Health Services (Suffolk)

Part of the debate – in the House of Commons at 10:01 pm on 24th January 2006.

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Photo of Tim Yeo Tim Yeo Chair, Environmental Audit Committee, Chair, Environmental Audit Committee 10:01 pm, 24th January 2006

I am delighted to have this chance to raise in Parliament the crisis in the health service in my constituency and in particular the threatened closure of Walnuttree hospital in Sudbury, a highly valued community hospital. The closure of Walnuttree, the loss of its in-patient beds and the ending of many out-patient services that are at present provided at the hospital, will be devastating for the town and the surrounding neighbourhood. The proposal has been brought forward by the Suffolk West primary care trust—which I will refer to simply as the trust—at a time when the population of both Sudbury and Cornard is planned to grow significantly and when the trust itself has confirmed that Sudbury has the highest level of mortality in the county. The proposal runs directly counter to Government policy, and the way in which the trust has handled it has destroyed the faith of my constituents in the integrity of the consultation process and the decisions that are likely to follow it.

Walnuttree serves 20,000 people in Sudbury and Cornard and thousands more in the nearby villages. It enjoys very high respect because of the quality of care provided by the dedicated and outstanding staff, many of whom have worked at the hospital for years. However, the hospital building—a former Victorian workhouse—has long been regarded as unsuitable, and it is greatly to the credit of the staff that the patients who have occupied its 68 beds and the people who use the out-patient services rarely if ever complain about the service that they receive. That is in contrast to the experience of some of my constituents in West Suffolk hospital at Bury St. Edmunds, where complaints are, regrettably, not infrequent. Unfortunately, patients who in the past have used Walnuttree will, if it is closed, be forced to go to West Suffolk hospital instead.

Proposals for a new hospital in Sudbury to replace Walnuttree have been around for 20 years, and recently hopes were high that final approval for its replacement was imminent. It was a shock, therefore, in 2004 when local officials produced an apparently damning fire safety report and used it as a pretext to recommend the hospital's closure. A big local campaign was mounted, with all-party support, to fight that threat. In November 2004, my former Labour opponent, Kevin Craig, and I jointly delivered a 10,000-signature petition to Downing street.

Great was the relief when that campaign persuaded local officials to see sense and a programme of fire safety work was announced. The then chief executive of Suffolk West primary care trust promised that Walnuttree would remain open until a replacement was built. In February 2005, the outline business plan for that replacement was approved by the strategic health authority. The then Secretary of State for Health wrote to Kevin Craig before the general election and said:

"Kevin . . . you have ensured that the voices of local people have been heard at the highest levels of Government."

The Chancellor of the Exchequer, no less, was quoted in Kevin Craig's election literature congratulating him on his role in that successful campaign. By April 2005, plans for the replacement hospital were well advanced and had been endorsed by a Department of Health gateway review report on the outline business case. Days before the general election, another meeting in Sudbury was assured that the new in-patient hospital would be built prior to the closure of the old site.

Alas, with the election out of the way and a new chief executive in place at the trust, all those promises were suddenly cast aside. In June, the trust dropped its bombshell: Walnuttree was to be closed after all. No replacement in-patient beds were to be provided, just a glorified GP surgery. Even the in-patient services provided at Walnuttree were to be transferred to West Suffolk hospital 20 miles away.

The reaction in the town was outrage. Days after the news broke, I chaired one of the biggest public meetings ever held in Sudbury, and the Walnuttree hospital action committee was formed. In July, with other Suffolk Members of Parliament and Lord Phillips of Sudbury, I met the Secretary of State, who assured us that the consultation process would be taken seriously. However, the trust's consultation paper, "Modernising Healthcare in West Suffolk" was a seriously flawed document, which stressed the need for financial savings but suggested only one way of achieving them—through savage cuts in local services and the closure of Walnuttree.

Throughout summer and autumn, the community mounted the biggest protest campaign in my constituency in the past 23 years. I pay tribute to the action committee, including its chair, Colin Spence; Michael Mitchell, a porter at the hospital; Michael Mandelstam; the mayor of Sudbury, Lesley Ford-Platt; Richard Titford of Sudbury Churches Together; Sylvia Byham, and Peter Clifford. Those are just a few of the people who have done outstanding work.

