§ Mr. Peter Hain (Neath)
On 18 and 19 March 1995, Neath hospital hit national headlines because its casualty unit was closed overnight; but that was only the tip of the iceberg. There is a crisis at the hospital, of which that casualty closure was simply an example. I believe that the hospital is deliberately being allowed to bleed to death as a result of Welsh Office policy.
The Secretary of State for Wales favours local hospitals and opposes centralisation. I applaud that. The way in which he has openly nailed his colours to the mast in that respect is very welcome. However, paradoxically, in practice his officials are sabotaging the policy that he has advocated, and that is no more clearly shown than in the impact on Neath hospital.
On 19 January 1995, my right hon. and learned Friend the Member for Aberavon (Mr. Morris) and I met the Secretary of State. To be fair, we were very impressed with his response. The Secretary of State said that he supported the local hospital. He said that he would agree to additional recruitment in excess of the going rate, and that he would give a clear commitment to the future of the hospital. That was very welcome.
However, since then, we have had two more vacancies in anaesthetics and one more vacancy among surgical consultants. The hospital now says that it cannot recruit any more senior house officers after August, except by going to Germany and except by allowing a trend to continue whereby the hospital will soon be staffed almost entirely by overseas doctors.
Neath hospital has traditionally functioned as the only district hospital in West Glamorgan supplying a full range of facilities and opportunities in general medicine, general surgery, obstetrics, gynaecology, trauma, orthopaedics, paediatrics and accident and emergency. It has always had the reputation of being an efficient hospital with low costs, short waiting lists and strong support from the local public, local general practitioners and the purchasing health authority.
For some years, there has been a demand—indeed there were proposals—for a replacement hospital. That has at last been agreed, but only after the saga has dragged on for many years. The outcome was that, following a review by the Welsh Office, the Secretary of State agreed that there would be a replacement general hospital. However, it would have only 250 beds instead of the present 350–bed facility at Neath, and, instead of providing the full range of general hospital facilities that are provided at Neath, the new hospital would admit all emergency and elective planned cases with a mix of medical emergency cases and elective surgery work but would require that all trauma and high risk elective surgical cases—by that, I mean emergency surgical patients—would be treated elsewhere. It was hoped that, if that model were implemented, the hospital would be up and running in about three years.
That model was accepted by the local community, not because we favoured it—we had grave suspicions about it, which are now proving well founded—but because we felt that it was necessary to get the new hospital up and running, and that half a loaf was better than no bread.
171 Many consultants, and all local GPs, believe that the model that the Secretary of State has proposed for the new hospital, which is now being introduced by stealth, is not feasible—is seriously flawed—because it was based on the proposition that there is over-capacity in West Glamorgan, whereas anyone who knows the region knows that that is not the case.
Last year, Neath hospital was closed 90 times because it was full. This year, it has already been closed 31 times. I know of many cases that have been referred to Bridgend, Llanelli and even Cardiff because the hospital at Neath cannot cope with the referrals to it. If that is the case now, reducing the hospital bed capacity by a further 100, as will happen when the new hospital replaces it, will be a disaster. It is a myth that there is over-capacity in West Glamorgan. For that reason, the model that the Welsh Office persuaded the Secretary of State to adopt is fundamentally flawed.
The majority of the consultants in West Glamorgan have taken a different view. They say that the model is flawed because it is inappropriate to manage medical emergencies without back-up surgical facilities. They therefore seek to centralise all emergencies, including medicine, on Morriston hospital and leave the new Neath hospital—and, indeed, increasingly the present one—responsible only for dealing with out-patients and day cases and perhaps some non-acute medical cases. The implication is that there will be no obstetrics or in-patient paediatric facilities.
We are victims of what is effectively a conspiracy—I use the term deliberately, although it is a serious charge to make—by Welsh Office officials, by the Royal College of Surgeons and by consultants, to undermine the facility at Neath and to turn a once proud hospital into a pale shadow of itself, because, if one does not provide emergency surgery, training for junior staff is inadequate.
