§ Mr. David Hinchliffe (Wakefield)
I am grateful for the opportunity to raise, once again, concerns about the provision of health care in the Wakefield metropolitan district. I have calculated that, within the past five months, this is the seventh occasion on which I have felt it necessary to raise these concerns in the Chamber. I know that my anxieties are shared by my hon. Friends the Members for Pontefract and Castleford (Sir G. Lofthouse) and for Hemsworth (Mr. Trickett), who made his maiden speech this morning. I apologised to him earlier for not being present during his speech. I know that he will make his mark in the Chamber in the years to come. Unfortunately, my hon. Friend the Member for Normanton (Mr. O'Brien) is unable to be here today—within the past fortnight he has spoken about his worries about the redevelopment of Pinderfields hospital, Wakefield, and he shares many of the concerns that I shall raise now.
I have asked for this debate because my constituents—and, I suspect, the people of the Wakefield district as a whole—are bewildered about and increasingly angry at the uncertainties and crises that seem to underpin health provision in our area. The record of the internal market, since its introduction in Wakefield following the 1990 legislation, has been one of unfulfilled promises, contradictions and U-turns. I am not making a political point. As the Under-Secretary of State for Health will be aware, it is impossible to find any trace of a clear strategic policy direction in local health care because those responsible have found the task of making the market work in Wakefield completely impossible.
I make it absolutely clear that I do not blame the local management for this problem—it has been landed with a situation that is totally beyond its control. As the Minister knows, there has been a series of events over the past two years, in particular, that have given local people and their elected representatives real cause for concern about the future of vital health services in our area. The transfer of the regional neurosurgery specialism from Pinderfields hospital, Wakefield, to Leeds marked the start of a wholesale series of threats to key provisions which have been available in Wakefield over a long period.
I have previously said that what constituted a raid by a larger trust on a smaller trust suggested further developments to come, with my constituents and those of my colleagues increasingly being expected to travel to Leeds and elsewhere for care that was previously on their doorsteps. The neurosurgery episode was particularly worrying. While we have become accustomed to the opinions of local people being disregarded time after time in what are called public consultation processes concerning closures or changes of use, the experience on this occasion was worse than usual.
Before the consultation period had ended, Wakefield health authority conceded the transfer of the service, despite there being not one voice in support of the proposal in the Wakefield area. I believe that some sort of deal was done whereby Pinderfields was assured of the provision of a centre of excellence in rehabilitation and a chair in rehabilitation in return—this is recorded in minute 71 of the Yorkshire regional health authority minutes of 8 March 1994. More than two years on, there is no sign of 346 this centre or of the chair. Is it any wonder that Wakefield community health council stated in a letter to the Secretary of State dated 6 March:The public of Wakefield and members of the Community Health Council have lost faith in the honesty and integrity of senior regional managers, and would question most strongly the validity of holding public consultation exercises"?
Those are strong words from a body of people who have learnt the bitter lesson that they have been far too trusting in the past about assurances given during consultations on closures or change of use. I felt that the CHC was wrong to accept the closure of the Manygates maternity hospital in my constituency following a consultation procedure in 1991. However, it did so on the basis of clear assurances on the provision of a purpose-built maternity unit on the Pinderfields site. Not only has that never materialised but, as I shall mention in a few moments, serious consideration has been given to the complete closure of the maternity unit at Pinderfields.
The Minister will be aware that, for some time, the health authority has been concerned about the viability of having two acute trusts in the Wakefield metropolitan district. Nearly three years ago, the authority launched a discussion paper proposing moves towards one trust. That proposal was quietly dropped after strong local opposition, obviously based on fears that it would result in a rationalisation of services at the current district hospital at Pinderfields in Wakefield and at the Pontefract general infirmary.
Just over a year ago, the then chair of Wakefield health authority, Mr. Brian Hayward, told me that the authority was seriously considering closing both Pinderfields hospital and Pontefract general infirmary, and moving the entire district's services to a new site somewhere geographically between the two. That came as something of a surprise to the chair and to the then chief executive of the Pinderfields Hospitals NHS trust who, at that time, were well on the way with a detailed proposal for a major redevelopment of the Pinderfields site through a private finance initiative bid. The left hand had no idea what the right hand was doing on that occasion, but this has been par for the course in recent years in our area.
