I beg to move,
That this House
has considered hospital services in south Manchester.
It is a pleasure, as ever, to serve under your chairmanship, Mr Hollobone.
I secured this debate to highlight to Parliament some serious and genuine concerns about the Healthier Together process, which is under way in Greater Manchester. Healthier Together Greater Manchester has been a three-year consultation that, according to its own website,
“was created to help make an NHS for the 21st Century, helping to save more lives.”
The Healthier Together proposals relating to hospitals seek to drive up quality and safety by forming a single service with networks of linked hospitals working in partnership. That means that care will be provided by a team of medical staff who will work together across a number of hospital sites within the single service.
The Healthier Together committees in common, made up of GPs from each clinical commissioning group in Greater Manchester, were responsible for making decisions about the proposals based on a wide range of evidence gathered during the past three years. That included evidence from a public consultation and data on travel and access, quality and safety, transition, affordability and value for money.
Before the public consultation, commissioners decided that there should be at least three single services in Greater Manchester, based in Salford Royal hospital, the central Manchester university hospitals and the Royal Oldham hospital, which will each specialise in emergency abdominal general surgery. That decision was made because of the clinical services already provided by those hospitals and to ensure that all areas in Greater Manchester had equitable access to specialist services. Each hospital will work in a single service model with other, neighbouring hospitals in Greater Manchester.
I congratulate the hon. Gentleman on securing the debate. I apologise, but I cannot stay; I have a Select Committee to go to. I am concerned, as he is, about the initial consultation, which we debated in this Chamber in the previous Parliament. For the record, however, I should say that I am delighted that Stepping Hill was chosen; in High Peak, we are outside Greater Manchester and I was concerned that we had been forgotten. Choosing Stepping Hill means an awful lot to my constituents.
The Healthier Together commissioners left us in a binary situation, so it became a competition between two hospitals. That should never have been the case.
The aim of Healthier Together—to give patients throughout the region the same standard of excellent service wherever they live—is the right one. The challenge is huge: Manchester has the highest premature death rate of any local authority in the country. There can be no doubt that healthcare services in Greater Manchester need to change.
Will my hon. Friend join me in congratulating a hospital in my constituency on its news? Today, Tameside general hospital has come out of special measures. Although we are concerned about Healthier Together and some of its proposals, that is fantastic news for the overall package for my constituents.
May I say a couple of things? On a personal level, I am delighted that my hon. Friend won her seat of Ashton-under-Lyne. She worked at the coalface of integrated care services in east Manchester and she brings all that experience to the House. I, too, was involved in public life in Tameside, for six years, so I am delighted that the hospital has been taken out of special measures today. I pay tribute to everyone who has helped that to happen, from those in the Ministry to local leaders and the consultants at Wythenshawe hospital who over the past few years have advised on bringing Tameside general hospital out of special measures.
Almost £2 billion has been taken out of the budget for adult social care, with more cuts to come. We need to do things differently to meet the challenges of the time. Better integration of local authority services and the NHS will be a key part of that change and will be realised under the new powers being devolved to Greater Manchester. My hon. Friend Kate Green, Mr Brady and I have serious concerns about the outcome of Healthier Together and believe that the decision-making process is flawed.
Reorganising our tertiary services before resolving the huge challenges that we face to integrate our health and social care in the region feels like putting the cart before the horse. The benefits to be gained from our devolved powers in this area are yet to be realised, so we are redesigning our tertiary services in the dark. My constituency is home to the University Hospital of South Manchester Trust, which delivers services costing £450 million, employs 6,500 people and has 530 volunteers who give up their free time to help patients and visitors. The UHSM hospital has several fields of specialist expertise, including cardiology and cardiothoracic surgery, heart and lung transplantation, respiratory conditions, burns and plastics, and cancer and breast care services. Indeed, the trust is home to Europe’s first purpose-built breast cancer prevention centre. Its hospital not only serves the people of south Manchester and Trafford, but helps patients from across the north-west and beyond.
Healthier Together has decided that UHSM will partner the Central Manchester University Hospitals NHS Foundation Trust, or CMFT, in a single service for Trafford and Manchester. UHSM and CMFT have agreed to work together to improve collaboration between the trusts. There is clearly a great opportunity for two of Greater Manchester’s leading university teaching hospitals to work together to improve services, to increase integration at all levels, including with social care, and to improve research and education.
The Wythenshawe hospital, however, provides an extensive portfolio of secondary and tertiary services that rely on support from general surgery to maintain their quality and safety. In fact, UHSM provides all 18 of the services identified by Healthier Together as needing support from general surgery, including secondary services such as maternity, gynaecology, gastroenterology, urology and acute medicine, as well as tertiary services such as heart and lung transplant, burns care, cystic fibrosis and extracorporeal membrane oxygenation, which are provided only by UHSM for patients from across Greater Manchester and the north-west.
UHSM regularly accepts elective and emergency surgical patients from Greater Manchester and beyond who require the specialist support of its tertiary services —for example, patients requiring emergency or complex elective general surgery with complex cardiac disease. There is genuine concern that those secondary and tertiary services, which are outside the scope of Healthier Together, could be destabilised or downgraded through the implementation of the proposals.
UHSM also provides all the services, as identified by Healthier Together, on which emergency, high-risk general surgery is absolutely dependent, such as interventional gastrointestinal radiology and interventional vascular radiology. The latter is only provided at three hospitals in Greater Manchester that also provide vascular surgery, one of which is UHSM’s Wythenshawe hospital. Wythenshawe hospital must continue to deliver high-risk, emergency general surgery procedures for in-patients and for surgical emergencies in its secondary and tertiary services. UHSM will need to retain its existing level of general surgery support at Wythenshawe hospital in order to undertake surgical assessment, perform emergency surgery and manage the elective workload from a highly complex group of patients.
