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4 July 2007 : Column 280WH—continued
3.17 pm
Mr. Nigel Waterson (Eastbourne) (Con): I shall try to keep my remarks as short as possible, given the throng of colleagues who want to contribute to the debate. I pay tribute to the save the district general hospital campaign, which I and others started 18 months or so ago. In particular, I pay tribute to Liz Walke and Monica Corrina-Kavakli, who are just ordinary mums who feel angry and upset about what is being proposed and who want the best for their children and for other mums who will have children in my constituency in due course. I should also stress the cross-party nature of the campaign, both here today and in Eastbourne; it includes all parties, as well as Churches and community organisations, all of which want the same thing. Thousands of local people have joined marches and demonstrations and signed our petition.
I want to make two or three quick points to the Minister, whom I welcome to her new role—she will be spending money for a change, rather than preventing others from spending it. First, there is the consultation process. There is a real danger that it is totally flawed and that it will end up in front of a High Court judge in due course. The clinical director of my local hospitals trust made it clear in November last year that the trust was looking at one maternity unit in either Eastbourne or Hastings—that decision had already been made. There is therefore a real worry within the campaign that the decisions were made long ago and that everything else is mere window dressing.
Secondly, there is the fact that the consultation in East Sussex went ahead, unlike the one in West Sussex, which was stopped for the local election campaign. We
cannot understand what the difference was, given that we also had local elections in our neck of the woods.
Thirdly, there are the options: 1 to 4. Again, despite past promises, the four options all conceivably include shutting a maternity unit, either in Eastbourne or Hastings. We have been putting forward option 5, as the hon. Member for Lewes (Norman Baker) mentioned. All too often that option 5, produced by the campaigners and based on advice from clinicians—properly costed and thought through—has been treated as the poor relation. The PCTs have sent details of options 1 to 4 to GPs’ surgeries, but, alas, they have not so far sent option 5. As I asked on Monday at a public meeting held as part of the so-called consultation, if, as I believe, the overwhelming response of local people is for option 5, rather than options 1 to 4, will they be listened to? Will that make any difference to the final decisions?
My hon. Friend the Member for Arundel and South Downs (Nick Herbert) mentioned in his speech the way in which the arguments have shifted. Money used to be the prime argument. Now we are told that the proposal is all based on safety. It is also being alleged locally that it is based on the support of clinicians. I am having real difficulty finding any clinician locally who supports the NHS proposals. Indeed, one of our leading local consultants effectively changed sides and said that he was unconvinced by the safety arguments.
The local GPs in Eastbourne have recently voted overwhelmingly against the options that are being proposed. It is total nonsense to suggest that the proposals have the backing of clinicians. Indeed, only in August 2004 a detailed clinical services review within the local hospitals trust for Eastbourne and Hastings concluded that a two-site maternity presence should be retained for those hospitals. The acid test should be, it seems to me, to ask the clinicians whether, if money were no object, a one-site solution would be safer than the present arrangements or something like them. I doubt whether any clinician could claim that things would be safer on that basis.
Accessibility has already been raised by one or two of the hon. Members who have spoken. I am told that the gold standard for the interval between deciding to perform a caesarean operation and actually performing it is about half an hour, according to the Royal College of Obstetricians and Gynaecologists. It can take an hour and a half, on average, or more, to get a pregnant mum from Eastbourne to Hastings or from Hastings to Eastbourne. At present we have two units—in Eastbourne and in Hastings—and they are as safe as any in the country. Why change a system that works well already and delivers safe, reliable services to families and mothers?
Finally, I want to touch on what has been called the domino effect. At the moment, the only thing that has been consulted on in my area is the future of maternity services, but hidden in the small print is the promise of future changes to paediatrics and possibly to accident and emergency services. As we know, once consultant-led maternity and paediatrics have been lost, it becomes difficult to hang on to a proper A and E department. My deep suspicion is that the powers that be in the NHS are waiting to see how much fuss there will be about closing one of the maternity units in our area, before they move on to paediatrics and A and E. I am deeply suspicious about the motives in all that is happening.
