that there are 30 per cent. more staff working in the NHS locally than there were 10 years ago. Nationally, the number of people working in the NHS has risen by 300,000 to 1,300,000. I find it difficult to take too seriously the argument that of all the possible reasons why we might have difficulties, those are due to a shortage of staff. The national health service has never had an increase in staffing like the rate of increase that we have seen in recent years. [Interruption.] I am aware that Opposition Members may be saying from a sedentary position that we should make doctors work longer hours and cut their pay[Hon. Members: We did not say that.] When comments are made from a sedentary position, I occasionally mishear them. I apologise. I heard staffing hours mentioned earlier, but that was by the hon. Member for South Cambridgeshire.
My key point is that in the Bristol health services plan, the proposals were put forward by clinicians and have been put forward by them for many years, for three basic reasons. In the greater Bristol area, as in many other parts of the country, 40, 45 or 50 per cent. of people who go to busy accident and emergency departments could be treated in local minor injuries units. They do not need to go to an acute hospital for treatment. Minor injuries such as cuts and sprains could be treated locally in a unit such as the one that I hope we will get at the Cossham memorial hospital in my constituency.
There are in my area, as in others, thousands of people who attend the major hospitals for out-patient clinics and diagnostic tests which could and, in my view, should be provided nearer where they live, in community-based facilities. We all know that, thankfully, we have an ageing population in this country. We should celebrate the fact that people are living longer. More people are therefore living with long-term conditions. They want to go to their local health centre or to a local community hospital nearer home. They do not want to have to traipse to an acute hospital for care and support unless that is absolutely necessary. So the first basis on which clinicians in Bristol have been arguing for reconfiguration is that far too many people are forced to go a fair distance to an acute hospital, when local health centres and community hospitals could provide that support.
The second point made by the clinicians was made earlier this afternoon, so I shall be brief. They argue strongly that acute and specialist services need to be concentrated in centres of excellence, so that patients who are gravely ill will be guaranteed treatment by people who have the expertise and the equipment to do the best job. Again, local clinicians in our area have said that the key obstacle to improving acute services is the legacy of acute hospitals on four sites. In the greater Bristol area, we have Frenchay hospital, Southmead hospital, the Bristol royal infirmary and Weston general hospital.
It is true to say that to some degree the four hospitals provide different services, which can be a disadvantage. I have had constituents who have been sent by ambulance from one hospital to another. It is not self-evident that the more acute hospitals there are in an area, the better. It can mean that people are treated for one condition in one hospital and then, sadly, they are afflicted by another condition for which an acute hospital a few miles away is the specialist provider, so, while chronically ill, they are sent by ambulance from Bristol royal infirmary to Frenchay to Southmead and so on. I do not think that is a clever way to run a health service, but I am not a clinician. It is doctors, nurses and NHS staff in Bristol who have said that we should have not four, but three acute hospitals with accident and emergency departments.
The big debate locally has also been about replacing old buildings. In 1997, we had a hospital service with 18th-century buildings, pre-war buildings, converted second world war huts, portakabins and a hospital built by French prisoners of war. Hospitals were not in a very good material condition. It was clear to everyone working in the health service locally that despite the magnificent efforts of staff, there were some hospital sites that required upgrading in order that patients could be treated properly and in sound and safe conditions.
In essence, the reconfiguration proposals in my area have not been dictated by financial pressures. They have been promoted by clinicians who argue that too many people have to go to acute hospitals for minor injuries, diagnostic tests and so on; that there is a clinical benefit in concentrating on specialist facilities, which everyone in the House accepts; and that existing buildings are unsuitable.
The Bristol health service plan for reconfiguration was first presented in 2003. There had been talk of it for years, but nothing had happened. It was presented
not because of financial pressures, but because the Governments substantial increase in investment in the NHS meant that resources were more likely to be forthcoming. Like other reconfiguration proposals, the plan involves transferring services from acute hospital sites to community settings closer to where people live, when appropriate. It also involves massive investment in Bristol royal infirmary, a new heart and lung hospital, new cardiology facilities in north Bristol and south Gloucestershire, and much more.
The controversial question was this: if the number of acute hospitals was to be reduced from four to three, which site should no longer act as an acute hospital? Would the new super-hospital for north Bristol and south Gloucestershire be on the Southmead or the Frenchay site? I make no apology for the fact that I passionately argued the case for the Frenchay site, as did many others. An equal number, including my good and hon. Friend the Member for Bristol, North-West (Dr. Naysmith), passionately argued the case for Southmead. The one thing that we all had in common was that we accepted, as we still accept, the clinical case for a single acute hospital, which we believed would put our constituents health in better hands.
