HC Deb 10 May 1995 vol 259 cc859-66

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bates.]

10.32 pm
Mr. David Hinchliffe (Wakefield)

I am grateful for the opportunity to raise serious concerns about the future direction of health provision in the Wakefield metropolitan district—concerns that I know are shared by my hon. Friends the Members for Hemsworth (Mr. Enright) and for Normanton (Mr. O'Brien). I know that they hope to catch your eye later, Mr. Deputy Speaker.

At the centre of those concerns is the fear that Wakefield Healthcare, the health authority purchaser, is considering a strategy that could result in the closure of either Pinderfields general hospital, Wakefield, or Pontefract general infirmary—or, indeed, both. Such is the level of public concern that I feel that the Government must be made aware of local feeling in the Wakefield district, and made to address their own responsibilities for the future health care of our constituents.

I make that specific point because I believe that the direct consequences of the Government's health policies are at the root of proposals that could totally undermine existing services. In short, the internal market is not working in Wakefield district. To try to make it work, Wakefield Healthcare is contemplating options for change that could result in cuts in service provision that are unacceptable to my constituents and to those of my hon. Friends.

Before I set out in detail my concerns, I want to make it clear that, although most of my constituents use Pinderfields hospital in Wakefield, I have no desire for that hospital to be sustained and developed at the expense of Pontefract general infirmary. My personal agenda—and I believe that of yourself, Mr. Deputy Speaker, and my hon. Friends—is to ensure that the future of both hospitals is secured. Both are popular, well used and major employers in a region that has recently suffered more than most from job losses.

Under the provisions of the National Health Service and Community Care Act 1990, for the past two years Wakefield Healthcare has been the major purchaser of health care in Wakefield district. Under the Government's health changes, that body is responsible for strategic planning of health care, and for determining its overall direction.

The three major providers in the region are the two trusts based at Pinderfields and Pontefract hospitals, and the Wakefield and Pontefract Community Health NHS trust. It would not be unfair to the health authority to say that, from the outset, it would have been preferred the establishment of one single trust, covering acute provision and based primarily in Wakefield and Pontefract. Indeed, the authority has proposed the amalgamation of the Pinderfields and Pontefract trusts—an option, as you know, Mr. Deputy Speaker, that is strongly resisted locally, because real fears exist that it would lead to the rationalisation of services and a serious loss of provision.

In recent years, my constituents in particular have seen significant closure programmes, and they simply no longer trust local health managers' assurances. Through the House of Commons Library, I have calculated that, between 1979 and the last general election, more than 1,000 hospital beds have been lost in hospitals serving my constituents in Wakefield. They have good reason, therefore, not to trust assurances given in the local health service.

As you, Mr. Deputy Speaker, will recall, we lost Snapethorpe hospital after being given assurances of alternative provisions which came to nothing. During consultation on the closure of County hospital in Wakefield, we were promised purpose-built geriatric provision on the Pinderfields site. It never happened.

More recently, during consultation on the closure of Manygates maternity hospital in Wakefield, where I, my son and my daughter were born, we were promised a purpose-built maternity unit on the Pinderfields site. That never happened either, so when new proposals emerge under the title of "Reconfiguring Hospital Services", my constituents and those of my hon. Friends know what to expect.

I learned of the proposals in a conversation with the chairman of Wakefield Healthcare, Mr. Brian Hayward, on the evening of Monday 6 March. I was left in no doubt that serious consideration was being given to the closure of both Pinderfields hospital and Pontefract general infirmary on the basis of building a new hospital somewhere between the two. He confirmed his statement on the following day, when we had a further conversation over the telephone.

On Friday 10 March, the Wakefield Express weekly newspaper reported Wakefield Healthcare's chief executive, Mr. Keith Salisbury, as stating that discussions about the idea of a new hospital were only "tentative", and that there was no question of closing Pinderfields. On that same day, however, I was telephoned by Mr. Roy Cusworth, chairman of Pinderfields hospital NHS trust, who, along with his chief executive, Mr. Peter Ward, had that week been made aware of the possible closure of Pinderfields.

Bearing in mind the fact that that trust had only recently published revised proposals for a major redevelopment of the hospital, and that it had been given approval to seek private financing for the project, the trust chairman was understandably incensed at suggestions of the hospital's closure. I know that he discussed his concerns at the time with the chairman of the Northern and Yorkshire regional health authority, Mr. John Greetham.