Subsequently, the proposal was quietly buried and we were advised that services would continue to be provided from the two separate sites by the two acute trusts. However, the latest proposal to emerge is, once again, the idea of one combined acute trust. Last month, the Pinderfields and the Pontefract trusts produced what was termed a formal expression of interest in making an application for approval for a trust merger. Although the proposal has yet to be put out for so-called public consultation, I understand that the Northern and Yorkshire region has given approval and that the chair and the chief executive of the new body are already known. By the time the public are supposed to have a say on the proposal. it will be more or less up and running.
The merger proposal document is the clearest admission yet that the encouragement of competition between health providers is wasteful and counter-productive. It speaks of the merger proposal reinforcingThe commitment to partnership rather than competition on the part of both Trusts.It flags up the possibility of potential partnerships with other acute providers in West Yorkshire, where that achieves a greater critical mass of population. 347 Such possibilities and what the document terms the "reconfiguration" of acute services across the district have raised serious worries about the continued availability of a range of services at both Pinderfields and Pontefract.
I want to make absolutely clear my wish to see existing services retained at Pontefract general infirmary as well as at Pinderfields. I have no desire to see services in Wakefield retained at the expense of those in Pontefract. It would be totally unreasonable to expect constituents in either the east or the west of the Wakefield metropolitan district to travel to the other end for basic services currently available in their own localities—but that is what is likely to happen as a direct consequence of the proposed merger.
The proposal to transfer maternity provision from Pinderfields hospital to Pontefract general infirmary is already being seriously considered. It flies in the face of clear assurances given to the public when Manygates maternity hospital closed. I have the consultation documents here for the Minister to see if he wishes to check that point.
With the debate concentrating on the critical mass issue, we are being told that maternity units with fewer than 2,000 deliveries per annum are no longer viable. As I reminded the health authority chair-elect—if that is the term for someone unelected—and the health authority chief executive last week, such a measure of viability would be contrary to the findings of the Health Select Committee maternity inquiry, the so-called Winterton report. I served on the Select Committee during that inquiry and I understood that the Government subscribed almost totally to its central tenets in relation to the size of units and clinical intervention.
I am not closing my mind to a reshaping of maternity, gynaecological and obstetric provision in my area, but I am saying that it is not on for women and their families to have to travel to either end of the district to a single maternity unit. Such a proposal would be fought in every way possible, as will other suggestions leading to the loss of long-standing services at either Pinderfields hospital or Pontefract general infirmary.
The district health authority's problems in trying to make sense of the internal market, have been made much worse by two other factors—the change in the national funding formula and the joker in the pack, GP fundholding. I previously pointed out that Wakefield health authority has been deemed the most overfunded authority in the new Northern and Yorkshire region since the new criteria were introduced. In the 1996…97 financial year—the current financial year—it is deemed to be more than £4.5 million overfunded because the new formula uses some questionable and dubious criteria.
For example, the market forces factor, under which we lose substantially, assumes lower pay rates in the Wakefield area when national pay rates for nursing staff are rightly still the norm. The population formula relating to age takes no account of the fact that people who die younger, as happens to be the case in the Wakefield area, require similar types of health care in their later years. It takes no account of the fact that hospitalisation rates per thousand in acute specialties, at 198 and 192 for Pontefract and Wakefield respectively, are considerably higher than the 160 average 348 for England. The Minister must address the fact that the new formula markedly worsens an already critical position in the health services in Wakefield. I hope that he will consider that point in detail.
I hope that the Minister will also consider the impact of GP fundholding on Wakefield's problems. He will appreciate that the surpluses recorded by fundholders in the previous financial year were in marked contrast to the serious difficulties facing non-fundholding GPs trying to obtain hospital treatment for their patients.
