HC Deb 23 March 2004 vol 419 cc856-64

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

9.16 pm
Mr. Steve Webb (Northavon)

After two and a quarter hours of voting, it is good to have the opportunity to raise the future of hospital and community health services in my constituency. I particularly welcome the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson), to her place, because I understand that she grew up in Northavon, or at least spent 10 very happy years there. She will therefore appreciate some of the issues that I seek to raise about the need for health care not merely for those living in inner-urban areas, but for those who live in market towns and rural villages.

The future of hospitals and community health services in my constituency is in a state of flux, and it feels as though it has been like that for as long as I have been a Member of this House, and probably for a very long time before that. The local strategic health authority is preparing something called the Bristol health services plan, and it is indicative of the approach being taken that it is seen as a Bristol-driven process to look at the needs of the urban community. The fact that it also serves the more rural communities of south Gloucestershire and north Somerset does not seem to feature quite as strongly on the agenda of the strategic health authority as I would wish.

At present, the local health trusts are involved in what they call "engagement" with the local communities, rather than consultation, as they do not yet know what they want to do. Public meetings are being held, some of which are well attended, some of which are sparsely attended. I could have saved the trusts a good deal of trouble in that regard. As the Minister knows, I undertook my own "engagement" with my constituents, in which I issued a detailed and careful health survey to every household in the constituency. I received more than 8,000 replies, and I have supplied the Minister with a copy of the report of the survey.

Sometimes such surveys can be a bit dodgy, involving questions such as "Do you want your local hospital to he closed: yes or no?" We all know the value of the response to surveys such as those. I like to think that the exercise that I undertook was a bit more serious. It put to local residents some of the hard choices that have to be made and asked them whether, if local health professionals advocated a particular reconfiguration, they would endorse it, whether or not it was driven by clinical guidance.

I should like to report some of the survey results to the House. The most striking was that 81 per cent. of the constituents who responded felt that the residents of south Gloucestershire—as distinct from the residents of Bristol—were not being fully taken into the process. To give an example of that, the local national health service trust, North Bristol NHS trust, recently reported a massive financial deficit and invited local MPs to a meeting to tell them about it. I discovered on the day of the meeting that I had not been invited. The meeting was being held at Frenchay hospital, in my constituency. When I rang the hospital to ask why I had not been invited, I was told that the Bristol MPs had been invited, and that I was not in Bristol but in south Gloucestershire. This may sound like parochial nitpicking, but it goes to the heart of my concerns. Health care decisions are often driven by an urban agenda, and by the needs of the big city and the big conurbation. Areas such as south Gloucestershire can sometimes be marginalised in the decision-making process. When I turned up to the meeting, I asked whether local councillors had been invited, and I was told, "Yes, the Bristol city councillors are here," so I said, "Have any south Gloucestershire councillors been invited?" The reply was, "Oh, no, we didn't think about that." It is indicative that the Bristol health services plan has not paid attention to the needs of south Gloucestershire residents, and that is why I am pleased to raise the issue.

Not only did 81 per cent. of my constituents feel that south Gloucestershire's residents were not being listened to properly in this process, but there was substantial opposition to one of the key ideas coming forward. That idea was that of the two principal sites currently run by North Bristol NHS trust—Frenchay and Southmead—the current drift of thinking is that Frenchay should be at best downgraded, perhaps lose its A and E department, perhaps be no more than a community hospital, or even have nothing at all on the site. Some 81 per cent. of my constituents said that they would not accept that outcome, even if the trust said that that was on medical grounds. The public are very sceptical. They have heard about the financial position of the trust, and they are sceptical about the proposals being driven by health considerations rather than financial ones. One of the difficulties that the trust faces is that at the same time as trying to make long-term plans, it is trying to deal with a massive deficit. Short-term cuts are therefore going on at the same time as it tries to set out a long-term vision. That sends confusing messages to the local public about cuts.

