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Dr. John Pugh (Southport) (LD):
I congratulate the hon. Member for Banbury (Tony Baldry) on securing this debate. We have a lot more in common than one
might thinknot simply charm and good looksas we were the only two candidates in the last election who were opposed by the independent Your party, backed by Martin Bell. I do not know quite why we were selected, but the candidate opposing me stood as a hospital campaigner, spending appreciable sums in doing so.
I had a lot of sympathy for that person, because what he fears could, despite ministerial protestations, come to pass. It happened in my constituency back in 2003, and it was proposed earlier this year. I was confronted with the reconfiguration of two hospitals. There were maternity statistics, which meant certain things to clinicians, and arguments about doctors hours and the working time directive. Maternity went. When maternity went, paediatrics went, and then, most shamefully, so did childrens A and E. Every child in the large seaside town I represent, as well as their anxious parents, must travel out of town along a winding road to receive any assurance or help from the NHS. As the hon. Member for Banbury observed in his speech, the midwife-led unit went shortly after; it was regarded as uneconomical.
That is what happened. The local primary care trust now finds it wholly anomalous and may do something about it, but there are general issues for any local district general hospital. Working patterns have changed. Junior doctors are an issue, as is the working time directive. Patient stays have shortened, expectations have been raised and finances have been stretched. An issue of clinical efficiency approaches us from two directions. It is argued that routine services are better delivered in the community, and it is argued from the other direction that many high-tech services are better delivered in less local specialist hospitals.
Some of those considerations undoubtedly have substance, but there is also strong support everywhere for district general hospitals. How much a politician is prepared to take on board the suggested implications in any one case tends to vary inversely with a DGHs geographical proximity to his constituency boundaries. Ministers are no exception in that respect; they behave in precisely the same way.
I have two points to make. One is that many suggested implications of the balance of consideration are false and do not followI am following the same line as the hon. Member for Wyre Forest (Dr. Taylor). The other is that the dilemma of the DGH that confronts us is a legitimate matter for genuine democratic decision and not decision by quango.
To address the first point, delivery in the community, which the Government talk about and most people seem broadly to support, does not mean not delivering in the DGH. The new renal dialysis unit in my constituency, about which I recently wrote to the Minister, will be on the DGH site, which is a wholly welcome development for patients. On the other hand, blood tests have been moved away from the infirmary and into the community clinic. It so happens that the community clinic is right at the end of my constituency, and people must now travel further to have blood tests. That is not ideal.
A district general hospital, as my examples prove, often represents a critical clinical mass where a variety of services can be accessed, cross-fertilisation of disciplines can occur and support services, which are quite important to most patients, can congregate. The clinics, which seem to be the new solution on the block, are the
equivalent of the NHS corner shopand the rise of the supermarket should tell us something about general public preference.
On the second point, patients need no encouragement to seek the best cure wherever they can find it, but ill people have no particular incentive to travel any further than is necessary. Clinicians are another matter. I am worried when the Government say constantly that the matter will all be decided by clinicians; historically, clinicians have been blissfully uninterested in the patients journey. The Shields report, which reconfigured my hospitals services, said that the reconfiguration would involve severe transport problems, but that is simply not a matter for the NHS; it is for somebody else to resolve. I tried to add to the recent Local Government and Public Involvement in Health Bill a clause saying that any consultation about reconfiguration should necessarily also be a consultation with transport authorities, but the Government resisted that proposal.
The wider patient experience is constantly neglected. Consultants time is regarded as precious and patients as infinitely expendable. We have all had the experience of turning up at an outpatient surgery at 10 oclock, finding that about 40 other people have turned up for the same appointment and waiting for two hours. Everyone knows that realistically, highly specialist care needs highly specialist hospitals, which cannot be everywhere. Patients in my neck of the woods do not hesitate to travel further for cancer care, for example. However, good secondary medical care should be available in most towns; it should be networked with specialist units and care, and act as a filter and a resource to back up those units. We ought to make a case for district general hospitals being supported by and supporting the local community.
