§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Andrew Mitchell.]10.31 pm
§ Mr. James Clappison (Hertsmere)
I welcome the opportunity to raise the issue of St. Albans hospital and the centralisation of acute services in north-west Hertfordshire. It is a subject of intense interest to the residents of St. Albans. I share that interest because, although the hospital is not in my constituency, it serves many of my constituents, especially those in London Colney. On the same basis, my right hon. Friend the Member for Watford (Mr. Garel-Jones) also shares our concern, as does my right hon. Friend the Member for St. Albans (Mr. Lilley) whose constituency contains the hospital.
Since the health authority first unveiled the proposals to centralise the services in 1990, with their consequent effect on St. Albans hospital, my right hon. Friend has been at the forefront of a long and vigorous campaign to preserve as many services as possible for the residents of St. Albans. At every turn and with exhaustive efforts, he has fought on behalf of the people of St. Albans, reflecting their great concern about the hospital services.
This is a matter of local pride and concern. Local people are worried about the distances entailed in having to travel to Hemel Hempstead and the attendant risks in the case of accidents. Their concern reflects the esteem in which the services and professionals at the hospital are held. I wish to refer in particular to the paediatric services and St. Julian's ward, which are the subject of much affection and esteem.
When the decision was finally taken in December last year to centralise the services and to move some from St. Albans to Hemel Hempstead, there was great disappoint-ment in St. Albans. It would be hard to overestimate the disappointment which has been manifested on several demonstrations and marches, all of which were properly conducted. Similar anxiety has been expressed by several groups in the district, local churches and the community health council. My right hon. Friend the Member for St. Albans shares that feeling.
It must be said that when the decision was taken, due weight was given to the professional opinions of the consultants who serve St. Albans hospital as to the best way to save high-quality services in Hemel Hempstead and St. Albans.
On the other side of the argument, I draw attention to the strength of local feelings and suggest that weight could also be given to them. Local feelings run deep indeed in St. Albans, and they are conditioned by the fact that, although the town has retained many important services in its hospital, including a 60-bed elective surgery unit, nevertheless, a substantial number of beds have been lost as the hospital previously had 293 beds. It has lost its maternity, gynaecological and paediatric services and—most significantly—from 8 March it will lose the accident and emergency services in the full form in which they now exist.
I call urgent attention to that loss. It is the focus of great concern, and people are wondering exactly what accident and emergency provision in St. Albans will be left with after 8 March. There is a strong case for taking a long hard look at that provision. Under the present proposals, after 1087 8 March there will be no service at all for six weeks, and then a nurse practitioner-led service, treating minor accident and emergency cases, will start. I urge that urgent attention be paid to the strong case for upgrading that service to a much higher level.
The health authority compiled some figures in a survey carried out in 1991 and released in August 1992, which revealed that, of the 35,000 or so attendances at St. Albans hospital, about 6,500—about 18 per cent. of the total—could have been met in that year by a nurse practitioner service. So a relatively small proportion of the cases that were being treated at St. Albans hospital would be suitable for the intended level of service.
The survey also considered how many of those cases would have been dealt with by a doctor-led service, involving either a general practitioner or some other suitably experienced and qualified doctor. It was found that, of the 35,000 attendances, a further 57 per cent.—or 20,000 cases—could have been met by such a service. That means that about 75 per cent. of the total attendances at the hospital that year could have been dealt with by a doctor-led service. That would make a great difference.
A doctor-led service would be an important facility for people in St. Albans, and save many of them a great deal of travelling. It would also save much of the pressure that would otherwise fall on the service at Hemel Hempstead. There are strong grounds for such a service to be introduced in St. Albans.
In making that suggestion, I am fortified by the fact that such a proposal was ventilated by the health authority in a leaflet issued in August 1992, which said:We hope to involve local general practitioners in making the best use of the minor accident treatment unit".Furthermore, last October the chief executive of the North West Hertfordshire health authority produced another document, which was intended to be the basis for local discussions leading to health authority recommendations. It suggested thatthe unit should be nurse practitioner, but this would not preclude GP involvement".I therefore suggest that such an upgraded service is already in the health authority's mind. There is an urgent case for the service to be upgraded to that level, to provide a better service for the people of St. Albans.
