HC Deb 02 May 2000 vol 349 cc37-44WH 12.30 pm
Mr. David Wilshire (Spelthorne)

As you rightly say, Mr. Deputy Speaker, the debate concerns Ashford hospital. To get the record straight, I hasten to say that that is Ashford in Middlesex. The debate is part of a last attempt to prevent the closure of the hospital's accident and emergency department and the scrapping of its intensive care beds. It is a plea to the Minister to change her mind.

My case for asking the Minister to scrap the proposed cuts is this: the overwhelming majority of the people whom I represent oppose them. They would lead to poorer national health service provision for my constituents and would make the current intensive care bed shortage even worse. The case for the cuts and the assessments of the consequences are flawed. The financial cuts being insisted on are no longer necessary following the recent Budget.

The other part of my final attempt to halt the planned cuts at Ashford is the delivery to Downing street tomorrow of more than 6,000 letters addressed to the Prime Minister from my constituents urging him to change the Government's mind. In case the Minister or anyone else is tempted to try to dismiss that as a party political stunt, I should make it crystal clear before I proceed that I speak for all my 70,000 constituents, irrespective of for whom they voted. One of the letters that I will deliver to the Prime Minister tomorrow says it all far better than I can. It reads: My husband and I…have voted Labour all our lives as did our parents before us. Never, never again will we be doing so, we feel so let down by Labour over our hospital in our town that we feel physically sick. That is not a Conservative point of view; it is a Government supporter's point of view.

I have no doubt that, once I finish my speech and the Minister comes to reply, she will again churn out the same claptrap that West Surrey health authority has been churning out. She will try to pretend that the cuts are not cuts and that they are not about to happen. Let me spell out the truth so that there can be no doubt. After the cuts have been made, Ashford hospital will no longer have an accident and emergency department and all its intensive care beds will have been scrapped. Those are cuts pure and simple, whatever the Minister says and however she tries to disguise them.

Should the cuts happen, they would fly in the face of the propaganda recently pumped out by the Secretary of State and the Prime Minister, both of whom keep saying that every accident and emergency department in the country is being improved and that more intensive care beds are being provided. The Prime Minister's recent appearance on "Breakfast with Frost" was a classic example of the propaganda that we hear week after week. He promised us all more funds for hospitals, improved accident and emergency facilities and more intensive care beds. However, that is not what is happening in my constituency. There, the exact opposite is happening. This debate is a plea to the Minister to keep the Prime Minister's promises by reversing her decision.

If the Minister follows the line taken by my local health authority and by the hospital trust concerned, I suspect that we will hear the same absurd claims that the cuts are actually service improvements. I heard that claim on the radio this morning from the chief executive of the hospital trust. Such claims are total nonsense. The truth in my constituency is that front-line services are being cut for a simple reason. The Government have ordered West Surrey health authority to make cuts worth £20 million over the next three years. The real purpose of the cuts at Ashford hospital is the saving of £3.6 million. There can be no nonsense about service improvements and no claptrap about what will happen. The truth is simple—the cuts are being made to save £3.6 million. It is madness to try to pretend that one can improve services while making cuts of that magnitude. It is nonsense.

If I read my crystal ball correctly, the Minister may again treat us to the spurious claim that the Royal College of Surgeons is refusing to recognise Ashford's accident and emergency department. That is not true. That is not what was said when it conducted an inspection recently. The story is pure speculation with no facts to back it up.

According to the claims made in this year's Budget speech, cuts in the NHS should no longer be necessary. I think that that is what we heard said in the House. I had a letter boasting that my local health authority was to receive an additional £7.5 million, but a string is attached to that: the Secretary of State insists that all the money goes to primary care groups for new services. My plea to the Minister today is for her to rescind that decision and to allow West Surrey health authority to use the additional money to stop the cuts at Ashford hospital.

Mention of the Budget leads me to consider the timing of the Minister's announcement that the cuts will go ahead. She made the announcement on Budget day, which was deeply cynical. It was a cynical attempt to try to hide the cuts behind the publicity bound to be given to the Budget. My reading of that cynical manoeuvre is that it confirms that the Minister knows perfectly well that what is really happening at Ashford is something to be ashamed of, something to be hidden behind other news. That is the politics of the gutter in my book.