There was extensive public consultation, and there was overriding support for one acute hospital to serve north Bristol and south Gloucestershire. Local councillors of all political parties, through the local joint health scrutiny committee and by other means, supported the Bristol health service plan and its central proposal for one new hospital at Southmead or Frenchay. They also resolved that the choice of site should be left to the local national health service. Southmead was chosen. Obviously I was not happy, but I strongly feel that revisiting that decision would be damaging for my constituents and others who live and work in Bristol.
The decision was made on a clinical basis. It was not about finance or staffing, and it was not made by the Government. At the last election the Tories made a point of saying, The Government are downgrading your hospital. That is absolute nonsense. The decision was made in precisely the way in which Conservative councillors in my constituency and elsewhere said it should be made. The members of the joint scrutiny committee said unanimously that there should be one hospital and that the decision should be made by the local national health service, and that is exactly what happened.
The one Tory Member of Parliament representing the Bristol area was so exercised that he did not even submit a written response to the consultation exercise, keeping his options open so that he could criticise whatever resulted from it. My Conservative opponent did not bother to do so either. How do I know? Through the freedom of information legislation. It is brilliant: it is possible to find out that people are not doing things, just as it is possible to find out that they are.
I am very sad that in my constituencyI hope it is not happening elsewhereTories are playing politics with peoples lives. I hope that the Government will be very clear in supporting what local doctors and local national health service staff are saying. I urge
Mr. Jeremy Hunt (South-West Surrey) (Con): We have had a good deal of discussion today about how the reconfiguration of acute services will lead to improved clinical outcomes, but the vast majority of Members who are fighting to protect services in their constituenciesConservative or Labour, Back-Bench or Front-Bench, even members of the Cabinetwill say that it is a question not of clinical outcomes but of financial deficits. This is about savings, not services.
I want to illustrate to the House why that is the case with reference to the Royal Surrey county hospital, which serves many of my constituents. Although I shall talk about one hospital in specific terms, I want to stress that all Surrey MPs are united in opposition to cuts or reductions in services for any of our constituents. We are four-square together on that.
The Royal Surrey county hospital has the lowest mortality rate in the country, and it sees 99.5 per cent. of its A and E admissions within four hours, as against a national target of 98 per cent. and a national average of 98.5 per cent. The Secretary of State spoke earlier about the critical importance of A and E departments managing their admissions so that as many patients as possible were seen locally and seen at hospitals only when necessary. On that indicator, which is known as managing variety in A and E admissions, the Royal Surrey county hospital comes top in the country out of 303 trusts. It is in financial balance and was rated as good by the Healthcare Commission. It even received a £100,000 prize awarded by the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), for real, significant and sustained improvement in performance.
Mr. Malins: I am most grateful to my hon. Friend, who is rightly speaking so favourably about the Royal Surrey county hospital. He will know that it serves many of my constituents in the Pirbright and Normandy area, who regard it as a vital asset. I support everything that he is saying and thank him for saying it. He will know that St. Peters hospital is another very important Surrey hospital, and the point about Surrey MPs being united is a very good one.
Mr. Hunt: I am grateful to my hon. Friend for his excellent intervention. A good illustration of precisely the point that he is making was given in the earlier discussion about primary angioplastythis important new specialist service that will apparently be made available by the reconfiguration of acute services. All three hospitals whose A and E departments are under threat of being closed or downgradedFrimley Park, St. Peters in Chertsey and the Royal Surrey countyoffer primary angioplasty, so the result of closing any of those departments will be to restrict, not increase, access to that vital service.
Why is it that we are talking about the closure of such a vital hospital, despite the incredibly impressive performance that it has shown? The average time that it takes my constituents to get through the doors of an A and E department after an accident or emergency is currently 52 minutes. That is dangerously close to what doctors call the golden hourthat vital 60 minutes in which it is vital to get people through the doors of an A and E department if their chances of a good outcome are to be maximised. That is important, for example, if they need a computerised tomography scan to identify whether they have a stroke or a heart attack, with the very different treatments that will result according to the diagnosis that is made. If the Royal Surrey county hospital loses its A and E department, the average time that it will take my constituents to get through the doors of an A and E department will increase from 52 minutes to 65 minutes. That means that more of my constituents will not get through the door of an A and E department within the golden hour than will do so.
According to consultants, the result is that 2,000 additional people from my constituency who are in need of resuscitationthe most acute form of emergency, involving people who have effectively stopped breathingwill not get into an A and E department within an hour. Consultants are quite open about the impact; they are saying that people will die.
Despite my anger with what the Government are doing, I am not suggesting that they have deliberately set out on a course of action that will cost the lives of my constituents, but that is precisely what will happen unless they are prepared to do three things. First, they need to tear up all the consultants reports that they keep using as the basis of the reconfigurations, because although they are often excellent in theory, they bear no relation to what happens on the ground. I remind Ministers that it was reputedly a consultants report that advised Railtrack to stop its ongoing programme of track maintenance in favour of a much cheaper policy of merely repairing tracks as and when they brokea policy that directly led to a series of appalling train crashes and, in the end, to the demise of Railtrack. This is the first day of Lent, so here is an idea for a Lenten resolution for Ministers: they should stop using consultants reports, to see whether they can wean themselves off the habit.
