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10 Oct 2007 : Column 108WH—continued
“it is vital that the views of local people are taken into consideration which is why service improvement proposals are subject to full consultation.”
I must tell the Minister that local people have made their views extremely clear.
Dr. Julian Lewis (New Forest, East) (Con): May I say something to my hon. Friend on the issue of consultation? I know that this debate is about the downgrading of a local general hospital. However, in the New Forest in Romsey, we have been fighting to save our community hospitals. We experienced all the techniques of bogus consultation options. Eventually, after huge public displeasure and demonstrations, which are almost unheard of in our part of the world, the PCT said that it had changed its mind. Even now, it is attempting to convert community hospitals into clinics—to do anything, rather than have in-patient beds. When it comes to democratic opinion, PCTs—sadly—have a great deal to learn.
Tony Baldry: My hon. Friend is correct that such service reconfigurations are characterised, almost universally, by bogus consultation.
Local people make their views clear. Some 35,000 local people signed a petition against the downgrading of the Horton, which was presented to No. 10 Downing street, and I presented a petition of some 15,000 signatures to the House. The Minister will find that the independent reconfiguration panel will receive hundreds, potentially thousands, of individual letters from local people setting out the reasons why the existing services at the Horton are valuable to them and why they wish to retain them.
Indeed, with the help of the “Keep the Horton General” campaign, ably led by George Parish, a local Labour district councillor, local people have done pretty well everything that it is permissible to do in a democratic society to demonstrate their almost total opposition to, and collective concern about, the proposals. Huge churches have been packed full, and there have been petitions, rallies and marches. We had “Hands around the Horton”, at which local people formed a huge chain of support around the hospital, but they do not believe that Ministers are listening. They cannot understand why the Secretary of State cannot be bothered to come to Banbury. They do not understand why the Minister of State, the hon. Member for Exeter, referred on Radio Oxford to the Horton as a “small cottage hospital”. If Ministers do not recognise general hospitals, there is a problem for us all.
Local people were totally bemused when the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) accused my right hon. Friend the Member for Witney (Mr. Cameron) of scaremongering by including the Horton on the list of general hospitals currently threatened by the Government. Even today, at Prime Minister’s questions, the Prime Minister suggested that there is no threat to the Horton. That is deeply insulting to local people, and the Prime Minister would do well to ensure that he is properly briefed by Ministers and officials before making such ludicrous assertions. When Ministers in the Department do not recognise
that the Horton is being threatened by the Government, they are clearly not living in the real world but in some parallel universe.
Local people find it insulting when the Prime Minister starts talking about citizens’ juries, and when he clearly does not know what is going on. Why do we need citizens’ juries when local people have made clear their views in a 35,000-signature petition presented to Downing street, and in a 15,000-signature petition that I presented to the House?
A stakeholder group, including representatives of patient, community and public bodies, rejected the clinical group’s support for the trust’s proposals, saying that they
“represented a significant downgrading of access to services and a worsening of choice for women and children”.
Against the background of such comprehensive local and medical professional opposition to the trust’s proposals, it was perhaps not surprising that the trust could not find a single witness—other than members of its own staff—to give evidence to the health overview and scrutiny committee in support of the proposals, or that the committee unanimously decided that the proposals should be referred to the IRP. Incidentally, that is the first time in the four years of its existence that the committee has made such a recommendation, so it was clearly not lightly made.
One of the fundamental principles of the NHS is, rightly, equity of access, but if the Government’s proposed changes go ahead at the Horton and at other general hospitals, my constituents and thousands of other people in the country will not have equity of access. Intolerably, they are going to have services that are less safe.
Dr. Richard Lehman, the senior partner in one of Banbury’s fastest-growing GP practices, describes the trust’s proposals thus:
“It is as if a third of the mothers in my practice are being randomised without their informed consent to a kind of provision which has never been shown to be safe and on basic first principles is very unlikely to be safe. If somebody tried to carry this out as a clinical trial, I cannot believe that any Ethics Committee would give it a second look.”
Next year is the 60th anniversary of the founding of the NHS. If the Government continue to undermine general hospitals, they will be undermining a fundamental principle of the NHS.
There are concerns about whether the John Radcliffe hospital could cope with the increase in the number of sick children as a consequence of their no longer being treated at the Horton. Figures sent to me by staff at the Horton show that the children’s ward was used as a safety net for the John Radcliffe on 18 occasions during July. So for more than half of July, the JR was full so far as new admissions of sick children was concerned, and had to refer them to the Horton. Indeed, statistics show that the Horton children’s ward was also on call for Milton Keynes, Stoke Mandeville, and the Royal Berkshire and Kettering hospitals. July is not a winter month, when pressures are high. If there are no 24-hour children’s services at the Horton and if the John Radcliffe is unable to take them, where are the children who currently go to the Horton going to go? Will they go to Swindon or Reading?
