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14 Jan 2009 : Column 96WH—continued
The legal challenge should not surprise us. It did not surprise me when I received the Secretary of State’s letter on 4 September, which referred to “Your Health, Your Future”, with the sub-heading, “Safer, Closer,
Better, Barnet”—no reference to Enfield. The letter went on to say that the independent reconfiguration panel
“has considered a great deal of evidence from a wide range of contributors”.
“the needs of patients, public and staff to ensure safe, sustainable and accessible maternity services in East Sussex.”
There was no mention of Enfield. That was plainly a mistake, but it gives rise to concerns at the very outset that this was a copy-and-paste decision, using national guidance and models, in relation to centralising A and E and maternity services.
Mr. Charles Walker (Broxbourne) (Con): Does my hon. Friend agree that the various consultations seem to have ignored the fact that approximately 150,000 people in Hertfordshire use Chase Farm A and E and other Chase Farm services? My constituents now face not only the prospect of a reduced service at Chase Farm, but reduced services at the QE2, so their nearest A and E will be the Lister, which is approximately 30 miles away and can take an hour and a quarter to get to in the rush hour, if not longer.
Mr. Burrowes: My hon. Friend makes a good point. Yesterday, I was talking to an ambulance man who raised a similar concern about the travel time to neighbouring hospitals, with the loss of accident and emergency services. My hon. Friend has been a doughty campaigner on behalf of his constituents and I pay tribute to him, as well as to his 16,423 constituents who signed the petition that was delivered to No. 10 and the House of Commons. That petition was ignored, along with the concerns of Enfield residents. That is summed up by one campaigner, who said that the recent comments made in the House by the Minister who will respond to the debate today have raised acute concerns that the interests of Enfield and neighbouring constituencies have not been properly considered and, indeed, that those concerns have been treated with contempt. In parliamentary terms, this debate comes soon after business questions in the House on 16 December, when my hon. Friend the Member for Eddisbury (Mr. O'Brien) asked the Minister:
“Will the Minister find time before Christmas to go to Enfield and tell the people there why they do not need an accident and emergency department at Chase Farm hospital and why it will be replaced by a non-blue light service at the urgent care centre?”—
I am not aware that the Minister took up that invitation to come to Enfield before Christmas to explain the position, but we have an opportunity today to get a proper explanation and to recognise the timely report by the College of Emergency Medicine, which concluded:
“There is no evidence of the clinical or financial benefits”,
and that the Government’s proposals are
“clinically unproven and against the principle of patient choice of access to proper emergency care.”
We look forward to an explanation from the Minister that goes further than his response to the House, in which he sought to hide behind the legal challenge, which we now know is unnecessary, given the rules of sub judice. He concluded:
“Everybody....is agreed that the proposals are the best solution for the north-east London health economy.”—[Official Report, 16 December 2008; Vol. 485, c. 955-56.]
We have already heard today that that is not the case, and that it is untrue. The words of Kate Wilkinson, one of the staunch campaigners on this issue, are pertinent. She says on behalf of many people that the Minister’s comments
“showed utter contempt for the strength of public opinion that has been shown so far and for the hours of work (years!) that various health scrutiny committees have undertaken to scrutinise the proposals in depth.”
Those objections and that scrutiny have been made on a cross-party basis, in an investigation ably chaired by Councillor Ann Marie Pearce, of the joint scrutiny committees of Haringey, Barnet and Enfield, which are united in their opposition. Opposition has also been ably led by my colleague Nick de Bois, and by Irene Wilson and Ivy Beard, who has come to hear our debate today. Opposition has consisted of a large number of petitions—notably one that was organised by Irene Wilson and presented to No. 10, which was signed by 30,000 people—and marches. Some 5,000 people participated in one march. Hon. Members present in the Chamber today and I were united at the front of that march. We were concerned and were campaigning against the downgrade of A and E and consultant-led maternity services. Also notable was a petition organised by Nick de Bois during the consultation process. It was signed by 9,000 residents. More than 70,000 people have signed petitions or made representations, and all of them objected to the downgrade. That is why it is time that we heard a full explanation from the Minister.
