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Crown Post Offices
10.32 pm
Jim Dowd (Lewisham, West) (Lab): I commiserate with my hon. Friend the Member for Stockton, South (Ms Taylor) on being drawn last in this long series of petitions.
The petition is on behalf of more than 500 constituents and other users of the Forest Hill, London SE23 Crown post office and concerns Post Office plans to merge with WH Smith. I am aware that the scheme is being implemented across the country, and that many other Members’ constituencies are being similarly affected.
The Petition of residents of the London Borough of Lewisham and others, Declares the Petitioners’ serious concerns about the future of Post Office counter services in Forest Hill following the announcement that this Post Office Branch will move to WH Smith. The closure of local Sub-Post Offices in recent years has meant a poorer service to customers, particularly for the elderly and disabled, and the petitioners are concerned that this merger may result in a deterioration in the quality of services on offer at present.
The Petitioners therefore request that the House of Commons urge the Secretary of State to use his powers to ensure that the Post Office does not reduce the level of services currently available to customers under its new partnership agreement with WH Smith.
Asylum Seekers (Vouchers)
10.33 pm
Ms Dari Taylor (Stockton, South) (Lab): I wish to present a petition from 394 signatories from Teesside and elsewhere. It is signed by Kath Sainsbury, who works tirelessly for all asylum seekers in Teesside.
The Petition of residents of Teesside and others, Declares the Petitioners’ serious concerns about the voucher scheme currently administered to individuals who qualify for support under Section 4 of the Asylum and Immigration Act 1999. The Petitioners further declare that the vouchers stigmatise and degrade those who are forced to use them. The vouchers fail to meet the needs of the recipient because they can only be used in certain shops for a limited range of goods. Often, these shops are not located in the neighbourhoods where the refugee community live and people are forced to travel—this can cause severe hardship because vouchers are not accepted on public transport, yet voucher recipients do not have the option of using cash.
The Petitioners therefore request that the House of Commons urge the Secretary of State for the Home Department to use his powers to rescind the Section 4 voucher scheme and replace it with cash payments.
Health Services (West Cumbria)
Motion made, and Question proposed, That this House do now adjourn. —[Mr. Khan.]
10.35 pm
Mr. Jamie Reed (Copeland) (Lab): This is the second time that I have raised in the House the future of health services in west Cumbria, the first time being in December 2005. Almost two years later, there has been some meaningful progress in the provision of health services in the area and the Government continue to provide record levels of investment, but much more still needs to be done. The reason for applying for this debate tonight is that in September, when Parliament will not be sitting, a consultation on the reconfiguration of health services in west Cumbria and Cumbria generally will begin. That consultation has been dubbed the grand plan. With that in mind, it is essential that, on behalf of my constituents and those of my hon. Friend the Member for Workington (Tony Cunningham), health service users and health care professionals alike, certain expectations are now set out, listened to and fully understood.
Those expectations relate to health services across west Cumbria, the services provided by West Cumberland hospital, the scope and timescale of the consultation, the need for all sections of west Cumbrian society to be able to take part in that consultation and for the opinion of local medical professionals to be listened to in the process of service design. In December 2005, I told the House that anxiety about health services in west Cumbria was seemingly endemic, that the people of west Cumbria had harboured deep anxieties concerning the local health services for well over 20 years and that their fears—my fears—are long held and not simply in response to any given public debate about the NHS at any given time. That is still the case.
Ever since I can remember, the people of west Cumbria have had to fend off one threat or another to the services provided by their hospital. For more than 20 years now, The Whitehaven News has reported on what has appeared to be a perpetual threat to our hospital services—most recently through the excellent save our services campaign, which has provided so many local people with an opportunity to have their voices heard. Like my constituents, I want an end to the threats. I want us to be free of the threats and free of fear, and that is what I expect the forthcoming consultation to provide.
The Minister will no doubt be aware of the background to tonight’s debate and the imminent consultation. West Cumbria is a unique area which provides unique health policy challenges. With approximately 160,000 people, west Cumbria is both urban and rural: the majority of people live in urban areas, but in small urban areas separated from other urban areas by vast tracts of rural expanse that themselves contain numerous small rural villages. Population centres are widely dispersed, the communications infrastructure is poor, public transport is poorer still and car ownership is low. In addition, west Cumbria is host to perhaps the most strategically sensitive industrial installation in this or any other country—Sellafield. Put simply, there is no
off the shelf solution for the health policy issues facing west Cumbria. Our unique situation requires unique policy solutions and there are no people better placed than the service users and service providers of health care in west Cumbria to produce and implement the solutions. Inevitably, that will require change of some kind, but it must be change for the better.
It is clear that change in the NHS is incredibly hard to achieve for a number of reasons. The size of the organisation means that change is complex, difficult and expensive. The nature of health care means that expert bodies will often violently disagree about the best way forward. The new Secretary of State has recognised all of that, identifying where the Government have got their approach wrong in the past, where they failed to listen to professionals and where they pursued change too quickly. The Secretary of State has called for a period of calm and stability in the NHS and the Prime Minister—the man responsible as Chancellor of the Exchequer for trebling the budget of the NHS—has said that the NHS is his immediate priority. Both approaches are exactly right for the health service in west Cumbria at this moment in time, but I would go further still.