On a weekly or sometimes daily basis, GPs all over north Oxfordshire are told that the John Radcliffe cannot cope and that they should refer patients to the Horton.
For example, on Tuesday 2 October, Thames Valley Emergency Access sent an e-mail to many GP practices stating:
“We have been advised by the Ops Team at the JRH that capacity remains tight today in all areas especially in adult and paed. medicine. As a result of this they would like you to refer adult and paed. medical admissions to the Horton Hospital in Banbury.”
Exactly the same thing happened the next day, Wednesday 3 October, and again on Friday 5 October. On three out of the past five days in the last working week, the JR was unable to accept new admissions, and the Horton had to shoulder the burden.
What about this week? Yesterday, 9 October, exactly the same thing happened. JR wanted all adult and paediatric medical admissions to go to the Horton, and said that
“there are also issues with Gynae”,
“refer Gynae patients to the Horton.”
Exactly the same thing happened today. On the day of this debate, the JR is asking adult and paediatric medical admissions to go to the Horton. That rather prompts the question: on what day is the John Radcliffe able to accept admissions? If downgrading of services goes ahead at the Horton, it will not be possible to send such patients there. Where are they going to go? Who will be responsible if things go wrong?
Catherine Hopkins, a qualified midwife who is now a solicitor in Oxford, has a practice that is devoted almost entirely to helping parents of children who have been brain-damaged during birth. She says:
“It is not sufficient to say that women will be carefully screened and high risk cases will be delivered at the consultant unit at the JR. How many emergency Caesarean sections were there at the Horton last year? I question what would have happened to those who would not have been assessed as having high risk pregnancies. If the current proposals are put in place, when a midwife at the proposed new unit decides a woman in her care needs emergency medical attention, the mother, possibly in an advanced stage of labour, will have to be transferred by ambulance to a consultant unit. The clinical Working Group found that an ambulance transfer from the Horton to the JR could be achieved in 48 minutes. This delay could lead to serious damage occurring to mother or child. As a former midwife and solicitor who acts for children brain-damaged in the course of their birth, I believe that (negligence) claims of this sort could rise as a result of this proposal.”
Interestingly, there appears to be no evidence of the Department of Health having done any work on the safety and risk of midwife-led units—no assessment of whether there are any greater risks to mothers and babies inherent in a midwife-led unit. In this instance, on the trust’s own figures, a significant number of mothers who start labour in the MLU will need to transfer during labour to a consultant-led unit. On the trust’s most optimistic figures, a significant number of mothers who start in the midwife-led unit will—not might but will—have to be transferred during labour some 26 miles to a consultant-led unit. It should not be forgotten there are many occasions when the M40 between Banbury and Oxford is closed, either due to bad weather such as fog or snow or due to road traffic accidents, which appear to be becoming, sadly, all too common between junctions nine and 10. As I said, I understand
that the trust today told Radio Oxford that the journey could be achieved in 30 minutes—that is complete hogwash.
It is not only the Horton that faces this threat. I commend my hon. Friend the Member for Worthing, West (Peter Bottomley) for his early-day motion on births on the road. It is tragic that hon. Members are having to table early-day motions asking that the strategic health authority guide the local primary care trust in maintaining consultant-led maternity services at Worthing, with the aim of reducing the number of babies born before arrival at hospital. This is third-world medicine.
What is the degree and range of added risk to mothers and babies of such moves? GPs locally have reviewed all the major medical journals for the past nine years, and no work at all appears to have been done on considering whether and to what extent larger midwife-led units may increase risk to mothers and babies. Indeed, I understand that there will be no sound data on this matter until September 2009, when the National Perinatal Epidemiology Unit is due to report.
Peter Bottomley: Will my hon. Friend accept, and will the Minister listen to, what is said by the Royal College of Obstetricians and Gynaecologists, which very clearly says that if there is to be a midwife-led unit, it ought to be through the wall from a consultant-led unit, not 20, 40 or 60 minutes away?
Tony Baldry: I entirely agree with my hon. Friend. It is significant that the largest midwife-led unit at present is next door to a consultant-led unit. The idea that it will now be some 26 miles away from a consultant is crazy.
In August, I wrote to the Secretary of State, asking a straightforward question:
“In these circumstances, how can the Government be confident that encouraging downgrading of Consultant-Led Units and replacing them in a number of instances with Midwife-Led Units is safe as the Government appears not to have done any work on this issue whatsoever?”
I am still awaiting a reply to that letter.
Ministers say that the changes are being driven in part by their having to implement the European Union working time directive, but other countries in Europe are also obviously equally covered by that directive. How are they managing to continue to have consultant-led maternity services in much smaller units?
Jim Thornton, professor of obstetrics and gynaecology at the university of Nottingham, has observed that
“Previous experience with mega mergers (of maternity units) like this has not been good”,
“Previous experience with freestanding Midwife-Led Units created after Consultant-Led Units closed has not been good. Examples. Wakefield—on edge of closure, only open working hours. Hull—ditto. Southport—Midwife-Led Unit created when Consultant-Led Unit closed proved non viable and has now closed.”