The university of Wales college of medicine allocates house officer posts. It is already signalling that it is unwilling to allocate house officer posts to Neath hospital on the basis of the existing deteriorating position, let alone the new model in the replacement hospital, in spite of the fact that Neath hospital has always had a very good reputation for training. Indeed, a recent survey placed it at the top of the list.
However, other hospitals are also in the market for house officer posts, so they are encouraging applicants, and indeed existing postholders, to withdraw from Neath and move to their own hospitals. The decision by the Royal College of Surgeons to withdraw training accreditation is making the position much worse.
I believe, and most—if not all—doctors in West Glamorgan would argue, that the model that the Secretary of State has proposed for the new hospital, which effectively is being put into practice from now on in anticipation, is fundamentally flawed, and that we should have a full range of emergency admissions, similar to that which exists, for example, at Llanelli hospital. Failure to do so has created a profound period of uncertainty, and many medical staff and other senior staff are voting with their feet. That has inevitably meant that a question mark hangs over the future of the hospital, and confidence has been destroyed.
172 The problem has been compounded by the requirement that the Secretary of State has introduced, to seek private finance funds for the new hospital, which has meant further delay and uncertainty, although he has given assurances that nevertheless it will be built on time, for which we are grateful.
The management of the hospital has tried several innovative approaches to recruit staff, but they struggle against a lack of commitment by many local consultants to the model that the Secretary of State has specified and active attempts to destabilise the position by the surrounding trusts, which are benefiting from having work taken away from Neath and moved to their hospitals.
The internal market of competitive trusts is strangling Neath hospital. That is clearly shown by the fact that independent trusts nearby are competing with Neath, not co-operating as the Secretary of State has asked. They deliberately poach staff and seek to undermine, rather than co-operate with, Neath hospital.
A whispering campaign is going on to undermine the hospital. It is happening in a variety of ways. Accreditation of junior staff is being undermined. The withdrawal of pre-registration house officer posts is having a serious effect. Disinformation is being provided to potential applicants at a junior staff level about the pace of change and the future of the hospital. Consultant staff are also being poached by adjacent trusts.
Those elements are collectively resulting in a crisis at the hospital, of which the closure of the casualty unit is simply one aspect. As a result, many of the specialties of Neath hospital rely on locum consultants, as it has proved impossible to recruit permanent staff.
We had a meeting with the Secretary of State in January, and since then, there have been a series of extra vacancies in anaesthetics and surgery. There are now four vacancies out of six in anaesthetics, and three vacancies out of four in surgery. Four of those vacancies have resulted from poaching by Morriston or Singleton hospital trusts in the neighbouring region. We suffer from direct competition.
In addition, there is one senior house office vacancy out of four in the accident and emergency unit, and house officers have threatened the withdrawal of all posts after August. That may be averted—the local management believe that that could be possible. If so, that will only be until next year, when emergency surgery is withdrawn almost completely. If that happens, there will be no casualty service—it will be closed not overnight, but permanently.
I welcomed the recent statement by the Secretary of State, in which he committed himself to local hospital provision, stressed the importance of local access and expressed his concerns about the impact of centralisation. He has shown some courage in doing so, and I welcome that. However, in terms of the way in which the internal market operates, Neath hospital was cost-effective and had strong purchaser support. It has had a reputation for being responsive to the needs of local general practitioners and the public. It has been torn apart, not because it was unsuccessful, but because of Welsh Office dogma.
That dogma is not necessarily shared by the Secretary of State, but it is implemented by his officials, and at present he seems unwilling to resist it. That has led to a disaster for outlying villages up the valleys—in former 173 mining villages such as Banwen, Glynneath and Tonmawr. Their residents now face journeys along the traffic-clogged M4 of up to half an hour to get to Morriston hospital, which has the nearest major accident and emergency and acute surgery provision. Any further traffic problems along that route could result in lives being put at risk, and many serious problems for outlying villages.