We were pleased that, in order to support UHSM’s tertiary services, Healthier Together recognised at a public meeting on
UHSM believes that the key features of a service that would maintain the quality and safety of its secondary and tertiary services are that Wythenshawe hospital should meet the Healthier Together quality and safety standards; should remain a receiving site for emergency general patients, including those with co-morbidities in its tertiary specialties and those who self-present; should have 24/7 senior general surgical assessment and opinion rapidly available to A&E; should remain able to admit and manage general surgery patients of all types; and should continue to deliver all emergency general surgery procedures, both major and minor, for in-house emergencies—for example, in-patients in urology—as well as for emergency general surgery patients with co-morbidities in its tertiary specialties. I am thinking, for example, of a patient with a bowel obstruction who is also being treated by the hospital for cystic fibrosis. As a minimum, the existing level of general surgery capacity must be retained in order to deliver and maintain that level of service in support of UHSM’s secondary and tertiary services.
Wythenshawe currently has a high-capability team of 10 consultant general surgeons with experience in all specialities of managing high-risk surgical emergencies in patients, supported by a team of trainee surgeons. Although Healthier Together analysed implications for the consultant workforce, it is not clear what analysis there has been of the implications for other staff, including the effects on medical training posts and the support those posts provide to consultants.
Healthier Together has recognised that the service model required at UHSM must be more than that described by the programme for a local general hospital, and UHSM’s surgeons have been invited to discuss potential service models with the Healthier Together team. However, serious questions have been raised with both me and Members whose constituencies border mine about patient safety and quality in what can only be described as a fudged model for UHSM, which would be neither a specialist hospital nor a local one.
Throughout the Healthier Together process, we have been told that the dominant driving force of the proposed changes is to save more lives, yet in the end the final part of the decision to allocate the fourth specialist site was taken based on one factor only: travel and access. It is clear that for the Greater Manchester-wide—indeed, north-west-wide—specialist services provided at UHSM to continue safely, a robust and high-quality general surgery service must be maintained at Wythenshawe hospital. That is essential to ensure the quality and safety of the secondary and tertiary services that our constituents and patients from across Greater Manchester, and beyond, rely on.
I congratulate my hon. Friend on securing this debate. He is making an excellent and detailed technical case on behalf of Wythenshawe hospital. Does he agree that the downgrading of the status of Wythenshawe—that is what this is—will make it much more difficult to recruit the necessary specialist staff and is another example of how flawed the whole process has been?
My hon. Friend knows more than anyone in this place about the principle of subsidiarity. He was fighting for devolved services for Manchester in the
’80s. We are beginning to catch up with his vision for devolved services across Greater Manchester that he argued for when he was ably leading Manchester through the depression of the ’80s and its economic regeneration in the ’90s. I agree that this fudged proposal could lead to a death by 1,000 cuts. It will undermine confidence, and we are passionate about avoiding that.
I hope the Minister will work with us to ensure that patient safety across Greater Manchester is the primary factor in the decision-making process. Very few Members of Parliament are fortunate enough to represent the hospital that they were born in. There is nothing I would not do for patients—not just in my constituency, but throughout Greater Manchester. We were told that Healthier Together was a clinician-led consultation; unfortunately, our clinicians are now telling us that they have serious concerns. Local MPs must listen and act. We have reached an unfortunate situation in which those clinicians have applied for judicial review, and we are at the stage of the letter before action in that process.
I urge all sides to negotiate to see whether an equitable solution can be found. If it cannot, the proposals are so flawed that any judicial review would probably be successful. That would not please me in any way whatever; I am the last person who wants to see a long and protracted legal process. I believe that, fundamentally, we should move towards a devolved set-up in Greater Manchester and that that process will be put back by this situation. However, I cannot stand by and be told that patient safety may be at risk without raising the issue in Parliament.
I congratulate Mike Kane on securing this debate. It is a pleasure to be working alongside him, Kate Green and other concerned Members from Greater Manchester, who are deeply worried and troubled by the proposals being put forward in Healthier Together as a whole and for Wythenshawe hospital, the university hospital of south Manchester, in particular.
It gives none of us any pleasure to be here and to have to raise this debate, any more than it gives the consultants at Wythenshawe hospital any pleasure or satisfaction to have been pushed to the point where they felt that the only way to make their voices heard and ensure that their fears about patient safety in the longer term did not come to pass was to pursue the initial stages of judicial review. I could not agree more with the hon. Member for Wythenshawe and Sale East that that is not the way that any of us would wish to have this question resolved.
As the hon. Gentleman said, throughout the Healthier Together process, colleagues on both sides of the House have warned that the process was deeply flawed. The consultation undertaken over a three-year period is the worst instance of public consultation that I have encountered in my 18 years in this place. It moved immediately from discussion of warm platitudes about improved collaboration, and the better results that that can achieve, to a table of possible outcomes that was so complicated that no member of the public could hope to understand the implications. The whole episode raises some profoundly serious questions, both about the delivery of the best possible health services in Greater Manchester and about accountability in the delivery of public services and the ways we can ensure that the public view is properly heard and respected.
As the hon. Gentleman—my colleague—said, in Greater Manchester we are poised to embark on some very exciting changes, which, if got right, will make dramatic improvements in our delivery of health and social care and could provide not just a great improvement for our constituents but a model for many other parts of the country to follow. If instead we see this sort of flawed decision-making process proceed, the danger is that people will see devolving power and decision making to a more local level not as something that will empower them and give them a stronger voice but as something that will result in less accountability and is less likely to deliver for local communities. We need to ensure that the Government understand and the Department recognises that there would be a significant cost if this episode were allowed to damage wider public trust. All of us want more devolved decision making in Greater Manchester, but we want it done right, not in the deeply flawed way presaged by this process.
Not only was the consultation flawed—it appeared to be designed to obfuscate and confuse members of the public, rather than to be a genuine exercise in seeking public opinion—but the decision-making process at its conclusion was pursued in a way that is clearly unreasonable. I concur with the hon. Member for Wythenshawe and Sale East that, given the unreasonable nature of the process from beginning to end, there is every likelihood that, should judicial review be pursued to its conclusion, it will be successful. That is an important reason why we need people throughout the process—whether power now lies with the Department of Health or with the commissioning bodies—to get a grip on this problem and to try to bring it to a more satisfactory conclusion.
