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4 July 2007 : Column 267WH—continued
Hospital Services (Sussex)
2.30 pm
Nick Herbert (Arundel and South Downs) (Con): May I welcome you to the Chair this afternoon, Mr. Conway? I also welcome the Minister to her new position.
I am grateful to have secured this debate on an issue that is probably arousing more passion and concern in my constituency and throughout West Sussex than anything else. There are hon. Members here from East Sussex and West Sussex who are all affected by the proposed reconfiguration of hospitals. We are grateful for this opportunity to make the case on behalf of our constituents and for the fact that this debate has brought the Minister here to listen to those concerns, which I am sure she will do. I should like to focus on West Sussex, in which my constituency lies, but my hon. Friends and other hon. Members might refer to the situation in East Sussex. I shall also keep my remarks as brief as possible, to allow everyone here the opportunity to take part in this short debate.
The situation in West Sussex is that the newly created primary care trust proposes to downgrade our three acute hospitals to one, so that there will be only one major general hospital for the whole county. That affects every hon. Member in West Sussex and some in East Sussex, and it affects me particularly, because my constituents use all three hospitals. I am therefore in a position to see how the proposals would affect the whole county.
The first thing that I should like to say about our objections to how the primary care trust has handled the process is that the justification for the proposals has fundamentally changed. More than a year ago, we were eventually told—when the strategic health authority and then the primary care trust admitted it—that the overriding reason for downgrading our local hospitals was a financial deficit in the health care sector in West Sussex and that it would get worse. The principal justification for the measures that the PCT said were needed was that it would no longer be sustainable to retain three acute hospitals for a population the size of West Sussex.
It is true that some clinical justifications for the change were set out at the time, but the overriding justification was clearly financial. Indeed, as a former chief executive of the primary care trust, Steve Phoenix, wrote to the West Sussex Gazette on 30 August 2006:
“The financial issues for West Sussex are very serious. Although the NHS will get more money, we are already in debt and there are major challenges in the way we receive funding.”
“if we do nothing, we will have a shortfall of £94 million by 2008/09. This an impossible scenario. Our plans will involve significant changes to major hospital services. We must invest our funding in direct patient care rather than expensive hospital buildings.”
He could not have been more plain that the principal driver of the changes was the lack of funding available to the primary care trust that he perceived. That position was reinforced by the strategic health authority. As the chief executive of the strategic health authority wrote to me and other hon. Members on 31 July 2006 on the issue of finance:
“It is much better, and more responsible, to plan for a clinically and financially sustainable healthcare system, as we are doing.”
The new Secretary of State, whom I welcome to his position, too, said in the debate on access to NHS services yesterday:
“These reconfigurations are being driven by local decisions in local NHS trusts, and they are driven by clinical need, not by any financial constraints.”—[Official Report, 3 July 2007; Vol. 462, c. 853.]
However, he cannot have been aware of the primary care trust’s original justification for the changes that are taking place.
Nevertheless, it now seems that the financial arguments for downgrading our local hospitals have simply evaporated. The latest case scenarios that the primary care trust has published, along with the plan for reconfiguration of our hospitals, actually show that in five years’ time, in 2012-13, the local health care economy—that is, the West Sussex and Brighton PCTs and the three acute trusts—will end up with an annual surplus of £52 million. Let us deal with the argument once and for all: there is no financial case for downgrading our hospitals in West Sussex. The Secretary of State has now also said that there is no financial case for doing so. That crucial part of the argument for change and how the PCT has approached it for the past year has gone, yet the trust persists in the changes that it wants to make.
Now the argument turns on whether there is a clinical case for downgrading our hospitals, but those arguments are strongly disputed. Locally, they are disputed by consultants, who disagree about whether there should be only one major general hospital in West Sussex—an issue to which I am sure my hon. Friends will turn their attention. Nationally, we are relying on the evidence of some of the royal colleges, on which the whole future of two major hospitals could turn, simply because it is argued that the most serious accident and emergency cases ought to be treated in major centres. Given that there is no financial imperative for reorganising those major hospitals, it does not seem to make sense to put at risk major and much-prized local facilities simply to address that concern.
The concern of my constituents and of the whole population of West Sussex is about accessibility. In my area of West Sussex, the question is not about the size of the population served by the three acute hospitals or about the catchment areas, in the narrow sense; it is about whether those hospitals are accessible to a community, many of whose members live in remote areas. From one village—it happens to be called Washington—right in the middle of my constituency, at the foot of the downs, the distance to Worthing general hospital, one of the three hospitals affected, is a very reasonable eight miles, with a travel time of 13 minutes. If Worthing general hospital is downgraded, which is one of the options that the primary care trust has set out, the travel time could increase by two and half or even up to five times if patients have to travel to Portsmouth, which is one of the potential effects of the changes.
Indeed, in the document that the primary care trust published when the proposals were launched, it conceded that
“a minority of people may have to travel further”
for what it called “improved services.” However, we are talking about a population that is relatively elderly. According to the 2001 census, just over one fifth of West Sussex’s population was aged 65 years or over, which compares with an average of 16 per cent. in England and Wales. It is extremely difficult for elderly
people to make regular visits to health care facilities that are further away. We are not just talking about travel times and safety for A and E services; we are talking about people who have to travel further for visits to facilities that are currently much closer.