The position all depends on the environment in which the hospital now has to operate. In determining that some of the district general hospital services should transfer elsewhere, the Welsh Office has disrupted a well-established and effective pattern of services and replaced it with a model in which no one has confidence. Local medical staff, consultants, GPs, the local health authority and the local management have no confidence in it—I can find no one in my area or elsewhere who has confidence in it. The model is untested, and no one has confidence in the Secretary of State's proposal for the replacement hospital, prefigured in the way that Neath hospital is being run down.
It is not too late for the Secretary of State to act, which is why I am appealing to him in today's debate. I hope that the Under-Secretary of State for Wales, the hon. Member for Clwyd, North-West (Mr. Richards), will respond positively. I am seeking not to engage in a political knocking exercise, but to obtain the support of politicians and to persuade them to put themselves in charge of the Welsh Office, rather than leaving it to medical experts with fancy theories of centralisation that bear no resemblance to the need for local provision on the ground.
It is not too late for the Secretary of State to make a business case stating that the new hospital is based on retaining all the general hospital facilities. There is no evidence that the anticipated savings that some believe would come from the Secretary of State's proposals and the new model will be achieved. I would argue—I stand ready to be tested on it in future years—that the changes will cost more because, if cost-effective, small district general hospitals are replaced by high-cost, centralised, specialised facilities, they tend to ratchet up of costs. The provision will not be cheaper, but more expensive, and local people will suffer badly.
Officials at the Welsh Office continue to agree to increasing capacity in hospitals near Neath. New theatres have been built at Singleton, and there is a phase 2 development at the Princess of Wales hospital at Bridgend. The Morriston hospital has recently been provided with a burns and plastics unit. All those developments have been taken place while Neath hospital has been run down.
All those hospitals have the potential to ensure that the proposed 250–bed hospital that will be sited on Baglan moor in the constituency of my right hon. and learned Friend the Member for Aberavon is not viable. That will be particularly true if all the senior medical staff walk away from the hospital.
Civil servants at the Welsh Office seem hellbent on destroying what was once one of the most effective district general hospitals in Wales and replacing it with a new model of care which has yet to be tested anywhere in the United Kingdom, which has no local medical support and which has the potential to end up as an expensive cottage hospital, not the district general hospital that the Secretary of State promised my right hon. Friend and me in 1993.
174 I have two specific requests for the Under-Secretary of State. First, will he ensure, and make a commitment this afternoon, that admissions for emergency surgery will be kept in the new hospital and at Neath hospital? Why should we be inferior to Llanelli hospital which has that provision? Will he reject the centralisation of facilities and emergency provision which is inherent in the existing position and which will accelerate as it deteriorates, so that everything will be concentrated at either Morriston or Singleton hospitals?
If the Secretary of State genuinely believes—I have no reason to doubt him—in local hospitals and community provision, it is essential for him to reject that centralisation. It would not affect the capital requirements in the project. If the concern is to obtain private capital, such a policy may be more attractive to those interested in providing private capital, because they will recognise a model that is more familiar and more cost-effective. My first request is for the Minister to reverse the process towards centralisation, and agree that the new hospital will retain all district general hospital emergency facility capabilities.
Secondly, will the Minister instruct all the neighbouring trusts to support Neath general hospital? In the meeting which we had with him in January, the Secretary of State told my right hon. and learned Friend and me that he was keen to discourage neighbouring trust hospitals from competing and undermining Neath, and that, on the contrary, they should support it. But there has been no letter from the Secretary of State's office to those trust hospitals to implement that wish.
I ask the Secretary of State to send such a letter. If he does not do so, local people will face a catastrophe—a hospital which they have valued for generations, which is much loved and which has provided a range of district general hospital facilities upon which they have grown to depend, will be swept away. In its place, we shall have a hospital on Baglan moor that is a pale shadow of its former self, because Neath hospital is being allowed to bleed to death.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Rod Richards)
I welcome the opportunity to discuss the current and future provision of accident and emergency services for the people of Neath and Port Talbot.