Fortunately for us and for Spelthorne, I and my constituents cannot and will not be spin doctored into silent acquiescence. The 6,000-plus letters that have arrived in a matter of a few days are proof that we will fight on while there is hope. We will expose the truth as we fight. I have a plea to make to the Minister and to the Prime Minister tomorrow. If they are not prepared to listen to the pleas of a Conservative Member, I ask them please to listen to my constituents, 19,000 of whom voted for the Government.

Let us turn to what has happened since the Minister approved the cuts. Not only have the Government been trying to hide the truth behind the Budget but my local health authority and local hospital trust have been telling lies, pure and simple. Adverts were placed in a local newspaper that cost close to £6,000. That money could and should have been spent on providing services to my constituents, not on putting lying propaganda in newspapers.

In letters to me and others, the health authority and the trust have deliberately tried to mislead my constituents. I have therefore reported their advert to the Advertising Standards Authority, which has launched a formal investigation.

The advert says that Ashford's A&E Will Not Close. That is a lie. The Royal College of Surgeons and the Audit Commission confirm that a hospital cannot have an accident and emergency department without an on-site intensive care unit. All Ashford's intensive care beds are being scrapped. There will be no accident and emergency department and it is a lie to claim that there will be. Curiously, the entire full-page advert, through all its propaganda and lies, forgets to mention that all the intensive care beds are being closed. I can only speculate as to why that little oversight took place.

The advert tries to pass off the downgraded replacement facility as an A and E department in all but name. That is another lie. The facility cannot be that, for the reason that I gave, and it will not be. The Minister's decision letter to me, and the NHS executive's press release, both dated 21 March, make it crystal clear that Ashford's A and E department will be closed and replaced by an urgent treatment centre. That is the truth that the local health authority is not prepared to admit.

Another lie is doing the rounds. In an open letter to me, which found its way into the press, the health authority's chief executive said that the proposed replacement for Ashford's A and E department was "tried and tested". However, in a subsequent personal letter to me, she said that there was nothing absolutely comparable with the planned Ashford model. How can the service be tried and tested if there is nothing with which to compare it? That is another lie. My plea to the Minister is that she tell her officials and managers to cut out the lies and stick to the truth.

I met the Minister before she decided to approve the cuts and told her that the health authority had got it wrong and that its proposals were flawed. Clearly, she did not believe me, because she approved the proposals. I hope that she will change her mind after she hears what I have to say.

When we met, I told her that my constituency already had too few intensive care beds. Spelthorne has since endured a crisis caused by insufficient intensive care beds, as have many other constituencies. It would be churlish of me not to welcome the Minister's decision to provide two new intensive care beds at St. Peter's hospital, but one can do the simple arithmetic: four beds closed and two beds opened means fewer beds. My hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) and I face a 25 per cent. cut in the number of intensive care beds available to our constituents.

I said to the Minister that the estimates of the number of people using the proposed urgent treatment centre were too high. I presume that she did not believe me. The London ambulance service has since confirmed that it will not take patients who might need surgery to Ashford. Therefore, the centre will not be used as much as is claimed. I also said that public transport provision from Spelthorne to St. Peter's hospital was poor and worsening. Since then, Arriva has notified the traffic commissioners that it proposes to pull out of the bus route from Staines, in my constituency, to St. Peter's. The situation was bad when we met, but it is worse now.

I do not take the expectation that a free bus service might be provided very seriously. It is only a hope; there is no proof that it will happen.

When the Minister and I met, I pointed out that the cuts would inevitably lead to more cuts, but I was pooh-poohed. I have since been given a letter, dated 27 March, addressed to a constituent of mine from the health authority's chairman, in which he confirms exactly what I predicted. My guess, for what it is worth, is that the next round of cuts at Ashford is not far away and that I shall be back ere long with an Adjournment debate about the withdrawal of all in-patient mental health facilities from the Ashford site. Yet again, my constituents will be forced to go elsewhere to receive much-needed treatment.

I have given a few examples of what has been going on since the Minister and I last met, but there are many more. If we had more time, I could continue and reinforce the facts that I explained to the Minister and that were clearly dismissed. However, even the events that have happened since we met add up to an enormously powerful case for the Minister changing her mind and scrapping the cuts, instead of services.

I will give the reasons why the Minister should take this 11th-hour chance to change her mind and stop the cuts. Despite all the attempts to mislead people, the truth is that the cuts will lead to poorer NHS services for my constituents. In spite of the extra two intensive care beds at St. Peter's, the cuts will result in fewer local IC beds, which will make the recent crisis even worse. Despite all the reassurances from the health authority, its case for the cuts and its assessment of the consequences are fatally flawed. The Government continue to demand that £20 million worth of cuts are made in west Surrey, but they are no longer necessary since the Budget.

