§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Coe.]
§ 8.5 pm
§ Ms Hilary Armstrong (North-West Durham)
On 1 May, during a debate on the private finance initiative and the health service, I raised the problems encountered by north Durham hospitals, and the difficulties caused by the delay surrounding the private finance initiative. I am therefore grateful for the opportunity presented by the Adjournment to put before the House the increasing problems faced by people of the area as the crisis in hospital care mounts.
In May, I reported that five wards had just been closed and that services had been transferred from Shotley Bridge hospital to Dryburn hospital, without consultation, because of financial problems caused by an overspend last year coupled with the need to make a further £2 million raving in the current financial year.
The accident and emergency unit had already closed at Shotley Bridge and had been transferred to Dryburn. Over the summer an increasing number of problems were reported with accident and emergency services, to the extent that the trust acknowledged that people were having to wait for too long and that new procedures would have to be introduced.
In a report to the trust board in October it was stated:The main problem is, however, that many patients are having to wait for a considerable period of time following an assessment, for their treatment…In relation to the emergency admissions via the A and E Department, whilst the number of admissions has increased, the number of patients having to wait to be admitted to a ward in excess of 2 hours has increased considerably.I am pleased that the trust has recognised that serious problem, and is seeking to tackle it, although I understand that no additional resources have yet been identified for the additional staff it knows will be necessary.
Those words hide many individual experiences that have come to light in the past few months. In their own way, each has been distressing, but they have also contributed to a general crisis in confidence in the ability of the accident and emergency service at Dryburn hospital to cope with the range of patients from the area.
There are also additional problems for constituents, particularly in my area, who now have to travel a minimum of 14 miles to the accident and emergency department. One constituent came to see me and recounted how he had been taken by ambulance to hospital having been mugged outside his home late at night. He was eventually attended to at the A and E unit, but then he had to make his own way home. That cost him about £15. I have been told that that is now the norm—that patients will be taken to the accident and emergency unit, but will then have to find their own way home. None of us had worked that out in the early stages of the debate on the transfer.
There has also been an increase in the number of cancelled operations—again, that has been acknowledged by the trust. I wrote to the trust in July, following receipt of a letter from Mrs. Eccleston of Shotley Bridge. Her father was admitted to Dryburn hospital on 25 June. He was not allowed to eat and was prepared for theatre on Thursday 27 June, but his operation was cancelled and she was asked to take him home. He was readmitted the following Monday.
1278 He was allowed no food and was prepared for the operation on Tuesday 2 July, but his operation was cancelled again. Mrs. Eccleston wrote:I feel the services which the North Durham Trust provide are becoming somewhat of a joke, and patients are suffering, no matter what quality measuring the trust claim to provide. I feel that two admissions, five days in hospital—on fluids only and two doses of Pecolax—a very severe acting laxative—on an 80-year-old man—and then to have the operation cancelled twice is no longer tolerable.The story does not stop there. I and my colleagues—I am delighted to see my hon. Friend the Member for North Durham (Mr. Radice) here—were informed in September that the business case for the new district general hospital had been refused by the health authority because it was too expensive. Having initially been promised that the private finance initiative route would bring real savings, which could then be used to develop community services in the Shotley Bridge and Chester-le-Street areas, including the development of new community hospitals, we were appalled to hear that the planned new hospital was to cost more in year-on-year revenue costs than the two hospitals continuing would have cost. I believe that the health authority was right to say that that was unacceptable and that a scheme which was, at least, revenue neutral—that is, one that would not cost any more than the two existing hospitals—would have to be prepared, so it was back to the drawing board.
We were also told that the trust had put it to the health authority that to make necessary savings because of current budget deficits the trust wanted to proceed with the further rationalisation of services from Shotley Bridge to Dryburn. Again, the health authority rightly said that it would not sanction further rationalisation until it was satisfied that the physical capacity of Dryburn was adequate to take the new services and the additional patients. My constituents are horrified at the suggestion that the transfer of services should go ahead with no guarantee of a new hospital and without necessary improvements to Dryburn having been approved or carried out.
