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Although there is evidence to suggest that the centralisation of services to deal with complex or specialised work provides better outcomes for patients, evidence for centralisation of non-complex and high volume cases does not exist.
The report also goes into the difficulties that payment by results may produce and the effect of losing some elective work to other providers, which may put a strain on acute general hospital services.
The reorganisation of services always provokes intense public and political interest. This is completely understandable.
Crucially, the report then gives a spectrum of proposed acute and emergency care services, which is supremely sensible. The first level, obviously, is primary care. Then there are community hospital and urgent care centres. The report then goes on to local hospitals, which is the group into which Kidderminster used to fit, although it does not now. Banbury certainly fits into that group and so, too, amazingly, do some tiny hospitals that have been changed, such as the Montagu hospital in Mexborough, which has precisely 115 beds, and Hexham in Northumberland, which has only 98 beds. Local hospitals provide 24-hour services, including A and E, acute medicine, including computed tomography, laboratory services and level-3 critical care. That is what local people want and need. Of course Lord Darzi can recommend changes in London, because it is unique and there probably are far too many hospitals, but he cannot do the same thing in country areas.
The report later says that medical emergencies mostly involve those over 65 years. Such people represent the largest group of patients admitted to hospital and they all require rapid access to care, with only a small percentage needing specialist services.
There are qualms about the possibility that it may not be safe for a hospital that loses acute emergency surgery to have unselected medical admissions. I am sorry that the hon. Member for Grantham and Stamford (Mr. Davies) is not here, because Grantham has bitten the bullet in that respect. Its A and E department has been slightly downgraded and it has produced an entirely sensible list of exclusionspeople who should not go there. Referring to those who should go there, the departments document says, in heavy type:
A patient may be brought to Grantham and District Hospital if they require immediate Airway and/or Breathing resuscitation.
Dr. Taylor: I thank the hon. Gentleman for that intervention. In fact, the paper from Granthamit is on the internet, and I got it only yesterdayis exemplary. The Academy of Medical Royal Colleges goes on to say that there will obviously be local changes, because different places will need slightly different arrangements.
I must mention clinical networks, because they are essential. Where we are combining the work of certain hospitals, they must work together. If we are to get networks going, there must be a high level of leadership from clinicians, and clinicians must agree to the proposals. The report says:
Successful networks cannot be imposed from above
Let me say a quick word about paediatrics, because paediatrics and obstetrics are special cases, and they are discussed to a degree in the report. Speaking of paediatrics, the report says that, even at the lowest levelthe urgent care centre in a community hospital
Staff should be competent in the initial assessment of children, including recognition of the sick child.
The report puts into stark perspective the myths about cardiac and stroke care that Ministers and national directors have promulgated. Only a small minority of hospitals can do urgent coronary angioplasty, while only a minuscule proportion can give thrombolytic drugs to people with acute strokes, and the report lists them.
To finish, the report is hugely important. At last, there is a blueprint for acute health care services, including acute general hospital services, which has been written with staff and patient input. It gives the independent reconfiguration panel an absolute standard to work to when faced with controversial, contested reconfigurations. The Secretary of State has promised to refer all such cases to the panel, and if its recommendations agree with the report, I hope that he will support them.
Mr. Nicholas Soames (Mid-Sussex) (Con): I am pleased to support my hon. Friend the Member for Banbury (Tony Baldry) in this debate, which is central to the interests of all our constituents. He covered an enormous amount of ground at great speedindeed, if he were a horse, I would breed from him.
The Prime Minister speaks about rebuilding trust in politics and reconnecting people with the political process, but what can those words mean when Ministers have given me and other hon. Members assurances on the Floor of the House in the recent past about the future of A and E facilities at the Princess Royal hospital in Haywards Heath and elsewherean issue that could hardly be of more importance and concern to our peopleand then reneged on those promises within two years? The Government should be truly ashamed of treating people in that way.
The proposals for the future of the Princess Royal hospital in my constituency include downgrading the A and E and the loss of all elective surgery and of our wonderful maternity services. The proposals across West Sussex more widely, which cover the Princess Royal hospital, the Worthing hospitals and St. Richards hospital in Chichester, are wholly unacceptable and unsuitable and would undermine the safety and accessibility of acute services in West Sussex. I take great heart from what the hon. Member for Wyre Forest (Dr. Taylor) said. I have indeed read the paper that he mentioned and I very much hope that the Government will pay close attention to what it says.
Tens of thousands of people have made their views on this matter known in the only way they know how. More than 300,000 people have signed petitions and 25,000 have marched. This weekend, in Haywards Heath, the support the Princess Royal campaign will have a march, which 10,000 people will, I hope, attend. People feel, rightly, that they have paid their taxes and that they are entitled to high-quality local and accessible services.
I know that the Minister is an excellent person, and I hope that she will not be got to, because I trust her judgment. However, I hope that she understands that this is the fourth time in seven years that the Princess Royal hospital has come up for review. That is no way to run a health service or to look after patients. Above all, it is no way to treat the staff. The staff at the Princess Royal know perfectly well that there is no clinical evidence in support of the changes, although they must of course be cautious about saying so.
