I am grateful for securing the Adjournment debate tonight. It concerns a matter of vital importance to my constituents. I am delighted to see in the Chamber my hon. Friend Hugh Robertson, whose constituents will also be profoundly adversely affected by the proposed changes to hospital services in Maidstone.
Let me set the scene. Maidstone is a large general hospital that was built under the Conservative Administration in 1983. It was modern and covered a wide range of services. Since that time, the oncology services have been vastly expanded and the hospital is now recognised as a centre of excellence for oncology in the south-east. Until a few years ago, the picture was a fairly happy one, but since 2000 there has been a consistent stream of proposals to—I can put it in no other terms—plunder Maidstone.
Over the past two years, we have been raided. We have already lost, in a fairly stealthy way, almost without anybody noticing, our chronic pain unit, which has charged down the road to Pembury. That leaves citizens of Maidstone, who were used to having pain services available, with pain services available only by means of a four-hour round trip on the No. 6 bus. It is scarcely an ideal situation for people without private transport.
Earlier this year, a proposal that had been made in 2000 and rejected was raised again. It would mean our losing the most important chunk of our accident and emergency services to Tunbridge Wells. In addition, there is a proposal that we would lose a major part of our obstetrics services, again to Tunbridge Wells.
The Government decided to merge trusts. It is impossible to imagine that when Maidstone was its own trust, it would have volunteered to lose services and suggested that they wander off 17 miles away—that is the shortest possible distance. But because the trusts of Tunbridge Wells and Maidstone have been merged into one large trust, there is no unique voice, other than mine and that of my hon. Friend, speaking up specifically for Maidstone.
If there were unavoidable strategic reasons for the changes, I might admit that there was some force to the argument for bringing them about, but close examination suggests that that is not the case. One of the reasons why that has been advanced is that the changes all stem from the European working time directive, which means that junior doctors cannot work the hours that they used to. We therefore have to recruit more junior doctors, and when that proves impossible, we have to merge services, so that where there were two services before, we shall have only one.
We have also been told that the consultants involved approve the changes. I shall quote from a letter from Mr. Christopher Walker, a consultant orthopaedic surgeon who worked at Maidstone hospital from its opening in 1983 until August 2002, and still does occasional clinical work. He says this of the proposal to take trauma services to Tunbridge Wells:
"Most importantly, the road access to the Kent and Sussex Hospital is poor when compared to that of the Maidstone Hospital. Maidstone is well placed to receive trauma rapidly having both good access to the motorways and a helipad. Indeed, in my time at Maidstone I received a badly injured motorcyclist who had been involved in a road traffic accident about one mile from the Kent and Sussex Hospital, as it was quicker to transfer him to Maidstone A&E . . . than to get a traditional road ambulance to take him at peak time to the Kent and Sussex A&E."
He goes on to say:
"If Trauma Services are moved to Tunbridge Wells, Maidstone patients will need to access another A&E. The Kent and Sussex would be very difficult for them to reach."
He says that they would be more likely to go to the Medway accident and emergency department, which is already under massive pressure.
Mr. Walker identifies as a further effect of the proposed move
"a downsizing of emergency services in general and a move of staff and facilities from Maidstone to Tunbridge Wells."
"Trauma Services cannot be managed successfully by Orthopaedic & Trauma Surgeons in isolation. Support is essential from other specialities especially General Surgery, Vascular Surgery, Anaesthetics, General Medicine and Paediatrics. Presumably adequate support could only be given by transferring support in these specialities from Maidstone to Tunbridge Wells."
As a consultant surgeon, he takes the following view:
"I believe this would have the effect of reducing Maidstone A&E to a minor injuries unit, as well as reducing the Consultant and Junior Staff numbers at Maidstone, so further disadvantaging the local population."
Mr. Walker is not alone in taking that view. Another consultant—this time a consultant physician currently practising at Maidstone hospital, where he is also a clinical tutor—contends that the proposals will have a serious effect not only on trauma services, but on training. He makes this point:
"The Acute Services Review of 2000 concluded that trauma services should remain at both Maidstone and Tunbridge Wells. It is the proposal to change this conclusion at this stage that has caused considerable disquiet."