On the following Wednesday, 15 March, the chair, vice-chair and chief executive of Wakefield Healthcare met you, Mr. Deputy Speaker, my hon. Friend the Member for Hemsworth (Mr. Enright) and myself at the House of Commons. We discussed in some detail the issues facing the authority. I was alarmed to be told that any decisions about investment in new hospital provision at Pinderfields, Pontefract or on a new site would be a matter for the private investors under the private finance initiative. I would welcome the Minister's comments on that specific point.

I gained the clear impression that, regardless of the proposed development at Pinderfields or other options that might be suggested by the Pontefract trust or the health authority itself, the central determinant would be the choice of those investing private capital. I know that it was not just me who gained that impression. The minutes of the Pontefract and District community health council meeting, held on 10 April, recorded your view, Mr. Deputy Speaker. The minutes state: Mr. Lofthouse said in his opinion, the issue would be totally influenced by private capitalists investing monies. At the end of the day, these people were looking for returns on their monies and this would be the biggest consideration. I recognise that Wakefield Healthcare has been landed with an extremely difficult task in implementing Government policy in the Wakefield district. The extent of those difficulties is made clear in its health strategy document, which I saw for the first time only yesterday. That document itemises various changes that have a bearing on the future plans of every health purchaser, including changes in professional practice, shorter hospital stays, day surgery and moves towards primary care.

In its specific policies for hospital provision in the Wakefield area, it makes particular reference to the reduction in junior doctors' hours, shorter training and the specific funding problems affecting Wakefield as a result of the Government's new allocation formula.

The Minister will recall that I previously raised the allocation formula with him in another Adjournment debate. As he knows, the formula assumes that Wakefield is overfunded by 4.9 per cent, or £7 million at current levels. The health strategy document states: It is therefore likely that development funds will be scarce during the strategic period and that there will be a continued need for redeployment of resources. As well as serious resourcing difficulties, the other key element affecting Wakefield's health care strategy is that it has one of the highest concentrations of general practitioner fundholders in the country. Fundholders now cover 75 per cent. of the district's population, and by next April the health authy will be a minority purchaser.

We have to ask, how on earth can a health authy, supposedly in the context of public consultation, be expected to develop a strategy as a purchaser when, in future, the main purchasers will be groups of fundholders whose only tentative link to accountability is to the regional office of the national health service executive. If we throw in the fact that Wakefield has five practices with 55,000 patients moving to total fundholding, is it any wonder that, to the objective observer, the planning of health provision in Wakefield appears to be degenerating into total chaos?

The health authority's four options for the future pattern of provision are all, for various reasons, unacceptable. The first option of no change is dismissed by the health authy itself. The second option of redistribution of specialisms between Pinderfields and Pontefract means constituents being forced to travel miles for care that is currently provided within their own localities. There is concern that specialties cannot be traded between sites because of the need to reflect best clinical practice, to ensure linkages with other specialties and to make the best use of equipment and support facilities.

The third option, of providing most emergency work at one hospital and most elective work at the other, would mean massive duplication of equipment and support facilities. More importantly—as you well know, Mr. Deputy Speaker—it would result in serious delays in treating accident and emergency cases, and could cost lives.

My hon. Friends the Members for Hemsworth (Mr. Enright) and for Normanton (Mr. O'Brien), and you yourself, Mr. Deputy Speaker, are probably more aware of the exact time it takes to travel by road between Pontefract and Wakefield, but I would say that 25 minutes is a reasonable estimate. In that period, people moving to either end of the district could die. That is what happens if access to accident and emergency units is delayed in the way in which it may well be as a result of the suggestions put forward by the health authority.

The fourth option is establishing a new hospital. The report that I have seen does not make it clear whether or not that would entail closing existing hospitals. It will inevitably result in the loss of many existing services at previous sites, inconvenience to patients and—of course—serious job losses.

The strategy document accepts that Pinderfields trust has been given permission by the regional health authority to explore the potential for private financial support for the redevelopment. While the trust states that it would not wish to adversely affect this private finance bid", it would surely come as no surprise to Wakefield Healthcare to learn that potential private investors attracted by Pinderfields may be somewhat put off to be made aware of the options in the strategy document, and their implications.

A backdrop to the Wakefield health pantomime is the current review of health provision in Leeds. Wakefield Healthcare's inability to defend regional neurosurgery provision at Pinderfields from the raid by the United Leeds Hospitals trust does not exactly inspire confidence in its willingness to rebuff the further predicted incursions in the direction of other regional specialisms within Wakefield.

