Rugby's St. Cross hospital has a catchment area of around 110,000 people. I wish to reassure immediately all those of my constituents who are watching and listening to this debate that St. Cross hospital will not close. Recently, however, serious concerns have surfaced about the quality of some of the clinical services. That has resulted in the board of the Rugby NHS trust, at its meeting on 3 February, recording that it
agreed in principle to merge with Walsgrave Hospitals NHS Trust and the North Warwickshire NHS Trust.
Since then, the chairman and the chief executive of the Rugby NHS trust have resigned.
The West Midlands NHS executive was asked to chair a project team to review the provision of services. Given growing fears about clinical safety, some of the royal medical colleges were invited to visit St. Cross and some of their recommendations were highly critical and far reaching and had serious implications for certain services. For example, the Royal College of Surgeons said in its report:
To provide comprehensive 24 hour cover, and develop site specialisation, a minimum of 4 consultant posts are necessary.
Rugby's catchment area is not large enough to provide either adequate clinical depth or sufficient opportunities for practice to enable clinicians to maintain skills.
College approval would not be forthcoming for four consultant general surgeon posts given the low work load and the lack of variety of work. By combining with Walsgrave, it would be possible to increase sub-specialities and to offer an improved service to both populations. A 5 day elective surgical service should be possible if merged with Walsgrave, providing an on-site resuscitation team and appropriate levels of post-registration junior doctors working in Rugby on an agreed rotational basis. A full accident and emergency service cannot continue without adequate support services particularly in intensive care and advanced imaging. Consideration could however be given to a casualty or minor injuries unit possibly on a GP-led basis.
I am able to confirm, following a meeting between my hon. Friend the Minister of State and the chairman of the West Midlands NHS trust, that a casualty and minor injuries unit will operate 24 hours a day.
It was interesting that the Royal College of Anaesthetists' report stated:
Rugby NHS trust lost recognition for training in March 1995. There are currently no trainees in anaesthesia in Rugby. Since the time of derecognition, there has been a change in training patterns which requires modular anaesthetic experience in various surgical sub-specialities. These would not be available at Rugby.
The consultants service 19 out of 27 operating lists on the weekly schedule. The remainder, and cover for absences, are serviced by the 4 non-consultant career grade staff. There are, therefore, insufficient consultants for the routine operating and this situation will worsen due to retirements.
The report added that anaesthetists in Rugby are not core members of the cardiac arrest team, although they attend if they are not in theatre.
The Royal College of Paediatrics and Child Health commented:
Children should not stay as in-patients overnight. Children requiring admission should be directed to Walsgrave and bypass Rugby. There should be a fully comprehensive children's daytime service to offer acute assessment and both general and specialist clinics. All consultants would work out of the Coventry and Warwickshire paediatric consortium on a rotational basis. There would need to be a back up consultant on call to cover out of hours calls in order to stabilise cases before transfer.
In addition to the visits made by the royal colleges, the regional postgraduate dean, Professor John Temple, visited the hospital on 20 February. He endorsed the comments made in the reports. That is a clear indication of the critical and developing position at the hospital of St. Cross.
Clearly, certain of the clinical—that is to say, surgical—services are unsafe. My hon. Friend the Minister will no doubt agree that it is the clear duty of the health service to provide treatment that is both safe and effective. Increasingly, it would seem that there is a move in the NHS towards increasing specialisation, and it would appear that treatments are being concentrated at a smaller number of sites. This is necessary to ensure that surgeons maintain clinical skills and that they see sufficient patients to prevent their skills from becoming outdated or rusty through limited use. In addition, those surgeons require effective support and back-up from junior doctors, skilled technicians and the high-tech equipment that is increasingly demanded by those in the medical world. It would appear that the day of the old general surgeon—the Sir Lancelot Spratt of mythology—is now coming towards an end. It would also seem that the day of the smaller—and local—hospital is fast changing. It is my view that what is currently taking place at St. Cross will, over the next few years, be repeated up and down the land, perhaps even, Mr. Deputy Speaker, in your constituency or one similar to it.