For almost four years now, the health economy of Cumbria has endured a series of consultations, reviews, reorganisations and reconfigurations. The pace of that process has been painful and the objectives very often unclear. The grand plan consultation must avoid the mistakes of the past and bring an end to the uncertainty and confusion.
I mentioned at the outset of this debate that there had been some meaningful progress in the west Cumbrian health economy. I shall give details of some of that progress. West Cumberland hospital opened in 1964 and it was the first new hospital to be built in Britain after Labour’s creation of the NHS. I am proud of this fact. I am proud too of the staff who work there, their care and commitment, their devotion and their absolute professionalism.
I am pleased that West Cumberland hospital is among the best in the country at preventing MRSA infections. I am pleased that our hospital trust has achieved two-star status. I am pleased that the independent Healthcare Commission reports that standards of care at our hospital are rated as good, and improving all the time. I am pleased that staff in the NHS are being paid better than ever before; they waited a long time for that and they deserve every penny.
In west Cumbria, we have been promised a new acute district general hospital. Our community hospitals in places such as Millom, Keswick, Cockermouth, Maryport and Workington have been saved thanks to the efforts of my hon. Friend the Member for Workington and me, facilitated by an additional £18.5 million cash injection from the Nuclear Decommissioning Authority, over and above the record investment made by the Government. I record my thanks to my hon. Friend, who continues to stand shoulder to shoulder with me as we work to improve the health services of west Cumbria. By convention he is not allowed to speak in this place but he makes up for that outside.
Cynics decry the record investment that Labour has put into the NHS. By cynics, I mean those who want to destabilise the NHS by claiming that increasing investment serves no purpose, and worse, in the case of the Conservatives, those who want to cut NHS spending as part of their £21 billion-worth of public spending cuts. However, I am delighted that the Government are investing unprecedented amounts in health services in west Cumbria and in Cumbria as a whole. When I last debated these issues, local NHS spending had risen by 97 per cent. since Labour came to power.
In addition, in April, North West strategic health authority, which covers Cumbria, saw its budget rise by 9.3 per cent.—an increase of £878.2 million. At the same time, Cumbria primary care trust received a 9 per cent. increase in revenue funding—an increase of £56.6 million—taking the revenue budget for the PCT from £632.5 million in 2006-07 to £689.2 million for this financial year, which is the 29th largest increase of the 152 PCTs in England.
The increase comes at a particularly appropriate time, as it means that more money is available to the PCT with which to commission services in west Cumbria, in particular at West Cumberland hospital, than ever before. That increase in funding must be reflected in the PCT’s grand plan and in the design of services provided at either West Cumberland hospital or a new acute hospital for west Cumbria. The sum of £56.6 million should go a long way in west Cumbria and having been given that additional money, the PCT must act equitably and responsibly to ensure that the grand plan delivers for west Cumbria and west Cumbrians. But that is not enough.
Despite those real improvements and unquestionable investments, I want our services to improve further still—they have to—and it is through the grand plan that I expect the improvements to be realised. When the new Cumbria PCT was brought into being, it promised, through its grand plan, to bring to an end the corrosive doubts about services. The plan is designed to be a final examination of all health services provided across the whole county of Cumbria, with a view to improving services and accessibility to services, driving up clinical standards and achieving clinical and financial sustainability.
I welcome the motives underpinning the plan. However, a great deal of work needs to be done with regard to the plan in terms of its time scale, scope, process and the involvement of medical professionals and the public. I hope the Minister will outline for the benefit of my constituents exactly how she now expects Cumbria PCT to facilitate that.
It is appropriate at this stage to welcome, in principle, the recently announced NHS next stage review to be undertaken by Professor Darzi. The terms of reference state that it will be clinically driven, patient centred and responsive to local communities. The review seeks to deliver NHS services centred on clinical decision making, improved joined-up patient care, more accessible integrated care and a
“health service based less on central direction and more on patient control, choice and local accountability and which ensures services are responsive to patients and local communities”.
Professor Darzi will publish an interim report in October and a full report next year, but I want the west Cumbria grand plan to incorporate those objectives now. I will not countenance another review of services in west Cumbria inadvertently caused by the Darzi review, so can the Minister assure me that she will ensure that the grand plan for health services in west Cumbria will now take account of the Darzi review terms of reference?
I can think of no better précis of how the people of west Cumbria would like their health services to be configured than that outlined in Professor Darzi’s terms of reference. When I speak to clinicians and medical professionals they tell me that they want to ensure that their abilities and skills are channelled into meeting local needs. Service users, young and old, on urban estates and in rural villages, tell me that they want a health service that is responsive to the needs of their local community. Expectant mothers tell me increasingly of their desire for choice and everyone—particularly those in the throes of a public consultation—is energised by the need for local accountability in their local health service. Decision making in the NHS cannot always be described as transparent, but transparent, honest and open the grand plan consultation must be.