This debate is timely because last night, something unexpected happened that made me aware of the need to retain services. Today, I could focus on the independent reconfiguration report, which expressed concern about the flawed consultation. I could focus on the 50,000 responses that were rejected in the consultation process. I could focus on the fact that option E, which would retain and improve existing major services at Chase Farm, was not included, and that the consultation document, as has been said, was fundamentally flawed and poorly communicated. I could emphasise the transport problems in east Enfield, in Cheshunt and in Winchmore Hill in my constituency, or I could focus on the capital plans, which the independent panel said do not have a clear source of funding.
I could speak about the concerns of chief executives and funding gaps. The chief executive of North Middlesex hospital is extremely concerned about how she will find the extra £60 million required—over and above existing plans for the private finance initiative expansion at North Middlesex hospital, which is welcome—to cater for the increased demand should Chase Farm hospital be downgraded. The chief executive of Chase Farm accepts that the planned £100 million will not be enough to cover the improvements necessary for the three sites.
Last night, I attended A and E with my daughter, Dorothy, who suffered a fall and an injury to her head. Perhaps that is taking preparation a little too far but, thankfully, my daughter’s injury was minor. The Minister would probably be quick to say that such an injury would be catered for under the proposals for a downgraded unit. Let us not call it a local A and E, as that is ambiguous. One could describe it as an urgent care unit,
but we need further details about what that means. However, it would deal with a minor injury such as the one that Dorothy suffered.
Just behind us at reception was the family of a constituent—an old ex-council colleague whom neighbouring MPs will know well. Last week, Richard Course suffered an aneurysm and thankfully survived. His family came to the hospital last night to thank the staff for saving his life. I pay tribute to the staff who did that—they save lives day in, day out. The family wanted to make the point that Mr. Course would not have survived under the proposals, as there was no time because of his aneurism to transfer him to Royal College hospital. Chase Farm—and the location of Chase Farm—saved his life. It also saved the life of my father when he suffered asthma attacks. Timing was crucial, so it was important he could get there quickly, and no doubt many others have similar experiences. I could also mention the complications during the birth of one of my children. A mid-labour transfer to another hospital would have jeopardised his life.
Mr. Mark Field (Cities of London and Westminster) (Con): I have some experience of the matter, having lived in Enfield in the run-up to the 1997 election when I was the candidate there. Chase Farm hospital was a big issue at that stage.
Does my hon. Friend agree that, given that there was a case at that juncture to keep the A and E open, that case is considerably stronger a decade or so on, not least because of the huge increase in population? The Enfield Island site was still in gestation in the late 1990s. It is now fully finished, and a huge number of people live in that part of eastern Enfield. The case is even stronger now, and it should be made by all the folk who have a local concern in Enfield.
Mr. Burrowes: I wholeheartedly agree. The Enfield area has a disproportionate number of nought to 14-year-olds and of over-74s, and the population is increasing dramatically. If one looks at maternity services, the latest statistics from the Office for National Statistics show that there has been a 17.5 per cent. increase in the birth rate, which is the second highest in London. The population of Enfield is the fifth largest and is increasing. The case was good when my hon. Friend was campaigning there, but it is even better now.
The situation became clear to me last night. I heard about it while speaking to various practitioners who were present. It was a very busy evening. There were three patients on trolleys who were waiting for beds. They were there with ambulance men, who said that usually people wait one or two hours for a bed. They explained that 164 patients had gone through A and E the day before yesterday. Patients were waiting to be offloaded from ambulances—they were stacking up—and four patients waited on trolleys for a bed. They said that overnight there had been 22 admissions for the 16 beds in the wards.
