HC Deb 16 January 2003 vol 397 cc915-22

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

6.19 pm
Mr. Mark Simmonds (Boston and Skegness)

I would first like to thank Mr. Speaker for allowing me to initiate this Adjournment debate, which is of fundamental importance to me, as the democratically elected representative of the people of Boston and Skegness, to my constituents, and to all those other individuals who use Pilgrim hospital in Boston. I also thank the Minister for being here to respond to my comments this evening.

Pilgrim hospital is the major provider of secondary health care in my constituency and the immediate surrounding area. As such, it plays a vital role in the community and serves a very large rural catchment population. Indeed, some calculations show that its catchment is greater than that of Lincoln and Peterborough—both of them cities that currently have larger hospitals. The catchment population of the Lincoln hospital is estimated to be 335,000, and that of Peterborough is estimated to be between 280,000 and 300,000. The catchment population of Boston and south Lincolnshire is approximately 400,000.

Before I proceed further with the specifics, I would like to place on record my thanks and admiration for all the hard work that is done, day in and day out, by all those at Pilgrim hospital. I am aware that staff at all levels work as tirelessly and effectively as they can to provide a first-class service. That is in the context of a work force who are increasingly disheartened and a public who are increasingly disappointed as a result of the unattainable level of expectation to which the Government's announcements have given rise, and owing to a recent merger with Lincoln, which in many people's opinion is having a detrimental impact and effect on service provision.

Pilgrim hospital first opened in 1972 and has 670 beds and a small, private wing called the Bostonian. The hospital and associated hospitals provide for approximately 35,000 in-patients, 12,000 day cases, and, depending on how the figures are analysed, up to 120,000 out-patients per annum. Pilgrim is by far the greatest contributor to those figures. It has a 24-hour accident and emergency department, and, currently, all the main speciality departments. As the Minister will be aware, a strategic service review is currently under way, which will assess the provision of services across the whole Trent region. Clearly, I recognise that every hospital in the region cannot provide every service. For example, the small hospital in my constituency at Skegness obviously cannot provide cardiovascular surgery.

There are dangers in relation to encouraging and facilitating centres of specialism, however, particularly in large rural areas such as Lincolnshire. Some low-volume work may have high costs, both in financial terms and in terms of expertise. Some specialist centres will be needed, but it is essential that the specialist centres that are required are provided in Lincolnshire, not outside the county in Leicester or Nottingham. There is pressure from both Government and the royal colleges on consultants to deal with a certain number of cases per year, and that each consultant must deal with a sufficient number of cases to be safe and professional and to maintain a degree of expertise.

That maintenance of professionalism and expertise, however, must be offset against considerations of travel and convenience. A balance must be struck. It is not compassionate or practicable to ask people to travel miles for basic medical care. Many of my constituents are not particularly affluent, and would find it impossible to get to Lincoln or Peterborough, never mind Nottingham or Leicester. The current state of rural transport in Lincolnshire is not conducive to ease of travel.

The current situation in which Government targets are only being met by reprehensible list manipulation is unacceptable to me and to my constituents. Let me give the Minister a specific example. I understand that, if a Boston resident approaches a 12-month wait for an ear, nose and throat appointment, he or she is offered an appointment elsewhere—for example, in Lincoln—with no consideration of his or her ability to get to Lincoln. If that person refuses or is unable to make the appointment, he or she is struck off the list, thereby receiving no treatment but enabling the hospital and the trust to deal with the 12-month waiting list. I am not blaming the Minister personally for that, as I am certain that the practice takes place elsewhere. However, the Government must take some responsibility for applying such draconian pressure on hospitals and trusts to meet waiting list targets that they feel obliged to distort clinical priorities.

It is no exaggeration to say that clinical directions have very little to do with clinical priorities. I would welcome the Minister's confirmation of his disapproval of, and distaste for, this practice. I hope that he will pledge to look into the matter, so that my constituents receive the health care that they need in the hospital that they deserve.

Pilgrim hospital has a 98 per cent. bed-occupancy rate. Indeed, on my frequent visits to the hospital, including having participated on a night shift, I have been amazed by the constant crisis management that exists, shuffling patients around in an attempt to find beds. There are patients who are in accident and emergency who should be in medical wards; patients who should be in medical wards who are in surgical wards; and patients who should be at home who are in surgical wards. Some people should be in care homes, but several care homes have closed, primarily as a direct result of some of the policies that the Government have pursued.