It is no exaggeration to say that there is now a crisis. Dryburn hospital is not ready to take more patients or to be responsible for more specialties. There are bed shortages now, as well as inadequate theatres. This week, we have been sent a letter by the consultant staff committee—I know that the Secretary of State was also sent a copy of the letter, so I am sure that the Minister has seen it. The letter outlines the consultants' growing concern. The consultants support the interim rationalisation of services from Shotley Bridge to Dryburn, but they are doing so because the quality of service is deteriorating and they feel that they cannot wait for a guarantee of the new district general hospital.
The consultants identify two key areas of capital investment: in coronary care and intensive care and in creating extra operating theatres. Dr. Robson, who is chair of the consultants committee, says that those two projects are an absolute requirement before the move can take place. He adds that the trust's financial position is such that it could not hope to fund such developments itself. He writes:Consultants are now concerned … with simple, critical issues of patient care.He goes on to say:Colleagues feel that already they are unable, because of bed and theatre limitations, to offer the quality and quantity of service which is desirable.1279 Whichever way one looks at this matter, it is a crisis. The PFI case is having to be rejigged—the new case is with the health authority, but has not been agreed, so the Government have not yet seen it. The financial position is driving a hasty rationalisation without adequate facilities and the public feel that they are the last to be considered. Their confidence is being shaken again and again. We are facing the worst of all worlds: there is to be no new district general hospital, but the services are to go from Shotley Bridge. The whole saga is one of unfulfilled expectations and broken promises.
I am not here to condemn any individual or to lay blame, but the Government have to accept responsibility, both for the often chaotic way in which the changes in the health service have been approached and for the way in which the private finance initiative has been pursued. There is no time left for any procrastination.
§ Mr. Giles Radice (North Durham)
I congratulate my hon. Friend on obtaining this Adjournment debate—she is using the opportunity to debate this issue with her customary skill. I want to add my voice to her assertion that there is a crisis of confidence in hospital provision in north Durham. We want to hear from the Minister some reassurance that there will be the leadership necessary to get us out of this crisis. It is a crisis of confidence, not only for those who work in the hospitals, but for patients and for our constituents.
§ Ms Armstrong
I could not agree more. Indeed, I was about to say that someone has to get hold of this sorry affair and make sure that the people of north Durham get some reassurance. Those people are covered by my constituency, by my hon. Friend's constituency and by the constituency of my hon. Friend the Member for City of Durham (Mr. Steinberg), who is unfortunately unable to be here this evening, but who has been supportive of efforts to ensure that something is done.
Reassurance will not come merely with warm words. The Minister must demonstrate today, first, that the Government recognise the crisis facing the people of north Durham in terms of hospital care and, secondly, that he is prepared to take action. The future of the new district general hospital does not feel secure. I want a commitment from the Minister tonight that the Government still intend to ensure that the PFI for the new district general hospital will go ahead.
Reading the Red Book for last week's Budget, I was concerned to learn that it allows for only half the projects currently being pursued in the health service to proceed over the next three years. That suggests that the Government will allow some to fall by the wayside and that a proposal that is not picked up by the market may not become reality.
That will not do. A new district general hospital for north Durham must not be left to the vagaries of the market. Surely the Government must have projects that they are not prepared to allow to fail. We seek from the Minister an assurance that they are not prepared to see a new district general hospital on the Dryburn site fall by the wayside because the contract is not right or because they cannot reach a private finance initiative agreement at this stage.
1280 What will the Government do to ensure that the necessary developments outlined in the letter from Dr. Robson take place? Before more services are moved from Shotley Bridge to Dryburn, we need to be sure that Dryburn is capable of receiving those services, delivering them effectively and caring properly for patients who will go there.
What will the Government do to ensure that there is an opportunity for the development of the community hospitals at Chester-le-Street and at Shotley Bridge? Dr. Levick, general practitioner in Consett, has done some excellent work for Shotley Bridge. Following wide consultation, he put together an excellent proposal for a community hospital which, if it is able to proceed, will become a model of its kind for the next 20 years. I seek reassurances that the Government understand the need for that facility and are determined to ensure that it will come into being.
We raise the issues in the House because of the real anxieties of our constituents. Recrimination does not take us forward, and we need to go forward. I cannot impress on the Minister too strongly the need for urgency. People in our area should have a health service that they can rely on and have confidence in. I am sorry to say that that confidence is ebbing away. It is our responsibility, in the positions that we hold as representatives of the people, to be the guardians of the health service.