The other day I met an elderly constituent of mine who lives in Storrington, in the middle of constituency, who has to travel a number of times of week to Brighton for radiotherapy, making a round trip of 41 miles on each occasion, with a travel time of 76 minutes. There is a huge amount of fear locally that, far from there being a greater provision of local services, which we were promised as part of the reconfiguration, services will be taken further away from the local community.
We have not seen the redeveloped local services that were promised as part of the reconfiguration, or any proposals for them. No assurance have been given in relation to one community hospital in Arundel, in my constituency. It simply does not make sense to say that acute hospitals might be downgraded and simultaneously to be unable to give assurances about the provision of community hospitals, on which people will presumably rely for more local services.
The absence from the primary care trusts’ proposals of an option for at least two major hospitals, which is what many clinicians and the public have asked for, is a significant omission. It makes the consultation paper a flawed one, and we asked the PCT board, unsuccessfully, to withdraw the paper until it could present an option that we felt should be considered.
I should like to convey to the Minister the strength of feeling in support of the three hospitals in West Sussex—the Princess Royal hospital in Haywards Heath, Worthing and Southlands hospitals and St. Richard’s hospital in Chichester. Some 300,000 people in West Sussex have signed petitions against the closure of those hospitals, and 25,000 people have marched. The Prime Minister may stand on the steps of Downing street, as he did last week, and say that he will listen to people and make the NHS a priority, and the Government may espouse the notion of patient choice, but what can any of that mean if the Government and the PCTs are unwilling to listen to the almost unanimous view of local people?
There can be no better way to demonstrate how people feel about the potential downgrading of their hospitals than to consider the Princess Royal hospital in Haywards Heath, in the constituency of my hon. Friend the Member for Mid-Sussex (Mr. Soames), who has fought tirelessly to retain those facilities. The Princess Royal will be the hospital most affected by the proposals. Under any of the scenarios proposed by the PCT, it will be downgraded. Yet a consultation document published only in 2004 promised that, in reshaping A and E services and moving trauma cases to Brighton,
“It is important to emphasise that the vast majority of local people will continue to receive A&E services from their local hospital. So there is no threat to A&E at the Princess Royal.”
That promise was made not only in the consultation document, but to my hon. Friend on the Floor of the House by one of the Minister’s predecessors, the right hon. Member for Barrow and Furness (Mr. Hutton), now a Cabinet Minister. He told my hon. Friend on 16 March 2005:
“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.]
When the Prime Minister speaks, as he did yesterday, about rebuilding trust in politics and reconnecting people with the political process, what can those words mean if Ministers feel able to come to this place, give assurances to hon. Members about the future of A and E facilities—an issue that could hardly be of more concern to local people—and renege on those promises within two years? That produces a sense of anger in my constituency and throughout West Sussex about how local people are being treated. They have no voice and they are not being listened to, yet they are being told by the Government that they will be listened to and that the NHS is now the new concern. How can the Minister square that circle? I urge her to recognise local people’s concerns about the issue and how the justification for the downgrading of our local hospitals has shifted and been undermined.
I am grateful to the Minister for listening to my case. I hope that she will appreciate the strength of local feeling and that she or one of her colleagues will take the opportunity to come visit the hospitals. The previous Secretary of State visited the hospital at Brighton, but did not visit St. Richard’s, Worthing and Southlands or the Princess Royal. If Ministers were to visit one of them, they would understand not only that clinical opinion is certainly divided about the merits of moving to one hospital in a county of that size but also that local feeling is strong. People have paid their taxes, and they feel that they are entitled to high-quality, local and accessible services. I think that they deserve no less.
Derek Conway (in the Chair): Order. Understandably, a large number of hon. Gentlemen wish to take part in the debate. The Minister and the Front Bench spokesmen have indicated that they are prepared to cut down their usual time. If subsequent speakers can finish on the right side of five minutes, we shall hopefully get everyone in, but that is in your hands.
2.45 pm
Norman Baker (Lewes) (LD): There is very little difference between the hon. Member for Arundel and South Downs (Nick Herbert) and me on this issue. I congratulate him both on securing the debate and on how he put the case, and I welcome the Minister to her position.
My constituency is in the grip of a pincer movement of threatened loss of services. At the eastern end, maternity services at Eastbourne are under threat. Most seriously, we face the potential or likely loss of accident and emergency services at Haywards Heath, a hospital that many of my constituents in the north-west look to. My constituents are angry and bewildered that at a time when more money than ever before is going to the NHS—I congratulate the former Chancellor on his record on that matter—cuts of a hitherto unseen extent are being proposed. It is difficult to square that circle.
I must make it perfectly plain that not only has the case for removing A and E at the Princess Royal not been made, but it is exceedingly dangerous and will be counter-productive in its consequences for my constituents and those of other hon. Members present today. We are
given three options in the consultation paper, all of which involve losing A and E services at the Princess Royal. The PCT is asking us whether we want to lose an arm, a leg or both. We are not given the option of losing none of the bits of our body.