Pinderfields—as you well know, Mr. Deputy Speaker—has a proud record in many of its specialisms, with its burns unit, plastic surgery provision, spinal injuries and younger disabled units, and other services which are very widely respected. But the Government's internal market means that such key services can be grabbed and moved elsewhere. There is a scarcely hidden agenda within the Leeds review, of shifting further specialisms to Leeds and leaving Wakefield's hospitals as mere satellites.

That is not acceptable from my point of view, or from the point of view of my hon. Friends who represent the Wakefield district. It is not acceptable that the Government can avoid responsibility for the problems which are now being faced within Wakefield. It is not acceptable for the Minister to give me parliamentary answers of the kind he has given to me on this issue in the past few weeks.

I shall quote two of those answers before I end my speech. On 16 march, I asked whether the Secretary of State will seek reports regarding the future of Pinderfields hospital, Wakefield from (a) the chair of the Yorkshire and Northern health region, (b) the chair of the Wakefield health authority and (c) the chair of the Pinderfields trust; and if she will make a statement. The answer from the Minister was: This is a matter for Wakefield Healthcare. The hon. Member may wish to contact Mr. Brian Hayward, chairman of Wakefield Healthcare, for details."—[Official Report, 16 March 1995; Vol. 256, c. 707.] Having spoken to that gentleman, I am none the wiser.

On 27 March, I asked the Secretary of State if she will make it her policy to ensure that Pinderfields hospital, Wakefield, remains open as a district general hospital maintaining regional specialisms. The Minister answered: This is a matter for the Northern and Yorkshire regional health authority. The hon. Member may wish to contact Mr. John Greetham CBE, chairman of the authority, for details."—[Official Report, 27 March 1995; Vol. 257, c. 422.] In conclusion, I would say that this is a matter for the Government. I want answers to some questions tonight.

10.47 pm
Mr. Derek Enright (Hemsworth)

May I pay tribute to all that you have done, Mr. Deputy Speaker, in the campaign in the area? I would not have time tonight to reveal all you have done. I wish to make some short but extremely important points. My constituency has seen Southmoor in Hemsworth slimmed down, Ackton hospital in Featherstone closed down and Warde Aldam in South Hensall pulled down. That is what we have found from the internal market in my constituency.

On top of that, the threat to Pontefract general infirmary is simply not acceptable. My hon. Friend the Member for Wakefield (Mr. Hinchliffe) has just referred to the time it takes to get to Pinderfields in terms of accident and emergency units. Attention has not been paid to the difficulties in transport at certain hours. I myself have spent over an hour getting into the centre of Wakefield in a small car. That is not unusual in the rush hour when such accidents can occur.

The internal market has been a disaster for our area. The only body that has benefited from it is a doctor's practice, which made a record surplus, enabling the doctor to extend his surgery in a totally unnecessary fashion. Yet that is the main capital expenditure that Wakefield has had. If that is an example of the internal market, we have had quite enough of it, and the Minister must take control and do some indicative planning.

10.50 pm
Mr. William O'Brien (Normanton)

It is not long since the Minister came to our area and agreed to close the accident and emergency unit and other facilities at the Castleford and Normanton hospital, which serves a large part of my constituency. People in the Ossett area of my constituency would have to travel tremendous distances if the Pinderfields hospital is somehow to be moved to the east of Wakefield. There are strong rumours that that could happen.

I want the Minister to be honest and open with us tonight, and say what future he envisages for hospital provision in Wakefield. There is strong opposition to the proposal to close Pinderfields hospital and Pontefract general infirmary with a view to building a smaller hospital in the area. People in the metropolitan area of Wakefield will not accept that proposal.

There are now strong rumours that the hospice services could face difficulties because general practitioners in the area will, in due course, be responsible for purchasing services at the hospices in Pontefract and Wakefield. People are tremendously concerned about the future of hospice services, because the Government are contemplating the purchase of such services in the future.

Will the Minister assure us that constant provision will be made for people who need hospice services in Wakefield and Pontefract? I hope that he will assure us that no changes will be made to hospital provision in Wakefield, and that the hospices in the area will continue to receive the same resources to maintain their services in both towns. That is important to our area, and we look to the Minister for assurances on that provision.

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

I am grateful for an opportunity to reply to this debate. I am aware of the strength of concern felt by the constituents of the hon. Members for Wakefield (Mr. Hinchliffe), for Hemsworth (Mr. Enright) and for Normanton (Mr. O'Brien), as well as your constituents, Mr. Deputy Speaker. You and I have corresponded about local health services and had more than one meeting at Pontefract hospital and elsewhere to discuss those matters.