One has to ask how many smaller hospitals are even now in a similar position to St. Cross with services coming under scrutiny and with services likely to move to larger hospitals. That is an issue which should have a much greater public debate than has so far occurred.
An article in the Coventry Evening Telegraph quotes a leading expert on health care organisation as saying that Rugby could become a role model for other small trusts facing similar difficult decisions. It continues by quoting Brian Edwards, professor of health care development at Sheffield university, as saying that Rugby could become a very interesting role model for the rest of the country in developing really imaginative first-class local services.
I am certain that you, Mr. Deputy Speaker, would agree with me that it is desirable to maintain services as close to the host community as possible. But at the end of the day, the paramount consideration must be the provision of a safe and effective service. We must provide patients with the greatest opportunity for recovery and extended life.
One of the areas which causes me particular concern and real anger is the threatened closure of the maternity unit. Five of my grandchildren were born there, so I know it well. But unfortunately that unit sees fewer than 1,000 births each year. It is argued that the minimum number for a consultant-led service is about 2,500.
However, I must say to my hon. Friend the Minister, who is listening, as I can see, intently to the debate, that we still undertake births at home where there is no consultant and where conditions will clearly be much worse than, or certainly not as good as, those in a maternity unit. In the maternity unit there will be other midwives able to provide help and advice. That is all obviously lacking with a home birth. If it is considered safe to deliver some women at home, why is it considered unsafe to deliver the same women in a purpose-built maternity unit when other staff are on call and able positively to assist?
I recognise that there may be some difficulties with legal liability should mistakes occur. But women are seen by consultants before the birth. The consultants should, therefore, clearly know which births are likely to be difficult and should be handled by a consultant-led team, so enabling ordinary births to take place in the surroundings with which women have become reasonably familiar.
My hon. Friend will recall that at the last meeting that I had with him I specifically asked whether the maternity unit could remain open for at least a period of consultation, and that was readily agreed by the chairman of the West Midlands NHS executive. That was a helpful gesture. However, I should be grateful to hear my hon. Friend's comments on the substantive point that I have raised regarding the maternity unit itself.
Another area that causes me concern is the accident and emergency department mentioned by the Royal College of Surgeons. It is proposed that the A and E be closed and replaced by a minor injuries and casualty department supervised by a staff grade doctor. I am happy to confirm to the House and to my constituents that that department will remain open for 24 hours a day. However, to pursue one of the points made by the Royal College of Surgeons, I believe that we need the additional high-tech equipment that would facilitate the treatment of those who are brought to the casualty department.
I welcome the assurance that the chief executive of the combined trusts, Mr. David Loughton, has given that 90 per cent. to 95 per cent. of services will remain at St. Cross, and that certain services may be enhanced. I am advised that some elective surgery that is currently undertaken at Walsgrave may be transferred to St. Cross. That is welcome news. It confirms that the hospital will not close, and will continue to serve my constituents. I also welcome the statement by Mr. Loughton that there will be no redundancies at St. Cross—a fact that will reassure both staff and public alike.
I am grateful to my hon. Friend the Minister, who will respond to the debate, for the five meetings that we have had so far about the hospital. That is a clear indication that he understands my anger and that of my constituents about events at my local hospital. I have also met members of the St. Cross board, the chairman of Warwickshire health authority, and many others involved in this matter. In addition, I shall lead a delegation, comprising the leaders of the Conservative and Labour groups on Rugby borough council, to see the Minister next Wednesday.
However, something has gone wrong at St. Cross, and it would be helpful to know precisely what has gone wrong and why—if only to prevent other hospitals from making the same mistakes, as mistakes have clearly occurred. I want to know what might be done now to sort out matters. I want assurances that St. Cross will continue to provide high-quality care for my constituents. I want assurances that that high-quality care will be available for the foreseeable future, and not simply for two years. I want assurances that there will be no further downgrading of our hospital. I want an assurance that resources are not a problem and that adequate funding for St. Cross will continue.