I do not want to go into enormous detail about the decision-making process—the hon. Gentleman has given a good survey of the technical questions that Healthier Together raises for UHSM—but we have seen clear support among the members of the public who responded to the consultation for Wythenshawe to be the fourth specialist hospital. Of course, the weight of responses cannot always be the factor that leads to a decision, but it is incumbent on those involved in any decision-making process to take public views seriously. If those views are to be discounted, that should be only on the most serious grounds and on the basis of clearly reasoned arguments.
I have two principal concerns about the grounds on which the weight of opinion was disregarded. First, there is the deeply spurious decision not to take account of the current standard of care delivered at Wythenshawe hospital. Any lay person and—I venture to suggest, having had many conversations with senior clinicians—any senior clinician would regard it as patently absurd to discount the hospital’s current clinical standards on the grounds that all the other hospitals are expected to reach the same standard at some point in the future so the standard is of no consequence. It is Orwellian to run policy and decision making in that way. I hope that the Minister will accept that that should give serious pause and serious cause for concern.
The second significant point, which the hon. Gentleman also raised, relates to the decision finally being grounded on the travel time for a relatively small population in High Peak—I am not saying this because my hon. Friend Andrew Bingham has had to leave the Chamber to go to a Committee. The failure properly to take account of the A6 relief road, which is now being built, and which will deliver flows of patients from High Peak to Wythenshawe in a much shorter time, is again, frankly preposterous.
I am sorry to make this point in the absence of Andrew Bingham, because I am sure that he would want to say something about it. However, is it not also the case that, in looking at the travel time, the failure to consider other options for High Peak patients, outside the Greater Manchester conurbation, also calls the decision into question?
Yes, absolutely; that is an important point. Without venturing too far into the realms of legal opinion and the judicial review that we could face, what makes the decision so demonstrably unreasonable is the failure to take account of a known factor that will materially change the travel times on which that decision is purported to have been based.
Furthermore, it is questionable policy to proceed with such profound changes to services at the same time as another review was going on. It may be sensible to proceed with some of the shared service propositions for UHSM and Central Manchester—that may be the way forward and may lead to better outcomes for patients in both trusts, and it should certainly be explored—but seeking to arrive at agreement on that while the Healthier Together process was still to conclude was deeply questionable and is a source of serious concern for us all.
I will not rehearse the long list of outstanding tertiary services offered by Wythenshawe not only to Greater Manchester, north Cheshire and north Wales but far beyond. We are debating hospital services in south Manchester, but as the hon. Gentleman reminded us, we are also talking about a hospital that provides the most complex tertiary services for a much wider area. Clearly, therefore, the issue is more significant, and it is more important to get it right, than would be the case were the hospital providing important tertiary services merely for a local population.
The consultants who have spoken to me—I am sure that they have also spoken to my friends on the Opposition Benches—have been very clear. There is no question that they are trying to defend their own patch or their own empire; some are constituents whom I have known for many years, and many of them are at a point in their careers when they really do not need to be concerned about those things. Some are very eminent in their fields, and when they tell me that their concerns are purely about patient safety—they say that they are entirely open to sensible proposals for reorganisation, shared service agreements and so on, but that they are worried that the work being done at UHSM could be threatened and could, in the hon. Gentleman’s words, suffer death by a thousand cuts—I am inclined to take those concerns seriously.
To boil the consultants’ concerns down to the simplest level, their analysis is that the high level of complex tertiary services at Wythenshawe can continue into the long term only if it benefits from an equally high level of general surgical support to ensure that different, co-dependent services and procedures can always be provided in the safest way. The hon. Gentleman said very clearly and correctly that, in the consultants’ view, the provision of general surgery would remain at an appropriate level only if Wythenshawe remained a receiving centre for complex general surgery. If the same level of support is not present—we have all seen how this works—it will be only a matter of time before we find ourselves here again, with a new review suggesting that it really is not safe to perform heart and lung transplants at Wythenshawe, because it lacks the necessary general surgical support when complications arise.
The consultants make a powerful and plausible case. First, there is the procedural case that Healthier Together has been flawed and that the process and decision were unreasonable. I also find it compelling when they say that having a certain level of general surgical support is the only way to protect the complex services that are provided at the moment.
I agree with the case that the hon. Gentleman makes about the importance of general surgery to the highly specialised tertiary services at Wythenshawe. Just over 30 years ago 55 people died on the runway at Manchester airport. I hope that such a thing will not happen again, but with the downgrading of Wythenshawe hospital is it not likely that, if people were to need services following an accident at the airport, those services would be of a lower quality? That is not acceptable.
I am grateful to the hon. Gentleman, who makes a critical point. Most other airports probably envy the level of support that Manchester has almost on site—given the trauma centre and the combination of capabilities that Wythenshawe enjoys, so close to Britain’s third busiest airport, which is a major international airport. That is where someone planning with a clean sheet of paper would want a major trauma centre. Added to that, Wythenshawe even has its own helipad to receive emergency cases and get them into the operating theatres as quickly as possible. It is a lifesaving centre for many reasons.
I want to conclude with some thoughts about the way forward. As has been said, correctly, if judicial review proceeds there must be a good chance of success. Unlike most branches of the law, judicial review rather relies on reasonableness, which is viewed through the prism of a reasonable lay person’s views. It is pretty clear that the Healthier Together process fails on those grounds. However, if we get a successful judicial review the price will be at the very least a protracted delay in the reorganisation of services, which should bring benefits to patients across Greater Manchester and beyond. Potentially the price may be much worse, if it is to inhibit the move to the new world of integration of health and social care, for which we all have such high hopes.
The least that we need now is a sensible pause for reflection. We need the parties to draw back from the brink and get back to the table—not to the kind of negotiation in which the decision is restated and people are told they are being silly not to accept it, but to a genuine consultation and discussion with senior clinicians, who have previously felt excluded from the process and unable to make the input that they should have been able to make in the interest of patients. I do not think that any of us cares whether the pause is effected by Ministers at the Department of Health, commissioning groups or the interim Mayor of Greater Manchester.
We need people to be brought around the table, with the genuine good will that I think still exists on all sides. We need a genuine willingness to reopen the question, and an understanding that unless Wythenshawe either becomes an additional specialist centre in the terms of Healthier Together or, at the very least, is guaranteed a status as a receiving centre for acute general surgery, we will not arrive at a state of affairs that is good for Wythenshawe, for Greater Manchester or for the thousands of patients from north Wales and the north-west of England who depend on the complex tertiary services currently offered there.
