§ Mr. Tony Favell (Stockport)This morning, I have the opportunity of drawing the House's attention to an issue which has concerned me since I was elected to represent Stockport in 1983, and on which I have compaigned ever since. I regard it as the single most pressing problem for my constituents. I refer to the split-site nature of acute hospital services.
There are approximately 30,000 in-patient admissions a year in Stockport. That is considerably more than for well-known teaching hospitals nearby such as Withington and Manchester royal infirmary. Yet the medical staff at Stockport face an enormous problem in trying to provide a modern and efficient acute service on sites that are three miles apart.
Three departments are located at Stockport infirmary: the orthopaedic department, the ear, nose and throat department, and the accident and emergency department. All other acute services are dealt with three miles away at Stepping Hill. That situation is intolerable and the patience of the staff is now exhausted. Despite that, excellent service is given at Stockport, and in league tables drawn up by the regional health authority the Stockport infirmary and Stepping Hill often come top. The staff would have caused the Government serious embarrassment long ago but for their dedicated, hard-working nature.
Stockport infirmary is a fine building that has just celebrated its centenary, but it is totally unsuited to be a modern hospital. It is situated in the middle of town opposite the town hall and the parking facilities are suited to the mid-19th century. Ambulances have enormous difficulties even getting to the hospital and an emergency case arriving by car cannot get anywhere near the entrance. Yet the infirmary houses one of the busiest casualty departments in the north-west. Last year almost 60,000 new patients were treated in that department.
I visit the infirmary regularly and I regret to report that, on many occasions, the atmosphere has been little short of pandemonium inside and outside the hospital simply because of the physical nature of the building. The staff are extraordinarily hard working, but they work under Victorian conditions that would have upset Florence Nightingale.
On my first visit to the accident and emergency department, soon after my election in 1983, Mr. Tony Redmond, then the consultant in charge of the department, showed me the conditions in which he and other staff worked. He pointed out to me the dangers created by the acute services being on a split site. I do not exaggerate when I describe the situation as dangerous. It is an extraordinarily busy casualty department and the major accident-receiving centre serving a population of 300,000, but there are no intensive facilities on site—they are three miles down the road at Stepping Hill. The blood bank is also situated there. Unless a seriously ill patient is fortunate enough to have problems requiring an orthopaedic surgeon or a complaint affecting his ear, nose or throat, he must be put back in the ambulance and taken down the A6, the busiest non-dual carriageway in the north, to Stepping Hill. Alternatively, he must wait for a taxi to bring a consultant from Stepping Hill to the infirmary.
490 Mr. Alistair Gray, the consultant now in charge of the accident and emergency department, wrote to me last year saying that there was no doubt that patient lives were put at risk each time there was a transfer to Stepping Hill. Lives have been lost, and will continue to be lost until something is done about the situation, which I deplore. It is a disgrace that a patient, having reached the apparently safe haven of the casualty department, should find limited facilities awaiting him.
Since Mr. Redmond first brought the matter to my attention seven years ago, I have bombarded the district and regional health authorities, the then Department of Health and Social Security and the Department of Health with demands that something should be done.
Not many Members of Parliament are happy to campaign for a hospital to be closed, but that is what must be done to give a decent service to the people of Stockport. I have brought—probably dragged—two Ministers to the House on the matter: first, my right hon. Friend the Member for Braintree (Mr. Newton) when he was Minister for Health and recently my hon. Friend the Member for Kettering (Mr. Freeman) when he was a Minister at the Department. I asked them to consider the position in Stockport.
There have been delegations to Ministers here in London, including one to the present Chief Secretary to the Treasury, my right hon. and learned Friend the Member for Putney (Mr. Mellor), when he was at the Department. The proposal to close the infirmary has the support of all the staff and the unions and, indeed, the whole of Stockport, apart from some members of the Labour party who seek some short-term advantage out of campaigning for it to remain open. All the staff support the hospital's closure because those dedicated health workers are determined to provide the best for Stockport and so am I. But we have been thwarted at every turn.
The proposal to move the accident and emergency department to Stepping Hill has been on the books for almost 10 years. During that time there has not been a single major capital project in Stockport. Yet last year Stockport was not included in the region's health capital programme up to 1992–93. I and the district health authority had been led to believe that Stockport had an overwhelming case for inclusion in the region's three-year £166 million capital programme. Its failure to be included in that programme was a devastating blow to the morale of the medical profession in Stockport.
It is clear that with the reform of the health service there is to be greater competition between NHS hospitals. The medical profession in Stockport is ready to accept that. But how can it compete with the nearby Manchester royal infirmary, Wythenshawe hospital and Withington hospital if it has the appalling split-site problem?
Next month Stockport has a further chance to be included in the capital programme. I cannot emphasise how important it is that the bid should be successful. In March this year the north-west regional medical committee pointed out that the Department of Health had accepted the recommendation of the Royal College of Surgeons and the Casualty Surgeons Association that it is unacceptable for major accident and emergency departments to be located away from the full back-up facilities of a main district general hospital. That point was taken by the regional medical officer, who stated that it was a fundamental principle of the region's service and capital planning developments.
