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The consequence if both goit looks as though the Princess Royal at Haywards Heath may also lose its maternity serviceswill inevitably be to put more pressure on Brighton. As has been said, access to Brighton is extremely difficult. Nobody in their right minds would build the hospital where it is. They would build it on the outskirts, connected to the trunk road system. Instead, it has been builtsome of it is pre-Nightingalebang in the middle of town, on a very constrained site with little space for development other than upward. The site is difficult to access and already suffers extreme pressure. There are long delays at accident and emergency in Brighton, and sometimes at maternity services in Brighton. It not at all unknown for expectant mothers who turn up at Brighton to be
referred elsewhere. It is not clear where they will be referred to in future if we have lost Eastbourne and Haywards Heath, and if we lose Worthing on the other side. Where will those expectant mothers go?
The capacity of Brighton is a serious issue which I do not think has been factored into the decision by the primary care trust. If it has, it has been factored in incorrectly. I hope the Minister will pay attention and have regard to the situation at Brighton, which is entirely relevant to the future of the Princess Royals maternity services and those at Eastbourne.
The hon. Member for Hastings and Rye spoke about the medical professional advice. Of course the primary care trust and Members of Parliament must have due regard for that advice, which is extremely relevant and pertinent. There is a belief that in some ways it is safer to have a single site than two sites. I understand that argument, but it is not overwhelmingly convincing. There are medical experts on the other side who believe that a two-site option is safer. The judgment is at least marginal.
What is not marginal, as the hon. Member for Hastings and Rye recognised, is that the travel distances across East Sussex to get from Eastbourne to Hastings or to get from Seaford to Hastings, to Haywards Heath or wherever it happens to be are extensive. I hesitate to say this as the hon. Gentleman might use it later, but the road from Eastbourne to Hastings is, as he says, not the most satisfactory road in the world for someone in an ambulance or for an expectant mother who has to get somewhere quickly. We all recognise that, yet people will have to rely on that road. It is no use the hon. Gentleman saying, Well, we can sort it out in retrospect or bolt on something once we have decided to take away Eastbournes A and E. That will not happen and he knows it. It is a county road and no way will the county council spend millions and millions of pounds to solve a problem on the A259 which has been exacerbated by the removal of a health service from Eastbourne. That simply will not occur.
Norman Baker: If the maternity department at Eastbourne goes, the consequences will be clear. People will be taken in ambulances and there will be more births en routeI referred to that in an oral question to the Secretary of State for Health a couple of months ago. We will have to ask ambulance service staff to exercise and demonstrate skills in which they have not been trained and which we should not expect them to acquire. Ambulance staff are wonderfulthe paramedics and their ambulances are first-ratebut they cannot do everything and deal with every single complication, and some of the situations that arise will be extremely complicated. We should not ask them to do so.
I turn briefly to the process. I agree with the thrust of the comments made by the hon. Members for Eastbourne and for Wealden. What has not been mentioned so far is that on the day of the meeting in Uckfield, the strategic health authority was meeting in Horley, expecting to ratify the local primary care trusts decision. So secure
were the SHA representatives in their knowledge of what the primary care trust was going to do that they had the recommendation, which had not even been discussed by the PCT, in front of them and were even prepared to meet early, before the PCT had reached its decision. The SHA representatives sat by the phone; as soon as it rang, they immediately ratified the PCT decision without much ado. If we want a definition of a rubber stamp, that is it.
I should also point out that in theory the SHA meeting was public, but even if the roads between Uckfield and Horley had been fantastic, people would not have been able to travel between both places in no time at all to be represented at both the PCT and the SHA meetings. Plenty of people wanted to be at both meetings, but they could not be. That is a travesty of democracy and an insult to the public. It is a way of saying, The public consultation doesnt matter. Weve got our little deal behind the scenes and are going to push it through. If you cant get there, thats tough. That is an insult to all those people who have marched through Eastbourne and elsewhere, attended public meetings and signed petitions. Frankly, the Government should tell the PCT and SHA to conduct themselves in a more seemly manner. The hon. Member for Wealden mentioned the bishop and the bouncerthe soundbite of the debate, and rightly so. It is appalling that a bishop and Members of Parliament can be shoved aside by a bouncer acting on behalf of an unelected quango that has made a decision that has no public support in the area that it is supposed to represent.
I hope that the Minister will not trot out the usual stuff about this debate being about a PCT decision that is taken in everybodys best interests. That is not how it seems in East Sussex. I hope that she will listen to the voices coming not only from my constituency and those of the other Members here, but from many thousands of people in East Sussex who have participated in a consultation exercise in good faith, done their best to make their case and put together an extremely good case, but have been thrown aside in a process that has treated them with contempt.