Those problems are coupled with the fact that Pilgrim hospital has only a day contract with the ambulance service—that is, between 9 am and 5 pm—and that means that the hospital staff can only arrange for patients to travel by day. On the surface, that may appear to be fine and acceptable, but the implication is that patients admitted at night cannot be sent elsewhere or even to their home. In some cases, they are treated because there is no ambulance. They have to stay in the ward overnight because they cannot get home. The nursing and other staff arrange for an ambulance to take them home, but there is a 24-hour booking time so they have to stay another night. That means two potentially unnecessary night stays in Pilgrim hospital, and that blocks beds for others. That is madness. The transport bill to transfer some people home by taxi must be horrendous, and an already horrendous bed-blocking problem is exacerbated. The implication is that significant numbers of operations are cancelled. Many are cancelled the day before and some on the day of the operation. That is not acceptable, and the position must be improved.

It is my view that the Lincolnshire East Coast primary care trust is keen, like me, to retain local services for local people. I hope that the pressure will convince the trust to keep Pilgrim offering a full range of services. Any diminution of service would not be acceptable. Any removal of a specialism would be seen as a downgrading of the hospital. For example, I understand that conversations are going on about gastro-intestinal specialisms.

I am also intrigued as to who will make the final decision after the strategic review reports. Will it be the regional health authority? Will it be the hospital trust? Will it be the public, whom I understand will be consulted? After all, what is the point of public consultation if the consultative process is ignored? If, as I understand it, the decision will be made at the last port of call—the regional health authority—will it not stand in complete contrast to the Government's supposed devolved decision-making policy and agenda for the health service?

How does that decision-making process fit comfortably with the Government's plans for foundation hospitals? I very much hope that Pilgrim hospital will ultimately become a foundation hospital, with local decision-making and local accountability. It is ironic that, just as the Government, at least, superficially jump on the devolved power bandwagon, the reverse seems to be happening in Lincolnshire.

I am ambitious for, and committed to. Pilgrim hospital. I want it to be empowered and enabled to have greater autonomy and decision-making authority. However, my constituents—both patients and those who work in the hospital—have expressed many concerns about the merger with Lincoln. They are worried not just about the immediate impact, but about the medium and longer-term relocation of specialist services. I understand that the merger has not only led to a large overspend but has been an expensive option, eating into resources that could and should have been used to improve front-line health care provision in Pilgrim hospital on behalf of my constituents.

The merger with Lincoln has brought not just financial problems but actual service provision deterioration on the ground. For example, because of the assistance that was required in the form of staffing resources, waiting times for hearing aids in the audiology department in Boston prior to the merger were four to six weeks. They are now four to six months. A neonatal screening programme to test all children in Lincolnshire was due to begin in Pilgrim in early 2000, but because of the merger it was put on hold and may begin in 2004.

The possible threat in reduction of service provision is causing anxiety among my constituents. Indeed, only last year there was a risk to the ear, nose and throat department when a distinguished and highly regarded consultant, Dr. Graham Westmore, retired. Many patients were unnerved and deeply concerned and there is still concern at the current provision that a seven-day service may be reduced to five. However, I am delighted that tomorrow I will be opening the new ENT department at Pilgrim hospital. I am delighted that this service provision has been cemented in Boston for many years to come.

I am deeply concerned about security at Pilgrim hospital. To be blunt, I have been horrified by the anecdotal evidence from nursing staff in particular about the behaviour of some of the patients towards the hard-working and excellent staff. That applies particularly, although not uniquely, to those who work in the accident and emergency department. There is a particular problem with patients who have a drug or alcohol problem; they tend to be the most aggressive. The local police force have been extremely helpful and now have a presence in the hospital at particular times of the week. Will the Minister talk to his officials and colleagues in the Department of Health and the Home Office to find out whether any new source of funding could provide additional security—not only in Pilgrim hospital, as I am aware that this is a problem across the country? That could link in with the Government's new drugs policy which was debated in the House earlier this week.

I am also perturbed and uneasy at the revelation that the West Lincolnshire primary care trust appears to have run out of money. I understand that there has been a significant overspend in primary care surgery and all future surgical operations such as hernias, eyelid cysts and vasectomies have been cancelled for this financial year. The scheme is to provide patients with more convenient and local treatment in a primary care setting, with the expectation of reducing travel and thereby patient transport costs and avoiding hospital visits. The cancellations are opposed by general practitioners who wish to continue with the scheme and also put pressure on an already overstretched Pilgrim hospital staff.