I have said before, and I think we have proved conclusively in Wakefield, that a two-tier system is operating whereby patients of non-fundholders are disadvantaged. It is more than a little galling for non-fundholding GPs to have to struggle desperately to gain access to such treatment because of resourcing problems when local fundholders are so flush with money that they are building swimming pools with their surpluses. It does not go down well with the thousands of people who have campaigned to retain Snapethorpe hospital in Wakefield and were told that its recuperative facilities were no longer needed to find the new GP fundholding total purchasing project proposing to use private nursing homes instead of the NHS for the same purpose. Yet another so-called consultation process is proved to have been a charade.
Such episodes leave my constituents, and those of my hon. Friends who represent the Wakefield metropolitan district, angry and resentful about the treatment of their NHS by the Government. Bearing in mind the fact that they fund the NHS, are they not entitled to know why the chief executive of the Pinderfields trust literally disappeared slightly more than three weeks ago? Are they not entitled to know whether, as I suspect, Mr. Peter Ward, the gentleman concerned, was a scapegoat for some of these wider problems, most of which I believe were way beyond his personal control?
I conclude by reminding the Minister what the Secretary of State for Health said in his speech to the pharmaceutical services negotiating committee on 4 March 1996. He made it clear that the Government's policy was to ensure that health services were available to patients in their local communities. The logical outcome of merger proposals in Wakefield, forced on health managers by the serious problems that I have outlined, is the opposite of the objective set out less than a month ago by the Secretary of State.
If local health services in local communities is Government policy, I hope that the Minister will today undertake to intervene in Wakefield to prevent proposals of the type I have outlined, which will undoubtedly arise from the trust merger process.
§ Mr. Jon Trickett (Hemsworth)
Thank you for calling me, Mr. Deputy Speaker.
I associate myself with the comments made by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) about a number of matters. In a recent meeting between the Members of Parliament for the Wakefield area and executives of several organisations associated with health service provision in the Wakefield area, it became clear to us that there had been a series of secret meetings of various types in Wakefield, at Quarry house in Leeds and probably in London about the future of health care 349 provision in the Wakefield area. It is also clear that decisions were well advanced in terms of an apparently urgent desire to bring about a fusion of the two trusts in the area.
It was also apparent that decisions had been taken about the personalities—names were known—of the putative chair and chief executive of the new trust. We were told that there would be a public consultation exercise, but it is not due to start until about July and will run through the summer. That is often a convenient time for such public consultation exercises, as many people are preoccupied taking annual leave and vacations, and so on.
We felt that we had been presented with a fait accompli and that we, as elected representatives for the area, had been excluded from the decision-making process. Not many days later, we received through the post documents indicating the early proposals to unify the trust. The documents we received—I have a copy in my hand—a formal expression of interest, are only part of a series of documents that have not yet seen the light of day, proposing the change in the health service arrangements in the Wakefield area.
We were told that it is intended to reduce what is called "duplication of services" and bring about a "centralisation of services" on one site or the other. My hon. Friends and I representing the Wakefield area feel that services will be lost to communities and removed elsewhere in the district or perhaps further afield, and that proper decisions have already been taken about that. I am worried about that and about the way in which the facts have emerged. I am also worried that health service managers in the area appear preoccupied with institutional change, perhaps at the expense of clinical concerns.
My hon. Friend the Member for Wakefield mentioned maternity care. I have in my possession a worrying document, a review of the case of a constituent, which I do not wish to go through in detail now; the Minister may be aware of it. It makes it clear that there are clinical, technical and managerial problems with paediatric care at Pontefract hospital yet, as I understand it, it has been proposed that there be an amalgamation and possibly a concentration of those services at Pontefract.
