NHS Reconfigurations

– in Westminster Hall at 12:30 pm on 14th March 2006.

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Photo of Richard Taylor Richard Taylor Independent, Wyre Forest 12:30 pm, 14th March 2006

It is a delight to serve under your informal, friendly chairmanship, Mr. Bayley. I am pleased to see the Minister here, and I applied for a 30-minute debate rather than a 90-minute one because I wanted her all to myself. That is not because I want to score political points, but because I want to help tackle the appallingly difficult subject of acute hospital reconfigurations. The debate gives us a splendid opportunity to reflect on that issue.

Given NHS deficits, the European working time directive and ever-increasing demands for better and more expensive treatments, the NHS must make economies. On an entirely separate issue, I would love to have an open, wide-ranging debate about health care rationing. On this subject, however, there is pretty much agreement across the country that there will have to be further reconfigurations of acute hospital services. Given the changes in practice and the Government White Paper, many of those services are probably not affordable or necessary.

On 9 February, Nick Timmins, an excellent reporter with the Financial Times, wrote an article headed "Financial mayhem exposes structural problems that beset the NHS". In it, he says that

"the changing nature of medicine means bigger reconfigurations are needed that will see more towns lose their accident and emergency departments and some other services."

NHS managers are crying out for the politics to be taken out of such decisions. Fairly recently, in the Health Service Journal, the Prime Minister was reported as saying that the Government would back managers over difficult decisions.

It might appear odd that someone who stood on the platform of saving a hospital should be speaking in that way, but I am uniquely qualified to tell the Minister, and thus the Secretary of State, exactly how not to carry out a reconfiguration exercise and how the Government have already put in place several mechanisms to take the politics out of the issue. If the Government used those mechanisms, they would have a good chance of success.

As I am sure that the Minister is aware, the Kidderminster effect has been spoken of with bated breath in certain quarters since my election and it actually achieved the honour of a cartoon in this week's Health Service Journal. People now refer not to the Kidderminster effect, but to being Kidderminstered. The cartoon compared that to being Scunthorped, although I really cannot imagine what is happening in Scunthorpe. None the less, we have achieved cartoon status.

I should make it clear that I am talking purely and simply about acute general hospitals, not community hospitals, which are entirely different. Community hospitals can be seen as absolutely in line with the White Paper and necessary for keeping work away from acute hospitals. With few exceptions, they deserve to be retained and used more and more.

What, then, happened in Kidderminster and why was it a disaster? A drastic downgrading took away the accident and emergency department and all acute in-patient services. People could no longer go to the hospital with a heart attack, acute appendicitis or a broken leg. Everything that makes an acute hospital an acute hospital was taken away. It was a total robbery, which was carried out simply to benefit two other hospitals and two other communities. How was that possible?

The health authority at the time used the marvellous divide-and-rule tactic and gave the other communities benefits so that they would support the change. It gave the project the euphemistic title "Investing in Excellence", and other reconfigurations have titles such as "Making Things Better". Everybody can see through those titles and they know that the reconfigurations are probably not making things better for them.

I wrote a saga on spin, although I shall not give hon. Members the whole thing. Here, however, are two examples. In Kidderminster, the health authority at the time said:

"Under the preferred proposal, a comprehensive hospital will remain (in Kidderminster), dealing with the majority of both elective and emergency services, for the people in its catchment area."

How could the hospital deal with the majority of elective and emergency services when it does not have an A and E or any acute beds? Then, there is a classic misuse of statistics:

"Out of 3.5 million contacts between Worcestershire patients and the NHS each year, less than 1 per cent. (around 12,000) would have to travel further in future for in-patient treatment."

Every one of the patients from the Kidderminster area had to travel further for in-patient treatment. We must avoid euphemistic titles and spin because people are sensible and can see through them—they are not fools.