I cannot stress too much to the Minister, with her new responsibility, the strength of local feeling on this matter. People are incensed in a way that I have not seen in my 15 years as the local Member of Parliament. They are worried and concerned, and deeply supportive of the idea of retaining core services, including maternity, at Eastbourne district general hospital. They also take the view that people in Hastings should continue to have the same services in their hospital.
3.23 pm
Mr. Nick Gibb (Bognor Regis and Littlehampton) (Con): I congratulate my hon. Friend the Member for Arundel and South Downs (Nick Herbert) on securing this important debate, and I welcome the Minister to her new position, blinking in the sunlight after 10 arduous years in the dark corridors of the Treasury.
The more I learn about the NHS the more convinced I become that the principal problem facing the health service is the quality of its management. It is that poor-quality management that has led us, in the southern half of West Sussex, to the absurd position in which the West Sussex PCT proposes to decimate one of two leading major hospitals, either St. Richard’s hospital in Chichester, or Worthing hospital. Both hospitals rank among some of the most efficient in the country, and both have strong reputations for clinical excellence.
Nothing, however, demonstrates the poor management I have spoken of better than the financial arguments deployed by the West Sussex PCT and the strategic health authority. We were told in January 2006 on page 11 of the document “Creating an NHS fit for the Future”:
“Healthcare in Surrey and Sussex is not financially sustainable”.
“The NHS in Surrey and Sussex had an underlying deficit of about £100 m in 2004/5”
“underlying position is likely to worsen after 2007/8.”
The graph showed a forecast deficit of something like £250 million by 2009-10. The S4 review—it stands for sustainable services for Surrey and Sussex; the NHS never misses an opportunity to create a new piece of jargon—demonstrated that
“the financial situation will get worse over the next few years if it is not addressed as the demand for healthcare continues to increase”.
On that basis, the whole reconfiguration pre-consultation process was started. It was the argument put forward by every NHS spokesman at the plethora of public meetings that were held in West Sussex in the past year. We were told that we had to live within our means, that the financial position was unsustainable and that we could not afford two major general hospitals with a full A and E service. It is odd, then, that when the West Sussex PCT board papers were published on Monday 25 June, we could, as my hon. Friend the Member for Arundel and South Downs said, find no reference to ongoing deficits or the unsustainable financial position. Indeed, in the key document, “West Sussex Health Economy: Investment plan”, the figures show a surplus of £12 million for 2007-08 and a surplus of £29 million in 2008-09, rising to £52 million by 2012-13. Those are calculated on the assumption of the status quo, with no downgrading of either Worthing or St. Richard’s. Of course, there
have been efficiency savings at both hospitals in the past year, but such savings do not turn a growing and large deficit into a surplus of the order of £52 million.
The problem is compounded by the issue of Littlehampton community hospital. That well-loved and supported community hospital is now a pile of rubble surrounded by a tall blue security fence. It was knocked down to build a 40-bed state-of-the-art community hospital, after a long and protracted consultation process and a detailed business plan that made it clear that such a hospital was needed and was financially viable. As a result of the projected deficit, which we were told about in January 2006, the rebuilding plan was halted, and the future of Arun’s community hospital was put in jeopardy and made dependent on the outcome of the West Sussex NHS reconfiguration. However, of course, there is no deficit. Yet there is no Arun community hospital in Littlehampton.
I ask the Minister to look into the case of that community hospital. We are told that it is Government policy to move health care closer to people’s homes. A huge amount of time and effort went into planning and designing the rebuild. The project is ready to go and it has just been put on hold because of the review, but it would be absurd if a review one of whose objectives is to move care closer to people’s homes were to conclude that Littlehampton and Worthing should have one less community hospital.
To conclude, I urge the Minister not to allow any of the three options proposed by the PCT. St. Richard’s and Worthing hospitals are excellent and efficient hospitals in an area with an increasing population and congested roads. They are loved by everyone who uses them or thinks that they might use them. People will not accept the downgrading of either hospital, and I urge the Government to overrule any such decision taken by the PCT in West Sussex.