Consultant paediatricians considering the service in Pontefract have said that they haveconcerns about the overall staffing structure and establishment in the paediatric department".They note that there are only three hospital-based consultant paediatricians and only one recently appointed community paediatrician. They say thatthere is no continuous safety net cover of an experienced resident paediatrician in Pontefract.They say:At the present time, the safety net cover is provided by a Registrar and staff-grade doctor and"—this is the important part of the sentence—for over 50 per cent. of the time there is no safety net provision available.They continue:The overall staffing levels are inadequate to provide a fully comprehensive children's service to a population of this size, with 200,000 people, 2,300 births and 1,900 acute paediatric admissions per year…The absence of a continuous safety net cover does not allow high dependency or intensive care work to be undertaken, and yet we understand that this still takes place on occasion.
350 The events to which the document refers—I hope to take up the matter with the Minister privately in due course—took place more than two years ago. According to the report that was published only last week, little seems to have been done to improve the situation. However, the local health service has employed highly paid and highly skilled professional managers to organise the planned merger, whose objectives have to do with private capital. The document refers tothe need to convince the private sector to reinforce to potential private sector partners the commitment to partnership rather than to clinical care".
We are seeking an early assurance that those discussions will cease and that an appropriate public consultation exercise will commence. In the meantime, I hope that the Minister will assure me that the eight recommendations of the consultant paediatricians in the report will be implemented immediately.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)
I am pleased to have the opportunity to respond to the hon. Member for Wakefield (Mr. Hinchliffe). I congratulate him on, once again, securing time to debate the important subject of health services in the Wakefield metropolitan district. This is the seventh time in five months that he has raised the subject, which reveals his assiduity.
I have noted also the concerns, which the hon. Member mentioned, of the hon. Members for Pontefract and Castleford (Sir G. Lofthouse) and for Normanton (Mr. O'Brien). I welcome the second speech of the day from the hon. Member for Hemsworth (Mr. Trickett), who I gather made a very good maiden speech. I noted his comments about Pontefract and paediatric care.
The hon. Member for Wakefield raised a number of points, and claimed that general practitioner fundholding in Wakefield had resulted in a two-tier system. He referred to increased resources for the national health service in Wakefield, and he and the hon. Member for Hemsworth expressed concern about the possible merger of the two acute trusts in the Wakefield area—the Pinderfields Hospitals NHS trust and the Pontefract Hospitals NHS trust. They questioned whether such a merger would be truly in the interests of patients and of improved health services.
The hon. Member for Wakefield also mentioned maternity services. I acknowledge his local concerns and those of Wakefield metropolitan district council. As he knows, I can claim a little local knowledge: although I am a Lancastrian, I had the good sense to be educated in Yorkshire, at Silcoates school, Wakefield. I therefore know a little about both Pinderfields and Pontefract hospitals.
The hon. Gentleman also asked questions about the resignation of the chief executive of Pinderfields Hospitals NHS trust, Mr. Peter Ward. I stress that that is a matter for the chairman and the board of Pinderfields Hospitals NHS trust, but I shall say more about Pinderfields later.
I shall deal first with resources. In May last year, the hon. Gentleman expressed concern in the House to my predecessor, the present Under-Secretary of State for the Home Department—my hon. Friend the Member for Bolton, West (Mr. Sackville)—about the fact that 351 health resources for Wakefield health authority and Wakefield metropolitan district were being cut. For the 1996–97 financial year, which has just commenced, the allocation for Wakefield health authority is just more than £140 million—a cash increase of £4.3 million, or 3.2 per cent. It is also an increase in real terms.
The resources that Wakefield health authority will receive this year include, as in the previous financial year, an increase in both cash and real terms. It is wrong to suggest that, because Wakefield is a certain percentage above its weighted capitation target, there may be a cut next year or in any succeeding year. Real growth in health resources will probably continue in the years to come. If so, Wakefield will continue to receive more resources in real terms. I accept the hon. Gentleman's point about market forces, and I assure him that those elements of the capitation formula are kept under review.
Secondly, the hon. Gentleman referred to so-called two-tier services and expressed concern about the way in which the undoubted success of GP fundholding is impacting on patients in Wakefield. I assure him, once again, that there is no question of a two-tier service. We stand by our agreement with the medical profession: all emergencies are seen immediately and all urgent cases that cannot be seen immediately are placed on common waiting lists.