I believe that the Government have let down the people of north Durham. Our constituents deserve better and I hope to hear from the Minister tonight that they will get better.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)
I acknowledge the persistence of the hon. Member for North-West Durham (Ms Armstrong) on this issue, and her grave concern about the provision of hospital facilities in her part of Durham. I also acknowledge the concern of the hon. Member for North Durham (Mr. Radice), who intervened in her speech.
May I first say something about the accident and emergency service and relate some of the history of this matter? In March 1995, Ministers approved the closure of the accident and emergency department of Shotley Bridge hospital, where about seven of every 10 patients were treated for purely minor injuries, and approved its replacement by a nurse-led minor injuries unit.
That followed more general public consultation on the proposed reconfiguration of services between Shotley Bridge and Durham. The A and E department dealt with 18,000 attendances each year, well below the threshold recommended by the British Association for Accident and Emergency Medicine. That agreement followed more general public consultation covering proposed reconfiguration of services between the two hospitals.
All serious cases are now redirected to North Durham trust's main A and E facility at Dryburn hospital. However, in conjunction with the changes, North Durham trust did the following things. It appointed an additional consultant to the A and E department at Dryburn; upgraded the A and E department at Dryburn at a cost of £1.25 million, to provide increased facilities such as resuscitation bays; and installed a high-technology communications system—telematics—to link the two hospitals at Shotley Bridge and Dryburn.
1281 The hon. Member for North-West Durham will concede that ambulance services have responded well. There are now paramedics on every emergency ambulance in the Consett area, and a high-dependency paramedic unit is stationed in Consett. It is equipped to allow paramedics to fax ahead vital information to Dryburn hospital.
The trust also issued leaflets explaining those changes, to help people understand them and to help the Shotley Bridge minor injuries unit to receive cases that it would be appropriate to treat there.
§ Ms Armstrong
I did not want to intervene, but it would be exaggerating to say that Members of Parliament feel that the ambulance service is doing everything well. There have been several hiccups. Although we want to demonstrate our confidence that the Durham ambulance service will in the long run get it right, we have not been altogether satisfied. We have had to deal with some very difficult issues in the past few months.
§ Mr. Horam
I take the point that some cases may have been less than satisfactory, but I am describing the new arrangements that have been made, and I believe that, in general, the performance of the ambulance service has been very good.
I recognise also that recently there has been concern in Durham because, as the hon. Lady said, some non-urgent patients have had to wait longer than usual for treatment at the A and E department. The North Durham acute trust has recognised that, as she said, and has acted speedily. In any case, it had always planned to review the A and E changes after six months.
The trust set up an internal review of its A and E department, and it will act quickly on many of the recommendations from the action plan produced by the review team. These proposals include: improvements in staffing of the A and E reception, so that nurses can use their time more productively; the appointment of a senior nurse to act as a nursing leader for the A and E department; and improved nurse staffing levels.
Contrary to what the hon. Member for North-West Durham said, the trust has allocated extra funding to cover the cost of those improvements until the end of March. It is also implementing a wide range of measures to improve communications with patients and prevent delays for patients awaiting admission.
The trust's chief executive recently emphasised that those improvements were being made. Last week he said:Despite the fact that the A and E department it treating an increasing number of patients, the overall quality of medical care provided is extremely high. It is important to remember that all emergency cases have always been dealt with immediately and this will continue to happen".So we should keep in mind the fact that patients do receive high-quality care in the A and E department of Dryburn hospital. The minor injuries unit at Shotley Bridge hospital is still capable of treating the vast majority of cases that previously went to the former A and E department there. Moreover, the new enhanced service represents a safer alternative for some seriously ill patients.
The hon. Member for North?West Durham mentioned the future role of Shotley Bridge hospital. I understand her worry about that. I understand the anxiety of local 1282 residents. As she knows, the Shotley Bridge working party was set up in 1995 partly in response to local concerns about the proposed new role for Shotley Bridge hospital. She is familiar with the history of the development of Shotley Bridge hospital, and I believe that the way in which it is developing has been perceived as very progressive by local opinion.