3.29 pm
Mr. Andrew Tyrie (Chichester) (Con): A great number of extremely important points have been made this afternoon. It is very rare that one can stand up near the end of a debate and say that one agrees with just about every word that has been said, but in this case, across parties, I do. It is important that the Minister should understand that this is not a case of MPs going through the motions. It is an issue of deep concern to all our constituents, quite out of proportion to anything else that I have come across in the 10 years for which I have been an MP.
I want to add just a few extra points to those that have been made. First, who is really taking the decision? We were told 24 hours ago by the Prime Minister that
“power must...rest with local communities”
and that individuals and communities should not be
“passive recipients of services provided by the state.”
Today in the House, the Secretary of State for Health reinforced that. He said:
“Patients must have the chance to shape the kind of NHS they want, to say how they wish to access services”.
That is exactly what we are all demanding for our constituents in West Sussex and East Sussex.
It seems extraordinary that the Secretary of State can make remarks like that at a time when it is so clear in our part of the country that an overwhelming number of people do not want the reconfiguration to go ahead. We will find out whether the words of the Prime Minister and the Secretary of State are just window dressing. If they are not, 140,000 signatures on a petition for St. Richard’s hospital alone tell us immediately what the answer of any local community power would be. They would see no reason why Worthing hospital should not retain its accident and emergency; they would see no reason why it should not continue as it is. Let us find out in the next 18 weeks whether the words of the Secretary of State and the Prime Minister mean anything.
Let us take St. Richard’s hospital as an example. It is a fantastic hospital. Morale has held up very well, despite the pressure that staff have been put under in the past 18 months with the pig’s ear of a consultation process that we have had. Those in the local community feel that the hospital is theirs. There is a sense of ownership, which is a remarkable thing that should not be tampered with casually. St. Richard’s was identified as the best hospital in the south-east last year, and in the top 10 for low mortality this year. Its financial improvement last year was the best of any trust in the country. The latest in-patient survey by the Healthcare Commission placed it in the top 20 per cent. in the country, and its reference cost—if costs were the issue—is the lowest of any acute trust in the south-east.
What is the case for reconfiguration? What logic could there possibly be for downgrading a hospital of that class? My hon. Friends the Members for East Worthing and Shoreham (Tim Loughton) and for Worthing, West (Peter Bottomley) could make a similarly strong case for Worthing hospital, too.
My second major point is about evidence for all the reconfiguration. A goodly number of my colleagues have already alluded to it. The financial case has been dissected by my hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb), and my hon. Friend the Member for Arundel and South Downs (Nick Herbert) accurately pointed to how the campaign by the primary care trust to close one or more of the hospitals has been retargeted around clinical evidence. But I believe we all know the truth, which is that demand will be managed downwards—that is, rationed by restricting supply. Fewer accident and emergency departments mean fewer people presenting. Ultimately, the reconfiguration is about money. We all know that that is the truth.
While we are on the case for reconfiguration, I would be grateful if the Minister defined in detail, in writing, what an urgent care centre is. I quite understand that she will not be able to do that today as she is new in her post. We sat opposite one another through the consideration of many Finance Bills. I welcome her, as my hon. Friend the Member for Bognor Regis and Littlehampton put it, into the sunlight of a spending Department rather than the drudgery of the Treasury.
Part of the so-called clinical case is that all our constituents will be better treated in the new urgent care centres, but a clinician said to me only recently, “We ask constantly for a definition of them but we discover that the emperor has no clothes. The PCT has no idea what an urgent care centre really is.”
My third point is about the criteria for the decision. What methodology will be used? I have heard scarcely a word about that. We talk in vague terms about access, cost, feasibility, quality, staffing needs and clinical needs. Again, I know that the Minister cannot supply this today, but it is essential that we should have at the outset of the consultation process the weighting that the PCT will ascribe to the different outcomes so that we can orientate our campaigns to save our hospitals around the weighting that the Government will direct—it will be the case that they will direct—the PCT to make in respect of each of the various key headings. Without knowing the weighting, we might find that we win the argument on, say, five headings, but because the PCT arbitrarily decides to give a 90 per cent. weighting to one of the others, our arguments will count for nothing at all. It is essential that we have that analysis of the methodology.