Dr. Doug Naysmith (Bristol, North-West) (Lab/Coop)

Will the hon. Gentleman give way?

Mr. Webb

I will not at the moment. If I have time, I will do so later.

I put to my constituents the idea of some community-. based facilities. One idea that I put to them was that of a walk-in minor injuries centre, perhaps at Yate, one of the principal population centres in my constituency. That idea was quite well received, but it was clear that people did not regard that as an adequate substitute for a properly resourced 24-hour accident and emergency unit at a proper hospital. My constituents will not be satisfied if they end up with somewhere to deal with bumps and bruises locally but lose access to a high-. quality casualty unit 24 hours a day at a local major hospital, which they currently have at Frenchay.

I put some options to my constituents as to community facilities that they would like to see. The three that came out top were: first, a minor injuries unit, particularly in the Yate and Sodbury area, but there was also support in the Thornbury area: secondly, being able to have out-patient appointments nearer home, which obviously would be popular and, given the lamentable state of public transport in the area, very sensible; and thirdly, intermediate care beds. Certainly, the existing provision in my constituency at Thornbury hospital, which people are able to use nearer to home, rather than a big, slightly impersonal hospital, is very much valued. Under the current process, local trusts are preparing what are known as strategic outline cases. Those are nearly finalised and will be submitted to the strategic health authority in the next few weeks. They will be sent on, assuming that they are approved by the strategic health authority, and will reach the Government by the end of April. I understand from talking to North Bristol NHS trust today that it is anticipated that the Department of Health will receive 11 of those strategic outline cases and is likely to approve five. The broad time scale to which it is working is by the summer. If that is not right, I hope that the Minister will correct me.

I want to ask the Minister what criteria the Department of Health will use in assessing those bids, which, I presume, will be from health authorities all around Britain. I want to suggest three criteria that I would like to see used. First, I do not want cuts in capacity. The current plan envisages cuts. At present, once minor adjustments have been made, North Bristol NHS trust has 1,563 beds. The draft strategic outline case that I have seen envisages cutting that by nearly 200 beds. That is at a time when demand, as a result of a rise in the population, would imply an increase of 281 beds. If we add those two numbers together, there is an implied shortfall, compared with present provision, of nearly 500 beds. In south Gloucestershire, the number of people over 65 will rise by half in the next decade or so, and the number of people over 75 will rise by a similar proportion. Given the huge growth in demand for hospital services, the idea that any strategic outline case would contain fewer beds than at present seems totally unacceptable.

We have seen what happens when hospitals do not have enough beds. Now we are confronted with the idea that we should plan on the basis of fewer beds. The theory is that the hospital will become more efficient, will drive people through more quickly, and will progress from being one of the worst to one of the best performers, freeing bed space and allowing the provision of care. Let us see the evidence. Let us see the hospital deliver improved throughput. Then we might look at how many beds are needed. The idea that we should plan on the basis of cutting hundreds of beds when population pressures imply that we should be adding hundreds of beds is totally unacceptable.

The BristolEvening Post recently ran a front-page story about cancelled operations at North Bristol, another big problem for my local trust. The main reason given was lack of beds. If that is the situation now, what will it be like when 200 beds are taken away, given population pressures that should add a further 300? I simply do not accept that a strategic outline case based on bed cuts will be acceptable to my constituents.

The second thing that my constituents want is access to world-class facilities, including accident and emergency. Access is a key issue. The Minister knows, having been to school in a village in my constituency, that reaching Frenchay hospital works for many of my constituents, particularly in the main area of Yate and Sodbury. If casualty services were taken out of Frenchay hospital, which is mooted in the medium term, I think it unlikely that people would be able to travel from my constituency up towards the Cotswolds, from villages such as Charfield, where the Minister grew up, Wickwar or Hawkesbury to Southmead hospital in a decent period. It may be possible at some times of day, but at others, when the north of Bristol and the south of south Gloucestershire are clogged and the ring road is clogged, people could get stuck. I am not convinced that any strategic outline plan that removes 24-hour access to A and E from my constituents will be acceptable to them. I hope that the Government will take that into account when responding to the strategic outline case.