I feel strongly that that is not what was agreed. When I had a meeting with the strategic health authority last year, I was promised that the options in the paper would include a status quo option, even if the PCT did not feel capable of recommending it. The option would be included, if only to allow the other options to be measured against it in terms of the clinical changes required and the financial costs. That has not been done. Similarly, with maternity services in Eastbourne, we were promised at an early stage that a status quo option would be included. It is only thanks to the hard work of campaigners who look to the Eastbourne district general hospital for services that a so-called option 5 is now being developed there.
The hon. Member for Arundel and South Downs referred to the financial case. He is right that the sands have shifted and the goalposts have moved on that matter, but it is worse than that, because there is a chance that what is proposed will cost the NHS money, not save it. The Princess Royal hospital in Haywards Heath is quite modern; it is about 15 years old. The Brighton hospital, which will be expected to take up the slack, dates from 1828. It is pre-Nightingale in how it was built and what it offers. Its car parking is insufficient; it is pretty inaccessible by public and indeed private transport. It is on the coast, so half its catchment area is in the English channel. It is not where one would put a hospital if one started from scratch, yet the proposal is effectively to close the emergency department in a hospital that is well situated in mid-Sussex and serves a wide population 360ยบ around it, and to relocate services to Brighton.
That can be done only if money from the sale of land at the Princess Royal—it has been discussed—is used to provide new facilities at Brighton. But where is the sense in closing part of a recently constructed, 15-year-old facility and using it to bolster a hospital built almost two centuries ago with very little spare land, which it would cost a significant amount to develop? It makes no financial sense at all.
If we are to have any changes to our acute services and move towards community services, which is the Government’s intention—I accept that it is a sensible intention in so far as it can be delivered—that will cost money, too. We do not know how much that will cost. The hon. Gentleman is quite right that the community aspect has not been properly considered. I do not know what the proposals are for Lewes Victoria hospital—it is not clear what will be put there. If we are to have services taken away, we need to know before they are taken away and, as part of the consultation, what will be done to provide an alternative to the services that it is proposed will be removed from our acute hospitals.
The issue of accessibility, which is key, was also raised. I represent a rural area, including villages such as Newick, Chailey and Wivelsfield. My constituents are already concerned about the journey times to Haywards Heath, without taking into account additional journey times to Brighton. I am sure that the hon. Member for Wealden (Charles Hendry) will have a similar point to
make about his patch. We talk about the golden hour in which to get people to hospitals. With the amount of traffic on the roads in east Sussex and the rural nature of many of the villages, I am not convinced that it could be guaranteed that people could get to Brighton within the hour. In clinical terms, it is simply not sensible to go down that route.
Public transport is pretty sparse in the rural areas, and the bus services that the Government want do not exist. Many of my constituents, who can ill afford it, end up taking extremely expensive taxi rides to get to hospital already. If they are going to be asked to take taxi rides to Brighton—or even to Hastings for maternity services—that will be an expensive business. It is not right to ask people to do that. I do not know the Government’s view on social exclusion, but they will make it worse through such proposals.
The pressure on the ambulance service has not been thought through, either. If we are to have people taken to hospitals that are much further away, by definition ambulances will be on the road far more, spending more time at each individual pick-up. Has the ambulance service been properly consulted? What will be the consequences for it? How many ambulances and ambulance drivers will we need? What is the cost of that? Has it been factored in? I do not think that it has.
I am not convinced by the clinical argument that we need to have these single centres and that it is not safe to have different centres. My constituents certainly believe that the arrangements are perfectly safe and are happy with them. In fact, many of them would rather go to the Princess Royal hospital in Haywards Heath than to Brighton, given half a chance. There is no question but that people in my constituency believe that the present arrangements are safe. If they are not safe, what happens in the north of Scotland, Cornwall or other places that are more sparsely populated? They seem to manage all right—with fewer people going through them as well, I say to the consultant who claimed that a certain critical mass of individuals was needed.
The matter crosses party lines. I am pleased to agree—I hope that I will—with the Conservative Members who will speak after me. It is good that we have seen a cross-party approach and I thank the hon. Members for Mid-Sussex (Mr. Soames) and for Arundel and South Downs for the way in which they have approached the matter. In the north-west of my constituency, that cross-party approach has worked quite well. We need to go forward on that basis.
I note that although we have a vast turnout of Conservative MPs and 100 per cent. of Liberal Democrat MPs for Sussex in this debate, it is sad that none of the five Labour MPs who represent Sussex are here—[Hon. Members: “One is.”] I beg hon. Members’ pardon; 20 per cent. of them are here. I hope that they will realise that it does not help Brighton and Hove if Haywards Heath is closed down and services are removed from there.
I ask the Minister to listen to public opinion, which is strong in all our constituencies. If she does, she will come to the conclusion that the options that have been put forward, for the Princess Royal hospital in particular, simply do not wash.
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