§ Motion made, and Question proposed, That this House do now adjourn.—[Dan Norris.]
§ 8.7 pm
§ Mr. John Greenway (Ryedale)
It is both a pleasure and a relief to speak to the Adjournment at such an early hour. Whenever I am lucky in the ballot for the 30-minute Adjournment debate, the House either sits throughout the night or the main business collapses. Until the moment arrives no one is ever sure which alternative will prevail.
The first Adjournment debate that I initiated in this Chamber was on the Nestle takeover of the Rowntree factory. Everyone expected that the main business would end at midnight but, as you may recall, Mr. Deputy Speaker—like me, you were a Back Bencher at the time—there were 43 Divisions on the Firearms (Amendment) Bill and the Adjournment began at 5.30 in the morning.
I rather feared that I would have to keep the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), up all night—or rather that some of her colleagues would have been here all night and she would have had to wait around for a long time. I was going to suggest that the wait for my Adjournment debate was not dissimilar to the wait that some patients experience for their operation. However, in the event, I feel as though I have been given my operation ahead of my appointment with the consultant.
The issue that I want to raise is important none the less. I am sure that the Minister will have been briefed and will understand why it is so important. Our community hospitals are held in great affection by our constituents; Malton hospital is no exception.
Two or three years ago, I visited our former colleague, Sir Giles Shaw, at the hospital. Sadly, he died about 18 months ago after a stroke. I shall never forget my visit to Sir Giles; it was a happy occasion. He said, "John, this is a great place. You are lucky to have it and I know that you will do everything you can to fight for it while you are the Member of Parliament". I did not think that circumstances would require us to have a debate of this nature at that time, but I am galvanised by the words of Sir Giles.
Malton is one of three community hospitals within the Scarborough and North East Yorkshire Health Care NHS trust. That creates a difficulty. Scarborough is a small district hospital. Although the population of the area that it covers is not high, the geographical area that it covers is huge and it has to look after three community hospitals. Malton hospital is effectively run by the general practitioners at the Derwent practice in Malton, who work as clinical assistants. I have formed a good relationship with them over many years, especially as various developments have taken place at the hospital.
One recent development prompted me to request the debate, although as I have more time than expected I will take the opportunity to raise one or two other issues as well. Trust managers decided in mid March to cease all general anaesthetic operations at Malton with effect from 1 April. That caused shock and alarm in the local community. The letter sent by the trust to the senior partner at the Derwent practice said that a shortage of consultant anaesthetists meant that it could no longer provide back-up cover for GA operations at Malton hospital.
432 On 22 February, however, the trust sent out a staff bulletin in which it suggested that the difficulty with continuing GA operations at Malton and the two other community hospitals at Whitby and Bridlington was based on concern about clinical governance. So the issue at that time was whether it was safe to continue GA operations at community hospitals. That caused confusion and we remain confused about what lies behind the decision.
I have made it clear to the trust that we are prepared to accept that the reason for the decision is the shortage of consultant anaesthetists, and I want the Minister to use all her good offices to ensure that the vacancies are filled as quickly as possible. In a written answer from one of her colleagues last week, I was told that more than 1,000 extra anaesthetic specialists—I am not sure that they will all be consultants—are being trained and made available to the NHS. However, it seems that they do not want to live in Scarborough or the Malton area, which is a pity given the quality of life there. Although I accept that their long-term clinical career might be more challenging at another hospital, our area would be a good place for those at the lower end of the learning curve. The shortage needs to be addressed. The local community will test the Government's commitment to the health service and their argument that things are improving by how quickly those posts are filled.
The serious question in the minds of patients and medical staff is that although GA operations are suspended at Malton, they continue at Whitby and Bridlington community hospitals. That is partly because patients have nowhere else to go—Scarborough does not have the capacity to provide the theatre time required. Given that there is a lingering suspicion that it might not be safe to perform GA operations at community hospitals—the clinical governance issue—I suspect that some patients will wonder why they are being sent from Malton to Whitby or Bridlington where the same circumstances apply.