The committee adopted a highly professional approach, raising money to commission an expert study of the proposal and its likely effects, and offering to work with the trust to achieve an outcome that was acceptable to the local community and more consistent with stated Government policy. Regrettably, the trust rebuffed that approach. I much regret that the trust's new chief executive, Mike Stonard, has obstructed the action committee's attempts to find a solution to the problem, to the extent of resorting on occasion to untrue statements and evasions when asked straightforward questions, and casting wholly unjustified aspersions on the integrity of people who are campaigning to protect our health service.

Truth has, on occasion, flown out of the window during the course of the argument. During Health questions on 22 November last year, I was told by the Secretary of State:

"Walnuttree . . . has already had £300,000 invested in it to bring it up to the standard required by fire safety regulations".—[Hansard, 22 November 2005; Vol. 439, c. 1358.]

When I challenged that assertion, the Minister of State, Department of Health, Ms Winterton, wrote to me on 24 December saying:

"I have noted your comments about the advice given by officials being misleading in relation to the £300,000 spent at the Walnuttree Hospital to bring it up to fire safety regulations. I should point out that I have been assured that this advice is accurate."

Last week, inquiries made under the Freedom of Information Act 2000 revealed that expenditure on fire safety works during 2005 actually amounted to £100,000, not £300,000. The Under-Secretary may like to apologise on behalf of both the Secretary of State and the Minister of State for their inadvertent misleading of the House. I hope that the Department will now examine the sources of the incorrect information that it was given.

The trust's consultation document refers to increased provision of intermediate care—something that everyone in Suffolk welcomes—but it utterly fails to make even a remotely convincing case for its claim that all those who in the past have received in-patient treatment at Walnuttree can be catered for in the community. Even the trust's own rules define a set of patients as ineligible for care in the community, which includes those without a carer at home, those whose home is unsuitable, those whose needs are too great, and those who do not have the potential for rehabilitation within six weeks. Nor has the trust explained how the cost of all that extra treatment in the community will be met.

Those proposals will also place a heavy burden on both Suffolk county council social services and on West Suffolk hospital. Unfortunately, in the current year—before the trust's proposals come into operation—the social services department already faces an overspend of £2.7 million. Far from being unable to cope with any extra burden, the department is looking for ways to make savings. West Suffolk hospital also faces a cash crisis and is planning to close beds.

The driver of the trust's proposals is not, as Mike Stonard claims, its desire to introduce an improved model of care. It is all about saving money. So desperate is the crisis that management is breaking all its previous promises and introducing measures that will clearly damage patients. Since it is only about money, why did the trust not consider whether it would be cheaper to keep open the in-patient beds at Walnuttree, as community beds are generally understood to be cost effective?

The truth is that if the trust wanted to improve services in Sudbury, it would revert to the previous evidence-based successful model of care, which included some in-patient beds at Walnuttree, alongside improved services in the community. Ramming through bed closures by alleging that none of the patients who has used them in the past will in future ever need to be treated anywhere other than at home is absurd. Some patients will be inappropriately left at home to suffer or even die without proper community support. Others, as the trust admits, will have to be accommodated within West Suffolk hospital, aggravating the problem of bed blocking and causing longer waiting lists, in direct contradiction of Government policy.

As the Audit Commission said in its report, "The Way to Go Home—Rehabilitation and Remedial Services for Older People",

"there is a danger that in the general confusion around the term 'intermediate care', older people will not receive the care they need".

Bear it in mind that less than a year ago the outline business case proposed, after months of consultation and with widespread local support, a model of care that included 32 new in-patient beds in the new hospital that would replace Walnuttree. What changed between February and June last year to render this model suddenly irrelevant? Not the evidence about patient need. Not the needs of the community. Not the number of people requiring care at Walnuttree. All that changed was the decision of the trust to put the demands of the accountants ahead of the interests of patients.

Ironically, the letter in which the Minister of State made her inaccurate claim about what had been spent on fire safety included a statement of policy on community hospitals. She stated:

"Our commitment to community hospitals is to support a new generation of community hospitals that can meet the needs of local people".