My hon. Friend will be aware that I have referred the issue to the Health Service Commissioner because I believe that there are some powerful lessons to be learnt from this affair. I am genuinely angry about what has taken place. My constituents are angry too, and some of them—particularly the elderly—are afraid. It is dreadful when the elderly are worried about where they will receive treatment. I urge my hon. Friend to assure me that my constituents and all those who use the services at St. Cross will continue to receive the best and the safest service available.
In conclusion, I take this opportunity to thank the St. Cross hospital staff for their work and for their dedication. There will be no redundancies and they will, therefore, be able to continue caring for patients in the future, as they have done for so long in the past.
I am delighted that my hon. Friend the Member for Rugby and Kenilworth (Mr. Pawsey) has secured the opportunity of an Adjournment debate on a vital issue in his constituency. First, I set on the record my thanks to him for all that he has done so far. Since problems with the trust first emerged he has, as he has said, had five meetings with me apart from all the other meetings that I know that he has had in his constituency on a continuing basis with all those concerned as matters have developed. As he also said, he will lead a local delegation to meet me next week. I look forward to welcoming the members of that delegation.
At an early stage, my hon. Friend asked that he be involved in events as they unfolded. I have been happy to respond, I hope, in a fulsome way. I repeat my pledge to him that his leading role in what is bound to be a lengthy process to secure the best-quality patient care for his constituents, delivered where possible from their local hospital, will be sustained by immediate access to Ministers should he require it. In short, my door will always be open to him as he represents the interests of patients in Rugby—in other words, his constituents.
It might be helpful if I, too, turn to recent events. At the beginning of the year, the trust realised that, with the forthcoming loss of its last general surgeon in April, steps to secure the best possible services for local people, which had already been discussed with others, would need to be taken within a short time frame.
On 3 February the trust board concluded that it would not be possible to continue alone and sought to reach agreements with other hospitals, principally Walsgrave in Coventry and the North Warwickshire National Health Service trust, with a view to merging services. As my hon. Friend has said, a project team was established, which invited expert clinical advisers from the royal colleges to visit St. Cross and advise on the way forward.
The royal colleges were set short-term and long-term agendas. The short-term agenda was to assess the immediate state of clinical services being provided. My hon. Friend has rightly set out the concerns that existed about that extremely important matter. He and all those who had been involved have rightly sought to represent the great interest of ensuring that the safety of clinical services was considered to be paramount in what has taken place. The long-term agenda will be to consider options for future delivery of services. That issue, too, has been considered.
The five royal colleges covered the specialties of surgery, obstetrics and gynaecology, anaesthesia and paediatrics and child health. My hon. Friend is well aware of the series of recommendations that were made. Indeed, he quoted them in some detail this evening. The recommendations were required to underpin essentially the quality of clinical services being delivered at St. Cross. It was not only the colleges that were involved. The results were endorsed by the regional postgraduate dean, Professor John Temple.
Much of what was happening in the hospital was associated with the ability to provide teaching facilities there. That is something that always underpins the delivery of high-quality clinical services. I use this opportunity to thank both the royal colleges and Professor John Temple for their rapid and thorough work, which has illuminated certain issues. Although many of them are unwelcome, I know that at the end of the day my hon. Friend, who understands these matters extremely well, would far rather they had been illuminated at a stage when steps could be taken to address them in the interests of his constituents than they had not been addressed at all.
Following the recommendations, immediate arrangements were put in place to ensure that they were implemented. Some of the recommendations have been uncomfortable for many who have been involved, but they have been taken on board and put in place extremely quickly, again with the primary purpose of securing a quality of clinical services for those who use St. Cross hospital.
Warwickshire health authority has announced that, as rapid changes have had to be made to secure clinical safety, a full retrospective public consultation on changes that have been made immediately on grounds of clinical viability will begin on 8 May and conclude on 4 September.