The Minister of State, Department of Health (Dawn Primarolo): I congratulate the hon. Member for Eastbourne (Mr. Waterson) on securing this debate about the future of national health service maternity services in East Sussex, a matter of great concern to him and his constituents. Like the other hon. Members who have spoken in this debate, he has raised the issue repeatedly. I appreciate the comments that the hon. Gentleman and others have made. It is a testament to the enduring popularity and success of the national health service that we have institutions that are held so dear by the people whom they serve. As I am sure that the hon. Gentleman has repeatedly acknowledged and would want to confirm today, that is a huge compliment to the NHS locally and to those who work within it to provide the best possible care for their patients.
That means, however, that talk about potential change often triggers huge public interest and debate, which is of course important. I recognise that change can be difficult and acknowledge that it provokes powerful reactions. Nevertheless, I would say to hon. Members that having decided to devolve the decision
on these issues to a local level, the consultation process must be left to take place without interference from Westminster. I understood that principle of devolution to be supported by Members from both Opposition parties who have spoken in the debate.
When people talk about the reorganisation of services it is often suggested that it is about money, as has been asserted today. Let us therefore be clear about the position of East Sussex Downs and Weald primary care trust. In 2006-07 and 2007-08, its budget was increased by £70 million, it is 2.6 per cent. above its fair funding allocation, and in 2008-09 it is to receive an extra £25 million. It is not about money, nor is it about politicsthat is, frankly, a ridiculous proposition. It is interesting how, when we respond to debates on different parts of the country, the allegation of political interference that Opposition parties make against the Government flexes in terms of whether they are in favour of or against the decision.
I know that my hon. Friend the Member for Hastings and Rye (Michael Jabez Foster) was disappointed by my reply when he and other Members from the area wrote to me asking to make representations to me before the local process has been completed. I have been clear that I am unable to meet to take those representations and express an opinion while the process continues.
It is not about politicsit is about saving more lives, providing better, safer services, and making care more convenient. That desire to see better outcomes for patientsincreased safety and quality in care, allied with increased fundingis ultimately driving considerations of change.
For example, some doctors have told usit has been touched on in the debatethat specialist care needs to be concentrated in centres of excellence so that clinicians have the right expertise, experience and equipment and can treat those most in need quickly, safely and conveniently. Delivering the best possible services for all women and their babies will mean that changes will have to take place.
Charles Hendry: I am mystified by the Ministers reference to convenience. Closing down a hospital or a service and requiring people to go an extra 20 miles can scarcely be more convenient. During the first Sunday in June last year, the maternity facility at Eastbourne was full and had to close, and by the end of that day the maternity facilities at Hastings, Haywards Heath, Crowborough, Brighton and Worthing had also closed to new mothers. How can she say that we have to centralise these things when, on occasion, we do not have enough capacity at the moment?
Dawn Primarolo: I am not saying, as the Minister, that we should centralise these servicesI am advancing to the House the argument that is put to the Government by clinicians and those who are expert in this area, and setting the scene.
Pregnant women talk about the services that are most convenient to them, as they have always done.
Those services might be home delivery or midwife-led services, and where necessary, they might involve the centres of excellence we are talking about. I also have to say that this is one of the safest countries in which to give birth; the quality of services and the changes being made have continued to build on that excellence and safety. I absolutely accept that the point of todays debate is to consider the proposals being put forward relating to this change and whether it will deliver the best possible service for all women and their babies in that area.
That is precisely why the Government published Maternity matters: choice, access and continuity of care in a safe service last year. It is our strategy and our intention to modernise maternity services, placing safety, quality and the improvement of standards of care at the very heart of our vision. That is exactly what the Government have always said to this House. The process of improving services is continuous; it means that we have to look to the next stage review, which includes a specific maternity and newborn care pathway, in taking this forward.
I listened very carefully and with great interest to the points made by hon. Members on the consultation on maternity services in East Sussex, which I understand had been going on since 26 March, and ended on 27 July 2007. I also understand that, following consultation, East Sussex Downs and Weald PCT and Hastings and Rother PCT, referred to by my hon. Friend the Member for Hastings and Rye, announced on 20 December last year the decision to develop a single-site option for consultant-led services in East Sussex based at the Conquest hospital in Hastings. The special care baby unit and in-patient gynaecology services will also be based on the same site.
Under those proposals, Eastbourne hospital would continue to provide a midwife-led serviceacross the entire NHS, most women have an experience of giving birth safely and with support thanks to such servicesand, in conjunction with the East Sussex Downs and Weald PCT, it intends to increase the provision of community midwifery services throughout East Sussex. It will do so to ensure that women do not end up going to hospital when they do not need to, and that they are supported in their homes. I am sure that the hon. Member for Eastbourne would support that.