I am grateful to my hon. Friend Mike Kane for securing the debate. As you have heard, Mr Hollobone, the three Trafford MPs have been working closely together, and with clinical staff at the hospital at Wythenshawe, on our concerns about patient safety, which I want to highlight. Many of my constituents use Wythenshawe hospital as their local hospital, especially following the downgrading of services at Trafford general hospital two or three years ago as a result of the new health deal for Trafford. Indeed, when NHS managers were making the case for that, their argument was that Trafford residents would receive better, more expert care at Wythenshawe. To be told now that services in that hospital may also be downgraded will at least cause a further collapse in public confidence in the processes by which decisions about health service configuration are taken.
My constituents also rely on UHSM’s specialist services, about which we have heard much this morning. They are full of praise for the care that they receive. My hon. Friend the Member for Wythenshawe and Sale East spoke in detail about some of those specialties and I have had the great privilege of visiting some of the specialist teams at Wythenshawe and meeting staff. All are adamant that their success—and they are very successful and in many cases world-class teams—is due to their strong team-based approach and their reliance on the support of a full range of hospital services. Removing or downgrading any so-called ancillary services will have a direct effect on the specialties. It is for that reason that consultants at Wythenshawe have told us that they do not have confidence in the Healthier Together model and that in their view the specialties at Wythenshawe cannot continue to be operated safely under it.
The interdependencies across the disciplines are wide-ranging, but, as we have heard this morning from both my hon. Friend the Member for Wythenshawe and Sale East and Mr Brady, the clinicians we have spoken to are clear that remaining a receiving centre for acute emergency surgery is at the heart of their ability to maintain the holistic care that is needed to ensure patient safety and specialties at UHSM. That is also borne out, for example, by some of the NHS’s national standards. The standard for thoracic organ transplants states the need for general surgical in-house support seven days a week. As we have heard, Wythenshawe is a—if not the—leading centre for transplant surgery in the north part of the country.
I recognise that the numbers of such highly complex specialist cases are small and that the vast majority of procedures and services currently provided at Wythenshawe could continue under the Healthier Together model. I am also happy to acknowledge the work that has been done by NHS managers in the Healthier Together team and acute trust and the commissioners, to look at ways in which the design can protect the expertise and specialism that we value. First, trying to manipulate the process to make a fundamentally unsafe model work is not the right way to proceed. Colleagues are right to say as they have this morning that we need to draw back and ensure that the model itself is correct, rather than trying to ameliorate some of its more dangerous elements. Secondly, it is not just a question of numbers and whether another half a consultant will resolve the problem. It is also about the ability to continue to attract, recruit, retain and develop the full range of professional skills; and about building and sustaining the strong multi-disciplinary teams that the consultants tell us are necessary. It is also, as we heard from my hon. Friend the Member for Wythenshawe and Sale East, about the ability to offer the rotations and varied experience that enable UHSM to function as a full teaching hospital.
Of course we all accept that the ambition of Healthier Together to raise standards across Greater Manchester is the right one. It is unacceptable that outcomes are so poor in Greater Manchester and so patchy across different hospitals and acute trusts, but the answer to that cannot be to put at risk one of the best performing hospitals in the conurbation—indeed, in the country—and its highly successful outcomes in the hope that other hospitals will, in time, rise to meet those outcomes. It is absolutely right that we want to see outcomes improved at all our hospitals in Greater Manchester, and very much so in the case of Stockport. I understand, however, that there is not even yet a guarantee that the resources will be available to enable the improvements at those other hospitals to bring them up to the standards currently achieved at Wythenshawe and, at the same time, we risk a deterioration in the outcomes that we enjoy at UHSM.
I am also concerned that the risk to safety could be exacerbated by the proposed governance arrangements. As things stand, UHSM and Central Manchester Foundation Trust—the two trusts that will be working together to deliver some of the services that are currently available at Wythenshawe—will each retain their own governing bodies. As we have heard this morning, some shared services have been agreed by the two trusts, for which I understand there will be a shared services board and a shared clinical standards board. For the rest, however, the model proposed for CMFT and UHSM will, effectively, create the largest single combined acute trust in the country, while retaining two separate governing bodies, creating potential for confusion, inconsistency and a blurring of accountability.
In my view, there are really serious and genuine questions about patient safety inherent in the Healthier Together model, and we all have an obligation to address those. As we have heard, the consultants are seeking to expose the risks, possibly via a judicial review, but given the nature of their concerns and the delays that a judicial review process would cause to getting the right health configuration for Greater Manchester, I believe we need to make sure that the process we follow now to reach the right decision is a health-led—clinically led—review of the issues.
When the Secretary of State kindly met my hon. Friend the Member for Wythenshawe and Sale East, the hon. Member for Altrincham and Sale West and me prior to the summer recess, we understood him clearly to say—and we appreciated this—that he would be prepared to intervene if safety were an issue. As we have heard this morning, the various concerns that have been expressed include safety concerns, and I hope that the Minister will say today how the Department intends to satisfy itself that those are being properly addressed.
One route might be—although this, too, would increase the risk of delay—to consider a referral to the independent reconfiguration panel. That would ensure a clinically led approach to the review of the decision, and we are familiar with that route in Trafford, given that it was followed as part of discussions on the new health deal for Trafford. Has the Department looked at that model, or will it? If that is not an appropriate route, will the Minister indicate other ways in which he can encourage a collaborative, clinically led pause and proper analysis of the situation within Greater Manchester, as the hon. Member for Altrincham and Sale West suggested?
None of the three MPs in Trafford wants to delay the changes that we desperately need in Greater Manchester to improve patient outcomes, but if the Minister is not able to give us assurances on behalf of the Department, I am quite sure that the legal action that the consultants are reluctantly considering will proceed. They will feel that they have no alternative, in the interests of their patients, but to ensure that this decision is properly challenged and exposed. I have to say, too, that given the concerns about patient safety that they, as clinicians, are highlighting to us as politicians, I will feel obliged, in the interests of my constituents, to support them.
