HC Deb 22 May 1992 vol 208 cc675-81

2 pm

Mrs. Jane Kennedy (Liverpool, Broadgreen)

Thank you, Mr. Deputy Speaker, for providing me with the opportunity to combine my first speech in the House with this Adjournment debate. As it is my first opportunity, may I add to those of my hon. Friends my congratulations to you on the achievement of your current position.

If the Minister will allow, I shall attend briefly to the conventions of a maiden speech before moving on to raise the concerns expressed by many of my constituents during the election campaign, both by members of staff who work at what is now Broadgreen NHS hospital trust and by residents who are worried about the future of what they describe as their local hospital.

The constituency of Broadgreen, on the eastern approaches to the city of Liverpool, encompasses the communities of Childwall and Wavertree to the south and Broadgreen, Knotty Ash, Old Swan, and Kensington to the north and west, at the end of the M62 motorway. For too many years, as a result of the application of unrestrained market forces, the M62 has been the only avenue for advancement open to many young people in Liverpool: southwards to London and to Europe.

People have wondered about the robust nature of Liverpool politics, but I would respectfully suggest that a local journalist and friend of mine, Ian Williams, got it right when he said, "If you give a city third world economics, why should you be surprised if you get third world politics?" Faced with dramatic demographic change, the people of Liverpool have struggled to find a way forward. The political divisions thrown up there should provide no comfort to the Conservative party. They are a symptom of the continuing decline of the local economy and the hardship that that has created for the people.

Liverpool people have shown great courage and dignity in the teeth of their troubles, turning aside attacks upon them with wit and gritty determination. My predecessor, Mr. Terry Fields, was an example of that determination when he demonstrated that he had the courage of his convictions. An unholy alliance of Conservative stubbornness over the poll tax and the Trotskyist need for a martyr meant that he was indeed convicted for his convictions. A sincere man, he took the rap for the real villains on both sides of that unhappy affair. I wish Mr. Fields a prosperous career outside this House. I am confident that he would not have accepted the governorship of Hong Kong, even if it had been offered to him!

May I take this opportunity to say how proud I am to be the first woman Member of Parliament for Liverpool since Bessie Braddock, who represented the Exchange division for so many years and who was first elected in the heady days of 1945. How I wish that I had been sent here for the first time in similar circumstances—with my party forming the Government and looking forward to a new future for Liverpool. However, that was, not to be. The result of the election places constraints upon us and has lowered our expectations.

Liverpool has, however, undergone a sea change. I am now one of many who are prepared to examine the political realities facing us and to work in partnership with whoever has the best interests of Liverpool at heart. That is what the people of Broadgreen expect, but they also expect the Government to listen and to take account of their very genuine concerns, particularly in this case—the future of their hospital.

Broadgreen hospital trust sees itself as a community hospital. It offers a comprehensive range of high quality services to the people of Broadgreen, Old Swan, West Derby, Huyton and the city's eastern surround.

In November 1989, my hon. Friend the Member for Liverpool, West Derby (Mr. Wareing) raised the issue of Broadgreen hospital in a similar debate. The area health authority had commissioned a report from six eminent local clinicians called the "Pan-Liverpool Review". It examined the future of medicine in the city and many of its recommendations have been implemented successfully. However, one of its proposals was that the accident and emergency service in the city should be rationalised—to use the terminology of the marketplace, which we now have to recognise as the new ethos for what has become the health industry.

Broadgreen district general hospital, as it then was, had to face the proposed closure of its casualty department. That decision remains the stated policy objective of Liverpool health authority and was confirmed as recently as two weeks ago at a meeting of the health authority and the community health council. My purpose in raising the issue is to ask the Minister to review that decision and to take account of the following changed circumstances: first, although the population of the city may still be declining, the catchment area for Broadgreen hospital has a stable population and will show growth over the next few years as the new housing estates being built around the district become occupied.

The hospital's orthopaedic department serves the city's highest concentration of frail elderly people. The accident and emergency department acts as the gateway to this and other specialties that are provided on site.