If this is a question of resources being made available for the provision of such a unit, the argument is strong and the case is clear that those resources should be provided for the people of St. Albans. They should be made available for a doctor-led unit, which would be open on the same 24-hour basis as the former accident and emergency unit. Before implementation, that unit should be the subject of full consultations with the general practitioners in St. Albans to ascertain the part that they wish to play and whether they wish to take the reins of the accident and treatment service, or whether they feel that it would be best served by some other form of suitably qualified and experienced doctors.
Perhaps most urgently of all, I call attention to the six-week interval that will ensue when the full accident and emergency service is closed on 18 March. With the plans as they stand, for those six weeks there will be no accident and emergency provision in St. Albans. The issue has been put to the health authority, which has said that the six weeks is needed for nurse retraining. I suggest that that is not a satisfactory explanation and that training could be provided in a way that would enable the service to be 1088 continued. The explanation is not a satisfactory reflection on the health authority. Great concern is being caused to the residents of St. Albans. They are to lose their accident and emergency service, and it would seem that they are not to have any form of transitional service for the following six weeks.
There are several other matters that are of great concern to my constituents in London Colney and elsewhere, including the other residents of St. Albans. Important issues remain to be resolved, including transport to Hemel Hempstead. Many patients have to use public transport or private transport to reach a hospital, but many of my constituents will be faced with a difficult journey. Some of them will have to endure two such journeys. I have much in mind my constituents in London Colney, who will have to travel into St. Albans and then on to Hemel Hempstead.
I appreciate that the health authority has considered these matters and that it proposes to provide a bus service from the centre of St. Albans to the hospital at Hemel Hempstead, but that service will operate for only certain hours of the day. It may be suitable for those who are visiting the hospital, but it will not be satisfactory for casualty patients or for those who wish for any other reason to use the hospital outside the hours of the service. I hope that attention will be given to that and to the predicament of elderly people. I know that there are many elderly people in London Colney and the rest of St. Albans who use the hospital there. I am mindful of the journeys that they will have to undertake. I invite the health authority to give special consideration to those people a nd the arduous nature of the journeys that they will have to undertake.
There is concern that there should be a continuation of maternity services at St. Albans. These services, in their full form, are to be centralised at Hemel Hempstead. What level of service will remain at St. Albans? There is uncertainty about that because different suggestions have been made. I urge that the health authority should follow the recommendations that are set out in the report that was specially commissioned to examine maternity services in St. Albans under Dr. Elizabeth Scott. I believe that it should implement as many of those recommendations as possible, especially those that relate to community midwifery, which were considered to be extremely valuable by the authoress of the report.
I have referred to several important issues for the people of St. Albans, including my constituents in London Colney. There is a great sense of disappointment, as there would naturally be in any district at the loss of such a hospital. Much local concern arises from that.
I know that St. Albans residents of all shades of opinion are united in wanting their hospital to remain in the form, and with the level of service, to which they are accustomed. I invite the House to consider the views of those local residents. We must take into account the views of the users of our services and give due weight to their opinions. So strongly expressed are the opinions of those in St. Albans at present that I can only urge the House to give full weight to them, and can only ask for the maximum possible provision to be given for accident and emergency and for other services remaining in St. Albans. The people will at least be able to feel that, although their hospital has been changed and its services have been centralised, they still 1089 retain high-quality and safe services. That is the very least that I ask on behalf of the residents of St. Albans this evening.
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
I am grateful to my hon. Friend the Member for Hertsmere (Mr. Clappison) for raising this important issue. The debate gives me the opportunity to place on record the reasons for the decisions which have been arrived at and also to set out what I believe to be some of the advantages which will accrue from North West Hertfordshire health authority's proposals for centralising acute services within the district. I hope, too, that I can allay some of the concerns that my hon. Friend has shared with the House this evening.
The problems of the health authority's acute services are, of course, long standing. In November 1989, the health authority began a comprehensive review of its acute services, as it was becoming an increasingly untenable proposition to continue to provide the full range of acute services on two hospital sites—at Hemel Hempstead General and St. Albans City hospitals. The need for change was dominated by a concern for quality and safety of care together with the ability to ensure that the provision of viable, cost-effective services was maintained. The key elements of such a service were defined as recruitment and retention of specialist skilled staff, accredited junior doctor posts with the right mix of volume and experience, and the optimum use of resources, both revenue and capital.