Responses to consultation must also be used sensibly. In the case of Kidderminster hospital, the responses from three community health councils, two county councils, four district councils and 11 parish and town councils were completely disregarded, as were innumerable responses from churches, medical groups and patient groups. To make matters worse, the outcome was decided on the basis of a weird pseudo-statistical option appraisal in which people had to give weightings and scores to the options. Twenty weighting sheets were sent out, but only 16 were returned, although that, at least, is understandable. However, 24 score sheets were also returned, even though there were only 21 scorers. One can therefore see why there was absolute resistance at the time to this total robbery, which was carried out with no fairness and as a result of a classic non-consultation.

What have the Government done since my election? Several things. First, health overview and scrutiny committees were established at county council level with the right to refer contested decisions to the Secretary of State for Health. With the demise of community health councils, primary care trust patient forums were given the right to refer issues to overview and scrutiny committees. In April 2002, a report in the Health Service Journal, headed "Powers of observation", stated that

"it is interesting to speculate whether some major NHS changes would have been handled differently if the new arrangements for local authority scrutiny had been in place. Would the reconfiguration of acute services in Worcestershire, or the strategic changes in Manchester, have gone ahead in the same way? Almost certainly, the NHS organisations involved would have been forced to tackle the process of consultation differently—and the resulting changes might well have been different, too."

Overview and scrutiny committees are therefore incredibly valuable.

Next, there is the independent reconfiguration panel, which was established in 2003 to advise the Secretary of State independently and with no political input about the merits of contested reconfiguration decisions. The panel contains clinicians, managers and members of the public and draws in other groups to review particular reconfiguration decisions. The advice will be made public; there for all to see and understand, so that there is no chance of political influence, spin or obfuscation. The organisation has tremendous potential.

What has happened to the panel? We asked another Minister at a Health Committee meeting a few weeks ago. The answer was that eight cases had been referred by overview and scrutiny committees to the Secretary of State, and at that time only one of them had been passed on to the panel. One had been withdrawn, one awaited decision and five had been decided by the Secretary of State without reference to the advice of the panel. The situation was brought into sharp relief in a recent debate in the main Chamber, when a Labour Back Bench Member was very pleased that the Secretary of State had decided to site a new hospital in her constituency and an Opposition Member was livid that it had not been placed in his. The process had obviously led to political bias and a huge opportunity had been lost. The decision should have been made not by the Secretary of State but by the independent, non-political panel, which is sitting there waiting for referrals.

I spoke to the independent reconfiguration panel's chief executive today, just to ensure that I was up to date. The panel has received two more referrals, so the total is now 10. To my amazement and pleasure, the one that was waiting to be decided or referred has been referred by the Secretary of State to the IRP with the extremely sensible suggestion that the panel get round the table with the overview and scrutiny committee and the health trusts involved and thrash out the way forward. I hope that that means that the Secretary of State has received the message that the IRP is there and that if it makes its decisions openly and independently, without political bias, MPs might argue, but they will not have a case to make because the decision will not ultimately be made by a political party in the interests of that political party.

The annex to the letter that I received following the Health Committee meeting contained at least one inaccuracy—I shall come back to inaccuracies later. It said of one referral that the Secretary of State had decided to support the local NHS decision. In fact, exactly the opposite was true; she had decided to go against the local NHS recommendation in favour of the Labour-held constituency.

I have mentioned overview and scrutiny committees and the independent reconfiguration panel. In February 2003, the document "Keeping the NHS local: a new direction of travel" came out, and it was followed by a further paper in July 2004. Since the downgrading of Kidderminster, no hospital or community has been treated as unfairly, severely or badly, but several have been downgraded successfully. Consider Hexham, which has a tiny hospital, serving only 70,000 patients. That has been changed, but it has retained cover for medical emergencies, a lot of surgery and an urgent care centre. The hospital at Bishop Auckland is also smaller than Kidderminster was. It has lost emergency surgery but has retained medical admissions, elective surgery and an urgent care centre. Those changes have met with acceptance.