None of us wants to go down that route this morning. We hope that the Minister will be able to give us practical but reassuring commitments about a better way to resolve these very serious concerns, which, as we have heard, not only affect our constituents directly, but will be far-reaching, both immediately, in terms of the wider care that is provided at UHSM to patients well beyond the Greater Manchester conurbation, and in the long term to the credibility of the approach that is being taken in Greater Manchester and our ability to operate devolved healthcare effectively, as we all want.
Thank you, Mr Hollobone, for the opportunity to take part in today’s debate. It is a pleasure to serve under your chairmanship for the first time. I echo other hon. Members’ congratulations to my hon. Friend Mike Kane on securing the debate.
I will be brief because I do not want to repeat other hon. Members’ comments about Healthier Together, but I agree with a number of concerns raised about the process. The consultation was less than ideal and I think we all agree that the model needs review to ensure that we deliver the highest quality services for patients. I also agree that there was a strong case for awarding Wythenshawe the fourth specialist status. The high quality of the services at that hospital has already been outlined and the transport connectivity, especially given the new developments of the Metrolink line and the relief road, makes it the best option.
Like other Members here, I was disappointed by the decision not to award the fourth specialist status to Wythenshawe. What is key now is for the assurances that we have been given in relation to the existing specialisms to be robust, and for those services to be protected. I visited Wythenshawe hospital over the summer and saw for myself some of the absolutely excellent, world-leading specialist heart and vascular care provided there. What I took away from that visit more than anything was how much some of that excellent specialist provision relied on high-quality general surgery support. I agree that it is vital that we do not lose those connections and that expertise.
Having expressed disappointment about the process and the outcome of the consultation and decision making, we should not be blind to the opportunities that we now have in healthcare in Greater Manchester, particularly south Manchester. Co-operation, not competition, needs to be the future for our NHS. That is what lies behind the principles of Healthier Together, which we agree with, and the plans for devolution of health funding and organisation to Greater Manchester.
I congratulate Mr Brady and my hon. Friends the Members for Wythenshawe and Sale East (Mike Kane) and for Stretford and Urmston (Kate Green) on making a compelling case, which I hope the Minister listens to.
Does my hon. Friend Jeff Smith agree that when we are looking at devolution and the reconfiguration of health across Greater Manchester, the evidence shows overwhelmingly that public opinion will be undermined if we rush ahead with a proposal that is clearly not good for the people of Greater Manchester? People have genuine concerns that we will not achieve the fantastic things that we could by looking at reconfiguration of health. We must consider pausing the situation and listen to the general population of Greater Manchester, giving them a voice in this process which they feel they have not had so far.
My hon. Friend makes an excellent point. Clearly, Wythenshawe was the public choice for a specialist hospital.
On working together, which I was just talking about, there is clearly a growing and improved relationship between Wythenshawe and the Manchester Royal Infirmary. Some people see that as a concern, but I think that it is very much to be welcomed and we need to see it as an opportunity.
In south Manchester, we have the opportunity to be an exemplar of partnership working. We have two fine hospitals in Wythenshawe and the MRI, which are on either side of my constituency. My constituency also houses the excellent—and, I believe, underused—facilities at Withington community hospital, which was established under the last Labour Government. I look forward to an expanded role for Withington community hospital in health provision in south Manchester, supporting the two major hospitals and providing joined-up services for all our communities.
We have an opportunity to use Withington community hospital to integrate community services, primary care, secondary care and mental health support, with health services and social care services working together for the benefit of all the community in Manchester Withington and the whole of south Manchester. I urge everyone involved to make the most of that opportunity to expand and improve services at Withington community hospital.
I agree with many comments that hon. Members have made about the Healthier Together process, but I welcome the opportunity to use all those hospital resources together—to use Withington as a thriving community hospital to improve health outcomes for people in south Manchester.
Before I call the Front Benchers, I should say that we are going to have the pleasure of hearing Mike Kane sum up the debate for three minutes at the end. I would be grateful if the Front Benchers would be kind enough to leave him enough time to do that and if he would be kind enough to leave me 30 seconds at the very end to put the motion to the Chamber.
It is a pleasure to serve under your chairmanship, Mr Hollobone. It is a pleasure, too, to be the shadow Minister in the Labour health team not running for the leadership of his party. That is a genuine pleasure, let me assure you.
I congratulate my hon. Friend Mike Kane on securing this timely and important debate, which is of huge importance to his constituents and those of many colleagues from across the House who are in the Chamber today. However, I will be brief, Mr Hollobone.
Hon. Members on both sides of the House will appreciate that changes to local NHS services can often be difficult and cause our constituents major concern. It is entirely appropriate, therefore, that when changes are being proposed, hon. Members speak up for their constituents and express any concerns that their constituents may have. I have been doing that with regard to services in my own local hospital for the past 10 years. The Minister is aware of that, and we are working together to try to resolve the issues.
We all know that the NHS will have to make major changes over the coming years. One of the big challenges facing health and care systems around the world is how to do more for less; that is as true in the UK as it is anywhere else. The ageing society and the need to move services out of the hospital and into the community mean that difficult decisions will have to be taken in the course of this Parliament. If done properly—if done rightly—those decisions could and should lead to a better standard of care for our constituents and a more sustainable future for local health services right across the country. Where that is the case, hon. Members have a responsibility to support the changes, but where the clinical case has not been made, hon. Members are right to be questioning and to seek reassurance that any changes are focused on the quality and safety of services.
It is vital when any changes to hospital services are being proposed that a number of basic principles should apply, and I shall outline some of those. First, the public should be involved at the very outset of any proposal for change. The proposals should not be designed behind closed doors, and the clinical case must be presented to the public at the earliest opportunity; I struggle to count how many well intentioned reconfigurations have fallen foul of that test.
Secondly, there must be a proper, meaningful consultation. Too often, proposals for change are presented as a fait accompli and the consultations that follow are little more than box-ticking exercises. My party has previously proposed that the formal responsibility for consultation should be given to an independent body, such as the health and wellbeing board, instead of being a responsibility of clinical commissioning groups. That could go some way towards improving the consultation process and would certainly restore faith in the independence of the consultation process. Thirdly, and perhaps most importantly, the process should be as open and transparent as possible. The public should be entitled to the full range of information and data required for them to have an informed view on any proposals put forward.
