Westminster Hall
Tuesday 14 July 2009
[Mrs. Joan Humble in the Chair]
Health Care (Shropshire)
Motion made, and Question proposed, That the sitting be now adjourned.-(Mr. Heppell.)
9.30 am
Mr. Philip Dunne (Ludlow) (Con): It is a great pleasure to serve under your chairmanship, Mrs. Humble. We know each other from our work on the Select Committee on Work and Pensions in years gone by.
I am particularly pleased to have this opportunity to review with the Minister the state of health care in Shropshire. I will mostly discuss the facilities in my constituency of Ludlow, but I will touch on the county's wider health care economy. I am delighted to see so many colleagues from Shropshire here today. I will, of course, be pleased to accept their contributions, which may be more focused on the acute hospitals in their constituencies, whereas I will focus mostly on the community hospitals in mine.
I begin with a slight sense of déjà vu. One of the first Westminster Hall debates that I was fortunate to secure in the year following my election to this place was on the same topic of health care services in Shropshire. That debate was held on 25 January 2006, during the period in which I was helping to lead the campaign to save all three community hospitals in my constituency, which faced the real threat of closure because of severe financial deficits in the local health care economy.
I fear that we are in danger of coming full circle, because after a couple of years of getting NHS finances in Shropshire into balance, the county again faces a severe deficit. However, before I turn to those issues and look to the Minister for some answers, I would like to touch briefly on some positive achievements in Shropshire health care since those dark days.
I recall a cold, wet Saturday morning a couple of weeks before that debate in early 2006, when I led a march of more than 4,000 people from a rally in the castle grounds in Bridgnorth to the community hospital, which was threatened with closure. Within two years, Bridgnorth community hospital had been transformed, with the opening of a new wing re-establishing the maternity unit with additional out-patient services and clinics. The hospital's manager, who oversaw that significant redevelopment, has just been promoted, and rightly so-Bridgnorth's loss will be Wolverhampton's gain. I place on the record my thanks to her and to the Bridgnorth general practitioners, particularly Dr. Pam Yuille, who campaigned so hard to ensure that that development went ahead. The town's GP practice has also been relocated to a new purpose-built health centre adjacent to the hospital, with improved parking and access for the GPs to in-patient beds next door.
On the same day in January 2006, some 2,000 people marched through the streets of Bishops Castle to demand that Stone House community hospital should be saved. This was a much tougher fight for lots of reasons, not
least because of divisions within the community that we resolved in part through the establishment of the Bishops Castle Stone House forum, which I was pleased to chair and through which Shropshire County primary care trust and all interested groups in the community could work together to support refurbishment of the hospital, which I am pleased to say is under way.
Shropshire County PCT, led by its responsive chief executive Jo Chambers, is investing some £1.2 million in that major refurbishment, the first phase of which took place in 2008-09, with an upgrade to the roof and new windows. In the completed project there will be a new main entrance and much-improved reception area, 16 in-patient beds, of which four will be en suite single rooms, and a significantly expanded out-patient and ambulatory care zone, which together will enable an extended range of GP, nurse and therapy-led clinics to be delivered locally.
The redevelopment will occur in two phases. The first phase, which commenced last month and will end in October, will mainly refurbish the in-patient areas and the second phase-from November, concluding in March 2010-will focus on out-patients and the ambulatory physiotherapy areas. During the refurbishment, existing services continue to be provided locally, which is critical given the physical isolation of this very rural population, which is served by the community hospital.
There will be 10 in-patient beds remaining available throughout the build period and out-patient clinics will be moved temporarily to the Bishops Castle GP practice, although physiotherapy will remain on the site. One of the 16 in-patient beds will be a bespoke palliative care patient room with an adjoining relatives' room and shared access to a walled garden outside. This will become increasingly important as the ageing demographic of the area places greater demands on end-of-life care. I will return to that in a moment.
This has been a real community effort, with significant input to the design of the facilities by local GPs and hospital staff, and fundraising for equipment organised by the hospital's league of friends and staff, who, with the PCT, have secured Department of Health-King's Fund funding through the Enhancing the Healing Environment programme, which the Minister will be familiar with. I shall single out a local GP, Dr. Adrian Penney, who raised some £10,000 for this palliative care scheme by participating in the five peaks challenge last year. Those people are all to be congratulated, and those are the two main success stories in my part of Shropshire in recent years.
Lembit Öpik (Montgomeryshire) (LD): I congratulate the hon. Gentleman on securing the debate. Does he agree that the experiences that he has described are a role model for what could be done on my side of the border, right next to him, to carry on supporting the operations of Welshpool, Machynlleth, Llanidloes and Newtown hospitals, all of which have been threatened with closure at certain times? He has proved that a proper strategic initiative, led by him and supported by local people, supports local health services and is ultimately cheaper than shutting local services down and sending people to district hospitals.