He says that
"the proposal to downgrade the trauma service . . . will impair access to appropriate care for patients from the Maidstone area who sustain a fracture; and . . . it will adversely affect Maidstone hospital as a general hospital and training institution . . . Removing trauma services from Maidstone matters for the hospital as a whole principally because it will reduce the capability of the A&E department."
He goes on to say:
"The Senior House Officer posts in A&E are accredited for training by the Royal College of Surgeons. It is uncertain if that accreditation would remain . . . if no major trauma came to the department . . . A hospital unable to offer the full range of experience will have difficulty in recruiting the best trainees, particularly those whose career plans might include surgery or critical care."
"A hospital lacking a full A&E department would struggle to be taken seriously as an acute general hospital".
I fully understand that point, even from a layman's point of view; the hospital would not be taken seriously as an acute general hospital, and it would find it very difficult to recruit and retain consultants in acute specialities, particularly general medicine and critical care.
Perceptively, that consultant goes on to say:
"The real problem with the current discussion is that it puts the cart before the horse. We are discussing individual services without any clear vision for the future of the hospital as a whole. There is a clear vision for cancer services in Maidstone, and there is a comprehensive vision for the new hospital in Pembury"— for which I am grateful—
"but for non-cancer general hospital services in Maidstone, however"— he puts this politely—
"the future is more opaque."
The future of Maidstone general hospital is a major question. Will it remain as a serious general hospital or will all its major general facilities be moved gradually and piecemeal to Tunbridge Wells, while Maidstone is promoted as Kent's answer to the Royal Marsden hospital? Is that the future that is envisaged? If it is, why do the Government, the trust and the SHA not come clean and let us know? It would cause my constituents massive disquiet.
For maternity services, consultants have stated that the European working time directive is not causing problems in obstetrics, but that difficulties will be created in recruiting serious consultants and doctors to a unit as small as the one proposed for Maidstone. Confronted with that massive reduction, the general expectation is that mothers will choose other hospitals. At the moment, 25 per cent. of mothers transfer from the birthing centre to the labour ward with difficulties. If the labour ward is 17 miles away, consultants claim that brain damage could be caused to babies.
I have also mentioned the loss, which we have already sustained—almost without anybody noticing—of the chronic pain unit. It was moved in September 2004 from Maidstone to Pembury. The first that the patients knew about it was a letter a couple of months earlier. Openness appears to have given way to at best opacity, and at worst secrecy. What is the future, and what is the vision for Maidstone as a general hospital?
Earlier, I said that it had been claimed that the consultants accepted the necessity for that disquieting decision. In fact, however, 50 senior clinicians have signed a letter to Rose Gibb, the chief executive of the trust. This is not a politician speaking; these are clinicians who say:
"We believe the proposed cuts at the Maidstone hospital to be dangerous, ill-advised and unnecessary. They will place acutely ill patients, particularly the elderly and children, at additional risk of morbidity and death by transferring them to an inaccessible and less suitable site. The loss of this acute service will result in the inevitable haemorrhage of essential skilled staff. We feel the knock-on effect on the remaining acute services will lead to their progressive erosion, reducing Maidstone to an elective hospital only."
Among the consultants who signed that statement are those in general surgery, anaesthetics and critical care, cardiology, medicine, neurology, ophthalmics, oncology, paediatrics and, of course, obstetrics and gynaecology. That is the view of those on the ground who actually have to deliver the service.
When I fully recognised the problems and their scale, I wrote to the Secretary of State for Health, who replied promptly but unhelpfully. Essentially, he told me what I already knew—that there was a consultation exercise. Yes, I had got that far. He then told me that there were proposals to reconfigure services—I had certainly got that far—and that it was a matter for the trust. This goes beyond just being a matter for the trust. There is, I believe, a serious crisis of confidence in Maidstone about the future of a large and well-respected general hospital.
On behalf of my constituents who live at the other end of the constituency, I am of course delighted that at last, after too many years, we are getting a brand-new hospital. I would not want any of the comments that I have made today to be taken to mean otherwise. However, the original plan was that essential services such as trauma and obstetrics should be available in both centres, not that there would be a share-out of some sort, as of eggs in a basket.