Dr. Naysmith

I thank the hon. Gentleman for giving way, especially as I did not observe protocol and ask him beforehand, and he has very little time. When consulting his constituents, did he ask them what they felt about the potential downgrading of Southmead rather than Frenchay? I ask because all three district acute hospitals in the Bristol-south Gloucestershire area serve the population of south Gloucestershire.

Mr. Webb

Every question I asked invited people to reply "Yes, just Southmead" or "Yes, just Frenchay", or yes to both or no to either. All the questions were framed on that basis. I must be straight with the hon. Gentleman: most of the population in my constituency are on the Frenchay side. While Thornbury residents look somewhat more to Southmead, they still look to Frenchay as well. I chose to refer to Northavon in choosing a title for the debate because I wanted to represent the interests of my constituents. They want quality provision that is accessible, and for them that means Frenchay. I am saying nothing against Southmead: my wife used to work there and my children were born there, and it is a good hospital. What I am saying is that to withdraw A and E and, indeed, perhaps more from Frenchay would be seriously detrimental to my constituents.

The third element that I think the strategic outline case should contain is scope for improvement in community facilities. Here I think we have the potential for more agreement. We have an excellent if small community hospital in Thornbury, in my constituency. Recently, and sadly, a friend of mine died there. The care that he, and particularly his family, received at that community hospital was second to none. Relatives and friends could just pop in. The hospital was small and friendly enough to enable his favourite armchair to be brought from home. That is a quality of care that cannot be found in some huge hospitals.

I hope that whatever emerges from the strategic outline plan will build on those strengths and will not undermine them. What that means to me is that Thornbury hospital must stay and, at the very least, continue what it is doing, even if not necessarily in exactly the same way: I do not want to give the impression that everything must be set in stone. My constituents and I accept that some hospital buildings are inadequate, that facilities are inadequate and that serious investment is needed. However, the idea that that should involve bed cuts, cutting access to A and E or any cut in community facilities is unacceptable to me.

The biggest area where new community facilities are needed is Yate and Chipping Sodbury. There was a big response to my survey in favour of that. The idea has been discussed and kicked around, and although I do not get a clear sense of how it will look, my constituents want new community facilities there. My constituents have sent a clear message. I have engaged with them and reported their findings to the House and to local health professionals. We do not say that things must not change—nobody in their right mind would say that. We want capital funding from the Government to upgrade, to keep Frenchay hospital in particular at the forefront of developments, and to see it move forward. I hope that, if the local trust can present a plan to the Department of Health for increased capacity, better access to quality accident and emergency services and better community facilities, the Government will reward it in the summer by accepting its proposals. If the trust does not present such ideas, I hope that the Department will tell it that it is not serving the local community as it should.

9.30 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I congratulate the hon. Member for Northavon (Mr. Webb) on securing the debate. I have listened to and appreciated his comments, not least because, as he remarked, I grew up in the area and know something of the local terrain. I pay tribute to all the staff in the local health economy area who, as he said, are committed to improving the local national health service.

In north Bristol, the health economy has already benefited from additional investment, and I shall give a few examples of that. A new children's high dependency unit opened at Frenchay hospital last November. It was funded by a grant of £858,000 from the Department of Health plus £800,000 a year from the local primary care trusts. A three-year project to improve and redevelop radiology services at Southmead has recently been completed at a cost of £2.5 million, including new equipment and building works. Now more than 130,000 examinations every year can take place using state-of-the-art diagnostic equipment. It is perhaps worth mentioning that the services provide more generally for the area because they are specialist facilities. I am sure that the hon. Gentleman acknowledges that they cover not only Thornbury residents but a wider scope of people from his constituency.

In January 2003, a new £600,000 satellite unit opened at Southmead hospital to improve the quality of life for renal dialysis patients. It provides 3,000 extra treatments a year for patients from a wide area.