There will always be some variation in waiting times for non-urgent treatment between health authorities, as well as between health authorities and fundholders, because different purchasers set different priorities according to their assessment of local need within the national patients charter guarantees and informed by patients' wishes. It is open to health care purchasers to negotiate the best contracts possible on their patients' behalf. Many fundholders use efficiency savings to fund more hospital services for the benefit of patients of all local GPs. Having a range of purchasers stimulates innovation and the delivery of care for the benefit of all patients.
The NHS executive has followed up cases of suggested two-tierism, which have invariably proved to be cases of fundholders making use of spare capacity, purchasing more services and making more resources available. That benefits all patients. Fundholding is achieving not a two-tier system, but an improved health system. We want our services to be based on the standards achieved by the best, not the worst.
As recently as last Monday, my hon. Friend the Minister for Health visited the new Wakefield health authority to learn about Wakefield's pioneering plans to develop a primary-led NHS. He praised the work of the health authority and of local GPs on total purchasing, which builds on the success of fundholding. In Wakefield, 85 per cent. of GP practices are now fundholders. Fundholding has improved patient care in Wakefield through the provision of new services, including rheumatology, cardiology, a cataract centre and increased day case surgery. It has also had a marked effect on waiting times at the two acute hospitals. At Pinderfields, waiting times have been cut by 50 per cent. for general surgery, and by about 25 per cent. for ophthalmology; at Pontefract, orthopaedic waiting times are down by 42 per cent. That is real success.
352 I shall now deal with the question of a merger. With three of his colleagues, the hon. Gentleman expressed concern about Pinderfields Hospitals NHS trust and Pontefract Hospitals NHS trust in a press release issued last week following a meeting with the chairman and chief executives of Wakefield health authority and the two trusts. The hon. Gentleman is aware that, in early February, both the trusts and the health authority decided that it would be sensible to look at services across the two trusts and to work more closely together for the benefit of everyone. They expressed a wish to consider a possible merger of the two acute trusts. It is worth stressing the fact that Wakefield health authority believes that there is a need for two acute hospitals: one in Wakefield and one in Pontefract. I understand also that there is strong clinical support for a merger.
An examination of the options will, therefore, surely benefit patients in the Wakefield area. I reassure the hon. Gentleman and his colleagues that the proposal is at a very early and tentative stage. The next step is that the proposed merger will come to me, as the responsible Minister and, if I agree to it and the two trust want to go ahead, public consultation will follow later in the year. That will involve local people, including the two local community health councils that cover Wakefield and Pontefract. I am sure that hon. Members will be involved fully in that consultation exercise: they will have every opportunity to express their views and I am sure that they will not be slow in doing so.
§ Mr. Hinchliffe
I am concerned that consultation exercises do not mean a great deal, as assurances are not followed through. Does the Secretary of State or the Minister study assurances that were given in past consultation exercises of the kind that I have described to check whether they were carried through?
§ Mr. Horam
Such assurances are not given lightly, and they are taken seriously. I shall study past assurances that were given in this case when it comes before me.
The hon. Gentleman knows that Pinderfields is developing a business case for a major new development under the private finance initiative. Any proposals for merger will take that project into account, so there are two reasons for consultation. One is the possibility of a PFI initiative by Pinderfields, which I welcome, and the second is the possibility of merger.
Pinderfields Hospitals NHS trust is progressing PFI testing for redevelopment of the site to replace a fragmented configuration of buildings, many of which—as the hon. Member for Wakefield knows—are of poor quality. I have heard the hon. Gentleman—I agree with him—complain at great length about the age of some of those buildings. We want new facilities, if that is possible, not only for patients but for staff. I have seen for myself the huge improvement in morale that can result from new facilities, provided by whatever means. I am sure that the hon. Gentleman would wish to welcome that possibility.
The trust is making good progress and it should not be long before it selects the consortiums that will be invited to submit detailed proposals. There are some financial problems, as the hon. Gentleman is aware, but Pinderfields Hospitals NHS trust has made major progress in reducing waiting times and the length of waiting lists. In my view—