The observation unit is often full to the extent that there is 24-hour observation, which goes beyond the remit for observation. I was told that the Barnet and North Middlesex hospitals were full that evening, and that often it is obvious from the board that Barnet is full. Indeed, Enfield often takes more patients than the surrounding hospitals. The ambulance men and nurses
told me that patients often require urgent surgical and medical attention, and that time is critical. Time-critical patients coming from the surrounding area are often elderly—every minute matters—and they need a local hospital to deliver the care they require.
North Middlesex hospital is the fifth busiest in London. It would have to take up capacity from Chase Farm hospital. The words of Sir George Alberti are particularly pertinent:
“Care will be needed to ensure that capacity is adequate at the two sites so that the end result is not two swamped departments unable to provide the level of care required.”
The Government hired him to provide advice, and they ought to listen to his words extremely carefully.
The concerns expressed by the ambulance men and nurses should be heard, as should the concerns of the consultants and doctors to whom I spoke last night. They said that the closure does not make sense, and that it is madness, given the demand coming through Chase Farm. They said that their concern and that of others was that if A and E were to close, it would lead to the end of the hospital. None of us would want that; it does not make sense. In legal terms, practitioners are concerned that the decision is irrational. No doubt that is why the council is challenging it, and it is why the Minister should give a full explanation today.
All that comes before we talk about maternity services and the grave concerns about a lack of true clinical benefits and the loss of consultant-led maternity services. Midwives have communicated their concerns. A group of 10 said that the closure will result in fatal outcomes if a shoulder dystocia occurs—that is when the baby’s head is delivered but the shoulders become trapped. They said that there are six minutes to deliver the shoulders before brain damage or even the death of the baby occurs. If a woman starts to haemorrhage during or after the delivery of the placenta, she could bleed to death in minutes. Those events and many others cannot be predicted during antenatal screening for suitability to deliver at the birth centre.
The birth centre and the labour ward at Chase Farm hospital are an ideal configuration. The midwives at the birth centre say that seven out of 10 women would not choose to go to the birth centre if the labour ward were not downstairs. Who can blame them for not taking a risk? Sadly, Enfield mothers would not choose to have their baby at the birth centre if there were not the assurance of a labour ward there as well. I again pay tribute to the staff at Chase Farm and to those who have worked tirelessly for local health care. I congratulate Nadia Conway on being awarded an MBE for her services. I commend the progress made in a number of areas that we do not have time to debate today. I am thinking particularly of infection control: Chase Farm has been praised for its cleanliness, staff knowledge and commitment to ensuring that appropriate control mechanisms are in place.
We are all convinced—there is almost unanimous support in the community for this—by the argument that the best opportunity to improve services is at Chase Farm. We need to ensure that we have a fully functioning A and E and consultant-led maternity services. That is what the council has said in motions and what the challenge is all about. Now the Minister has an opportunity to provide an explanation. I hope that he will use the
opportunity to say, “No, we’re not just going to go to court. We’re going to retain a fully functioning A and E and maternity service.”
11.20 am
The Minister of State, Department of Health (Mr. Ben Bradshaw): May I begin by congratulating the hon. Member for Enfield, Southgate (Mr. Burrowes) on securing the debate? I would like to recognise the good work being done by NHS staff throughout Barnet, Enfield and Haringey. They are delivering a better-quality health service than ever before, benefiting the constituents of the hon. Gentleman and of other hon. Members.
Before addressing the detail of the concerns that the hon. Gentleman raised, it is important to put in context the proposals that he discussed. During the first 60 years of the NHS, society, technology and medicine have changed beyond all recognition. Today, patients with more and more conditions can be treated and cared for in their own homes or local communities, and for many of the procedures that still require hospital admission, the length of stay has reduced dramatically. As medical science has advanced, NHS staff have become capable of ever more extraordinary feats of clinical care. For some complex procedures or operations, it is important to have well-equipped and well-staffed specialist centres where round-the-clock consultant and specialist nurse expertise can be assured and where sometimes extremely expensive technology can be concentrated. There is a kind of two-way traffic in the health service: an increasing amount of care is being devolved out of the traditional acute hospital setting into the community, GP practices, health centres and people’s homes, while more complex, specialist, emergency or acute care is being concentrated in fewer, more specialist centres. The changes in health care in north London are taking place in that environment.