Secondly, Ministers should go out and look at what is happening on the ground. It is no good their hiding behind the fiction that these are local decisions made by local people on the basis of local circumstancesthey are made on the basis of a policy framework decided by Ministers and a financial framework set by the Government. True leadership involves getting stuck into the detail so that Ministers really understand what is happening.
Finally, Ministers need to start to think about the root cause of these problemsfundamental flaws in the funding formula, which massively underweights age as a factor relative to social deprivation. Of course socially deprived areas have additional needs in terms of health care, but the current weighting is very skewed against age. My constituency has a lot of older people, and as a result our funding allocation is increased by 2 per cent., but the lack of social deprivation means that it is reduced by 25 per cent. That cannot be right
when all the evidence shows that the biggest determinant of demand for health care services is age, not social deprivation.
Mr. Hunt: I am delighted to give way to my hon. Friend, who is so committed to the campaign for Royal Surrey county hospital that she stayed out in the cold in Parliament square one night in December to protest against the closure plans.
The Minister, who has been shaking his head, would find many people throughout the country who agree with every word that my hon. Friend has said. Age is the strongest indicator of morbidity, and he needs to divorce himself from the belief that deprived areas need health care serviceswhat they need is money for public health.
Mr. Hunt: As ever, my hon. Friend makes an excellent and important point, which is backed up by strong evidence produced by Professor Sheena Asthana of the university of Plymouth who has studied the areas with deficits and identified a strong correlation between deficits and semi-rural areas with large older populations. It is not true to say that deficits are the result of poor financial management, because that is as likely to happen in an urban area as in a rural or semi-rural area.
If Ministers decide to proceed blindly on, ignoring all the concerns expressed with the greatest sincerity by Members in all parts of the House, the anger in the country will make the poll tax riots look like a vicars tea party. I could be cynical and say that the lack of marginal Labour seats in Surrey makes it unlikely that Ministers will show any interest in coming to Surrey to see what is happening there. We have invited them countless times, and every time they have refused to come. I would rather appeal to their better nature by saying this: the NHS was founded to help older people, poorer people and vulnerable people, and if they proceed blindly on with the plans, those are the people who will suffer as a result. For all their sakefor the sake of the people in South-West Surrey, Guildford, Woking and Surrey Heaththey should stop before it is too late and the lives of ordinary people are lost.
Mr. Iain Wright (Hartlepool) (Lab): The people of my constituency and the surrounding area have experienced uncertainty about the future of hospital services for approximately a decade. The recent set of recommendations from the independent reconfiguration panel, following its review of maternity and paediatric services, gives rise to more questions than answers.
My interpretation of the IRPs recommendations differs from that of my hon. Friend the Member for Stockton, North (Frank Cook). I think that it recommends building a new hospital and closing the existing hospitals at North Tees and Hartlepool. It also recommends that specialist neonatal services for the whole of Teesside should be situated in the new
hospital, that in the interim periodwhich could last a decadeconsultant-led maternity and paediatric services should be centralised at the University hospital of North Tees, and that a midwife-led maternity unit and paediatric assessment unit should be provided at the University hospital of Hartlepool.
To say that I am disappointed and feel profoundly let down by the decision is an understatement. The IRPs set of recommendations looks suspiciously like that which the County Durham and Tees Valley strategic health authority produced in 2003. Those recommendations stated that
the long-term intention is to have one single acute hospital north of the River Tees.
So much work and effort by a wide range of people was for nothing. That work included the observations of Professor Darzi in his review of a single-site option for the North Tees and Hartlepool NHS Trust. He said that
neither the University Hospital of North Tees or the University Hospital of Hartlepool could provide services for the whole of north Teesside. Any single site option would therefore involve a major capital development. The timescales for such developments are often in the region of 7-8 years. As such, this would not be a solution to the issues facing the health service today
and, in particular, the need for rapid change to deliver sustainable, thriving, convenient and high quality services.
The people of Hartlepool, who already suffer greater health inequality and shorter life expectancy than those in virtually any other part of the country, have experienced uncertainty about hospital services for almost 20 years. Staff at the North Tees and Hartlepool NHS Trust suffer similar uncertainty and a corresponding loss of morale and job satisfaction. That is unacceptable and runs the risk of undermining all the investment in the local health economy that the Government have made in the past decade.
The panels recommendations also disregard Professor Darzis comments that the centralisation of all emergency services at North Tees or in an area away from the University hospital of Hartlepool would
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