I am pleased to note that the leader of Derwentside district council, Alex Watson, is a non-executive director of Community Health Care: North Durham NHS trust—the trust that is playing a leading role in the development of Shotley Bridge hospital. His concern and knowledge will be valuable in that context.
I shall now discuss the matters of concern.
§ Mr. Radice
I understand why the Minister would not want to mention it tonight, but will he ask his Department to inquire how the plans for a new community hospital in Chester-le-Street are developing? Perhaps the Minister would write and give me a progress report.
§ Mr. Horam
I am happy to give the hon. Gentleman that assurance and I will write to him. having investigated the state of play on the Chester-le-Street community hospital.
At the end of July, the hon. Members for North Durham and for North-West Durham visited me to discuss the important and innovative scheme for Dryburn. The hon. Lady then vigorously explained the need to update the facilities and I know that there is considerable local support for the scheme.
It is fair to say that the hon. Lady emphasised her enthusiasm for the proposals going ahead at Shotley Bridge, transforming it into a community-style hospital that would work in parallel with the Dryburn scheme. I can well understand her frustration and her wish that a new hospital be developed at Durham. I too would like—and indeed expect—progress to be made, but it is necessary for the scheme to pass through a rigorous process to obtain an affordable, high-quality hospital, which is good value for money and provides excellent facilities. The project is worth about £65 million. The hurdles that it must surmount are not particularly unusual and are generally overcome. The PFI route for North Durham also offers the opportunity to construct new facilities in one phase rather than via a phased development. One of the advantages of the PFI system is that everything can be done at once. As the hon. Lady and the hon. Gentleman will be aware from their experiences in north Durham, hospitals constructed via the public route often involve one, two, or three phases which can disadvantage the local community.
The hon. Lady voiced her strong concerns about the future of the PFI scheme in Durham. I am assured that the trust and the County Durham health authority are working jointly on measures to bridge the "affordability gap". The next step will be for the trust to finalise the full business case for the project and ensure that it has health authority agreement. I give both hon. Members this assurance: I am personally involved with the case and I know that all the parties concerned locally—the trust, the health authority and the regional arm of the national health service executive—are working extremely hard on the project.
As Minister responsible for PFI schemes, I assure the hon. Lady that the project remains a high priority. It is one of the leading PFI schemes and it enjoys my full 1283 support and attention. Obviously I cannot guarantee its success, but it will not fail for want of trying. We are convinced of the need for a new hospital in Durham and we believe that we are on course to achieving that. There is no reason why it should not be accomplished within the timeframe that I mentioned. The project does not lack the necessary support and leadership, and I shall be dedicated to it while I remain the Minister responsible.
The hon. Lady said that the transfer from Shotley Bridge to Dryburn should not take place without adequate improvements to the hospital at Dryburn. In a sense, the PFI scheme and those improvements are linked. I also recognise the point made by Dr. Robson in his letter that the improvements are necessary on clinical grounds. They will go forward on clinical grounds, as the financial grounds are not strong. Clinical needs and patient care are the important factors driving the improvements at Dryburn. I recognise the hon. Lady's assertion that coronary care, intensive care and extra operating theatres are the three key issues around which the improvements revolve. I hope that I have reassured the hon. Lady that the scheme does not lack priority: it will go ahead if the parties who are currently working extremely hard continue to do so.
1284 Finally, I turn to the overall position of the health authority. The hon. Members will be aware from the letters that they have received in the past week or so that the health authority received an integrated allocation for next year of £295.7 million—which is a £6.4 million real cash increase and a 2.3 per cent. increase. They will know that Durham is an under-target health authority: its budget is below what it would receive normally. Therefore, it will continue to receive above-average increases in revenue, year on year, until it reaches the target level. At present it is about 1.6 per cent. below the target—which is not a lot—so it will benefit in future years.
We intend to try to raise all health authorities in the country to the correct revenue levels steadily, year on year. We cannot achieve our objective in one year, but we shall reach our target over time. The health authority is in a promising position as it will receive the revenue necessary to deal with some of the immediate problems facing the trust. For all those reasons—first, the commitment of the PFI scheme; and, secondly, the situation facing the health authority—the hon. Lady has reason to be optimistic.
Question put and agreed to. Adjourned accordingly at twenty-six minutes to Nine o'clock.