Accident and emergency facilities play an important role in the provision of health services to meet the needs of the public. My right hon. Friend the Secretary of State and I are committed to ensuring that both the current service at Neath general hospital and the future service at Baglan hospital will meet those needs. Contrary to recent media reports and to what the hon. Member for Neath (Mr. Hain) has said, there is no conspiracy against Neath general hospital, although there are difficulties in achieving the outcome that we desire.
I thought that the hon. Member's attack on Welsh Office officials was quite disgraceful. He knows perfectly well that they are in no position to answer his outrageous charges against them. If the hon. Gentleman thinks for one moment that my right hon. Friend the Secretary of State for Wales is not in full charge of the Welsh Office, he clearly does not know my right hon. Friend very well.
175 The hon. Gentleman went on to talk about a whispering campaign designed to undermine the morale of Neath general hospital. Nothing is more likely to undermine the morale of the hospital's staff or the recruitment of future staff than his standing on the world stage and drawing attention to some of the difficulties that Neath general hospital currently faces.
§ Mr. Hain
That is an outrageous charge. I know what is going on in Neath general hospital. The Minister talks to his officials from on high; he does not know what is going on at Neath hospital. What I have said has nothing to do with accusations; I have presented the factually supported results of the Minister's policies. People are walking away from Neath hospital. The whispering campaign is being conducted not by politicians, but by his own Welsh Office officials and by consultants working in concert with them.
§ Mr. Richards
I am grateful for the hon. Gentleman's intervention, because it leads me to my next remarks. I visited Neath general hospital on 16 February 1995 to see at first hand the excellent work that all involved at the hospital have achieved. I also talked to the local clinicians, and listened to their concerns.
I share the concerns expressed at the staffing difficulties that led recently to the temporary closure of the accident unit at Neath general hospital. I understand that efforts are being made to avoid further disruption, first through the appointment of a full-time locum consultant in the accident and emergency department in order to cover the maternity leave of the present consultant; and, secondly, by attempting to recruit accident and emergency senior house officers from a wider field, such as Germany. I think that the hon. Gentleman's comments about medical staff from overseas being employed at Neath general hospital are a bit rich, in view of the fact that he is an overseas Member of Parliament.
Should that exercise be unsuccessful, I understand that efforts will be made to identify other career-grade doctors who could be employed on a permanent basis. I am assured that five candidates have been shortlisted for anaesthetist positions at the hospital. That is an encouraging response, and interviews will be held shortly.
My right hon. Friend the Secretary of State and I are determined that everything shall be done to ensure that accident and emergency units in Wales—not just in Neath—avoid further temporary closures due to staffing problems. But the staffing problems are not particular to Neath or to Wales; they are being experienced in many parts of the United Kingdom.
My right hon. Friend wrote to the hon. Member for Neath on 28 March, summarising the urgent action that he has asked for in order to address the staffing problems. That aims to ensure that any short-term staffing difficulties in accident and emergency units are identified as soon as possible. It also seeks to ensure that effective measures are taken to reduce significantly the risk of disruption to patients.
Senior medical staff from the Welsh Office recently met accident and emergency experts in South Wales to identify the problems involved. They also agreed what needs to be done to ensure continuity of service in this 176 essential area of care. I am told that the meeting identified a number of the more important factors which have made it difficult to recruit enough experienced staff to the casualty service.
The meeting also proposed possible solutions to those difficulties. They include the employment of nurse practitioners, more career-grade appointments, and the rotation of medical posts to include a number of other accident and emergency departments. The co-operation that the hon. Member for Neath referred to, and specifically asked me to comment upon, is taking place already. I assure him that the chairman of West Glamorgan health authority recently wrote to the chairmen of the three existing national health service trusts to emphasise the need for local cooperation.
More work will be required in order to build on that promising start, but I am hopeful that a satisfactory understanding can be reached between hospitals in South Wales as to how they can work together to minimise the risk of further disruption to those essential services.