Will the Minister confirm that the withdrawal of GA operations is only a suspension of the facility at Malton? That is important. I am sure from your long experience as a Member of Parliament, Mr. Deputy Speaker, that you appreciate that if the services provided at a local hospital are changed there should at least be a public consultation involving discussions with GPs, patients and the community health council locally. There has been none of that.
In my early days as a Member of Parliament, the accident and emergency centre at Malton was downgraded to a minor injuries unit—again, largely for reasons of clinical governance and staffing. There was such alarm and concern that some of my political opponents even suggested that the hospital was about to close, although nothing was further from the truth. I must stress that people are not worried that Malton will close; their concern relates to the services that it will provide. When the accident and emergency centre was downgraded, a public meeting at the local hall in Malton was attended by about 1,000 people. I am sure that there will be a similar interest if and when we consult on this latest development.
433 I want to concentrate on the future. Not only were GA operations unexpectedly withdrawn on 1 April, but the hospital became part of the Scarborough, Ryedale and Whitby primary care trust. A number of community hospitals in other parts of the country experienced a similar change. That development is working well in general. It enables the community hospital to concentrate on diagnostic issues and makes the best use of the facility, so freeing up time that can be spent on more serious matters at district hospitals.
The Minister must expect the chief executive of the PCT, the trust members and doctors to have their own agenda for the future. It was certainly not in their plans that GA operations would be withdrawn on the very day that they took over responsibility for the hospital. Even given the background of the clinical governance issue, they must have expected three to five years in which to plan a withdrawal or contraction of GA operations at Malton.
The PCT, the doctors and patients are worried that no alternative was agreed in advance. Some 640 patients were treated under general anaesthetic at Malton hospital in the past year. In my 15 years in the House I have worked well with the managers at the Scarborough hospital trust and have a great deal of time for them. Although they will do their best, a strain will nevertheless be placed on alternative facilities. People will have to travel long distances for relatively minor operations that cannot be performed under local anaesthetic, which is the case with many procedures.
Some of the operations are not urgent; they concern what the medical profession calls "lumps and bumps", such as minor problems with varicose veins. However, many gynaecological operations are carried out and, on a more difficult point, a number of women have terminations under general anaesthetic at Malton hospital. Clearly, they cannot wait for treatment but have to be seen and dealt with promptly, whatever the rights and wrongs of the situation.
There is, therefore, concern that Scarborough hospital and the trust can cope with the situation. It is accepted that there is a lack of anaesthetist cover, but up to now the telephone back-up cover has worked extremely well. I am told that it is unlikely to continue because of the shortage of consultant anaesthetists, but I stress to the Minister that while the back-up cover clearly is important, it is the GPs, as clinical assistants, who are doing the work. I understand that it is proposed that one of the doctors who provides the anaesthetic service should also do sessions at Scarborough to ensure that he is thoroughly up to date with all the clinical procedures and can work well with the consultant anaesthetists based there.
I seek clarification on another issue. Although consultant anaesthetists do not come to Malton for GA-based operations that are done routinely in the mid-week, half-day sessions, they have been coming to Malton on Sundays for the waiting list initiative. It will stick in people's throats if they discover that routine operations have been withdrawn, but consultants are coming to the hospital for GA sessions on a Sunday and opening theatres that are normally closed simply to do operations under the waiting list initiative. I am sure that the Minister will understand my concern about that.
434 I mentioned that the primary care trust has its own plans. It is important that we have public consultation about a strategic plan for Malton hospital for the next five years. If there is to be a controlled withdrawal of some of the services at peripheral sites that we have been used to, in tandem with the restructuring of service provision, the public must go along with the plans. For example, as I said, there may be more diagnostic services at Malton, and some surgery may be restricted as the day surgery unit at Scarborough hospital is built up. The public must be reassured that they will receive treatment in a timely fashion and that all the changes are intended to improve not only financial efficiency but the quality and standard of treatment. People understand what is happening, but they must be taken along with the process.
As I have indicated, people will find it difficult to understand why it is not good enough to do GA-based operations at one peripheral unit at Malton, but those operations may continue at Whitby and Bridlington. I find it deeply unsatisfactory that individual clinicians are making what are effectively strategic decisions that have profound and wide-ranging implications for patient care.