I could talk at length about a number of key health services in west Cumbria that in themselves would easily fill the time allocated for this debate. I could talk about the need for drastic improvements in dentistry provision, or the real need to address the implementation of local mental health services, or the importance of accident and emergency services at West Cumberland hospital. I expect the grand plan to address all of those, but I wish to talk tonight about consultant-led maternity services at West Cumberland hospital—not because my wife is seven months pregnant and due to give birth there in September, but because as a service it underpins so much of what other acute service provision must encompass in a general district hospital such as West Cumberland hospital.
Perhaps more importantly, this is about social justice. Centralisation of maternity services in my constituency does not mean the same as it might for other colleagues in all parts of the House. We are not talking about moving services six, seven or eight miles away in this instance, but 42 miles—42 miles of road between Whitehaven and Carlisle, characterised by steep undulations, blind corners, slow-moving heavy freight and agricultural traffic.
I believe that the case for maintaining those services at West Cumberland hospital is irrefutable. A convincing case has never been made for the centralisation of obstetric services in Carlisle; on the contrary, there is a clear and irresistible case against centralisation. This case is now supported by national experts, national guidelines and clinical practitioners. I have spoken with service users, special interest groups, national experts and clinicians since centralisation was suggested, and have found, with very few exceptions, widespread opposition to the suggestion.
The case for retaining a consultant-led maternity unit at West Cumberland hospital and its potential replacement is based on a number of factors. West Cumbria's birth rate is rising. It continues to rise and is on an upward trend. Last year the hospital delivered 1,330 babies—an increase of 3.7 per cent. on the previous year. The national increase is currently 1 per cent. In 2002, the hospital delivered 1,163 babies. The number of deliveries has risen by 167 over a four-year period—an increase of almost 13 per cent.
The performance of the consultant-led maternity unit at West Cumberland hospital is impressive. Its perinatal mortality rate is steadily declining. In fact, the latest figures show that its figures are significantly better than the national average. The latest available UK figures, for 2003-04, show an average perinatal mortality rate of 8.2 births per thousand births. In 2006, the perinatal mortality rate for West Cumbria was 4.5 per thousand births.
Consultant-led maternity units are safer and more cost-effective than midwifery-led units. In June 2006 the National Institute for Health and Clinical Excellence published draft guidelines on intrapartum care. NICE found that although midwifery-led units were cheaper to operate, consultant-led units were more cost-effective. NICE also identified a higher perinatal mortality ratio of 7.2 to 7.8 per thousand deliveries in MLUs, as opposed to a rate of 5.1 per thousand deliveries in consultant-led units.
Centralisation would lead to inequalities of access to care and remove the choice of west Cumbrian women. The national service framework for children, young people and maternity services published in October 2004 states that
“care should be provided within a framework that enables easy and early transfer of women and babies who unexpectedly require specialist care.”
The emergency ambulance “blue light” transfer time between west Cumberland hospital and Cumberland infirmary in Carlisle is now one hour 42 minutes. Currently, most women giving birth in north Cumbria are within 35 minutes of obstetric care; centralisation would increase this time by almost 200 per cent.
Centralisation would also mean that west Cumbrian women were necessarily either classified as high or low risk, with all high-risk patients being immediately transferred to a centralised obstetric unit. That removes choice, in direct contradiction of Government policy.
In addition, the vast majority of west Cumbrian women require obstetric intervention in labour. Obstetric risk prediction is exceptionally difficult. This risk is mitigated by births taking place in an obstetric unit, where most eventualities can be catered for. Of the 1,330 births at West Cumberland hospital last year, the vast majority required obstetric intervention. Given the imprecise nature of obstetric risk prediction, the World Health Organisation has recommended:
“In order to significantly reduce maternal mortality, all pregnant, labouring and recently delivered women must have access to essential obstetric care should complications arise.”
Centralisation would mean approximately 1,000 west Cumbrian women per year being transferred to Carlisle to give birth.
Distance matters: women more than 15 miles from an obstetric unit face hugely increased risks. The British journal of gynaecology published studies in 2002 which identified that living more than 15 miles from a maternity hospital was one of the most important variables in maternal mortality.
Perhaps more importantly, the Cumbrian health infrastructure cannot accommodate obstetric centralisation. The centralisation of obstetric services at Carlisle would distort the finances and resources of the local NHS. Significant new investment in human resources and the physical infrastructure would have to be made to Cumberland infirmary to accommodate approximately 1,000 new cases every year, and the most likely effect is that the necessary financial and human resources would be diverted from West Cumberland hospital or its replacement.
In addition, national experts refuse to recommend centralisation. Dr. Maggie Blott, author of the North Cumbria Acute Hospitals NHS Trust’s obstetric and midwifery service review report wrote that
“There is no obvious solution”
with regard to reconfiguring services and was unable to recommend centralising services in Carlisle. Local lay members of the steering group also refused to recommend centralisation. They wrote that centralisation would do little to address the needs of disadvantaged groups in west Cumbria and that west Cumbrian women would not regard centralisation as either safe or equitable. The national maternity tsar has also acknowledged the unique needs of west Cumbria. In “Making it Better: For Mother and Baby”, published in February 2007, Dr. Sheila Shribman wrote:
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