A great deal of work has gone on in various organisations to work out how to maintain local access for straightforward emergencies. That is the critical thing that communities want. I draw the Minister's attention to the acute hospitals review in Northern Ireland, which took place as long ago as June 2001. For the first time, that split accident and emergency departments into three groups: the major, all-singing, all-dancing ones where patients could go with head and chest injuries, an intermediate group and a level three, which it envisaged would be

"a centre serving a smaller catchment population, operating in a managed clinical network with a level two service. The range of services available in each centre will vary according to local circumstances. They would have physicians, surgeons and anaesthetists available during the day and a full A&E service."

That sort of compromise would be much more acceptable than losing an A and E and ending up with a minor injuries unit without a doctor on site.

I shall conclude by listing the lessons that I should like the Minister to take on board. First, proper consultation means honesty, no euphemisms, no spin, no pseudo-statistics and, finally, a vote by local people. Obviously, one must comply with section 11 of the Health and Social Care Act 2001, and the mandatory referral to overview and scrutiny committees. As an aside, I am rather worried about the PCT merger consultations that are not going through section 11. They could be challenged.

Secondly, there must be total accuracy. A rather distressing example of inaccuracy came to my attention last week. The Health Committee is undertaking an inquiry into independent sector treatment centres. A large submission was received from the Department of Health about the existing ones, so I looked up my own centre. The information is not right. It says that we have a local emergency centre. We have not; we have a minor injuries unit. It says that we have back-up in the form of telemedicine links between us and A and E departments. Those links were taken out some years ago, because nobody used them because there was nobody to answer them. It says that we have a midwifery-led maternity unit. That was closed in 2003. The bed numbers do not tally with my understanding. All those inaccuracies throw a dubious light on the entire submission. I do not know the details of other treatment centres so I cannot check whether they are correct, but it is crucial for a Minister to have the right information. If the Department were right in saying that we in Kidderminster have a local emergency centre, what would we be making the fuss about? It is because we have not that we have made a fuss. The third lesson, which I shall not labour now, is that we should use the independent reconfiguration panel that was set up to do just what it says.

The Kidderminster consultation failed and became political because it was a robbery and unfair. People saw through the spin and all the pain was borne by one community. Changes have to come in many parts of the country, including Yorkshire, the north-east, Shropshire and Gloucestershire. To succeed, they have to be seen to be fair, based on networking and sharing. The disadvantages have to be shared as well. We cannot send everybody from one area to another; people have to go both ways. Services must be built up in one place if they are removed from the other so that it can be seen that the disadvantages are being borne by both places. We all want all-singing, all-dancing acute hospitals, but we cannot have them; that is not possible. Therefore, there must be sharing and when decisions are contested, the IRP must be used.

I shall leave the Minister with three proverbs, because fairness is a part of our way of life: from the 14th century, "Fair and softly goes far in a day"; one we all know from the 16th century, "A fair exchange is no robbery"; and from the 19th century, "Fair play is a jewel." The independent reconfiguration panel could be a referee and take things out of the political equation to see fair play for all concerned.

Photo of Jane Kennedy Jane Kennedy Minister of State (Quality and Patient Safety), Department of Health 12:50 pm, 14th March 2006

It is a pleasure to be here this afternoon with you in the Chair, Mr. Bayley.

I congratulate Dr. Taylor on securing the debate on NHS reconfiguration, and thank him for his contribution to the recent Select Committee on Health report on changes to primary care trusts. The report has provided a helpful contribution to the debate. We carefully considered the Committee's recommendations, and published our response last week. He argued cogently, and I do not disagree with a lot of what he said; in fact, I strongly agree with much of it. There are some suggestions to take on board.

It is fair to say that all the changes being made in the national health service are designed to achieve even better NHS services for patients. That is the goal, and the test, of everything that we do, including our asking the health service to engage in increasing financial transparency, which is causing the current high level of public debate about the future of health services. PCTs need to become the focal point for planning, designing and shaping local health services, but in a way that best meets the needs of local communities and delivers value for money from allocated resources.