The health authority and local general practitioners will also, as purchasers of services for Rugby residents, look closely at the longer-term plans for the development—I stress the word "development", as my hon. Friend sought assurance on that point—of services. Again, there will be full and formal consultation with the public on any changes that would have a significant impact on the people of Rugby. The second consultation will begin on 4 September and report on 8 January 1998. I anticipate that my hon. Friend will play a leading role in both consultation processes. I remind him that, in the event of a failure to resolve matters locally in a satisfactory way, decisions, ultimately, come to Ministers to be made.
I now deal with some of the specific concerns raised by my hon. Friend. He referred to the long term. Let me refer, as he did, to the comments of the new acting chief executive, who expects to see some 90 per cent. of the services that local people have come to expect at St. Cross continue under the new arrangements for clinical supervision and to be available locally in Rugby.
In view of some of the doom-laden reports that appear in the press at difficult times such as this—I have read some of the irresponsible things that have been written about the future of St. Cross—I can tell my hon. Friend that the agenda set out by the acting chief executive sounds very much like a firm basis on which to build a flourishing hospital that will enjoy a long-term future.
Let me say a word of thanks to all who have been involved locally in a series of difficult and complex decisions. I include, among others, those at St. Cross hospital—my hon. Friend referred to the fact that those who are there can be assured that there is no immediate prospect of redundancy—those at Walsgrave hospital and also members of the national health service executive, who have worked tirelessly to secure benefits for patients in Rugby. In short, the actions that they have taken mean that the future of the hospital in Rugby is secured.
My hon. Friend asked for an assurance about adequate funding. I am happy to be able to tell the House that I can give him that assurance tonight. Let me remind the House that, in this case, funding is not the issue; it is the ability to provide quality clinical services. That is the issue that confronts those delivering services in Rugby. It is being dealt with.
I am happy to go further than that. My hon. Friend referred to the fact that perhaps there needed to be some change to provide some of the services. He alluded in particular to what would happen to the reshaped accident and emergency service now envisaged. I am happy to tell him that I have listened carefully to all that he has said, particularly at the last formal meeting that we had on this matter, and understand that securing needed change sometimes requires investment. For example, new technology, to which he alluded, can often support an improved quality and range of care that could not properly be provided before. Should such opportunities emerge, I expect those responsible locally to do all in their power to secure them for the benefit of people in Rugby. If my hon. Friend feels at any moment that that is not taking place, I expect him not to hesitate and to knock at my door again.
My hon. Friend referred to maternity services. As Minister for Health, I travel across the country looking at the ways in which services are delivered in a range of contexts. He was right to point out the Government's policy, which was set out in "Changing Childbirth". People can have their children in an appropriate setting where proper clinical attention can be given. We must remember that childbirth is not an illness; it is a natural process. Should people wish it, they should be encouraged to have their children in a setting of their choice. The underpinning of maternity services, for which my hon. Friend expressed gratitude, is a step in the right direction. The document "Changing Childbirth" and the associated developments in maternity services must be borne in mind by those who commission services for people in Rugby.
Faced with such a problem, which touches the lives of all our constituents, hon. Members have two choices: the cheap and easy shot, or the tougher choice of taking the difficult high ground. I say to my hon. Friend and to the House in all sincerity that he has chosen the difficult high ground. He has battled from the start to secure the long-term future of his local hospital, which I believe is in prospect, while also supporting difficult decisions required to safeguard the standards of care that his constituents expect.
It is all too easy to take the simple way out and join the madding crowd, who see more in these developments than meets the eye, and who presage disaster when no disaster is to be seen. My hon. Friend has not taken that course. He has understood his responsibility to his constituents, which, particularly in this period, is primarily to secure for them a safe clinical service. I congratulate him on that.
I hope that those who listen to or read these words will understand the major contribution that my hon. Friend has made to securing progress so far. His continuing contribution will be crucial for his hospital and for the local constituency that he represents in the months and years to come.