Secondly, the hospital's medical board and the new directors of the trust oppose the closure. In October 1989, the medical board published its opposition in a letter signed by all the senior medical staff, in which they said that they were concerned that the hospital would be unable to sustain a thriving acute medical and surgical service if the accident and emergency department were to close. Members of the medical board have made it clear to me that that still remains their view and the uncertainty surrounding the proposal is causing serious problems for the trust. The creation of the trust is a reason for not closing the casualty department, but I shall deal with that later.

Thirdly, the community health council has consistently opposed the closure. In 1989, in reply to my hon. Friend the Member for West Derby, the then Under-Secretary of State for Health, the hon. Member for Kettering (Mr. Freeman), stated that if the community health council were consistently to oppose the closure the proposal would come to Ministers for final consideration after a period of public consultation. Two years later, that public consultation has not taken place. The department is, however, scheduled to close in 1993. I urge the Minister to allow further representations to be made before action to close the department is taken. Obviously, we all wish to see it remain open.

The Secretary of State for Health has talked of allowing a period of stability to enable the traumatic changes that the Government have made to the health service to bed in. Labour Members have opposed the changes every step of the way, and rightly so, but I agree that time must be allowed for staff to adjust to their brave new world and to show whether the Government's predictions of improved patient care can be achieved.

For Broadgreen hospital, the need for a time of consolidation and stability is great. Its staff are worn out and tired of the constant reorganisation, and the uncertainty is undermining morale. The trust has made it clear that it wishes to retain and develop its casualty department. It pioneered in Liverpool the introduction of a clinical nurse practitioner to reduce waiting times. That has been successful and it deserves support and encouragement. I hope that the Government will issue a permanent reprieve.

I always intended to make my maiden speech on this topic. However, as there has been no opportunity to raise it in a debate on health, I was pleased to be given the opportunity to raise it now and to hear what the Minister has to say. The changes caused by the establishment of an NHS trust and changes in the way in which the hospital is managed are very important factors which should be borne in mind before any final decision is taken about the future of the accident and emergency department. Public consultation is a necessary part of that process and I look forward to hearing what the Minister has to say.

2.9 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

I am glad to have this opportunity to respond to the hon. Member for Liverpool, Broadgreen (Mrs. Kennedy) in a debate on the future of the hospital and to congratulate her on her success in the ballot for the Adjournment and—I had not expected this—on making her maiden speech. If she carries on in the same vein—suggesting that some of us might have been surprised by the robustness of Liverpool politics—she will win plaudits for understatement which will carry her through. I especially enjoyed learning that her predecessor would not have accepted the governorship of Hong Kong—she might care to sponsor a local competition for what governorship he would have accepted.

Mr. Richard Burden (Birmingham, Northfield)


Mr. Sackville

Indeed. Broadgreen hospital has been an NHS trust hospital since 1 April 1991. The hospital has 540 beds providing a wide range of general medical services, acute care for the elderly and an adult mental illness unit. The trust is successfully meeting the health needs of the local community and progressively developing the services that it offers. Tremendous strides have been made in reducing waiting lists, with no patients waiting more than 12 months since April 1992. The number of people treated increased by 4 per cent. during the 12 months to April 1992.

A number of impressive service developments have also been made. Over the past few years £19 million of capital investment has been made at the Broadgreen site to build a new medical and geriatric block, a new purpose-built psychiatric unit and new facilities for the cardiothoracic centre. Two new consultants have recently been appointed —one to orthopaedics in September 1991 and the second to general surgery in January 1992. Other new initiatives include the establishment of a courtesy car service for transporting patients back to their homes and the appointment of a patient relations advisor who provides an extremely useful link between patients and hospital management.