On the face of it, the proposals are absurd. The Princess Royal is 15 miles south of one of the biggest international airports in the world, 5 miles from a very busy motorway, and at the centre of one of the fastest-growing places in the United Kingdom, which has an increasing, and increasingly young, population. It sits in West Sussex, which, I do not have to remind the Minister, covers more than 770 square miles, and has a population of more than 750,000 people, a struggling transport infrastructure and a growing and ageing population.
As the hon. Gentleman said in a speech in the House of Commons just before the House rose for the summer recess, to which I paid particular attention, infrastructure is about more than roads, railways, sewers and health and social services. It underpins national and local well-being, and people in my constituency, and elsewhere, know that and will make a powerful case to the Minister. Most importantly, the people in Mid-Sussex, and across the county of West Sussex, who have been through an awful lot with the health services in the past seven years, want an assurance from the Minister, if the so-called consultation is to be seen to be realI hope that she intends it to be realthat the powerful, detailed and knowledgeable views expressed locally will be listened to, and that attention will be paid to them when it comes to the shake-up at the end of the process.
I speak this afternoon on behalf of my hon. Friends the Members for Worthing, West (Peter Bottomley), for East Worthing and Shoreham (Tim Loughton), for Arundel and South Downs (Nick Herbert), for Wealden (Charles Hendry) and for Chichester (Mr. Tyrie) and the hon. Member for Lewes (Norman Baker). All the campaigns in West Sussex to save our hospitals are emphatically all-party, and they embrace all shades and none of political and social opinion. They are not to be despised by a slippery and thoroughly unreliable Government.
Finally, I should like the Government to know that Dr. Herry Ashby, a magnificent and inspirational GP in Newick in East Sussex, has 180 letters from GPs in the Mid-Sussex and Lewes area, representing 300,000 patients, saying that they believe that the proposals relating to the Princess Royal, and other wider changes, are untenable and clinically unsafe, and that they will not support them. Across Worthing and Chichester, opinion is just the same. We look to the Government to resolve those matters in a way that is serviceable and reliable to our constituents; perhaps the hon. Member for Wyre Forest has given the Government a good signpost.
Mr. Peter Bone (Wellingborough) (Con):
It is a pleasure to follow my hon. Friend the Member for Mid-Sussex (Mr. Soames). We have had two powerful
speeches about saving hospitals, and I congratulate my hon. Friend the Member for Banbury (Tony Baldry) on securing such an important debate. I also feel very sorry for the Minister. I know that she is an excellent Minister, but not a single Labour Back-Bench MP has bothered to turn up to support her in the debate, whereas there are Conservatives, Liberals and independent Members in the Chamber today.
I will not, the Minister will be pleased to hear, campaign today to save a hospital. There are hundreds of thousands of my constituents in Wellingborough, Rushton and east Northamptonshire who do not have a hospital. It takes them the best part of 40 minutes to get to the nearest hospital, and if one were to travel by public transport, it would take up to two hours. The hospitals that they must go to are at Kettering and Northampton. They are full to bursting point. There is no room for them to expand. Yet the Government have said that Wellingborough must be at the heart of a growth area, with 52,000 new houses to be built in the next 10 years or so. Even the Government, in their policy document, say that there should be a new general hospital in the area. There are no plans for such a hospital. Yet the same Government, who say that Northamptonshire should have a certain amount of money for its primary care trust, have, every year since the formula was devised, deliberately underfunded Northamptonshire. I am saying to the Government: take the money that you should have given Northamptonshire, build the hospital for Wellingborough and Rushton and relieve the pressure on the other two hospitals, in Northampton and Kettering.
I have a listening to Wellingborough and Rushton campaign. The idea is to discuss local issues. Unofficially, two weeks ago, I launched a campaign for a hospital in our area. I have had more than 1,000 letterspeople bothering to write to me, put on a stamp, and post their lettersbefore we have even launched the campaign. I hope that the Minister will consider the issue and realise that in a growth area it is really necessary to have a hospital to serve the people.
Dr. William McCrea (in the Chair): Order. I am trying to allow as many hon. Members as possible to speak in the debate. The last two to speak have been very considerate in the time that they have taken, and I should deeply appreciate it if others would bear that in mind.
Paul Rowen (Rochdale) (LD):
I congratulate the hon. Member for Banbury (Tony Baldry) on an excellent exposé of some of the issues that have affected all of us when reconfigurations and district general hospitals have been under consideration. Rochdale infirmary has just been through such a process. Our hospital is being downgraded. We are losing maternity, paediatrics, acute medical and acute surgical services, and our accident and emergency is being downgraded to an urgent care centre. The hospital is situated in a ward where the average morbidity rate is the fifth highest in the country, the average lifespan being 68 years of age. The changes are from a Government who talk about delivering services locally, where people need them. We are losing those services. A petition against the proposals has been signed by 44,000 people, all in vain.