Today’s debate has focused on the Healthier Together review and, as we have heard from several colleagues, the review appears to have fallen short on a number of factors. My hon. Friend the Member for Wythenshawe and Sale East spoke in particular about the decision not to choose Wythenshawe hospital as the fourth site to provide emergency abdominal surgery, as part of the single service model proposed by Healthier Together. He made a compelling case as to why Wythenshawe hospital should be recognised as one of the “fixed site” specialist hospitals. I do not want to take up too much time, as I am conscious that hon. Members have raised specific concerns to which the Minister will want to respond in as much detail as he can, but I would like to press him on a couple of points to which my hon. Friend referred.
First, it appears that the decision to allocate the fourth specialist site was made largely on the grounds of travel and access. The strapline for the review includes the phrase “helping to save more lives”, but it seems clear, not just in Manchester but across the NHS, that access to services and the quality and safety of those services are too often presented as a binary trade-off. We must improve on that way of configuring services, so will the Minister tell us what more can be done to resolve what appears to be an invidious choice facing people right across Manchester?
Secondly, I understand that during the public consultation 33% of respondents gave Wythenshawe as their choice for the final specialist site, while Stepping Hill was backed by 26%. The Minister will appreciate that that has led some to question the point of the consultation and, understandably, has led to concerns that the views of the public are not adequately being taken into account. Wythenshawe hospital’s medical staff committee said that the decision was “irrational” and, as we have heard, there were reports last week of a plan to apply for judicial review. That is in no one’s interests. No one wants their hospital or services caught up in legal disputes.
I hope that the Minister appreciates that there is genuine frustration among hon. Members across the political spectrum—he has seen that for himself here today—about the Healthier Together process and that there are important questions that require answers. More broadly, I hope he will ensure that the NHS reflects on what lessons can be learned from this process to ensure that the public can have confidence that future proposals for change are focused on improving the quality and safety of local NHS services, and also that access to safe and high-quality—indeed, world-class—services remains equitable for all service users and taxpayers.
My final point is about Manchester airport and the nearest adjacent hospital. As a country, we need to address the needs of those communities that host nationally significant, strategic pieces of infrastructure. That might be Manchester airport or Sellafield nuclear reprocessing plant in my constituency. The communities that house such infrastructure require special regard to be paid to them when it comes to the configuration and supply of services at their local hospital. We should do that as a nation. It is done in other countries. I hope that the Minister will reflect on such an approach. I look forward to working with him on precisely that approach and to hearing his response to the points that I have made.
First, I thank and congratulate Mike Kane on bringing this debate to the House. It is a particular pleasure to be answering him. His predecessor became something of a friend, and I know that he had a similar admiration for him and certainly a far closer friendship with him, so I feel honoured now to be answering, as one of my first clutch of Westminster Hall debates, a debate brought here by him.
As is so often the case with Westminster Hall debates, it is frustrating that the debate will not be more widely seen and understood by members of the public, because they would see Members of Parliament fighting hard for their constituents and constituencies, and speaking with great eloquence and detailed knowledge and understanding of complicated things. Those things are not necessarily within their professional expertise, but they have done the research and acquired the knowledge to be able to speak about them. And, most important, Members are speaking on a cross-party basis. If more people were to see that, they would see the value that they were getting from their representatives. I value very much the passion and the detail that the hon. Member for Wythenshawe and Sale East has brought to the debate, as I do that of other hon. Members who have spoken and the measured response that the shadow Minister, Mr Reed, has given.
I should say at the outset that I am rather more restrained from giving an expansive answer to the hon. Member for Wythenshawe and Sale East than I would normally be, because a letter before action has been issued and, although the Department of Health is not a party to any legal action, I would not like to prejudice something that did come about. I hope that the Gentleman will not mind if I comment on those areas on which I can comment and then on the general principles that were raised. Kate Green specifically raised the general policy of reconfiguration. I can give her more detail about that and give, I hope, a narrative explanation of how I and the Department understand the process as it has gone on so far.
In the round, it is welcome that the hon. Gentleman and other hon. Members understand the importance of devolution. I agree completely with him that the turn of events in Manchester is of serious significance; it is of a generation-changing nature. It was good to hear my hon. Friend Mr Brady saying exactly the same thing. It is important that decisions that are taken at any stage by devolved administrations, whether they be clinical commissioning groups, local councils or health and wellbeing boards—or indeed the overview and scrutiny committees in the way they look at these decisions—inspire confidence in devolved decision making, rather than acting against it. Of course, reconfiguration and change normally cause some disruption and disquiet in areas not chosen as sites for new or increased activities. He spoke powerfully of the need for devolved powers, but I hope that he accepts that it is in the nature of such decisions that people will sometimes be disappointed.
I understand entirely why Wythenshawe, with the extraordinary range of specialisms, both secondary and tertiary, which the hon. Member for Wythenshawe and Sale East pointed to, and with a history famous not only in the north-west but across the country, should feel aggrieved that it was not one of the four centres chosen to be part of Healthier Together. It would be unusual if the world-respected clinicians and management at the hospital did not fight their corner, and it is appropriate that he should represent their concerns. I agree with everyone who has said that it would be extremely sad for the matter to go to judicial review. We certainly do not want that to come to pass, either in this consultation or elsewhere.
Before I talk in general about consultations, I want to bring the hon. Gentleman up to date on events in the past couple of days. I understand that there have been some constructive conversations between commissioners and clinicians at the hospital, and that discussions will continue about the relationship between tertiary specialties and the general surgery that, it is proposed, will be moved to one of the four sites. A conversation has begun and is continuing, so there is a glimmer of hope that the parties involved will not go to the courts on this matter, which is so important for patient safety and healthcare in Manchester.
I want to speak about the nature of consultations, and to respond to the shadow Minister’s entirely correct points about how a consultation should be conducted. As a constituency Member of Parliament, I, too, have been through a number of health consultations. Some are good, and some are bad, but I hope that we are generally getting better at them. I remember several, under the previous Administration—this is not a party political point, but I think that the process is generally iterative within government—which were particularly poorly conducted. To their credit, the previous Administration reversed some of the decisions.