I have with me an internal NHS document that lists the options regarding the overspend. The only item in the "Advantages" column is that cancelling the operations Avoids any overspend on this budget. The disadvantages are numerous. The document says that this will cause problems with the providers and patients at a time when Lincolnshire is promoting the development of primary care specialists. It says that some of the providers may withdraw. The third item in the "Disadvantages" column is fundamental and quite unbelievable. It says that there is no scope for undertaking the operations at the acute hospitals as they are unable to deliver their existing activity, let alone any extras. Another disadvantage, according to the document, is that the cessation of this activity could mean that some providers may become deskilled.

That says to me that the myth being perpetrated that everything is fine in the national health service, that there is no shortage of money and that everyone is being treated where and when they want is clearly untrue. I do not expect an answer from the Minister this evening, but I would like him to talk to his officials and come up with an answer on how we can improve that aspect of health care, take the pressure off Pilgrim hospital and make sure that the operations that were being done under the remit of the primary care trust continue.

In conclusion, I want my constituents to be provided with the best possible health care. I also want to continue to facilitate a motivated and enthusiastic work force at Pilgrim. I will not accede to proposals to remove or downgrade services under the auspices of specialisation or any other excuse. I trust that the Minister will assure me that that will not happen.

6.35 pm
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)

I congratulate the hon. Member for Boston and Skegness (Mr. Simmonds) on securing the debate. I am aware that he takes a keen interest in health issues that affect his constituency. Indeed, he initiated a similar debate in November 2001 on the future of Skegness district hospital. Having been schooled in Peterborough, I am familiar with the area, so it is good to play a role in the debate.

I recognise the concerns of the hon. Gentleman's constituents to retain access to acute hospital services in their local area. All our constituents would be concerned about that. It is wholly understandable that they should demand modern, reliable and efficient services at a location that is convenient to them. I want to assure them from the outset that they need not fear for the future of their hospital or the future of the NHS under this Labour Government. The hon. Gentleman mentioned the hospital's finances, which I hope to deal with in a moment. However, he is at odds with his Front-Bench spokesmen who said that there would be a 20 per cent. cut in NHS investment.

Mr. Simmonds

I have raised some serious issues. The Minister knows that it is not Conservative party policy to cut NHS spending by 20 per cent. May I suggest that he adheres his remarks to those serious issues?

Mr. Lammy

NHS funding is an extremely serious issue. Labour Members voted overwhelmingly for investment in the NHS and I am concerned that the hon. Gentleman's constituents have the best services available. I am pleased that our allocation to Boston primary care trust will rise by 8.6 per cent. over the next three years. I want them to get that investment and the facilities they need. However, given the hon. Gentleman's manner and tone on finances, it is right for me as a Minister to explain that they would be cut.

Pilgrim district and general hospital has been providing services for the people of Boston and southeast Lincolnshire since the early 1970s. Since April 2000, it has been part of the United Lincolnshire Hospitals NHS trust, when all acute hospital trusts in the Lincolnshire health authority area were merged. In the mid-1990s, the then Lincolnshire health authority reviewed services in the county. Among the recommendations proposed following the review was the transfer of ear, nose and throat services from Boston to Lincoln. I understand that that was not popular locally and the change did not proceed.

The restructuring of health services in 2000 prompted a further wide-ranging review of clinical services in Lincolnshire. A formal review has been commissioned by the local health authority. That is due to be completed in March this year. It would be inappropriate for me to prejudge the outcome but I understand that the trust wishes to see the Pilgrim continue its role as a vibrant hospital that provides a wide range of services. It may be that the outcome of the review sees some enhancement of facilities.

That position is borne out by the significant investments that the Government have made at the hospital in recent years. In 1998, a five-year capital programme was agreed to improve the Pilgrim. A total of £12 million has been invested, which facilitated the creation of a new accident and emergency department; the revamping of the outpatients department; two new theatres and two new wards; and essential repairs to the general fabric of the buildings.

As part of the Government's Action On programme, there is United Lincolnshire Hospital NHS trust's bid for the creation of a new ENT and dermatology department at Pilgrim hospital. The Action On programme was developed in 1998 to target efforts to address areas of high waiting times. Four priority areas have been identified—cataracts, orthopaedics, dermatology and ENT—and specific programmes have been created. They are designed to ensure that local services are shaped around patients' needs, streamlining patient pathways and improving patient access. The programmes aim also at facilitating improvements in the quality of care through the dissemination of best practice—maximising efficiency, balancing capacity with demand and providing support to NHS staff.