Professor Thornton goes on to give examples of at least seven free-standing MLUs that have recently closed or are closing soon. Why are the Government intent on creating new large midwife-led units, when
the experience is that many of the MLUs created when a consultant-led unit closed have proved unviable and are closing?
On the proposals to downgrade children’s services, what response are the Government giving to the report of the children’s surgical forum of the Royal College of Surgeons, which in July concluded:
“The current downward trend of provision of general paediatric surgery in General Hospitals needs to be halted and reversed”?
It is not just consultant-led maternity units across the country that the Government want to downgrade, but a significant number of accident and emergency units. Many of the same concerns apply. An academic study published in August by the medical care research unit at Sheffield university carefully collated statistical evidence for what might seem a blindingly obvious conclusion: that there is a direct correlation between the distance that emergency patients must travel to receive hospital treatment and an increased risk of mortality. Put bluntly, the further away a victim is from a hospital with accident and emergency provision, the more likely they are to die from their illness or injury. One might think that conclusion so obviously a matter of common sense that it is difficult to understand how any Minister can attempt to maintain that the closure of local accident and emergency departments in favour of regional—which is to say, fewer—centres for emergency treatment somehow benefits NHS patients. One cannot benefit from elite specialist care if one is dead on arrival.
The trust’s response to the concerns of professionals, patients and residents has been wholly inadequate. It is simply no substitute for consultant-led services to have, as the trust proposes in its revised proposals, a phone line for midwives in Banbury to call doctors in Oxford for advice in an emergency. General hospitals cannot be run like NHS Direct.
I hope that the Secretary of State, who is still comparatively new in his post, will sit down with Ministers and officials and look again at the collective impact of the Government’s policies on general hospitals. Unless he can be confident that patients will not be put at risk, the Horton and other general hospitals should not be downgraded. Medical science may have improved since the 1970s, but the journey to Oxford has not. We believe in general hospitals; the Government, seemingly, do not. GPs, nurses, midwives and patients all wish to see existing general hospitals thrive, and I simply want the Government to produce policies that enable us to keep the Horton general.
Dr. William McCrea (in the Chair): Order. I trust that it will be helpful to hon. Members to know that I intend to commence the winding-up speeches at 3.30 pm. A number of hon. Members wish to speak, so I trust that, when speeches are being made, that will be taken into account. I call Dr. Taylor.
3.6 pm
Dr. Richard Taylor (Wyre Forest) (Ind): Thank you, Dr. McCrea. I thank the hon. Member for Banbury (Tony Baldry) for raising this absolutely vital issue. I shall concentrate on generalities rather than specific cases.
I am sure that not many hon. Members read the British Journal of Healthcare Management, but I happened to be reading it on the train on the way home one day not that long ago and I nearly fell off my seat because the political commentator was suggesting to the Prime Minister that I should be the next Health Secretary. I have been waiting ever since to be asked for advice and I am about to give advice that I think will help the Minister in her response and that I know will help all the Opposition Members, because in the past few weeks, an absolutely vital paper has been published. The only people I am doing down are people such as me, who might want to stand for election again to protect their hospitals.
The Academy of Medical Royal Colleges is a group consisting of the presidents of all the royal colleges, including GPs, anaesthetists, physicians and surgeons. They have all come together with a working party and published a paper called “Acute Healthcare Services: Report of a Working Party”. To my amazement and pleasure, it is written in a patient-friendly, authoritative way. It goes away from the Royal College of Surgeons saying that every hospital has to serve populations of 500,000 people, which is quite impracticable. I shall talk briefly about the report, commending it to everybody to look at.
The foreword, on one of the introductory pages, states that the three main challenges to which the paper responds are to ensure that any change should be to improve safety and quality, to consider the impact of the European working time directive and to recognise the interdependency of acute services—if we take away one service, another is likely to fall down. The foreword goes on to state:
“There is evidence that for some very serious conditions, care in specialised units is associated with better outcomes.”
Nobody would argue with going to a specialist unit for a major head injury, a major chest injury or a ruptured aortic aneurism. The foreword goes on to say:
“However, these conditions together only account for a small percentage of acute care episodes. The evidence is much less clear for the majority of common conditions that make up 95 per cent. of acute care. There is evidence that larger emergency departments have longer waiting times. Big is not necessarily better.”
A little later, the report lists 15 key issues, and I shall read just one or two of them:
“Patients should have good access to emergency care but for some serious acute conditions they and their relatives may have to travel further...The population and patients should be involved in shaping proposals to change services at an early stage. This will need an honest discussion of the real reasons for change”—
not the sort of spin that we are used to in consultations. Most importantly, the report says:
“Plans to redesign services which involve moving services from a particular site must not be fully implemented until replacement services are established and their safety audited.”
That did not happen in my area, despite requests that it should. Elsewhere in the list, the report repeats:
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