We have always been clear that changes to service provision should be initiated only when there is a clear and strong clinical basis for doing so. I absolutely acknowledge that there might not be 100 per cent. agreement, and that doctors may have differing views, but in this instance the clinical case for change was based on the ability of a single, larger unit to provide safer, better-quality services, and on concerns about the sustainability of consultant-led services at the Conquest and Eastbourne sites. There was a recognition of the challenges, and the fact that they needed to be addressed.
Norman Baker: Will the Minister say whether she believes that that clinical assessment took into account the objections raised by hon. Members in this debate, including the difficulty of travelling and the capacity problems at Brighton?
I shall come to the hon. Gentlemans point when I deal with the point at which the decision becomes a matter for Ministers to consider, as opposed
to when the process of decision making and consultation is dealt with locally. I know that he has been a great champion for the devolution of decision making in a whole range of policy areas, not just the health service, and that he accepts the principle in this case. I accept that he is totally dissatisfied with the outcome of this process. However, the principle must be, as the Government clearly set out, decisions and consultations undertaken locally and based on local opinion, need and advice to ascertain what is best for that area. I will deal with what the process will deliver next shortly.
It would be very hard for a unit delivering under 2,000 births a year to offer adequate training opportunities for junior doctors.
Furthermore, the East Sussex PCTs established a new options panel in response to the points that were made locally in the consultation about different approaches. The hon. Member for Eastbourne mentioned that. The new options panel was independently chaired by Professor Stephen Field to appraise clinically all the emerging alternative options that were submitted during the consultation. They included an option submitted by local campaigners for a consultant-led service on both sites. I have been informed that it was given full consideration by the PCT boards but did not prove to be the preferred option.
I am aware that the hon. Members present in the Chamber played an active role in the consultation process and I appreciate that they are dissatisfied with the outcome. They have made their feelings clear. However, reconfiguring the service will enable the local NHS to maintain safety and allow a single, bigger unit to offer improved quality of service at the Conquest hospital in Hastings. The Eastbourne unit will continue to provide ante and post-natal clinics and midwife-led care.
As the hon. Member for Eastbourne knowshe referred to the matterthe decisions made by the PCT boards are subject to scrutiny by local authority overview and scrutiny committees. That has not happened yet. Those committees comprise locally elected councillors whose role is to consider issues that affect the health of local people. When the OSCs are unhappy with the consultation process, or do not believe that the proposed changes are in the interests of the local health service, they can refer the proposals to my right hon. Friend the Secretary of State for Health for final decision and, if necessary, to the independent review panel. Given that the meeting will take place on 28 January and that the outcome needs to go through a proper process of review and independent consideration, it would be incorrect for the Governmentindeed, it would constitute the very political interference about which the hon. Member for Lewes
(Norman Baker) complainedto express an opinion or make a decision while the democratic process is going on.
Mr. Waterson: On that point of procedure, what criteria, based on recent experience, would make the Secretary of State unlikely to refer such a decision to the independent review panel? How many decisions get referred, proportionately?
Dawn Primarolo: I am happy to write to the hon. Gentleman specifically on that, but I understand that the Secretary of State has made it clear that decisions on reconfiguration that were not concluded would be referred to the independent review panel. I will ensure that that is correct and write to all hon. Members who have spoken in the debate. I know that, because of the expertise of the hon. Member for Eastbourne on such matters, he will understand that the process is independent, without political interference and based on revisiting all the issues, especially the clinical ones. The independent review panel is the final arbiter and the Secretary of State accepts its decisions. I think that covers the point that I was going to make.
What is obviously important, for every hon. Member who has spoken and for the health community in East Sussex, is, as the PCT has clearly said all along, to ensure strengthened antenatal and post-natal care across East Sussex, to develop more community outreach services and to ensure that pregnant women have access as quickly as possible to the high-quality intensive care that may be necessary. We are all required to ensure that maternity services remain a priority in East Sussex. I am sure that the hon. Gentleman will join me in welcoming the proposals regarding more support in the community for those parents who choose it, and access to the midwife-led units.
My final comment is about the various issues that the hon. Member for Wealden (Charles Hendry) raised with regard to a public meeting during a public consultation. He reported to the House that, in his opinion, the behaviour of some at that meeting would have been discourteous and inappropriate when directed towards any member of the public, let alone the person whom he cited. I have no knowledge of that, but it has now been raised. I certainly intend to take the issue away, because it is an entirely separate point, and to seek suitable explanations. Again, I will write to all hon. Members who have spoken on that, because if what the hon. Gentleman described turns out to be true, we would all want to be sure about how public consultations would be conducted in future by any public body, even in such difficult circumstances, where feelings are running high on both sides. Everybodythe PCT, Members of Parliament, the local community and the health communityis motivated to do what is best by those whom they serve. That is the principle that we must remember.