Some consultations are well run, however, and have the support of large numbers of people in the community. I can only report on the information that I have received, but I am impressed by the support from local councils, from clinicians, from the clinical senate, from doctors and from management across Manchester for the Healthier Together programme, and for the size and scope of the consultation. As the shadow Minister and Opposition Members know, a consultation is not a plebiscite, so we cannot take the raw number of responses in favour of any particular solution as a “correct” response. It is important that all consultation responses are taken into account, and I have been assiduous in trying to make sure that the Healthier Together team—the commissioners—have listened to all consultation responses. I have urged them to engage as profoundly as possible with Wythenshawe to show that the responses have been listened to with care.
At the core of the proposal is a noble ambition: to save in excess of 1,000 lives over a five-year period. If Manchester were to match the best mortality rates achieved elsewhere in the country, 300 lives a year would be saved, which is nearly a life a day. The decisions being taken are difficult, but they will produce a considerable dividend not only for hundreds of potential victims of currently substandard care but for their families, extended families and friends. The prize is considerable, and it is worth striving after.
I agree with the shadow Minister that consultations need to demonstrate wide public engagement. I am impressed by the number of people involved in this consultation, which received some 29,000 written responses. There has been 18 months of consultation, and 23,500 people were involved in this specific part of the consultation. There are conflicting answers to the question of how to reduce mortality in Manchester; that has been clear even from hon. Members’ contributions. To mangle St Augustine, we are almost saying, “Let us have service reconfiguration and service improvement, but not yet.”
I do not fully agree with the suggestion made by my hon. Friend the Member for Altrincham and Sale West that consultations and service changes should happen sequentially. It would be impossible to run anything as complex as the health service, or, indeed, anything in government, if one were to take that approach. We must in this instance, as elsewhere, rely on the clinical judgment of commissioners. That lies at the very heart of the changes that the Government have made—both in our coalition iteration and in this new Conservative Government—towards relying entirely on the clinical basis for service reconfiguration. I must, therefore, bow to the judgment of clinicians in this and other instances, and I know that most Members here will want to do the same.
Although the shadow Minister has said that the proposal comes within the global need to try to do more with less—I do not want to rehearse the arguments about healthcare spending—I think that everyone has agreed that, in this instance, finance does not play a part. The chairman of the Manchester local councils made that explicit in his response to the consultation. This is actually about doing more better. There will always be a trade-off between travel times and sites, and clinical excellence. We would all like to have, right next to our house, a hospital with the full suite of tertiary expertise, but as we all know, a high throughput of patients would be required to maintain the necessary skills within clinical teams. Clearly, that would not be possible, so there has to be a balance between the number of sites and the distance that people must travel to them. That is the balance that the consultation and the proposal have sought to strike. In the majority of Manchester, it is believed that they have struck that balance correctly.
The Minister spoke a moment ago about the decision being taken by clinical commissioning groups—by clinicians. The problem is that a different group of clinicians, namely the consultants at Wythenshawe hospital, are offering a different opinion about patient safety from that of the commissioners. As politicians, I believe that we must take account of the fact that safety is being flagged up by clinicians. How does the Department reconcile the difference of opinion about patient safety between commissioners and consultants?
The hon. Lady is right to say that there are concerns from some clinicians at Wythenshawe hospital, and we should listen to those. There is an established process by which those concerns should be brought to bear. If she does not mind me running through the detail of how reconfiguration policy works, I am sure that she will find answers to some of the questions in her speech.
Our first principle is that the service changes should be led by clinicians, which is the point of the process. In this instance, the service changes are being led by 12 clinical commissioning groups coming together to discuss the future of 10 hospitals. The service changes will affect just under 1% of in-patients, and just under 20% of patients receiving general surgery, at Wythenshawe hospital. Within the context of Wythenshawe hospital as a whole, we are talking about a very small number of patients. I appreciate the hon. Lady’s concerns about the interrelationship with other specialties, but let us keep it in mind that this is a small number of patients.
Once the commissioners have come to their decision, there are two ways of resolving complaints from one party or another. The first is by a recommendation from the joint overview and scrutiny committee to the Secretary of State for Health—such a recommendation has not been made in this case—or by a referral to the Independent Reconfiguration Panel, which the hon. Lady mentioned in her speech. The Independent Reconfiguration Panel has made a number of recommendations in the past. That is no predictor of future performance, but at no point in the past, under any Administration, has a Secretary of State gone against the Independent Reconfiguration Panel’s recommendations. The point of both those exercises is to retain clinical ownership of decisions, albeit by different clinicians from those who made the original decision. If we go back to the bad old days, when decisions were made for political purposes following a clinical recommendation, we would not listen to clinicians in the round and, therefore, would make decisions on the wrong basis, possibly putting lives in jeopardy.
The hon. Lady has raised clinicians’ concerns about the effect on tertiary services, which are impressive at Wythenshawe hospital. All I can say is that NHS England has undertaken a thorough clinically-led review of all tertiary services at the hospital and has concluded that the changes to general surgery for stomach and bowel accidents will not adversely impact on the tertiary specialties available at Wythenshawe hospital. That is the advice that the Department has received from clinicians at NHS England. I have described the other options open to parties in Manchester, and I reaffirm that, even if it might suit some Members present to take that decision-making process out of clinical hands at whatever level and to vest it in the Department, it is not a direction that anyone on either side of the House ultimately wishes to take. We must therefore trust the opinion of clinicians in the bodies that have made those decisions so far.
My hon. Friend, for obvious and very good reasons, is valiantly treading a tightrope between discussing the specific case and addressing the general points, but I must counter the suggestion that any of us is here to try to overturn clinically-led decisions. On the contrary, our concern is that very senior clinicians feel that they have had no voice in this process. As Kate Green said, they are now raising very serious concerns about patient safety. As I said earlier, the consultants I have dealt with at Wythenshawe hospital are serious professionals who do not say that lightly. I also suggest that the three local Members here today do not have a record of hysteria on such things, and we are united in our concerns. We are perfectly capable, and we have shown that we are capable, of making reasonable judgments about reconfiguration when that reconfiguration is reasonable.