I shall deal with the local issues that the hon. Gentleman raised shortly, but first I should like to point out that we all acknowledge the pressures on the NHS, not only in his constituency but throughout the country. We want not only to increase capacity but to improve clinical standards generally. We do not want more of the same but a radical re-examination of the provision of services. We want to design services around the needs of the patients and I was interested by the hon. Gentleman's comments about, for example, the strength of the cottage hospital experience.

It is our policy, in the framework in the NHS plan and in the "Shifting the Balance of Power" initiative to devolve more funding decisions to the front line. It is for primary care trusts, in partnership with strategic health authorities and other local stakeholders to determine the best use of their funds to meet national and local priorities for improving health, tackling health inequalities and modernising services. They are in the best position to decide how to do that because of their specialist knowledge of the local economy.

I am sure that the hon. Gentleman agrees that we all acknowledge that hospital and community services need to change if we are to continue to fulfil patients' needs and improve access. Services should not remain static for ever; they need to be responsive to local needs and changing needs. There are several different pressures on the service. However, providers of health and community services have a responsibility to live within their means. Those issues and many others need to be taken into consideration. Biggest is not always best. Indeed, we have already had an example of that. We need to recognise that patients want more, not fewer local services. We need to focus on redesigning, not relocating.

Perhaps it is worth mentioning the quality of the building stock at both hospitals in north Bristol, which the hon. Gentleman did not touch on. Frenchay and Southmead hospitals both have serious needs in building terms that must be addressed. They both have accident and emergency departments. There is a hospital with a major A and E department in the centre of Bristol, the Bristol royal infirmary.

The hospitals are between four and seven miles apart. Services are duplicated and fragmented across the two sites of the North Bristol NHS trust. They are cramped and rundown health centres. The current configuration makes it difficult to work effectively with primary and social care.

The current configuration means that there are particular difficulties in complying with national standards for clinical services, in particular for emergency patients, children, cancer patients, cardiac patients and those requiring specialist care. Therefore, the status quo is not an option—it cannot remain. There is clear scope for improving performance and, as I have said, the way in which health and community services in the 21st century are to be provided is less focused on hospitals than may have been the case in the past.

I come to the point that the hon. Gentleman made about the strategic outline case and the process. The outline case will be considered by all local NHS boards in April and the proposals will then go out to public consultation later this year. Although he talked about engagement and mentioned consultation, a very informal stage of the process has taken place in his area, in which he has been actively engaged recently. As part of that process, the local overview and scrutiny committee board will consider the matter as well. The plans will be transferred under normal processes to the strategic health authorities, which will ensure that a fair process is followed. They will not necessarily come to Ministers or to the Department. That is under the "Shifting the Balance of Power" arrangements that I mentioned earlier.

Mr. Webb

Just for clarification, central Government presumably need to decide which strategic health authorities get the very large amounts of capital funding that we are talking about, or is it the case that every strategic health authority gets a big capital budget and will then make the decision on the local projects? Clearly, the local trust was under the impression that the Department of Health would determine which five of the 11 bids went forward. Has it got that wrong?

Miss Johnson

As I understand it—this may prove not to be as accurate as it could be—it will be for those bodies to decide under normal circumstances. If there were some contest, as it were, there could be a question of a ministerial decision but normally the decision would be made at strategic health authority level.

The hon. Gentleman talked about his own survey and the future discussions and consultation. The local NHS in Northavon has embarked, with the local NHS in Bristol, on developing a Bristol health services plan. We need to have a range of options, and it is important to be able to engage the wider public in those discussions. Those will include developing acute services on either Southmead hospital or Frenchay hospital, with an associated development of a range of primary care and community-based services, as he mentioned. About six options are being canvassed.