I want to talk about the process that we went through. When he was appointed, the Prime Minister talked about restoring trust in politics. If the way in which we were treated is an example, he is even more cynical than his predecessor. The decision to downgrade Rochdale was announced on the Friday before the August bank holiday. At 4.30 on that evening I got through to someone at the Ministers office, who refused to confirm to me that a statement was to be made the following morning, even though I had an e-mail that had been sent out to the press and media inviting them to the press conference. That is a disgraceful way to behave. It is totally contrary to the way in which Members of the House should be treated, but it is typically cynical. The fact that there are no Labour Members present illustrates that point. As the hon. Member for Wyre Forest (Dr. Taylor) eloquently said, there are alternative methods and ways. The Government need to start listening, because the people are not satisfied, and will not put up with this disgraceful way of running the health service.
Peter Bottomley (Worthing, West) (Con): May I briefly make a small correction to something that was said earlier; there are Labour Members here. The Minister and her Parliamentary Private Secretary the hon. Member for Crawley (Laura Moffatt) are here, and the Minister will be as concerned about what is happening in the county as the rest of us are.
I have two points to add. First, in my part of West Sussex the chief executive of the primary care trust has constantly said that there is clinical support for the proposals. We asked whether GPs had been consulted. The answer appears to be no. We put out non-judgmental questions to GPs. Of the first to respond, one said that he could see the point of the proposals, but wanted to remain anonymous, and 50 said that they opposed them, and gave their names. When we asked the consultants and other medical staff at the hospital, and midwiveswho are also cliniciansthey opposed the proposals.
At the primary care trust meeting on Monday in Worthing, at the Pavilion theatre, at 7 pm, probably nine out of 10 of those who attend will not be able to get in. Nine hundred will be able to attend. I expect up to 10,000 will not be able to. I hope that those who are there will hear the primary care trust announce that it will put to Sir Graham Catto proposals developed by clinicians in Worthing and the districtwith, hopefully, people in Chichester as wellwhich can be considered on all fours with the three inadequate proposals that have been considered up to now.
The consultation has so far been nearly a disaster. It can be rescued; if the Minister has a chance, will she tell the strategic health authority and the primary care trust to take the representations of councils, clinicians and Members of Parliament seriously? They speak with the people who will try to be at that meeting.
Andrew George: I shall not. Perhaps I should have been told afterwards, Dr. McCrea, but I shall be brief in any case. I am grateful to the Front-Bench spokesman for allowing me to speak, as we are now over the allotted time.
Within my constituency, which comprises west Cornwall and the Isles of Scilly, we have been in campaign mode for a very long timein fact, we have been in perpetual campaign mode for many years on behalf of West Cornwall hospital in Penzance and St. Michaels hospital in Hayle. That is one of the inevitable consequences for Members of Parliament who represent areas with small general hospitals.
I appreciate fully that it is neither possible nor appropriate for Ministers or the Government to micro-manage the delivery of health services in local areas, but they do set the context in which such decisions are taken. The Royal Cornwall Hospitals NHS Trust, within which West Cornwall and St. Michaels hospitals fall, faced financial difficulties last year. Depending on how it is defined, the trust faced a deficit of up to £58 million for which it had to find solutions. Inevitably, panic-laden and highly regrettable decisions were taken at the time. Under effectively new management and a new primary care trust, things are turning around. I welcome some of the Royal Cornwall Hospitals NHS Trusts proposals to reconfigure and put right some of the decisions taken last year to downgrade services at West Cornwall and St. Michaels hospitals.
It is worth making a more general point. Listening to the points made by the hon. Member for Banbury (Tony Baldry) respecting obstetric services in his constituency, one can understand the situation in remote rural areas. For example, if things go wrong in the delivery suite at St. Marys hospital on the Isles of Scilly due to the unpredictability of such circumstances, there are massive challenges in removing the mother to the nearest obstetric unit, which is more than 60 miles away, with more than 25 miles of sea between St. Marys and the mainland. The Government must not presuppose that we live in semi-suburban, landlocked middle England. Many of us represent areas for which suburban solutions involving the closure of small general hospitals do not applythe remoter areas of the United Kingdom.
In December, the Government redefined the term accident and emergency. Minor injury units can now be defined as accident and emergency units. I feel that that is perhaps a cynical ploy to allow the Government to say that they have kept A and E units open simply by redefining them as level 1, 2 and 3 A and E units. I am worried that that ploy might be used.
The terminology in this debate must be reflected on. I hope that the Government will give us some stability on that and recognise that in some areas, the trade-off between emergency services and planned surgical events is often used to allowor rather persuadea local community to accept the downgrading of its services. Although I accept that the Governments role is limited in many ways, they can recognise the difficulties in many areas in their funding formula, provide clarity and stability in definitions and acknowledge that the country is not a single homogenous suburb.
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