Under this Government, the ENT and dermatology unit became operational last year and will be formally opened by the hon. Gentleman tomorrow. I am pleased because across the country, people are seeing investment, new hospitals and new services in their communities. Hon. Members in all parts of the House are able to open new facilities in their constituencies. I am delighted and want that to continue—which is why I proudly stand here at a Labour Minister against cuts that would see services disappear.

Those developments are indicative of the large investments that the Government are making in the health service. We are committed to ensuring that everyone, no matter where they live, has access to high-quality, modern and dependable NHS services. The Government recognise that for too long, patients in some parts of the NHS have not had access to the standard of care and treatment they deserve. Last week, we announced a further round of NHS capital allocations for the next three years. They show a growth of 31 per cent. for 2003–04, 14 per cent. for 2004–05 and 20 per cent. for 2005–06—the first time that day-to-day operational capital has been directly allocated to NHS strategic health authorities, trusts and primary care trusts and the first time that capital allocations have been made for three years rather than one. That arrangement will allow local NHS managers to plan for the future and make decisions about the services that they provide.

Right hon. and hon. Members on this side of the House take the view that the NHS cannot be run from Whitehall. We believe in shifting the balance of power, which is why we have localised the NHS, handing it to local communities through their PCTs—performance-managed by our strategic health authorities. I note that the hon. Gentleman disagrees with that position. He would like greater centralisation and me to intervene in some local decision-making processes in his area.

Mr. Simmonds

I did not say that and must correct the record. I certainly believe in devolving power to democratically accountable, decision-making bodies. I was trying to address the point that potential decisions about the future level of service at Pilgrim hospital will not be made by the people at Pilgrim hospital but by people in Trent regional health authority. That does not seem to fit comfortably with the Minister's view and mine that power should be further devolved, not taken away.

Mr. Lammy

The decision will be made by local people, the strategic health authority and the primary care trust working in conjunction, and may well bring enhancements for the local hospital. It is about localisation, which we support, and I am grateful that the hon. Gentleman seems to support that. I urge him to let that process take its course. His constituents can take heart in the fact that the Government are committed to a modern, enhanced 21st-century NHS, which is why we are investing in his hospital, and why he will be able to open those ENT facilities tomorrow.

The total provided for the United Lincolnshire Hospitals NHS trust is almost £34 million over the next three years, allowing it to continue its programme of modernising and improving its facilities. The hospital trust is predicting a deficit this year on its annual revenue budget, but I have been reassured that a recovery plan is in place and is being monitored by the Trent strategic health authority. That plan does not include the reduction of services—the trust is instead considering alternative and more efficient service delivery methods. That deficit needs to be set against Government investment. We have significantly increased funding. For example, East Lincolnshire PCT is to receive an increase of nearly 9 per cent. on its budget for the year 2003–04. We are changing the way in which funding is allocated so that trusts can plan for a three-year period and make provision for the future.

The Government are keen to ensure that that investment is accompanied by reform. The NHS has delivered major improvements in health, but it falls short of the standards patients expect and staff want to provide. The NHS has to be redesigned around the needs of patients. As I have said, local hospitals cannot be run from Whitehall. The purpose and vision of the NHS plan, which was launched in 2000, is to give the people of Britain a health service fit for the 21st century which is designed around the patient. That change will improve the quality of care and affect how and where services are delivered across the NHS.

High-quality care is not just about good outcomes, but about giving people the kind of services that they want. Local people are being placed at the heart of the debate about their local health services. A new legal framework came into force on 1 January 2003 which places new duties on the NHS to consult the public in the ongoing planning and development of services, not just when a major change is required.

There are telemedicine links between Pilgrim hospital, Skegness and District hospital and other services that benefit the area. Those are just some of the ideas we have been exploring over the past few months as part of the work of the configuring hospitals project. I have been greatly encouraged by the fact that there seem to be real opportunities for smaller hospitals in particular to have a new lease of life, with service redesign and networked health systems offering the potential to deliver the kind of local health service that local people want.

We will shortly publish a document for consultation. I repeat that there is definitely a bright future for Pilgrim hospital. Any future developments there will be at the forefront—

The motion having been made after Six o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at eleven minutes to Seven o'clock.