We have to accept that there is a trade-off to be made between clinical excellence and availability. I make my position clear: clinicians and hospital and PCT executives have important advice to offer on how that trade-off is to be managed. Ultimately, however, the matter should be negotiated by local democratic bodies; it should not be the local decision making of which the Government speak, which is essentially decision making by appointees. As the people of Banbury have witnessed, that is profoundly alienating and ultimately profoundly insulting.
Lord Darzi has put PCTs across the country into consultation mode. My worry is that unless something is done about the accountability of decision makers, we may get the kind of consultation that gives consultation itself a bad name. That frustration will be so strong and so marked that it will certainly deny the Labour party any prospect of a fourth term. I listened with interest to the Secretary of State speaking earlier today of increased accountability. He was questioned on the matter, but his responses were enigmatic. In no sense were they precise. It is on that issue that things need to be made clear and changed radically.
Mike Penning (Hemel Hempstead) (Con):
I congratulate my hon. Friend the Member for Banbury (Tony Baldry) on acquiring this debate. It is on a subject close to my heart, and those who know me will know that I have been banging on about the future of the Hemel hospital for a lot longer than I have been a
Member of the House. For those who do not know, this is my first outing on the Front Bencha fact of which I am very proud. I am also proud to see so many of my Conservative colleagues here today, along with members of other parties. One of my colleagues said earlier that there was a Labour MP on the Back Benches, but I think that she has to be here; the Minister needs someone to hold her hand. It is obvious that the people of Banbury are not alone. I am pleased that they understand so much about the hospitals future, and having such an excellent MP to represent them is so important.
The Health Committee, a Labour-dominated Committee of which I am still a member, issued a report not long ago saying that the devastation in the NHS and the cuts in hospitals were due not only to clinical concerns. Actually, there was little clinical argument; in most parts of the country they were the result of financial deficits, due to the Governments inability to ensure that nearly £100 billion of taxpayers money got to the front line.
Lord Darzi may have been handed a poisoned chalice, but the Government want him to try to help them understand better the needs of hospitals, A and E departments and other specialist health facilities. However, he seems to be at loggerheads with his Front-Bench colleagues. For some timesince long before this Government came to powerthere has been a push in the NHS for big is beautiful. I note that the Secretary of State was recently in Basildon. Basildon hospital has been hugely expanded, but the nearby Orsett A and E hospital was closed to fund it. I know that because I was brought up in that part of the country.
Lord Darzi says that there does not have to be a population of about 500,000, but that it could be as low as 200,000 or 250,000. If so, we have a real concern about what has already happened. So many facilities, not least in Kidderminster and Hertfordshire, have already been closed on the basis that big is beautiful and that we need facilities to deal with populations of about 500,000. I have to say to my hon. Friend the Member for Banbury that this may be only the start; his concern about the closure of maternity units and A and E units is that they tend to be the first of the problems. Sadly, if they go other facilities will go with them.
The clinicians will argue that if there is no consultant-led maternity ward and the hospital could cope with a birthing unit, it will become unsafe. I cite the example of the Hemel Hempstead general hospital in my constituency. Our consultant-led birthing unit was closed, which left those needing the unit with a 12-mile journey to Watford. We were then given a shiny, brand new birthing unit, but 18 months later it was closed because it was not safe.
If we lose acute A and E, what do we lose with it? We are highly likely to lose acute cardiac unitsthat has already happened in my hospitaland we will also lose stroke units and almost certainly intensive care beds. Then those involved start looking at elective surgerybut what happens if something goes wrong during elective surgery? We need the acute back-up. I hate to be the bearer of bad tidings, but that is happening across the country.
Many hon. Members have articulated their concerns about their areas, and about specialist provision in their communities. They have shown that one size does not fit
all. It is not physically possible. We are not talking only about the southern tip of Cornwall or the top of Scotlandeven if we could, given that it is a devolved matter. We are talking about community and district hospitals and about acute A and E hospitals across the country, all of which are very worried.
One factor that concerns me is that the public do engage. I have presented petitions, as so many hon. Members have done. Thousands upon thousands of people have signed petitions and marched the streets, some pushing hospital beds. We have participated in consultation. We were asked, What do you want to happen? Our comment was, Leave us alone. Indeed, 86 per cent. of the consultees in the West Hertfordshire Hospitals NHS Trust consultation said no to closure, but what happened? They closed it.