So far as the PCT is concerned, I would like to think that as the health service develops, we could have more flexibility within service provision and about who is responsible for employing whom. Someone stopped me in the street at the weekend, knowing that I had secured this debate, and said, "I gather that the primary care trust now runs the hospital. Why can't it employ its own anaesthetists?" That is a very good question. It highlights the fact that NHS structures are too rigid, and we need to bring down some of the barriers. I sincerely believe that community hospitals have an exciting future, but flexible thinking and attitudes are necessary if they are to realise their full potential.
I draw the Minister's attention to another aspect of Malton hospital's future. The two main wards are what are known, in the medical world, as Nightingale wards. I understand that when the Nightingale ward modernisation programme, if that is the correct title, was first mooted, the impression was given—although I cannot say whether this is accurate—that the wards would be modernised. Sadly, however, that has not yet occurred. I believe that the first application was not successful, but the Scarborough trust is trying again. The sum involved is £1.3 million. It would significantly reassure the people of the Malton area if the Minister announced today when she thinks that money will be provided.
From the title of the debate as on the Order Paper, "The Future of Malton Hospital", someone who did not understand the issues might have thought that the hospital was to close, but that is not on the agenda. We have been over that matter in the past few years, and we persuaded Ministers in the previous Conservative Government, in particular my right hon. and noble Friend Lord Freeman, that community hospitals had a vibrant future. However, it is harder to convince the public of that when decisions are made out of expediency because of shortages of clinical staff. I believe that Malton hospital can have a great future, but that can be achieved only if managers and clinicians in the Scarborough trust and the primary care trust work together.
We know that the Scarborough trust has problems. Its budget is constantly overspent. The recent report on the trust did not make totally favourable reading, as the Minister knows.
435 I end with a plea—let us not sacrifice the work that Malton is doing, and that it can do in the future, to resolve the problems of the Scarborough trust.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)
Like the hon. Member for Ryedale (Mr. Greenway), I have the unexpected pleasure of speaking in this debate early in the evening. Hon. Members on both sides of the House talk more sense at a reasonable time of day.
I congratulate the hon. Gentleman on securing this important debate. He is, rightly, eager to ensure that the highest possible standards of health care services are available to his constituents. I know that he has taken a keen interest in the services that Malton hospital provides. He has tabled parliamentary questions about it and written to my ministerial colleagues, and he has been assiduous in following up these issues. I reassure him that the Government are committed to providing high quality services for everybody, no matter where they live.
We want to provide services that are as close to people's homes as possible but that are also safe and viable. Striking the right balance between local access and high quality has always created tension in the NHS; it is a problem that we continue to wrestle with, and its impact on local services is the subject of many Adjournment debates. Getting that balance right is not without its difficulties. It is fair to say that, if possible, most of us want services almost on our doorsteps, yet we also want them to be safe and of the highest possible standard. Trying to explain to the public and patients the difficulty of striking that balance is one of the challenges that faces us all. The hon. Gentleman clearly set out the background. He raised a number of specific queries and I shall certainly try to respond to them during my speech.
The NHS plan, which was published in July 2000, set out an ambitious vision of a service designed around the needs of patients. That new approach is aimed at trying to ensure that we achieve high quality national standards, that the services are fast and convenient, and that we use modern methods to provide care where and when it is needed. To deliver that, I genuinely believe that we needed a fundamental shift in power and resources to the front line. That is why we have, in just the past couple of weeks, established 302 primary care trusts which cover all parts of England and are in the driving seat in the provision of health services locally.
From 1 April, ownership of Malton hospital transferred to the newly established Scarborough, Whitby and Ryedale primary care trust. That locally based organisation will be able to ensure that Malton hospital continues to have a strong future, serving the needs of its rural population. I am delighted that the hon. Gentleman has emphasised the fact that we see a strong and vibrant future for Malton hospital. We are certainly not in the business of seeing services reduced or the hospital being in any danger. I have no doubt that things at the hospital will change, but it certainly has a very useful future in providing health services to local people.