491 I have been led to believe that some mix-up resulted in Stockport not being included in the capital programme last year. It would be a shattering blow if next month it were not included. I beg my hon. Friend the Minister to do all in his power to ensure that it is included. If he gives me that assurance, I and all of Stockport will wish him a very happy Christmas.
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)As my hon. Friend said, he has been a consistent supporter of this project ever since the day he was elected to the House in 1983. He made it clear that he was an early convert to the unacceptability of the present arrangements for the treatment of accident and emergency and other patients on the split-site basis of the Stockport hospital. He has been an effective—I might even say relentless—campaigner for action to resolve the problem since he first arrived in the House. I am conscious that I am the latest of a long line of Ministers, most of whom are now much more distinguished and eminent than I, who have been the recipients of my hon. Friend's representations on behalf of his constituents.
I am sure that they will agree with me that the argument that my hon. Friend has presented to us and to the House is a powerful one and I am confident that it will ultimately succeed, not least because of the power of my hon. Friend's advocacy. The House has witnessed his advocacy on behalf of his constituents twice this week. Today, he has had the opportunity to present the argument at some length. Yesterday, he presented it at Question Time—not at such great length, but perhaps at more length than is usual on such occasions.
It is extraordinary that an argument which is so widely supported in the Stockport area and which has been recognised to be powerful by many in the health service, including Health Ministers, should have elicited such a hostile reception yesterday from the hon. Member for Denton and Reddish (Mr. Bennett). It is odd that an argument based clearly on the principle that the proposals that my hon. Friend supports would produce a major advance in the quality of care provided to patients in that area should be the subject of opposition from a member of a party which prides itself on its espousal of the cause of the national health service. I am sure that my hon. Friend will lose no opportunity to give the hon. Member for Denton and Reddish a chance to explain his point of view more widely in the Stockport area.
My hon. Friend has made it clear to the House that Stockport infirmary is an aging hospital. Although it is distinguished, the building is perhaps better equipped to stand opposite the town hall and perform some distinguished function in the centre of Stockport than to house a hospital. Certainly, the building is widely recognised not to be adequate for the use to which it is currently put.
As my hon. Friend explained, the infirmary has one of the busiest accident and emergency departments in the north-west, treating almost 60,000 new patients each year. It is not the 60,000 new patients, however, who pose a problem in the provision of accident and emergency facilities in Stockport—it is the fact that 2,500 of those patients have to be transferred during their treatment from Stockport infirmary to Stepping Hill hospital, three miles down the A6, which is one of the busiest roads in the 492 north-west. I have good reason to know that, because at a point further south in its course it passes through my constituency. My hon. Friend may be interested to know that in Leicestershire we have been able to obtain finance for dualling the A6 and taking it round some villages, precisely because the road is so heavily used.
§ Mr. DorrellMy hon. Friend will know that, although, for constituency reasons, I may wish to join him in that campaign, I cannot deal with it in detail now.
The transfer of patients during their treatment between two acute hospitals carries with it significant risks, especially as the journey can take 30 minutes or more at times of peak traffic. It is a matter not of speculation but of fact that cardiac arrests have taken place in ambulances between those two hospitals. Not only does the transfer present avoidable and unnecessary risks for patients; it is a waste of resources because every patient transferred between the two hospital sites has to be accompanied by medical and nursing staff. It is an absurd waste of the time of front-line, highly trained, expensive, dedicated staff to have them stewarding patients between two hospital sites, especially when it is in the patients' interests that that transfer should not take place.
It is a powerful case. One does not have to be an expert in every detail of the circumstances of the Stockport area to understand the inadequacies of the present level of provision. As my hon. Friend has said, this is not merely a lay assessment of the position on the two sites. The case that he has espoused has been argued strongly by, among others, Mr. Redmond, and by all the consultants involved in acute medicine in Stockport, by the North Western regional medical committee, the Royal College of Surgeons and the Casualty Surgeons Association, which have all said that it is unacceptable to have accident and emergency provision divorced from general acute provision within a district general hospital. The expert opinion merely reinforces what most of us would regard as common sense. If we are admitted to hospital through an accident and emergency department, our hope would be that our acute condition could be treated by whatever specialist treatment and back-up was necessary within the hospital to which we were admitted.
In Stockport at present there is clearly a wasteful duplication of resources. The infirmary offers less effective medical care to the patient and has been described as unacceptable by those with a lay interest, and general management and professional opinion in the health service. Furthermore, precisely because it is recognised to be unacceptable, no one is surprised that the College of Anaesthetists has temporarily refused to recognise Stockport infirmary as a training centre for junior anaesthetist posts, and the ear, nose and throat hospital recognition committee has demonstrated its concern about the level of provision in the district by granting only temporary recognition for junior ENT posts in the hospital.