What point is there in having bogus consultations? Why do the Government lead the public up the garden path by saying that there will be consultation? What point is there in having independent reconfiguration panels if they can do only what the Government tell them to do? There is no point. Anything to do with such specialist areas must be clinically driven. It must be driven by those who know best. Politicians of whatever party do not know best when it comes to the future of the NHS.
I pay respect to Lord Darzi. He is a consultant. He does not know best for the entire the NHS. He is a specialist in a specific area. Even he has admitted that there are areas where he does not have expertise. Why not listen to the clinicians, the experts and the GPs? Hundreds of GPs are writing from West Sussex saying, Leave our hospital alone. Why do the Government not listen? Is it not the job of the Government to listen to those who know?
What is a local general hospital? I am greatly concerned that we are leaving the public in a dangerous situation. Those who drive through my constituency of Hemel Hempstead will see signs everywhere saying, Hospital: A and E. There is no A and E; it is a minor injuries unit. If those with acute conditions drive there, the hospital will do its best, but the patients will then be transferred by ambulance to the nearest acute hospital, perhaps to Watford. However, if a blue-light ambulance comes from Hemel with a patient who has an acute need, it will go immediately to Watford. It is wrong to allow any trustor any politicianto mislead the public into thinking that a hospital has certain facilities when it does not. It will cost lives. It is fundamentally wrong.
It is a crying shame that we are not having a general election. If we had had one, a Conservative Government would have led a moratorium on those closures. We would have been able to protect the services that our constituents so rightly deserve.
The Parliamentary Under-Secretary of State for Health (Ann Keen):
I congratulate the hon. Member for Hemel Hempstead (Mike Penning) on his appointment and I welcome him to the Opposition Front Bench. I look forward very much to working with him. I thank all hon. Members who participated in the debate. With
your permission, Dr. McCrea, I acknowledge the presence of those in the Public Gallery.
I congratulate the hon. Member for Banbury (Tony Baldry) on his success in the Speakers ballot and on initiating this debate on the future of smaller hospitals. I know that he will understand that, as he mentioned at the beginning of his contribution, the matter concerning the Horton General hospital is now with the independent reconfiguration panel and I am personally unable to acknowledge those comments. He will understand that I cannot do so because, as was mentioned, we want to take the politics out of the decision making; that is the purpose of what we are doing.
It is a testament to the popularity and success of the NHS that we have such beloved institutions that are held so dear by the people whom they serve. That is a huge compliment to the national health service locally and all the people who work in it, who provide the best possible care for patients. It is obvious from the numbers of Opposition Members who are in attendance today that they are committed to the NHSto its funding and its structure in its modern format. As a former nurse who worked in the NHS for more than 25 years, it is extremely encouraging for me to see Opposition Members who are so committed to the NHS and its future. I say to the hon. Members for Wyre Forest (Dr. Taylor), for Mid-Sussex (Mr. Soames) and for Wellingborough (Mr. Bone), who were so complimentary, that I am listening; the Government are listening. That is the whole purpose of the review. The hon. Member for Banbury quoted Lord Darzi and what was quoted or rather misquoted in the newspapers. It is important that I put on record what Lord Darzi actually said:
I have been widely quoted as saying the days of the District General Hospital are over. Let me be clear about what I did and did not say. The days of a one size fits all provider, repeated over and over again in a Metropolitan Capital are over. This does not represent the world-class service that a world-class city deserves. However, in my Report I did describe a key role for Local Hospitals. This is where the future of District General Hospital lies.
When people talk about the reorganisation of services they think that it is about money, but it is not; it is about safety, quality and what is more convenient. That is why the consultation is taking place with clinicians, patients and user groups across the areas that the local health service serves. Lifestyles, society, medicine, technology and the NHS itself have all changed over the past 60 years, and I am sure that all hon. Members would agree with that. Change is certainly nothing new in the national health service. The NHS has always responded to change and the latest treatments by organising itself to deliver that care. We are responding to a variety of drivers for change. The change that we are asking all clinicians, patients and communities to consider is about clinical practice, clinical safety and delivering services to the user in the best possible quality way. It is not about reorganising staff or health authorities.