As the hon. Member will know, there are a great many achievements of which the health services throughout the Mersey region can be proud. The region has the country's best record on waiting lists. No patient has waited more than two years for in-patient or day case treatment since March 1990. In-patient and day case treatments are up 5.4 per cent. on last year. In the same period, coronary artery by-pass grafts increased by 21 per cent. and hip replacements by 14.2 per cent. Mersey initiatives on drugs and AIDS, of which the hon. Lady will be well aware, continue to attract international attention. The region has eight first wave trusts, eight second wave trusts and all the remaining units are in the third wave. The trusts are treating more patients and reducing waiting lists. I took careful note of what the hon. Lady said about the need for a period of stability and I am sure that the point is well taken.

As I indicated earlier, I am aware that there is some local concern about the future of the hospital, specifically the provision of accident and emergency services. Let me give my comments some historical perspective.

In June 1989, Sir Donald Wilson, chairman of Mersey regional health authority and Professor Graeme Davies, vice-chancellor of the university of Liverpool, invited six clinicians to advise on "The Future of Medicine in the City of Liverpool". This became widely known as the pan-Liverpool review. The review centred on the 15 hospitals managed by the Liverpool and South Sefton health authorities. Some of those hospitals had already expressed an interest in becoming self-governing, which meant that the deliberations had to be pursued urgently and the report presented at the earliest opportunity. The inquiry team's report was in fact produced in September 1989 and made a number of wide-ranging recommendations on the direction that service developments should be taking over the next decade.

One area on which the group commented in detail was accident and emergency services. Communities rely extensively on their local hospital to deal with sudden illness and injury, to the extent that an accident and emergency department is often regarded as essential. That can be the source of 90 per cent. of in-patient treatment —and, because of the open-ended commitment, the justification for an array of departments on varying levels of standby. Such departments are staff intensive, which means that the replication of such provision drains resources.

At the moment, accident and emergency services for Broadgreen residents are provided by three hospitals in Liverpool and one hospital in the neighbouring St. Helens and Knowsley district. All four hospitals are situated within four miles of Broadgreen. The pan-Liverpool review concluded that with Liverpool seeking to attract staff from a falling population—for example, there was a 10 per cent. fall between 1981 and 1990—and striving to retain its share of resources, which would decrease because of moves towards resident-based funding, it would not be possible to maintain three A and E departments in Liverpool.

The review considered that the A and E department at Broadgreen hospital should close, not only because it is the smallest of the three Liverpool A and E departments, but because of its location between the A and E departments at the Royal Liverpool hospital—now a trust—Fazakerley hospital—which now forms part of the Aintree hospitals trust—and Whiston hospital—managed by the adjacent St. Helens trust.

The current position is that Liverpool district health authority is proposing to follow up the pan-Liverpool review by undertaking a study of A and E services in the city. I understand that a paper will be put forward at the forthcoming meeting of the district health authority and I imagine that the hon. Lady has heard that the matter is to be discussed. The purpose of the study is to advise the authority on the optimum future provision of A and E services in Liverpool and the implications for neighbouring communities. The study will be undertaken in the light of the recommendations of the review group into the future of medicine in the city of Liverpool—the pan-Liverpool review—of the development of a new A and E department at Fazakerley hospital and of the upgrading of the existing A and E department at Whiston hospital.

Let me make one point clear: the recommendations in the pan-Liverpool review had their genesis prior to the implementation of the NHS reforms and their emphasis was on the role of the purchaser in assessing health care need and increasing patient choice. It is clearly appropriate that the Liverpool health authority should revisit those earlier conclusions. The authority needs to consult other purchasers in Liverpool to ensure that there is co-ordinated provision of A and E facilities in the city and that the views of GPs and residents are taken into account. Those discussions must be reflected in any proposals. It is fundamental that the health authority as purchaser of services must develop a clear focus on the health needs of its population.

I understand that the study will rigorously appraise different options. In view of my earlier comments, I add specifically that there will be a systematic attempt to identify local needs and wishes, that the active involvement of GPs will be sought in all the deliberations and that the provider trusts concerned will be fully involved at all stages, as will those of their staff most closely concerned.