Mr. Dunne:
I am grateful that the hon. Gentleman has joined today's debate, not only because we share a border-some of his constituents will take advantage of
the facilities in Bishops Castle, because it is adjacent-but because Shrewsbury hospital is the main acute centre for his constituents. We share a lot of health issues in Shropshire and across the border into Wales, but although he is right in saying that it is important that the local community get together and work with the local commissioner, I suspect that the Welsh Assembly plays an important role with regard to his constituents.
Mark Pritchard (The Wrekin) (Con): I would like to say well done to my hon. Friend on securing the debate. Acute hospitals have been mentioned. Given Shropshire's growing population-on the Welsh border side of the county, on the eastern side and on the south-eastern side, where that affects his constituents-is it not vital that the acute hospitals retain their 24-hour, seven-days-a-week accident and emergency facilities, particularly the paediatric unit at the Princess Royal hospital? Does he agree that it should not just have a sign over the door showing that it is open 24 hours a day, seven days a week, but should deliver consultants and doctors throughout the night so that his constituents, and mine on the eastern side and in central parts of the county, are not rushed, under threat and by blue light, all the way over to Shrewsbury?
Mr. Dunne: My hon. Friend makes an important point, particularly for his constituents, who have the benefit of the Princess Royal hospital, with its A and E unit.
I will mention some of the pressures that the whole county is placing on the two A and E units, because it is clear that there has been a significant increase in A and E usage and I would be interested to hear the Minister say whether that is a national problem or one that can be solved locally, perhaps through more efficient processes for helping people to get out of the acute hospitals, freeing up beds to help to address some of the problems in A and E.
Let me mention some of the difficulties. There are three primary challenges to health care in Shropshire, particularly in my part of the county, which I urge the Minister to address in his speech. Four years ago the financial deficits in Shropshire were centred on the acute hospital trust, which had racked up more than £34 million of deficits under its previous management. The current chief executive, Tom Taylor, and his team have done a good job in turning around the fortunes of Shrewsbury and Telford Hospital NHS Trust, which is working hard to achieve its goal of foundation trust status with the aim of submitting an application for that status by the end of the year.
Active financial disciplines have been introduced so that from peak losses of some £12 million annually, the trust is on track to generate in the current financial year its second successive surplus of £4 million from an income base of some £247 million-just over a third of the total spent in the county by the NHS. A consequence of restructuring the acute third of Shropshire's health care economy has been to shift the financial deficit from the acute trust to the commissioners, primarily Shropshire County PCT, which will have a deficit of £11.5 million in the current year if no action is taken.
Daniel Kawczynski (Shrewsbury and Atcham) (Con): I agree with my hon. Friend about progress on reducing the deficit, but does he agree that a large part of that deficit resulted from the previous chief executive, who submitted a fake CV and had inappropriate qualifications for being a chief executive? When I tackled the then Secretary of State for Health about the matter, I was told that not everyone's CV can be checked. I hope that my hon. Friend agrees that the Government have learned from what happened in Shropshire and that the CVs of those who apply to become chief executives of trusts will be better scrutinised.
Mr. Dunne: My hon. Friend raises two important points. One is that due diligence when recruiting for senior health service posts has had to improve, and it has. Secondly, a more fundamental point is that under this Government NHS restructuring has given rise to the opportunity for administrative chaos, which unfortunately beset Shropshire in the Government's earlier years. In 10 years, they have introduced nine complete reorganisations of how health care is administered in this country. With such dramatic changes at all levels in the health service, it is not surprising that there were management failures.
When some 300 PCTs were introduced more or less overnight, the Government had to find suitably qualified managers to manage each PCT and acute trust. They found that challenging, and one of the worst examples of poor recruitment occurred in Shropshire's acute trust. That problem is behind us, and I hope that the Government have learned how to recruit and how to minimise reorganisation. I believe that reorganisation is off the agenda for the time being, which is very welcome.
On the specifics of the deficit, first, it is not yet crystal clear to me how the deficit has arisen, but we have been told by PCT management that some £4.5 million of the £11.5 million annual deficit relates to what it describes as legacy issues in the contract with the acute hospitals relating to underlying demand. I think that is code for difficulty in assessing the tariff introduced through payment by results in relation to the actual cost of the procedures performed, or difficulty in estimating the demand for service involved with moving from one system to another. It is not clear exactly what it means.
The second aspect, which is more identifiable, is that some £2 million of cost from new investments in key service developments-in upstream interventions and preventive services-has helped to contribute to the deficit.
The third aspect, and the one for which the Government have most responsibility, is the introduction of the national payment-by-results tariff, which directly increased the contract between the PCTs and the acutes by some £4.5 million for no additional activity. The deficit is being shunted from one side of the health care economy to the other. Is the movement of resources from one side to the other-from primary to secondary, or vice versa-indicative of a national problem? If it is local to Shropshire, will the Minister give some guidance on how it can be resolved and whether experience from other areas can be brought to bear?