In July 1994, my right hon. Friend the Secretary of State gave his approval to West Glamorgan health authority proposals for improving health services for the people of Neath and Port Talbot. The plans included the provision of a 24–hour local accident unit at the new hospital at Baglan.
In giving his approval, my right hon. Friend recognised the need for the people of Neath and Port Talbot to have an appropriate local accident and emergency service. The new local accident unit will provide for the majority of cases currently cared for by the existing accident and emergency departments—including about 75 per cent. of all cases at Neath hospital—including simple fractures, and it will do so in state-of-the-art facilities.
It remains the view of my right hon. Friend and me, based on the best medical advice available to us, that seriously injured patients and those requiring more complex or high-risk emergency surgery should be treated in centres where full back-up services are available, including neurosurgery in the case of Morriston. It is centres such as those which have been shown to deliver the best results in terms of reducing the threat to life and avoiding permanent disability.
I have talked about accident and emergency services at Neath, and our commitment to providing appropriate local accident services at the new hospital at Baglan. I would also like to take this opportunity to comment on progress with the new hospital as a whole.
My right hon. Friend the Secretary of State met the hon. Member for Neath, together with the right hon. and learned Member for Aberavon (Mr. Morris), on 19 January 1995, and confirmed he his commitment to developing services for the people of Neath and Port Talbot. Contrary to what the hon. Member for Neath has said today, we want to see services maintained at Neath general hospital while planning for the new Baglan hospital goes ahead.
I am aware that local medical opinion remains divided about the precise role of the new hospital. Concern has been expressed about the recruitment of medical staff for the new hospital, and the opportunities there will be for the training and development of such staff. When my right hon. Friend gave his approval to the new hospital, his three main criteria were: clinical safety, access to services for the local population, and value for money. Of those, the most important are clinical safety and access.
177 A judgment was made that, in order to maximise access for the local population, the widest range of health services that could be safely delivered locally should be provided at Baglan. As well as the local accident unit, the new hospital will therefore offer out-patient clinics and the most up-to-date facilities to deal with non-emergency surgery, as well as acute general medicine, care of the elderly, rehabilitation services and facilities for people with acute mental illness.
When the decision was made, all of the local national health service interests were asked to work together to ensure that the new hospital was developed as quickly as possible, without disruption of services. It is therefore with disappointment that my right hon. Friend and I have observed the continuing public disagreements in West Glamorgan about the role of the new hospital. The hon. Gentleman does his constituents no favours by continuing that argument in the Chamber. I am sure that many—including, patients and local people—will see the disagreements as blocking the way to early progress with the development of Baglan.
At the end of the day, the Welsh Office can provide only the framework and funding, where needed, in order to improve local health services. The delivery of improved services depends entirely on local health professionals and managers putting aside any differences and working together to improve services for patients. Local people expect no less.
I was therefore encouraged to learn that the chairman of West Glamorgan health authority has invited the chairmen and chief executives of local NHS trusts to meet to agree what needs to be done in order to resolve local differences and how best to finalise the planning for the new hospital at Baglan. I very much welcome his initiative, and I have asked for a report on the outcome of the meeting.
From 1 April 1996, when the new West Glamorgan health authority is to be established, the area will be well served by four national health service trusts, which will provide high-quality patient care from four main district general hospitals. A full range of community care and health services will also be provided for many local hospitals and clinics throughout the area. The services in West Glamorgan will then comprise the regional burns and plastics centre, a magnetic resonance imaging scanner, a special care baby unit and a centrally funded treatment centre, in addition to acute and community services.
The trusts will employ a dedicated staff of around 10,000, including highly qualified clinicians and nurses. When my right hon. Friend the Secretary of State announced the proposal to build a hospital at Baglan, he said that, if there was insufficient capacity there in terms of the number of beds, it would be looked at again, and the hon. Member for Neath knows that.
I hope that what I have said confirms the Department's determination to ensure that health services for the people of Neath and Port Talbot meet the high standards which the public rightly expects from today's NHS. I also emphasise—