There were a number of compelling reasons for change. Action needed to be taken to ensure that the unit, in competing with other hospitals for limited numbers of staff, was in the best possible position to recruit extra nurses, midwives and support workers. To reduce junior doctors' hours, additional doctors would be required across both hospital sites. However, the number of posts recognised for training is strictly regulated by the Department of Health and the royal colleges because of the need for a full range of experience. Posts not recognised for training do not attract good staff. Moreover, experience was showing that the two hospitals could not attract junior staff to existing posts.
There was also the issue of the optimum size for a viable unit and the need to concentrate expertise to provide good quality care. The unit has failed to attract specialist services which it might otherwise have been expected to attract because neither St. Albans nor Hemel could sustain such services in individual hospitals.
Finally, there is a continuing need to replace dilapidated building stock with appropriate new facilities designed to meet the demands of modern medical techniques and procedures.
The report of the 1989 review concluded that accident and emergency services, paediatrics and maternity services could not be replicated efficiently and safely on two sites, only a few miles apart, within the district. It was important to achieve the concentration of expensive and sophisticated diagnostic and treatment technology and highly trained staff necessary for all those services and, indeed, to address concerns about the accreditation of medical posts and the supervision of junior doctors. Two hospitals, each 1090 attempting to provide the same services and competing for staff, would represent a diminished service, becoming unsafe and eventually uneconomic.
In 1990, following full public consultation, the health authority submitted proposals to the Department of Health, which recommended the centralisation of most acute services on one site. Hemel Hempstead was chosen because the existing buildings at Hemel could better cope with the additional work load. The implications of the proposals for the residents of St. Albans were considered carefully by officials in my Department over several months.
In January 1992, my predecessor rejected the overall proposals on the grounds that they did not give sufficient weight to the need for local access to hospital services for St. Albans residents. However, he agreed that acute accident and emergency services could be centralised in Hemel Hempstead, accepting the clear evidence that that would offer a higher quality and, above all, safer service to all residents of the district.
My predecessor also approved the centralisation of in-patient maternity services at Hemel. Maternity services had been temporarily centralised at St. Albans in 1989. They are now housed in an excellent new consultant maternity unit in Hemel Hempstead.
My predecessor also gave approval of the establishment of an elective surgical unit in St. Albans, but asked the health authority to draw up detailed proposals which would maximise services to patients in St. Albans. He asked the health authority to consider plans for the provision of services at St. Albans to treat the majority of minor accidents and examine models of maternity provision—general practitioner or midwife-led—which would respect the understandable wishes of pregnant women in St. Albans not to have to travel to Hemel Hempstead for delivery unless absolutely necessary.
I must emphasise that my predecessor's decision did not challenge the concept of centralisation. I am convinced by the arguments in favour of centralisation, especially in the interests of safety, quality and efficiency for the district as a whole. The concern then was to find a configuration of services which allowed major acute and emergency services to be provided on one site, but which still retained a wide range of services for the majority of local residents at the other.
The health authority prepared its response in the light of my predecessor's letter and, having tested public reaction, submitted revised proposals to my Department in October 1992. I gave those proposals careful consideration and visited the district to see the services provided, assess the impact of the revised proposals and hear at first hand the views of the local people—the patients, consultants and others.
I was satisfied that the health authority had not only responded to my predecessor's request for reconsideration but adapted the original proposals as far as possible in the light of public concern. I believe that the health authority had demonstrated cost-effectiveness, increased quality and safety in its revised proposals and that the district as a whole stood to benefit. I therefore approved phase 1 of the scheme.
I will briefly outline the health authority's revised proposals. They provide for additional staffing, equipment and training for the community midwifery service so that home births can be offered as an option to women who are assessed to be at low risk of complications and for 1091 improvements in antenatal care provision in St. Albans with the provision of an antenatal day care unit there. Those recommendations enhance the centralised inpatient service provided at Hemel Hempstead and ensure that a high quality maternity service is provided for all mothers in north-west Hertfordshire.