If all that is not enough to persuade the Minister to change her mind, I suggest that she listens to the voice of the people. She claims to be part of a listening Government, but she has ignored our pleas. If she ignores them again, it will prove beyond doubt that the Government are all mouth and no action.

Before Christmas, I presented to the House a petition opposing the cuts, signed by more than 25,000 of my constituents. Since then, our local community health council has lodged a formal objection to the cuts. To date, none of that has made a blind bit of difference. Therefore, I will end with the description given by one of my local accident and emergency consultants—whom the Minister has met—of the consequences of the Minister's actions. Talking about the cuts, the consultant said: People will suffer, and some will die. That is a statement of fact; he did not use the word "might". If the Minister will not listen to my constituents or me, will she please listen to an expert, or is she happy to have the deaths of some of my constituents on her conscience?

12.49 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I congratulate the hon. Member for Spelthorne (Mr. Wilshire) on securing this debate on what he chooses to call—I note this with some sadness—the Government's decision to approve the closure of Ashford hospital's accident and emergency department and ITU. Of course, a Member of Parliament has a responsibility to represent his constituents' interests and concerns and respond actively to the proposed reorganisation of health services. I therefore congratulate the hon. Gentleman on his interest in a subject that touches the lives of so many people in all walks of life. I congratulate him also on his detailed submission on the proposed changes, and note his continued interest since the decision to modernise health services at Ashford and St. Peter's hospitals was approved.

However, having heard the hon. Gentleman today and after reading the local press account of what he said, I say only that he has simply been scaremongering. He is also in danger of doing great disservice to the NHS locally if he continues his present attack on the effect of the changes to acute services in Ashford and St. Peter's hospitals NHS trust.

This is not the first time that Opposition Members have damaged the NHS. I remind hon. Members of the position that we were in when we took office in May 1997. Record waiting lists were rising faster than ever. More importantly, and of particular relevance to the health economy in that area, the debts run up by the NHS in the year before we took over amounted to £450 million. The NHS in west Surrey alone overspent by some £18 million. The number of nurses in training had been cut and investment in buildings was at its lowest for 10 years. I will not go on.

The basis for the proposed changes to services in west Surrey—which I suspect the hon. Gentleman knows—was expert clinical advice and sound financial judgment that questioned the existing configuration.

I need to explain briefly the background to the acute services review because the hon. Gentleman seems to have conveniently forgotten to mention the main drivers of those changes—or, if he did mention them, he merely cast aspersions on the soundness of the judgments. Current and future medical developments require complex, modern and comprehensive models of health care. The modern health service is responding to demands from doctors and other health professions for skills requiring greater specialism. There is a need to deliver well-equipped hospitals with appropriate numbers of staff. Our aim is to provide the best clinical service for all the people, including the hon. Gentleman's constituents. The changes to services to Ashford and St. Peter's hospitals were therefore about the supply of doctors and their training needs and working practices. They are of the essence in the delivering of high-quality health care.

It has again been suggested that the main driver of the changes was the need for financial cuts. That was not so, although I understand the hon. Gentleman taking that line with his constituents, given the financial mess that we inherited in the NHS. The suggestion is without foundation. Money was one factor in the decision but it was not a driver. Even with the extra investment over and above that provided by the previous Government, with an allocation of more than £400 million—a cash increase of £30.2 million or 8.3 per cent—changes would still have been necessary because there was a genuine threat to the accreditation of junior doctor training posts in Ashford hospital. It had already lost accreditation for the training of junior doctors in some specialties and there was a genuine risk to others. In addition, the trust was unable to meet the requirements of the new deal for junior doctors. Without proactive measures to ensure that services were reconfigured appropriately, the position could have been critical, with unplanned changes to services having to be made. We propose a proper, planned reconfiguration which continues to meet the needs of the local population.

Mr. Philip Hammond (Runnymede and Weybridge)

Will the Under-Secretary give way?

Ms Stuart

I will not give way, for two reasons. First, time is limited and, secondly, it is important to put a number of issues on record. I am delighted to see the hon. Gentleman in the Chamber. However, I understand that he did not respond formally to the consultation process. I will take this time to put a number of simple facts on record, for the simple reason that we have heard in this Chamber such terms as "nonsense", "claptrap", "propaganda" and "the politics of the gutter." I would like to put some facts on the record because such language does not help anyone.