The hon. Gentleman raised some real concerns about the proposals and has obviously taken a lot of time to compile the results of his survey. That is why I am grateful for the opportunity to assure him that no decisions have yet been made about the configuration of services. Indeed, the proposals are still being discussed as part of the engagement exercise that I mentioned, and that is being undertaken locally. Any decision will be made only once formal consultation has been completed. That is expected to start later this year.

Dr. Naysmith

The Minister will have gathered from my earlier intervention that I like to think that the aim of the changes that are taking place in Bristol and the south Gloucestershire area is to make the whole health community, as she described it, more efficient and work more effectively. That means that there will be no loss of any clinical specialties that are currently there, but that they may be moved from one site to another. I understand much of what the hon. Member for Northavon (Mr. Webb) said and agree with a lot of it, but does she agree that the important thing is that patients in south Gloucestershire and Bristol as a health community end up with a much better service, irrespective of where the changes have to take place?

Miss Johnson

I am grateful to my hon. Friend for his comments. I can certainly confirm that there is considerable scope in existing arrangements for services to local patients to be much improved as a result of whatever changes are made to the existing configuration. The hon. Member for Northavon and my hon. Friend the Member for Bristol, North-West (Dr. Naysmith) will understand that there are various possibilities, all of which contain scope for improvement. We would not expect to see any loss of service at all from the changes.

To address my hon. Friend's point on the health economy and the need for balance in it, it is envisaged that the time scale in which the changes are likely to take place will take us beyond existing financial issues in the area. Those will be dealt with before those changes, as a precursor to them. The changes will not be a response to any financial deficit issues in the local economy, but are about considering with excitement the possibilities for better service provision for patients to ensure that they receive not just the same but better services in the future. Those services should not only remain the same in quantity, but should he improved in quality.

When the hon. Member for Northavon conducted his questionnaire, residents may have responded to it without necessarily having the full benefit of the facts on the current services or future proposals. That is partly because the local NHS has been undertaking an extensive public engagement exercise since the end of January, and has been promoting its proposals through the local media, including papers, television and radio. About 10 public meetings have been scheduled, and five have already taken place—one of them, I believe, in the hon. Gentleman's constituency. I have heard his remarks about the invitation list at various meetings, and I am sure that the strategic health authority wants to manage the process as sensitively as possible. It will have listened to his views on the possibility of extending the invitation list on appropriate occasions to ensure that the wider picture is reflected.

It is welcome that the hon. Gentleman has conducted an exercise, but the local NHS is also conducting a series of wide engagements, in which the local media are playing a major part. Following those exercises, the results will be collated in a public report, due to be published in June. I understand that the early results show high levels of satisfaction with the format of the public engagement meetings, notwithstanding the points that the hon. Gentleman has raised.

As I mentioned earlier, it is our policy that primary care trusts, in partnership with other local NHS trusts and the strategic health authority, decide the priorities for the NHS locally. That is where specific local knowledge and expertise lie, and it is not appropriate for Ministers to decide on that direction of travel, or on how services should be configured. We have made that clear in general, and I want to make it clear again in this particular context.

Mr. Webb

Where is the democratic accountability if the strategic health authority decides to close my local hospital? Whom do the electors hold accountable for that decision?

Miss Johnson

In the exercising of its powers, the strategic health authority is accountable to the Department and ultimately, therefore, to this place. I should make it clear, however, that the view that the hon. Gentleman has just expressed—that Frenchay hospital might close completely—is nothing other than a suggestion on his part at this stage.

It is right that the local NHS should take such decisions, and it is important that those Members who have attended this debate continue to work with the local NHS to build a better future for residents in the area. Whatever the decisions that are reached locally, they will have been made after full and public consultation, and after much consideration and open debate. The strategic health authority will listen carefully, because that is one of its roles; indeed, it is important that it do so.

I cannot comment further on this matter. In case—

The motion having been made after Seven o'clock, and the debate having continued for half an hour, MADAM DEPUTY SPEAKERadjourned the House without Question put, pursuant to the Standing Order.

Adjourned at fifteen minutes to Ten o'clock.