The proposals also provide for the creation in St. Albans of a new elective surgical unit of 60 beds in the Moynihan block and a new day care unit in the main theatre complex in the Gloucester wing. Those proposals maximise theatre utilisation and provide capacity for up to 7,000 in-patients per annum at St. Albans City hospital. Most importantly, those plans are sufficiently flexible to allow for an increase in the number of elective beds in line with the demands of purchasers.
A project team led by the unit's director of quality assurance has now been established to oversee the development of a minor accident treatment unit, and I have noted carefully the remarks of my hon. Friend about that. Initially, the unit will be run by nurse practitioners and operate between the hours of 9 am and 9 pm, seven days a week.
That will provide a valuable service by greatly increasing the number of minor accident cases which can be treated in St. Albans rather than in the major accident and emergency department at Hemel Hempstead. It will provide much speedier treatment of a range of minor accidents and injuries for the residents of St. Albans. Whether that can be upgraded to, for example, a GP-led service, depends very much on the attitude of local GPs. I am pleased to say that the health authority is in discussion with local GPs and that it seems likely that the service can, indeed, be expanded. Having said that, I note what my hon. Friend said about other features of the arrangement and about the six weeks following the closure.
In-patient paediatric services are now concentrated on the Hemel Hempstead general hospital site. The concentration of services has allowed the unit to satisfy itself and the local population that a safe and good quality service can be provided. As a consequence, nurse staffing levels, particularly the availability of RSCNs, have improved. On medical staffing the service is now fully supported by permanent medical staff rather than a series of short-term locum doctors. The consultant paediatri-cians can now focus their availability to deal with emergencies on the one site, where both paediatrics and the special care baby unit are located.
Out-patient children's services continue to be available on the St. Albans city hospital site. In addition, arrangements are also in place for children to attend St. Albans for the removal of dressings, and so on. In addition, from 1 April this year the unit plans to offer a monthly paediatric day surgery service for children from the St. Albans area.
I am, of course, aware that public opinion, especially in the eastern part of the district, has remained antagonistic to the proposals. It was largely on account of the strength of local feeling that I took the decision to assess the scheme personally, even though the capital investment called for 1092 by the revised proposals is within the limit for the regional health authority to take such a decision without referring to Ministers.
In giving approval to the proposals, I made plain to the health authority the need to gain public confidence by emphasising the benefits of the reconfiguration. I am pleased to note, therefore, that the authority has drawn up comprehensive plans to ensure effective communications to reassure the public about hospital services—for example, by deploying local newspapers to inform the public of the services available to them.
Most public concern has been centred on the closure of the accident and emergency services in St. Albans and the related issue of ambulance services. I am assured that the "blue light" journey times between St. Albans and Hemel Hempstead will not be more than 15 minutes. In any case, ambulances would take urgent cases to the nearest accident and emergency department with the most appropriate facilities. Five hospitals with such facilities ring the district within eight to 16 miles of St. Albans.
In the event of a major accident, there is access to more than 100 paramedics across the two counties. Within the district there are currently 18, a number which will rise to 24—the national target—by 1994. That would represent one out of every two ambulance staff trained as paramedics and a paramedic on every available ambulance. I stress the importance of pre-hospital care in the treatment of accidents and emergencies today.
As my hon. Friend the Member for Hertsmere said, public concern has focused on the difficulties of access and parking at Hemel Hempstead. I am pleased to report that the health authority has taken positive steps to address those anxieties. Access will eventually be improved by a county and borough council plan for a new spur road and by agreements which will give 250 additional parking places.
Proposals for the provision of an hourly inter-hospital bus service are currently being assessed and the service will become operational from early March. I understand very well the strength of feeling. During the two visits that I made to the district, I was left in no doubt about it by the public reaction. It has also been made known to me by pressure from Members of Parliament, including in particular my right hon. Friend the Secretary of State for Social Security.
A certain misunderstanding and misapprehension also exists about the nature of the proposals. Much opposition has focused on the perceived diminution of service, as though the closure of St. Albans hospital were being considered. For the reasons that I have given, nothing could be further from the truth.
In conclusion, I am confident that once the new proposals are clearly communicated and understood they will be of benefit to the residents of north-west Hertfordshire by providing them with a safe and high quality health service of which they can be proud. I hope that all local interested parties can work together with the health authority to ensure the smooth implementation of the proposals.
§ Question put and agreed to.
§ Adjourned accordingly at Eleven o'clock.