I am acutely aware of the huge spread of sensibleness on both sides of the Chamber, and I would not want any of my remarks to be construed as suggesting otherwise. On the contrary, I restate that it is not only reasonable but right that local Members respond to the views expressed by very experienced clinicians in their local hospital.
In my short discussions so far with local commissioners —I am sure there will be more discussions—I have impressed on them the need to engage fully with all clinicians. I understand that they began the process afresh before I made that request and that they will continue that engagement. We will only get good reconfigurations across the country if we have the general buy-in of clinicians and the public. We are now doing that better than we were five, 10 or 15 years ago, when every reconfiguration of every kind was fought tooth and nail by everyone. There is now a general move to an understanding that we need to make some changes to some areas. Indeed, the shadow Secretary of State for Health, Andy Burnham, has made clear his desire to see some services centralised:
“If local hospitals are to grow into integrated providers of Whole-Person Care, then it will make sense to continue to separate general care from specialist care, and continue to centralise the latter. So hospitals will need to change and we shouldn’t fear that.”
I could not agree with him more on that general principle, but it does not change the fact that commissioners need to engage with every single party.
My hon. Friend the Member for Altrincham and Sale West, and every other Member, can be sure that I will pass back to commissioners their specific concerns about that engagement. In the discussions, which I am sure will continue between all of us, I hope that he and other Members will notice continued engagement between commissioners and clinicians at the hospital, and I hope that there will be a happier outcome than the one that might come about through judicial action.
Graham Stringer and the shadow Minister both spoke about Manchester airport and made interesting and valid points about the need for a stated relationship between important national infrastructure and centres of major trauma care. I will respond to the shadow Minister in writing on that specific question, if he does not mind sharing that response with his colleagues. This is an important matter, and I want to ensure that I can answer it in detail and in full.
If I interpreted his remarks correctly, the shadow Minister also said that consultations had been taken out of the hands of clinical commissioning groups specifically to be conducted by a third party, such as health and wellbeing boards. Again, I have not previously heard that idea, but I am happy to respond to that specific point once I have been able to give it greater thought, with no implication for the current consultation.
I will now close in order to give the hon. Member for Wythenshawe and Sale East time to reply to my comments. We all agree that reconfiguration needs to happen. In this instance, there has clearly been support from those Members who have been the beneficiaries of the reconfiguration in their constituencies, but the most important beneficiaries will be the people of Manchester, who I expect will see world-leading trauma care connected to emergency stomach and bowel surgery as a result of these changes. We must be proud that clinicians are leading the review, we must be proud that clinicians have been prepared to make bold and difficult decisions and we must be proud that Members present have come forward to represent the concerns of some that clinicians have not made those decisions in the right way. Members have made those points with lucidity, care and passion.
I hope that in the next few weeks we will resolve this matter in a rather happier way than it might otherwise have been resolved, and I pledge to continue my discussions with Members on both sides of the House to ensure that that is the case.
Thank you for your excellent chairing of these proceedings, Mr Hollobone. I am grateful to the Minister for his reflective comments on the process and for bringing us up to date on the latest developments. I stress to him that Mr Brady, my hon. Friend Kate Green and I are not behind the curve, as he can probably tell from the excellent contributions made by them.
I also thank the Minister for what he said about Paul Goggins, who worked with local elected members long before I did on the reconfiguration of Trafford services. In some ways, the assurances that he had about those reconfigurations and about working with NHS England are not being met through the process. It was also Paul Goggins, along with colleagues, who campaigned for the improvements in accident and emergency at Wythenshawe hospital. A £12 million scheme will begin there in November to create a new A and E village, a world-class facility. The Minister is right that this is a once-in-a-generation opportunity to integrate health and social care. It is also a once-in-a-generation opportunity to show that large conurbations such as Manchester, which is moving towards 3 million people, can take control of their powers to deliver their own health and social care.
I thank the Members who have turned up. What my hon. Friend Jeff Smith did not say about himself is that he was at the forefront of the campaign to build the new hospital in Withington all those years ago, when we reconfigured the services. We can make more of that hospital; we are already discussing 24/7 GP access there. If we can realise that vision to ease the pressures on A and E departments across the conurbation, it will be a major achievement, thanks in no small part to his campaigning activity long before he came to this place.
I am delighted that my hon. Friend Angela Rayner is in her place. The hospital in her constituency has undoubtedly had a torrid time over the past six or seven years, but today NHS England lifted it out of special measures, which is cause for everyone to celebrate. My hon. Friend Graham Stringer has been a constant defender of his local hospital, North Manchester General, and has been a visionary leader, in the sense that we are now getting to the point of being able to devolve powers on skills, housing, transport, business, investment and, eventually, healthcare to Greater Manchester. He has been at the forefront of that.
I thank the shadow Minister for his erudite contribution and for linking the issue to Manchester airport. We cannot consider health on its own. The decision on “The Northern Way”, or the northern powerhouse, can be pivotal in getting world-class inward investment in healthcare in Manchester. It will link to the airport next to the hospital, which had 23 million passengers this year, increasing to 40 million over the next couple of years. We have plans in our area to expand the Metrolink at some stage to connect Wythenshawe directly. Currently it connects to Manchester airport, but we want to send the loop around to connect with the High Speed 2 station and back to Wythenshawe hospital.
We in the north-west have had problems in the past, as hon. Members will know. I pay tribute to David Rutley, who has been considering life sciences across the region, including AstraZeneca and regenerating Alderley Park, and linking the issue to our vision of a life sciences institute medi-park on the Roundthorn industrial estate next to our hospital. That could be further linked to the Corridor project involving graphene and the life sciences, associated with Central Manchester hospital. We need more links with that in the future. That site also ties into Airport City, which is in development both south and north of the airport. We are expecting massive change in south Manchester and Trafford over the next 10 to 15 years. It will be generational change that will drive the northern powerhouse, with the addition of HS2 and possibly, given the discussions that the Department for Transport is having, of HS3.
We have a wider vision for the site, and we do not want it to be set back by process issues. Let us all—people watching today and everybody in this Chamber—commit to the vision of making south Manchester and Greater Manchester a world-class place for economic investment and healthcare.