My first question for the Minister—who has, I am sure, been in contact with the trust—is this: what is the future for Maidstone? Will it remain a general hospital? If so, will it be taken seriously as a general hospital, given the changes that are mooted? Or will it simply become an elective surgery and cancer specialty? Secondly, as so many consultants are so worried, how can the administrators of the trust decide that this is the right way forward?
Thirdly, may we have an absolute undertaking that, if services such as the chronic pain unit are to be moved in future, there will be a proper and full consultation? Interestingly, when one of my constituents rang the local press, the people there did not know anything about that particular move—but they certainly know about the trauma services, and they are making a fuss.
Although in such circumstances there is always a fine line to be walked, between alerting one's constituents and alarming them, I myself have become alarmed by the proposals. I believe that they should be abandoned, and that the original decision taken in 2000 to retain services in both hospitals should be maintained.
I congratulate Miss Widdecombe on securing this debate on the proposed transfer of services from Maidstone hospital to Tunbridge Wells. Before I turn to the specific issues that she raised, I should like to take this opportunity to recognise the work across the whole of Kent in delivering good-quality services and to pay tribute to all the staff who are dedicated to that process. I am sure that she would join me in that.
All Members rightly attach the highest importance to developments in the NHS in their constituencies. It is important that local people are able to have local access to high-quality health services for users of orthopaedic and maternity services, as well as several other services that the right hon. Lady mentioned. As she knows, our policy is one of devolution to give local communities a real opportunity to plan and to develop health services according to their needs and demands. We have backed that up with significant additional funding. Over 2003–04 to 2007–08, expenditure on the NHS in England will increase on average by more than 7 per cent. a year over and above inflation—an increase of £34 billion.
The majority of that funding has been made direct to primary care trusts. In that way, we are putting resources in the hands of front-line NHS staff alongside their responsibilities for developing and running services. In the right hon. Lady's constituency, Maidstone Weald PCT will receive an increase in its revenue allocation of £36.4 million between 2003–04 and 2005–6. That represents a cash increase of 28.7 per cent.
The right hon. Lady raised several concerns, some of which touched on the proposed transfer of women's and children's services from Maidstone to Tunbridge Wells. I stress that those remain proposals and that no firm decision has been made.
The right hon. Lady concentrated most of her remarks on the trauma services and linked orthopaedic services. I can give her assurances on some of the matters on which she seeks them. I understand that she is a local Member concerned about what is happening in her patch. She graphically expressed her anxiety about the matter, and I understand that, but she need not worry about a unique voice, because many of us would say that she is a unique voice. I am sure that she is a unique voice on behalf of her constituency.
The joint Maidstone and Tunbridge trust has stressed throughout the discussions that the area and the people that it serves will always need two acute district hospitals. I emphasise the word "acute" because the right hon. Lady is worried that one will become totally elective. That is not the trust's intention: there will be one hospital in Maidstone and another in Tunbridge Wells, and they will work together in a complementary way. I understand that that can sometimes cause anxieties, and I am familiar with the situation from elsewhere, not least my constituency.
I accept that there will continue to be an accident and emergency unit at Maidstone, but the consultants' point is that it will be greatly reduced. All the orthopaedic trauma will go to Tunbridge Wells and the consultants point out that that cannot be done in isolation. Others will follow, and in the end, the unit will be so small that it will not deserve to be considered in the same way as a big general acute unit.
I appreciate the right hon. Lady's view, but both hospitals will continue to provide the bulk of acute surgical, medical, emergency and life-saving care for patients and each will need accident and emergency departments capable of dealing with minor and major illnesses and injuries. I am told that the strategic health authority has categorically stated that Maidstone hospital's accident and emergency department is not closing down or being run down.
I appreciate that issues such as training hospital consultants and doctors, and accreditation by the royal colleges need to be sorted out. That needs to be done locally to ensure that the mix of cases that goes to both hospitals is capable of sustaining the right accreditation by the royal colleges—for example, for accident and emergency accreditation purposes. I understand that the chief executive has met the majority of the consultants individually or collectively.