I invite the Minister to tell the House this evening that he will instruct the trust to honour that commitment. Or was it, like so many statements from Ministers now, just words, which the Minister never intended should have any real meaning?

Community hospitals are, after all, not just cheaper and more cost effective for in-patients than acute hospitals; they are closer to home, patient friendly and offer more continuity of care provision. What is more, the Minister of State has boasted of £100 million being available to develop them. What about a fraction of that for Sudbury?

It is not only in-patients who will suffer. Last year the outline business case included consultant clinics at the replacement hospital. These, too, have disappeared from the trust's plans for Sudbury and will instead be moved to West Suffolk hospital in order to save £40,000 a year. At least in this regard the trust admits that decentralised services can sometimes be more expensive, a factor that it conveniently overlooks when costing the extra intermediate care which it claims will be provided in future.

Centralising the clinics in West Suffolk hospital will greatly burden the patients who use them. The car journey to West Suffolk hospital from Sudbury takes half an hour at best, costs a significant amount and adds to pollution, including CO 2 emissions. Many elderly patients have no access to a car and will have to make the bus journey of more than an hour, which culminates in a five-minute uphill walk from the bus stop to the hospital—something that no one at the hospital was even aware of until I pointed it out.

I tried the bus journey myself last August and invited the directors of the trust to join me. None did, possibly fearing that first-hand knowledge of what they were planning to inflict on vulnerable patients, who until now have enjoyed a local service, might force them to admit their mistake. Incidentally, patients report that the hospital's own transport service is even worse and can take up to six hours door to door because of the need to collect patients from all over a dispersed rural area.

Ministers have stressed the Government's commitment to patient choice, but patient choice is not what the trust will provide. Ministers have spoken about care closer to home, but the trust is taking care for many patients further away from home. Not surprisingly, nobody affected by these proposals supports them. The three main GP practices in Sudbury, including one that could benefit if the proposals go ahead, have all rejected them. Rehabilitation clinicians and therapists within the Suffolk West primary care trust have protested internally. The BMA has condemned the plans. Sudbury town council has objected to them. Babergh district council said that the proposals

"are not cost effective and will not deliver increased access to services" and that they

"will have an adverse impact on Babergh's disabled adaptations budget".

Suffolk county council passed a motion urging

"the Secretary of State for Health to instruct primary care trusts not to close Community Hospitals until some other means of intermediate care is up and running."

The local patient and public involvement forum stated that

"the actual proposals appear to be ill-thought out, lack real factual cost justification and in our view are likely to cause unnecessary pain and suffering to those in need".

Five thousand letters have been sent to the Secretary of State, and 3,500 submissions have been made to the trust. There is not a shred of justification for the proposals. They will harm the population that they are supposed to serve, and they contradict Government policy. Understandably, residents now have little faith in the integrity of the consultation process.

In East Suffolk, where 90 per cent. of the responses to the consultation, "Changing for the better: next steps", criticised the proposals, the agency interpreting the data on behalf of the various trusts commented:

"The consultation questionnaire was assessed to have poorly drafted questions that tended to lead respondents towards an apparently "obvious" (and negative) answer . . . What little evidence there is suggests the response sample was not representative . . . the health community would be unwise to place excessive weight upon the quantitative views expressed during this consultation."

Would that have been the reaction if the public had backed the proposals? I fear that when the responses to the Suffolk West primary care trust consultation are analysed, a similar charade will occur. If the questions do not produce the answers that the trust wants, someone will say that they were the wrong questions, and the people who replied to them will not be considered representative. To make matters worse, the Suffolk West primary care trust will soon be abolished, before its bosses have to answer for the damage and suffering that their proposals will be inflicting.

One final point must be emphasised. Although the trust must bear a big share of the responsibility for what has gone wrong, it is also true that Suffolk West has been disgracefully treated in cash terms by the Department of Health. Serious underfunding from the centre has compounded the problems with which the trust has had to grapple. The tragedy is that, against that background, the solution that the trust proposes will not solve the problem.