The provision of comprehensive and accessible services is right at the heart of the NHS. We want to try to apply those principles to local services, and to try to strike a balance between convenience and the requirement to ensure safety and quality. Achieving that balance in the case of Malton hospital has led to the need to change the provision of anaesthetic services there.
436 The Scarborough and North East Yorkshire Health Care NHS trust's department of anaesthesia provides a full range of anaesthetic services at Scarborough hospital, which is the main district general hospital in the area. For many years, it has provided anaesthesia for day-case and overnight-stay patients in community hospitals in Bridlington, Whitby and Malton—all of which are approximately 20 miles from the main hospital.
Much of the anaesthetic service at the community hospitals has been provided by GPs, who work alone as clinical assistants under distant consultant provision from Scarborough. The consultant anaesthetists at Scarborough hospital have become increasingly worried that, owing to the shortage of staff, they are unable even to provide that remote supervision of all the peripheral sites. The trust is trying to provide the highest quality services possible across the whole area for which it is responsible. The decision to withdraw general anaesthetic surgery at Malton was taken because Malton has the lowest level of such activity of all three sites. So the decision is very practical and designed to affect the least number of patients.
The problem in question is really the lack of qualified staff, which is endemic in the health service. The main problem now facing the health service is not necessarily the provision of extra money. People throughout the country will say that they see the resources coming through. The NHS is growing faster than any other health service in Europe, and has undergone the longest sustained period of growth that we have ever known. However, one constraint is the capacity for trained and qualified staff across a range of specialties. Increasing the work force is thus a top priority for us.
We have said that, by 2004, there will be 7,500 more consultants, 2,000 more GPs, 20,000 extra nurses, 6,500 extra therapists and 1,000 more medical school places on top of the extra 1,100 already announced. That is a huge programme of growth. In 1996, there were 2,629 consultant anaesthetists. Five years later, there were 3,549—an extra 900—but that is simply not enough. We estimate that, over the next nine or 10 years, we will need another 2,540 consultant anaesthetists, but as we expect 1,850 extra, it is looking as if there will be a shortfall. We therefore need a massive recruitment campaign.
I know that the trust in Scarborough has been very active in trying to recruit extra staff. Mrs. Collinson of the trust has said:This is a lovely part of the country to live and work and we have good educational and health services, and moderately priced housing.She is keen to try to attract people to the area. Indeed, I believe that representatives of the trust are going to a careers fair in Berlin fairly shortly to see whether they can recruit some consultants. There is a great deal of activity.
The trust currently has an establishment for 10 consultant anaesthetists. One post has been vacant for just over a year, another became vacant on 1 April, a third will become vacant in June, and a retirement is anticipated in late summer. Against an establishment of seven middle-grade doctors, the trust currently has only three substantive appointments and four fairly long-standing vacancies. So the situation is very serious, as the hon. Member for Ryedale has said. The shortage of anaesthetists means that even remote supervision from the Scarborough site, with occasional visits to the community hospitals, is currently unachievable.
437 The hon. Gentleman specifically asked me whether, if we are successful in recruiting the extra anaesthetists, it would be possible for general anaesthetic surgery to recommence at Malton hospital. Discussions have been taking place with the GP anaesthetists who currently carry out the service, and two issues have arisen. The trust is very keen that GP anaesthetists should retain their skills, so that it will not be impossible to resume the service simply because of the passage of time. It is therefore making arrangements for GPs to go to Scarborough to keep their clinical practice up to date, which is important.
The trust is also mindful of the guidance of the royal colleges. The move is to provide GA services in an environment which includes on-site intensive care and back-up services. I would not at this point rule out the resumption of GA services at Malton, but the trust must be mindful of royal college guidance as well as the need for accessibility and for local convenience for the hon. Gentleman's constituents. I have no doubt that discussions will continue, but I want to ensure that they are not pre-empted by the loss of skills among clinicians who are currently carrying out the work. It is therefore important that we keep their skills up to date.