We do not deny that some concerns have been expressed. They have centred around the misconception that all the surgical services would be transferred to the Kent and Sussex hospital. Some consultants were also worried that there might be pressure on them to express certain views. Notwithstanding that, some have genuine concerns about the future. We accept that concerns have been expressed, but I assure the right hon. Lady that the strategic health authority is committed to two full accident and emergency departments in the two district general hospitals and sustaining the mix of services.
The right hon. Lady mentioned the transfer of the chronic pain clinic. I am not familiar with as much of the detail as I suspect she is. I understand that some £600,000 of additional resources have gone into the clinic at Pembury hospital, to which it is to be transferred. Extra investment has gone into that pain unit, and I am sure that that creates an improved service. We accept that we need two accident and emergency units and two district hospitals. The question is about the division of some of those areas of specialty, which can be provided principally in one or another of the hospitals.
In the past few years, Maidstone hospital has had major investment in its eye, ear and mouth unit. There has been some £11.9 million of investment. The hospital has received £2.8 million for a new breast care centre; £2.2 million for a new emergency care centre; and £1.7 million for the orthopaedic unit. In Tunbridge Wells, the Pembury hospital and the Kent and Sussex hospital have received £3.5 million investment in more doctors; the chronic pain unit that I mentioned; some refurbishment of the maternity unit; and £1.15 million for a new MRI scanner. That shows that there has been a division of resources between the two sites.
The right hon. Lady talked about the pressure on junior doctor hours as a result of the working time directive, but there is a wider rationale. That rationale includes the following considerations: to improve the quality of services for patients; to reduce the number of cancelled operations, as currently one in five elective procedures are cancelled in Maidstone and Tunbridge Wells, which the trust and the strategic health authority are looking to improve on; to reduce the risk of infection by segregating all orthopaedic patients from surgical patients, which is highly important; and the development of on-call rotas that offer consistency of care. Among all the other factors are the fulfilment of the requirement to meet junior doctors' working hours under the European working time directive, and gaining efficiencies of full day-care elective theatre lists to reduce waiting times for patients. The provision of centres of excellence for patients that offer and are able to meet national standards of care and to attract highly skilled staff is also important. Making the best use of the consultant work force, with sub-specialisation, is also a factor.
The benefits for patients that the trust and strategic health authority are looking for are: ensuring that booked operations are not cancelled; reducing waiting time for operations; reducing the risk of infection following surgery; delivering rapid assessment, out-patient, diagnostic and day-case services at both hospitals; and ensuring that professional standards are consistently met. That shows that a rationale exists that makes clear the reasons for this discussion.
Currently, we have only a proposal before us, and I realise that, sadly, the right hon. Lady did not appreciate my right hon. Friend the Secretary of State's letter. I gathered that. He was being very fair in what he wrote to her, however, as he was pointing out that this matter was still up for discussion, and that the details need to be thrashed out. I understand that such discussions raise a lot of local anxieties, and I sympathise with local MPs and local people concerned about them. I have set out a number of powerful and important reasons why it is necessary to examine these issues, including the benefits that can be gained for patients from improvement of patient care.
I want to touch briefly on maternity services, because I want to assure the right hon. Lady that we are committed to good-quality, women-centred maternity care. We have a commitment to improving maternity services by modernising maternity units, increasing the number of midwives and giving women greater choice in childbirth. There have been huge advances. It is now much safer to give birth, and women are now actively involved in making decisions about the maternity care that they want to receive. As I am sure she is aware, we published a national service framework on
Additional funding has been made available for refurbishments, including of hospitals in Kent, to improve the environment. I hope that the right hon. Lady will agree that we all recognise that hospital services need to change if we are to continue to fulfil patients' needs and improve access. Services cannot remain static. They must be responsive to local needs and changing patterns, higher standards and the different services that can be provided as modern medicine advances. That is what we are seeking to achieve through the changes that are being implemented.
The matter in hand is still a discussion on a proposal, and I trust that the right hon. Lady will be able—
I cannot envisage anything. I was blessed with neither a cup of tea leaves nor a crystal ball. The dialogue must continue, however, so that all the parties are reassured about what the outcomes are. There cannot be a huge difference—
The motion having been made after Six o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at ten minutes to Seven o'clock.