The consultation process was set in place in 1998 with the public discussion document "Setting the Scene". Over three months we sought the views of the public, health professionals and others. The document set out clearly the reasons for change and the opportunities that it would provide for improving services locally. The health authority took account of the representations and commenced formal consultation with the launch of the document "Modernising Local Health Services" in June 1999. Consultation was undertaken at 47 public meetings and the health authority also worked closely with Ealing, Hammersmith and Hounslow health authority throughout the planning and consultation process. Some 70,000 leaflets were distributed and there were a number of briefings and meetings with borough councils, local MPs and other key stakeholders. That is consultation, not propaganda.

Mr. Hammond

The community health council objected to those proposals and many people are cynical about the attention the Government pay to them. How many times have the Government upheld CHC objections to reconfiguration plans instead of riding roughshod over them?

Ms Stuart

If the hon. Gentleman listens to the end of my speech, he will find that some changes were made as a result of that representation. The real issues here are not the assertions that have been made but how people will be affected by the changes at Ashford and St Peter's. The reasons for change were clear. At the end of the consultation, the community health council objected formally and that is why it came to Ministers. There was no doubt about the strength of local feeling. I met a large number of the stakeholders. We ended up with a configuration that we believe will serve the community well.

Let us examine what will happen to patients requiring urgent treatment for an emergency or an accident. Ashford will continue to have a consultant-led emergency service. Most medical emergencies will continue to be treated at Ashford hospital. The reference to the Advertising Standards Authority and the terminology was pure sophistry. It was asserted that the model has not been tested, but there is a similar model in Solihull at the Birmingham Heartlands hospital. I know that that works.

Ashford hospital will continue to deal with well over 80 per cent. of those patients who currently visit the A and E department. Those requiring admission will be admitted through the medical assessment and admissions unit on the Ashford site, which will be open 24 hours a day. Ambulances will also be able to get to the medical admissions unit and patients will be assessed and admitted promptly without going through A and E, which is an improvement. Ashford hospital will continue to receive non-trauma patients. That small number of patients who have suffered major trauma will be seen at St Peter's or other hospitals such as West Middlesex. In recognition of the extra travelling time involved, there will be additional investment in local ambulance services, with crews having additional training for pre-hospital trauma.

I turn now to the provision of intensive care. Six coronary care and high-dependency beds at Ashford hospital will provide critical care. There will also be the capability of ventilating patients on a life support machine for up to 36 hours. Patients would be stabilised if transfer were necessary. Arrangements are in place so that out-of-area transfers will no longer be needed. We listened to representations and agreed that there was insufficient critical care and that there should be two additional ITU beds at St Peter's hospital. Critical care facilities will be developed at Ashford as an integrated service. I refer the hon. Member for Spelthorne to the Audit Commission report, which made important observations, not just about the number of critical care beds, but how they are used.

Mr. Wilshire

Will the hon. Lady give way?

Ms Stuart

No, I will not.

The transfer of trauma and surgical emergencies to St Peter's or other hospitals will not only prevent the cancellation of operations but will allow far more planned services at both hospital sites. Furthermore, the improvements to the admission systems in both hospitals will mean that patients will receive a much more predictable and reliable service. It is about choice and greater certainty. We must also look at who is attending A and E departments. Some of the improvements in community services are to ensure that people do not have to go to A and E any more.

It is disingenuous to describe the changes as a loss of service. They take account of the appropriate response to emergencies. When I announced the decision I stated that transport services would be improved too. That will happen. The hon. Gentleman was wrong when he said that these changes are all about money. He was wrong when he said that Ashford hospital was under threat. He was wrong when he said that Ashford hospital would not be able to deal with emergency cases. He was wrong when he said that patients would have to wait longer for treatment and he was wrong when he said that local hospitals would not be able to cope in an emergency.

The changes are intended to ensure that patients are treated in modern, safe and appropriate surroundings. The hon. Gentleman should stop scaremongering. He is demoralising the staff and causing his constituents unnecessary anxiety. He should get behind the local NHS. He should support the reorganisation and be convinced that this will be a better and more responsive service that is more reliable and clinically effective.

Question put and agreed to.

Adjourned accordingly at One o'clock