All this is profoundly unsatisfactory. However, the situation is a tribute to the dedicated staff of the two hospitals, in this context particularly those at Stockport hospital, who have put so much effort into making an avowedly unsatisfactory state of affairs work in the best 493 way possible in the circumstances. The health service relies on a dedicated caring staff, and nowhere more so than in my hon. Friend's constituency.
§ Mr. FavellI am grateful to my hon. Friend for giving way, as he is talking about the dedicated way in which staff at Stockport infirmary behave. In many parts of the country, there would have been shroud waving by now. It is only because the Stockport staff are decent, hard-working, capable people who have gone on in their quiet way that the situation has been allowed to continue. If the same circumstances had applied in central Birmingham, all hell would have been let loose. The decency, hard work and dedication of the Stockport staff should be recognised.
§ Mr. DorrellI recognise the decency and hard work of the staff in the district. Without that, the system could not have been made to work. It is up to us not to take advantage of that, and my hon. Friend is anxious that we should not do so. The dedication, hard work and quiet getting on with the job by his constituents is matched only by the noise that he generates in trying to change the situation.
One of the arguments against my hon. Friend's proposals—the concentration of accident and emergency care on one site at Stepping Hill—is the implications of that for patients coming from the northern part of the Stockport health district. That concern is entirely misplaced and that argument does not tell, as it is alleged to do, against my hon. Friend's conclusions. The argument is wrong because it devalues and fails to take into account the service offered by the Stockport ambulance service and its ability to take patients in need of acute hospital care quickly and effectively from the northern part of the health district to Stepping Hill hospital.
All the ambulance staff in the Stockport service have either completed modular training courses in paramedic skills in some specialties or have qualified on the full NHS training authority paramedic course and are therefore fully equipped to ensure that patients are taken safely to Stepping Hill hospital if they need emergency care.
Furthermore, every emergency vehicle in the service is already equipped with defibrillators, which should be of some comfort to people in the northern part of the area who may be concerned at the entirely wrong idea that their interests are not served by concentrating accident and emergency services at Stepping Hill. Residents in the northern part of the area need to remember that the Greater Manchester ambulance service has standing instructions to take every accident and emergency case to the nearest accident and emergency department. If provision in Stockport moves to Stepping Hill, more patients will be taken from accident and emergency services in the northern part of the district to hospitals in south and north Manchester. There is nothing new in that; the decisions will just be taken across slightly new boundaries.
It would be absurd to take too seriously the arbitrary boundaries between health districts and not to take account of the fact that what is important is that patients in need of emergency care should be put in well-equipped ambulances with well-qualified staff and taken to the 494 nearest emergency department, which may not be within the arbitrary administrative boundaries of the health district.
I wish to draw attention to some of the benefits that would flow from the unified service for which my hon. Friend has argued. It would not only provide better quality accident and emergency care; it would enable the district to achieve an integrated paediatric unit on one site. That would provide a single environment geared for children's needs, including a mother and baby unit, a child isolation unit, an ear, nose and throat department, and ophthalmology—all paediatric care in one unit. That would be a major benefit of the scheme that my hon. Friend supports.
Secondly, the orthopaedic services would be concentrated on two sites instead of three and there would be separate provision for traumatic and elective work, so that the one was less prone to interfere with the other.
Thirdly, this would allow more effective use of operating theatres. The health service attaches greater importance to that than it once did, and rightly so, because fully staffed operating theatres not operating on patients are a crass waste of resources, and the chance to plan their effective use would be a major benefit of a unified system.
The money saved through the greater productivity which would result from implementation of the scheme would amount to £860,000 a year in the single district in my hon. Friend's constituency. Of that, £152,000 would come not from more efficient use of medical manpower but from savings on energy and maintenance. The present set-up cannot be allowed to endure too long, given that so much money is being wasted in that way.
I hope that I have made it clear that the argument espoused by my hon. Friend finds a ready ear in the Department of Health and in the administration of the health service generally.
§ Mr. FavellI thank my hon. Friend for the careful and receptive way in which he has heard my argument. On behalf of the people of Stockport, I wish him a happy Christmas.
§ Mr DorrellI am grateful to my hon. Friend, but I hope that what I am about to say will not lead him to withdraw his good wishes. The proposal that my hon. Friend espouses has a ready audience in the Department and, in one form or another, it will be implemented by the NHS in his area in the not too distant future. He will understand, however, that the administration of the health service and decisions on investment proposals are quite properly matters for the management of the NHS. It is not for me but for regions and districts to decide.
As my hon. Friend has said, in the next month or six weeks the North Western regional health authority will decide its three-year capital programme to 1993–94 and no doubt Stockport health authority will argue strongly for the proposal in the context of the capital programme. The decision whether to go ahead with the proposal in that capital programme properly belongs to the regional health authority, which will have to decide in the context of its capital budget-setting process. It would be wrong for me to pre-empt that decision, and I shall not do so.
The clear argument that my hon. Friend has advanced is widely accepted not only by the Department but by the NHS in the north-west. I am confident that my hon. 495 Friend's powers of advocacy will ensure that the unacceptable standard of provision for accidents and emergencies in his constituency will soon be improved.