The question of resources has come up a couple of times in the debate.

It has been alleged in a previous Adjournment debate, and it was mentioned in this debate, that the Wakefield health authority is over target, and it has been said that therefore there will be cuts. I must tell the House that, in the current year, there is an increase of 4.4 per cent., and that means a real increase in resources.

Although, compared with some other districts, Wakefield may be above the target, it is unlikely, given that there is likely to be a continuation of real increases in health resources in the years to come, that any over-target district health authority will lose resources in real terms as a result of redistribution. Fears raised about future resources should therefore not be exaggerated.

There are other reasons why Wakefield health authority, like many others, must consider the future pattern, not only of hospital acute services, but of all health services throughout its district. Obviously, resources come into it, but the pattern of health services is evolving. The hon. Member for Wakefield mentioned some of the reasons—the growth in day surgery and the increase in the numbers of patients who will be seen in primary care settings rather than in hospitals in future. All sorts of changes are taking place that will make it necessary to reconsider the number of acute beds and acute hospitals in each region and each district.

It goes without saying, therefore, that it would be irresponsible of Wakefield or any other health authority not to look very hard at the pattern that it envisages for the future, looking 10, 20 or 30 years ahead and making proposals now.

I also refer to what the hon. Member for Normanton (Mr. O'Brien) said about hospice services. I will inquire into that matter. There has been anxiety that, because the central funding of hospices and palliative care has been devolved to districts, there would be a detrimental effect on local hospices. There is no reason why that should happen, but I will inquire into the matter for the hon. Gentleman, because the resources that are provided centrally by the Department of Health for hospices have increased sharply in the past, and I am sure that we intend to continue to support that sector, in which the country has such a splendid record.

On the subject of Wakefield Healthcare's health strategy document, which lies at the heart of the anxieties of the hon. Member for Wakefield, consultation on a proposed health strategy in Wakefield between July and October 1994 was extensive. It covered the needs of the whole population of the Wakefield metropolitan district council area. About 1,000 copies of the proposals were issued, and a further 125,000 copies of the summary were printed and issued through the free press or distributed at various local events.

Representatives of Wakefield Healthcare spoke to several local groups about the strategy, as well as holding meetings of the three local national health service trusts and two community health councils in Wakefield and Pontefract. It is worth emphasising that the Wakefield health strategy discusses the way in which services in the Wakefield area may be shaped in the next five years and considers the need for any shift to primary care that may be appropriate.

Wakefield Healthcare set up a sub-group to consider responses. The group included three local general practitioners, the director of public health and two directors of Wakefield Healthcare. The two community health councils were invited to contribute, especially about the proposed move of some services to the primary care sector.

The sub-group looked at four main options, which were: option 1, to do nothing; option 2, to redistribute specialities over two hospital sites; option 3, to identify one hospital to undertake elective care and one for emergency care; and option 4, to build a new hospital on a new site. Those options were discussed informally with local Members of Parliament and other representatives. Since then, the focus of attention has understandably been on one section of that strategy—the possible reconfiguration of acute services.

It has been stressed a number of times that the discussions are at an early stage. I am therefore unable to give any definitive idea to hon. Members as to which option will finally be recommended. I understand that the proposed health strategy will be published later in May. Wakefield health authority also proposes to take a series of steps—for example, to explore the cost benefit and feasibility of each of the four options with local hospitals and, in particular, the three trusts.

Services that support any future configuration will be reviewed. There will be further consultation on the proposed way ahead with hospital clinicians, GPs, community health councils and all other local organisations. I understand that that is likely to begin in the summer. It will be followed by confirmation of the preferred option for the future configuration of services for the district.

Mr. Hinchliffe

Will the Minister specifically address the problem of fundholding that I raised? Will he consider the difficulty in which the authority will find itself next year as a minority purchaser?

Mr. Sackville

It goes without saying that the health authority will continue to be a major force and a major purchaser of acute services for all fundholding GPs in the district. It would be wrong to suppose that it is not possible to plan health services where there is a wide distribution of fundholding.

I reject the hon. Member's description of health planning descending into chaos, or words to that effect. The consultation exercise must be gone through, because health services are evolving. It will be for the health authority, principally, to decide what option should be recommended. Those matters must be planned coolly and rationally, because they affect the pattern of health services for decades to come.

I assure hon. Members that the outcome of the deliberations will mean a better and more modern health service for the entire district for generations to come.

Question put and agreed to.

Adjourned accordingly at two minutes past Eleven o'clock.