It is important to stress at the outset that the organisation of health care is no longer decided by Ministers or civil servants in Whitehall, but by local health care professionals on the ground. Organisational changes must be based on medical grounds—what is best in terms of patient care. If democratically elected local councillors wish to object to proposals from their local health service, they can do so—as they have in this case—and refer the proposals to the national independent reconfiguration panel. That system was deliberately set up to take the politics out of such decisions and it has served the NHS well. The IRP is genuinely independent. It has, for example, rejected two major reorganisations in recent months, in Oxfordshire and in East Sussex.
As the hon. Gentleman acknowledged, there has been considerable local debate about how health services should be organised in north London, dating back a considerable time. The Barnet, Enfield and Haringey clinical strategy set out how the NHS proposed to provide services to his constituents. The proposed case for change was as follows. Services are duplicated across hospital sites. Some local hospital buildings are in poor condition and are no longer suitable to deliver the high-class care required. Despite recent significant increases in investment, local health services are overstretched and score poorly against national standards. The current
pattern of children’s, neonatal and maternity services locally is neither safe nor sustainable in the medium and long term.
As part of the work leading up to the launch of the formal public consultation on the proposals, and as the hon. Gentleman acknowledged, NHS London invited Professor Sir George Alberti, the national director for emergency access, to work with the local NHS and offer an independent view on the medical clinical case for change across Barnet, Enfield and Haringey. His work was published in May 2007, and he stated:
“Put starkly, it is evident that safe, high quality modern care cannot be provided for all specialties in all three acute hospitals in the area...Care of the standard that members of the public have a right to expect will require the centralisation of some specialties on two of the three hospital sites. Immediate care around the clock by experienced clinicians cannot be guaranteed whilst efforts are made to maintain all three sites as full acute hospitals.”
Following formal consultation on the strategy, Barnet, Enfield and Haringey PCT boards met in December 2007 and agreed unanimously to take forward option 1 for their clinical strategy. The hon. Gentleman and other hon. Members will be well aware of what that option involves. In-patient planned operations—hip and knee replacements, for example—will be concentrated at Chase Farm and expanded. The existing service will expand to incorporate surgery from Barnet and North Middlesex hospitals. The local NHS estimates that 240 patients a month will benefit. Separating out planned care, provided at Chase Farm, and emergency care, provided at Barnet and North Middlesex, has the benefit of reducing the number of planned operations that have to be cancelled because of an emergency admission.
There will be an extended-hours local A and E service, led by senior A and E-trained clinicians at Chase Farm hospital, which will be open for at least 12 hours a day to cover the period of maximum demand, with urgent care outside those hours provided by a co-located GP out-of-hours service. That means that Chase Farm will no longer take blue-light ambulance cases or patients who require emergency admission to hospital. However, the local NHS estimates that 80 per cent. of people who attend A and E at Chase Farm hospital could continue to be treated by the new service on the site. The proposal recognises that it is better for seriously ill or injured patients to go to a bigger, better staffed and equipped A and E rather than a smaller one, even if it is closer. To put it simply, bigger specialist A and E centres save lives.
There will be a midwife-led unit at the Chase Farm site replacing the existing consultant-led service. The service will be available for women identified as low risk, which is the majority of expectant mothers. There will also continue to be a full range of antenatal and post-natal services. The recommendations from the Royal College of Obstetricians and Gynaecologists on the consultant presence and the volume of births per unit for the safe delivery of babies in high-risk cases led to the conclusion that two sites would provide a safer and better service than three. Similarly, the support needed from paediatricians for a special care baby unit and the required round-the-clock anaesthetist cover could not be provided on three sites.
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