The hon. Gentleman rightly says that there is agreement across England that there will have to be reconfiguration of acute hospital services. Waiting lists are at their lowest level for generations. Under previous Governments, patients were corralled into waiting lists. Patients were managed to suit the chronic shortage of available resources, or, in some circumstances, the way in which the health service was configured in any locality. The Government have addressed that problem by providing extra resources and better pay to health service staff, which has encouraged more flexibility in the way in which services are delivered. The consequence of that is that the backlog of people waiting for urgent, acute in-patient treatment is clearing.

The hon. Gentleman is right to say that we must ask our acute hospitals what their future role should be. We are providing more support for people with long-term conditions and are managing their conditions differently. Even cancer is becoming considered more as a long-term condition and less as the absolutely appalling critical and acute illness that it used to be seen as. Therefore, it is managed differently. The improvement of screening services and the better monitoring of people's general health mean that we can intervene at an earlier stage to prevent people from getting to the stage of having the acute health needs that require the acute response that we have traditionally built into the NHS.

The management of a range of acute conditions has changed. The provision of cardiology services is an example of that. A strong debate is going on in the west of Cheshire, where Halton hospital is facing its services being moved to Warrington hospital. The strong local debate there has been couched very much in the terms described by the hon. Gentleman when he talked about the strong attachment that local communities have to their local hospitals, their fears about services being changed and their need to be reassured that changes are being made for the sake of providing better services that are clinically safer and that will provide better outcomes for patients.

Cardiology is one area in which treatment is being transformed by advancements and innovations. It is being delivered by the better management of people with heart conditions, so that open-heart surgery is performed much less often than it was. Management of patients is organised differently. Indeed, the kind of patient is changing, so the pressures faced by acute services is also changing.

The hon. Gentleman invites us to take politics out of service configuration. Would that it were possible. He rightly advocates the structures that we have put in place to do that. He uses the example of Wyre Forest and his constituents' experiences, and describes the consultation as being not the best-handled consultation ever.

The hon. Gentleman may not know that I cut my parliamentary political teeth in Liverpool, Broadgreen, where the then Government, or the then local NHS, sought to close the accident and emergency unit in the local district general hospital that served the constituency that I sought to represent. The then Liberal Democrat candidate—she is now a Labour Member, my hon. Friend Rosie Cooper—and I fought a vigorous local campaign against each other to see who could save the hospital the quickest. The problem in that case was that, although there were anxieties about the A and E, I believed that a coherent argument was being presented that the A and E services there were clinically less sound than the services that would be provided in the proposed bigger A and E department, which would be only three or four miles away, and which would have 24-hour consultant provision. That campaign was in the context of wholesale hospital closures across Merseyside, and local communities genuinely feared that they would lose the whole hospital, not just the A and E.

I know only too well how deeply attached people are to their hospitals. If people were to visit my constituency today and see the hospital that has been retained on the site, they would see a unit that provides some of the best cardiology services in the north-west of England through the cardiothoracic centre. Other services on that site are continually being developed and invested in, and local people can have confidence that those developments are genuinely being made in the interests of better local services.

The hon. Gentleman strongly recommends that we support the oversight and scrutiny process, which we do. As he rightly says, the consultations must be genuine and open, and command ongoing public support. He expressed his concern that the consultation on the primary care trust and strategic health authority configuration is not a section 11 consultation. He is right to say that, because reconfiguration proposals amount to managerial and administrative change only, there is no duty to consult under section 11. However, it is a full public consultation involving a wide variety of local stakeholders, including patient and public representative bodies. I know that in his area, the west midlands, the SHA has gone beyond the regulations to consult with a wider variety of people, including local MPs, professional executive committee chairs, the police and fire services and the general public.

We have made it clear in guidance and correspondence to all SHAs that the consultation must be conducted fairly and properly. I came to the debate prepared for discussion about the "Commissioning a patient-led NHS" consultation. I have given an open and honest response, taking on board the hon. Gentleman's helpful contribution. I know that I can look to him for support and encouragement as I take forward some of these difficult configuration issues and as we develop the health service further, always to the benefit of our patients.