Although the earlier review may have suggested the closure of the Broadgreen accident and emergency department, the proposed analysis by Liverpool district health authority may lead to wholly different propositions. However, this is not the occasion for us to debate what may or may not be the outcome.

The hon. Lady spoke about consultation. Let us be absolutely clear that the proposed study will take into account the views of general practitioners and local people before it enters the period of formal consultation towards the end of the year.

The community health councils have an important role. Community health councils were created by Parliament as part of the accountability mechanism of the national health service and we have stressed their role in the development of local health services within the framework of the NHS reforms. We have emphasised their role in the development of the purchasing function. Clearly, the local CHC will be closely involved in the development of Liverpool's services. If the CHC wishes to object formally to the health authority's proposal to change services, the district health authority will refer the matter to the regional health authority and thereafter, if the RHA supports the district's proposals, the CHC's objection will be referred to Ministers. If that happens, I will consider representations from interested parties. I understand that it is hoped that the outcome of the consultations will be known in time for the first elements to be incorporated in 1993–94 contracts.

I hope that I have given the hon. Lady an idea of the position of the Department of Health on the matter. Her comments about a great deal of change having taken place in local health services are well taken. I can understand that staff and others involved feel that a period of consolidation is needed. I welcomed the hon. Lady's olive branch when she said that the reforms require a period in which to take effect and to achieve their full benefits.

I emphasise that there is no case at present for Ministers to intervene as the hon. Lady requested. The health authority is proceeding in an appropriate manner. I hope that the hon. Lady will draw some measure of reassurance from what I have said in today's debate.

Mrs. Jane Kennedy


Mr. Deputy Speaker (Mr. Michael Morris)

Does the hon. Lady have the Minister's leave to intervene?

Mr. Sackville

indicated assent.

Mrs. Kennedy

I want to take up an earlier point about staffing problems and about the health authority's fears that it may not be able to recruit sufficient staff to sustain three accident and emergency departments within the city. I was astonished to hear that that was one of the main factors to which the Minister referred. Surely provision for patients and patient care should be the primary concerns. There are certainly enough unemployed nurses and medical staff in the city of Liverpool to provide the staff necessary for the accident and emergency department at Broadgreen hospital.

The Minister referred to public consultation. I am assured that the community health council has been involved all the way through in discussions with the health authority and with the trust. At no stage has it been invited to make a formal comment on the proposal to close the accident and emergency unit. I should have assumed that that would come as part of the formal public consultation process. The community health council will make a formal comment in due course.

Mr. Sackville

The hon. Lady is right to raise the question of staff. It was said earlier that there could be a problem with staff recruitment. There are two points in having a review. First, in the atmosphere of the reforms, we have an entirely different basis on which to work. A reformed base review may come to a completely different analysis of the situation. Secondly, as the hon. Lady said, there may be entirely new points to raise; she mentioned some of them in her speech. All those factors must be taken into account in informal or formal consultations. I hope that the hon. Lady will play a role in that process; I am sure that she will. She will have an opportunity, both in the House and locally, to make all those points and to provide any additional ammunition that she feels is appropriate at the time.

The hon. Lady mentioned the community health council. The mechanism according to which the CHC operates in connection with any proposed closure is well laid down. There can be informal consultations and deliberations by the CHC at this stage, but only if and when a formal closure proposal is put can the CHC lodge a formal objection under its statutory role. No doubt it will do that if the situation arises.

Let me make it clear, however, that no such move would be made—especially given the strength of local feeling to which the hon. Lady referred—unless there is a cast-iron case for making it in clinical and staff terms. The distance between one A and E department and another and the effect that an A and E closure would have on the other operations of the hospital would also be taken fully into account. I hope that the hon. Lady will draw a measure of reassurance from my remarks and I congratulate her once again on securing the debate.

Mr. James Arbuthnot (Wanstead and Woodford)

I beg to ask leave to withdraw the motion.

Motion, by leave, withdrawn.