As a former nurse, I make no apology for why some of these changes are essential. If we do not keep up with the times, services will not keep on improving. Today we are reaping the benefits of new medical technologies and safer surgery, which means quicker recovery times
for patients and shorter lengths of stay in hospital. For example, years ago, in cardiology we had to have beds for patients suffering from heart attacks. Patients were kept in coronary care units for two or three weeks at a time and surgery was not possible. We have advanced our surgery and bypass techniques to the extent that we can look into the coronary arteries on a day-case basis and provide a surgical procedure through the coronary artery. We can also now provide drugs, such as statins, to stop cholesterol building up in the coronary arteries. Thousands and thousands of lives have been saved and with the cessation of smoking people can look forward to having a healthier heart and lifestyle. We look forward to that change; it is a massive change. The needs and the way in which we care for cardiac patients will always change. Medicine is and always should be dynamic.
We need to consider the issue of inappropriate buildings. We love our buildings. I for one was brought into the House to save my local hospital, so I empathise with everybody who has come to this debate. That hospital was to be closed and the land sold off. The issue was not about acquiring services locally and nobody consulted the people in that constituency and community about where we could have services. Such a consultation is what is being suggested in the present format of reconfiguration; it is documented that that is how it is being delivered. The Government, Lord Darzi and myself are committed to that process; it is being clinically led. Now we have an independent review looking at some areas in the country. I do not think that we could be fairer than that.
There was a history of widespread hospital closures in the 80s and that is why people fear the existing consultation. Yes, there is mistrust of the past and people would be right to mistrust what happened in the 80s and 90s. They would be right to mistrust a period when people had to collect money for urgent hospital equipment. People do not have to do that today. We have just seen a settlement to the NHS that is 4 per cent. above what was expected. We know that there is a sense of safety in relation to the health service. Everyone of us who represents a constituency has a duty to ensure that that message is put across because the fear is damaging. The hon. Member for Mid-Sussex mentioned the stress of constant change. I recognise that that is not good for staff or for delivering services. I urge managers and those who are conducting consultations to do so in a manner that reduces stress as far as possible.
We have modernised facilities. We have 54 major new hospitals, more than 2,500 refurbished or replaced GP surgeries, 520 new one-stop centres and more than 60 walk-in centres. We are considering every district general hospital and every area that delivers an aspect of the health service, every area that has specialist nurses and every area that has maternity services, which were mentioned today. I ask all hon. Members to debate with the Royal College of Midwives on having a midwifery-led centre that is in fact safe. Midwife consultants are safe. Yes, different measures of maternity care are required and will require different levels of either obstetrician or midwifery-led care, but that does not mean to say that we should not discuss that issue.
When someone takes an ambulance journey, the practice of paramedics means that it is a very different experience from 10 or 15 years ago. That is because of the knowledge of our paramedics. I would like hon. Members to acknowledge the knowledge that paramedics have and the advancements that we have made in waiting times in accident and emergency departments. Patients are expected in accident and emergency on a controlled arrival because their journey has been controlled by many expert paramedics. That is different from what we offered patients some years ago; it is an advancement, and I hope that all hon. Members recognise the difference.
Yes, there is always anxiety about any change. Yes, there are always problems with consultation. Also, it is not easy to get practitioners to change their practice. Sometimes we have to encourage our peer group to accept change. That is not easy, and that is why the wide scope of Lord Darzis review includes all staff and patients; not just the top docs, but everybody concerned. The role and expansion of the primary care team must also be considered. The GPs who are the real backbone of our services and who are willing in many instances to look at change would be grateful for the consultation not to be dealt with in a manner that spreads fear because to do so is unfair. Some 60 years ago Aneurin Bevan said that the NHS will always have to change. Aneurin Bevan asked us to look towards the professions and people of responsibility to consider that change.
I thank everybody for their contribution today. I will listen. I have listened. I will go away and consider what has been said, and in the future, I hope that there will be a consultation process that hon. Members and their constituents can accept.
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