The PCT, like the hospital trust, is disappointed that staff shortages have precipitated the withdrawal of general anaesthetic surgery at Malton hospital, but supports the operational decision in the interests of patient safety. No long-term plan has been agreed between the PCT and the acute trust. Short-term difficulties have precipitated the change in service provision.
Any strategic decision and associated significant service changes would be subject to public consultation and—if the legislation before the House has been enacted—local authority scrutiny too. I give the hon. Gentleman that undertaking because, like him. I feel that local people must have trust and confidence in their local services. Involving them in full discussion of the available options is the right way to proceed. Local accountability is key in such circumstances, and it is all too easy for local communities to lose confidence in local services if they are not involved in discussions.
Where significant change is proposed and a consultation process takes place, that process will in future be led either by the local PCT, or by a group of PCTs if the issue crosses several boundaries. At the end of the consultation process, the PCT must take into account all the comments it has received. If, as we hope there will be, there is local agreement, the change can go ahead, but if local agreement is not achieved, the matter can be referred to Ministers either by the community health council, if that is still the proper body, or by the local authority overview and scrutiny committee, after implementation of the provisions of the NHS Reform and Health Care Professions Bill.
If the matter is referred to Ministers, we will take account of all the available evidence. We hope to have the independent reconfiguration panel up and running soon. The panel will be able to provide independent advice to Ministers, and help us to create a more coherent framework for future service changes. In that way, local people will be able to feel that the process is fair, transparent and based on established criteria.
438 The introduction of the new PCTs will enable local communities to commission appropriate services for local people. The hon. Member for Ryedale is right to mention flexibility and new ways of working. The decision to devolve resources and power to front-line local organisations will result in greater diversity in the ways in which services are delivered to local people. Local communities are often innovative and imaginative because they are aware of local needs, so giving them freedom to establish a wider range of ways in which to deliver care is a good step forward.
I assure the hon. Gentleman that the new PCT is committed to ensuring that Malton hospital has a vibrant future in which it continues to serve local people, and that the development of appropriate services continues. The PCT has advised me that there are no plans to withdraw further services from Malton hospital.
The hon. Gentleman is aware of the current work, initiated by the PCT, on the longer-term future of Malton and Whitby hospitals. As he said, that work includes a bid to modernise the Nightingale wards at Malton hospital. The proposal is to extend the existing Fitzwilliam ward, provide the correct match of single bedrooms and two and four-bedded bays, together with the appropriate support facilities, and ensure segregation of the sexes, thus enhancing dignity and proper patient care. The bid is being assessed against the national criteria, and I promise the hon. Gentleman that the results of the bidding process will be announced very soon; but I must ask him to he patient a little longer. I am informed that the announcement is imminent.
It is important that hon. Members have the opportunity to debate important proposals that affect local people. Representing local communities' interests and concerns is one of the most important jobs that we as Members of Parliament do, so the hon. Gentleman was right to secure this Adjournment debate.
I understand that all the patients who will be affected by the decision to suspend general anaesthetics have been contacted by the trust and supported by representatives in ensuring that their future needs are met. It is important that that be done while recruitment activities for anaesthetic services in the trust continue apace. I hope that those efforts are successful.
I assure the hon. Gentleman that general anaesthetic procedures that continue at the other hospitals do so safely. Local people may feel that procedures at Bridlington and Whitby are no longer safe, but I am told that there is a consultant anaesthetist on site at Bridlington for approximately 75 per cent. of the general anaesthetic lists, and that at Whitby the trust's medical director has agreed to take responsibility for the continuation of GP anaesthetists' lists there for a further 12 months, while certain measures are taken. There is adequate consultant cover for the other two hospitals; unfortunately, it has not been possible to retain that at Malton.
I am delighted that the hon. Member for Ryedale has been able to raise such important issues. I hope that he will receive a response to the Nightingale wards bid very soon. In the meantime, I hope that he will feel able to assure his constituents that they will continue to have access to safe, high quality services at the local acute trust.
§ Question put and agreed to.
§ Adjourned accordingly at eighteen minutes to Nine o'clock.