Another significant issue relates to capacity constraints in the Shropshire health care economy, most of which result from Shropshire's peculiar demographics. The Minister, who comes from an almost neighbouring
constituency, will be familiar with the attractions of Shropshire as a place to live. We benefit from significant inward migration of retired people. The county has an above-average population of over-65s and an above-average and increasing population of over-85s. That is significantly above average in my constituency in the southern third of the county. At the last count, almost 25 per cent. of the population was over 65, and the proportion of over-85s is rising rapidly. That inevitably puts demands on our health service that commensurately affect other areas with less.
One of my concerns, which has been highlighted in material provided by some of the GPs who have contacted MPs in recent weeks, is that a lack of recognition of the demographic challenge in allocating funds from the Department of Health to providers around the country is giving rise to a significant shortfall in funding. Dr. Rummens, chairman of Shropshire's local medical committee, wrote to me and other Shropshire MPs, suggesting that Shropshire County PCT is underfunded by 3.8 per cent., calculated using Government's own fair shares formula, which is equivalent to some £15 million of relative underfunding. The Minister will recall from what I have just said that that is more than enough to cope with the deficit that has been identified in the PCT this year.
What is the Minister doing about the fair funding formula, and can he offer any encouragement to Shropshire that it may receive a better reflection of the challenges posed by the demographic circumstances when looking forward to funding formulae in the next comprehensive spending review? I realise that he is relatively new to his post and that he may not be in post when the allocations are made, but I look forward to his response.
To illustrate how capacity constraints are affecting Shropshire-this picks up a point made by my hon. Friend the Member for The Wrekin (Mark Pritchard)-demand for accident and emergency services reached unprecedented levels in 2008-09, with some 3.7 per cent. more emergency admissions during the year than during the previous year. There has been a 30 per cent. increase in ambulance transfers to the Princess Royal hospital in Telford, compared with a 6 per cent. increase in ambulance transfers to the Royal Shrewsbury hospital previously.
We recently had a briefing from the management of the acute hospital at one of the Shropshire MPs' regular quarterly sessions, which the hon. Member for Montgomeryshire (Lembit Öpik) also attends. Their analysis suggested that clinicians felt that, at any one time, up to 60 patients in the two acute hospitals did not require the specialist care offered by those hospitals and could have been cared for in rehabilitation beds in community hospitals. There is a shortage of rehabilitation beds in the two major conurbations in the county-Shrewsbury and Telford-because their provision comes through the acute hospitals. The community hospitals are located in the smaller, outlying towns. There are three in my constituency, two of which I have mentioned already.
There has been pressure on the community hospitals to shrink the number of beds to find efficiency savings. There is pressure on the acute hospital to provide somewhere for patients to be released to once they have undergone treatment through A and E or regular admission. The solution that the acute hospital would like to put in place to deal with the problem of bed blocking and
throughput through the hospital is to introduce a further 30 rehabilitation beds in Telford. I am sure that the hon. Member for Telford (David Wright), were he here, and my hon. Friend the Member for The Wrekin would welcome the addition of rehabilitation wards in their community, but so would we elsewhere in the county, because one problem that flows from the pressure on space is that it clogs up the admissions process throughout the system.
We have also been told by Dr. Rummens that we suffer in our acute hospitals from many of the same problems that we read occur elsewhere in the country, with patients being unable to be admitted through A and E, partly to ensure that the A and E departments meet their target waiting times, but partly because of the bed blocking problem elsewhere in the hospital, to which I have referred. In his letter of 7 May, he said that one of his colleagues, a GP in the Shrewsbury area, said:
"Last time I did a Shropdoc session there were 24 patients waiting to get into the Medical Emergency Centre, many of whom were waiting in ambulances that were not allowed to unload the patient".
We read about that in national newspapers from time to time. I have never before heard a Shropshire GP giving hard evidence that it is happening in our county now. I think that the reason for it is, as I said, that there are not enough rehabilitation beds-step-down beds-in the county at times of intense pressure. Of course, the pressures at this time of year are somewhat less than they normally are in the winter. We have been told that Shropshire, mercifully, has not suffered a significant number of hospital admissions because of swine flu. That does not appear to be giving rise to the pressure. I think that it has more to do with the demographic factors to which I referred.
The importance of rehabilitation beds and the role that the community hospitals can play in providing a step down from acute care is my third and main point. It relates to the third community hospital in my constituency-the hospital at Ludlow. I should like to take the Minister back to that Saturday in January 2006 when, after marching in Bridgnorth in the morning, I sped across my constituency-well, I travelled across my constituency within the speed limit, of course, but quite rapidly, because I had to get from a morning march to an afternoon march in Ludlow. Some 4,000 people assembled in Castle square and marched through the town to a rally at St. Peter's church, opposite the community hospital in Ludlow. That was in reaction to the threat, which was even more real in that case, posed to their hospital. Although we managed to save the hospital from closure, we could not prevent the closure of the mental health ward there.
| Next Section | Index | Home Page |