My last point is about my constituents and our campaign. The reaction in my local community to the threat of closure of St. Richard’s hospital has been quite amazing. It is extremely unusual for thousands of people to come on to the streets of Chichester about anything. They certainly did about this issue.
The Minister of State, Department of Health (Dawn Primarolo): What about poll tax?
Mr. Tyrie: I do not think that they came on to the streets of Chichester about the poll tax, but that was before my time. I take the Minister’s point, but she may find that it acts like a boomerang. If she thinks the poll tax was a big issue, she will find that this is a far bigger issue than the poll tax ever was.
My constituents simply do not believe Ministers when they say that finance is not the issue, and that the decision will be taken on the basis of clinical evidence. They are absolutely convinced that finance is the issue and that many clinical concerns and all their wishes will be set aside. When I find so many volunteers such as one of the lead campaigners, Abigail Rowe, and so many clinicians such as my co-chairman on the campaign, Dr. Marjorie Greig, who are prepared to give up so much of their free time to work together on a campaign for St. Richard’s, and when I see the groundswell of support, I know that if local consultation means anything at all, St. Richard’s will stay open as now. I have absolutely no doubt that the same can be said for Worthing hospital as well.
3.36 pm
Dr. John Pugh (Southport) (LD): I congratulate the hon. Member for Arundel and South Downs (Nick Herbert) on initiating this debate and all hon. Members on having spoken so eloquently about the problem in Sussex. I welcome the Minister and congratulate her on being released after years of selfless and penitential toil on behalf of the nation’s finances.
Traditionally, hospitals grew up as a result of local need, philanthropy and pride, and only sometimes through strategic planning. Services evolved in hospitals usually as a result of a change in the requirements of the patients or the national health service. Much of that change, to be fair, has been relatively painless—I think of the closure of tuberculosis hospitals and the like—but we now live in an age of rapid and painful reconfiguration,
which is reflected in debates in this Chamber. Recently, we have had debates about Hertfordshire, Teesside and now Sussex. The story is not only about closures. There have been some new and much-needed developments as well in some of the reconfigurations.
In essence, there are normally only four drivers for change, three of which are legitimate and one is clearly not. The three legitimate drivers are clinical, financial and demographic. The clearly non-legitimate driver is party political interest and things such as heat maps. Sussex illustrates all of them. It also illustrates—quite clearly, on the basis of the contributions of hon. Members—the pain, protest, anxiety and downright huge amount of political trouble caused when reconfiguration comes in sight.
Sussex is almost a textbook example not of how to do reconfiguration but of how things turn out under the current circumstances. All the classic ingredients are there. There are financial pressures and debts, which are clearly accentuated in many places by trusts running services on multiple sites. There are clinical arguments about neonatal mortality, accident and emergency services and the trade-offs between distance, capacity and sophistication, with which I am sure hon. Members are fairly familiar. Institutional rivalry and town pride are at play, and professionals and politicians are backing different outcomes. That was obvious in the comments made by the hon. Member for Arundel and South Downs in introducing the debate.
However, ultimately, the inevitable solution—not the ideal solution—will be a decision by quango. Forget the consultation, whether it is good or bad. As hon. Members clearly believe, I accept that that process is often a sham, but even when it is not a sham, it is seldom decisive and is essentially ruled by quango. That is what the Government call local decision making, or decision making by local trusts.
Norman Baker: On the consultation paper, does my hon. Friend agree that it is difficult for people in the east of my constituency and in Eastbourne to make a rational judgment about maternity services for Eastbourne and Hastings when they are unaware of what the proposals are for maternity services in Haywards Heath?
Dr. Pugh: My hon. Friend is pointing out the weaknesses in the consultation process; often consultation is simply a preamble to do what people will do anyway.
Trusts are, in a sense, a slight misnomer because, although they are staffed by perfectly decent and qualified people, they are rarely ever trusted. Trusts in Sussex seem to fit the bill in that respect, as they span more than one community, which is always a difficulty, and answer to different masters and pressures. As is evident from the contributions made, the trusts do not reflect the democratic will, and it seems as though the NHS is deemed too complex for democratic decision making.
The hon. Member for Hastings and Rye (Michael Jabez Foster), who is not here, put these matters rather well in a quote that I read recently. He said:
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