§ Mr. Nicholas Soames (Mid-Sussex)
I am grateful for the opportunity to draw the Chamber's attention to the serious and unacceptable implications of the proposals of the central Sussex partnership programme in the document "Modern Hospital Services for Central Sussex—A challenge for us all". My right hon. Friend the Member for Horsham (Mr. Maude) and my hon. Friend the Member for Arundel and South Downs (Mr. Flight) are closely involved with these matters and associate themselves fully with my remarks.
In my 17 years as a Member of Parliament, I have never known an issue so to galvanise the community. Following the debacle at Crawley hospital, in which local opinion was clearly trampled on, the Minister should be aware that public opinion has been greatly inflamed by the proposals. Everyone understands that the national health service cannot and should not stand still and that real difficulties still need to be addressed, but my constituents and I believe that the proposals for the Princess Royal hospital are reckless, foolish and, above all, wholly lacking in common sense and practicality.
The Princess Royal is a modern, purpose-built acute hospital with 328 beds on the outskirts of Haywards Heath. It opened in 1991 and is most conveniently co-located with specialist mental health and neuroscience services. The hospital has a full accident and emergency service with resuscitation facilities for seriously ill patients. A refurbishment of its facilities has just been completed following a —150,000 grant from the NHS executive. The department is recognised for junior medical staff training and approximately 32,345 patients attended for treatment last year. The Minister should know that that number has been rising steadily throughout the mid-1990s. The hospital also provides a full range of general medical services, including for patients admitted as emergencies. Elderly people are cared for expertly on specialist wards and the hospital also provides comprehensive surgical and orthopaedic services, including for all emergencies.
During the past year, 9,090 patients were admitted to the Princess Royal hospital as emergency cases; 3,812 were admitted for treatment as planned patients and stayed one or more nights. Alongside its ward-based patient care, the hospital has an active out-patient department where, during the past year, consultant teams have seen 76,763 patients. It directly employs 41 consultant medical staff across all specialties and receives services from a further 21 medical staff supplied by neighbouring hospitals. It employs 421 nursing staff, 220 technical clinical support staff, 68 hard-pressed midwives, 73 junior medical staff and 339 support staff. In total, there are 1,162 staff, all of whom are dedicated to their work and those for whom they care. All of them are extremely anxious about the future.
I hope that the Minister will acknowledge that the Princess Royal hospital is an excellent hospital that is at the heart of its community. It is important that she understands how proud we all are of the service that it provides, the skills and excellence of its staff and its enlightened management, to whose efforts I pay warm tribute. I acknowledge that a great deal of hard work 272WH was put into the central Sussex review by good and honourable people who are trying to provide the best local services. There is some good stuff in the report to work on, but, as I explained to the hon. Lady when she was good enough to meet me, the central Sussex review was really a south Sussex review. It did not include Crawley and it lumped Mid-Sussex in with Brighton and Hove. That was not a good start and it unbalances the services that are required.
The report identified three frameworks to be discussed prior to more detailed consultation. They have all been given pretty short shrift. Following a meeting with Sir Williams Wells, the regional chairman of the NHS executive for the south-east, which I attended with my hon. Friend the Member for Arundel and South Downs and my right hon. Friend the Member for Horsham, it is clear to me that the review team is out to obtain a result based on framework 3. That would culminate in the accident part of the accident and emergency department being transferred to the Royal Sussex County hospital. That would mean a downgrading of the Princess Royal hospital, with all the attendant problems of skills lost, a serious morale crisis and declining services.
Following the publication of the proposals for discussion, there have been a series of public meetings in the area. On Thursday 31 August this year, I attended a large meeting in the Clare hall at Haywards Heath. Nearly 700 people were present and officials of the central Sussex partnership programme had a good opportunity, in reasonably dignified and certainly attentive surroundings, to state their case. It is safe to say that their proposals met with universal opposition, much of it extremely well informed.
I draw the Minister's attention to some of the points that were made at that meeting, which have since formed the non-medical argument. First, I refer to the growth of Mid-Sussex and surrounding areas, which is to be substantial under the Government's new housebuilding plans. That really demands a fully funded and properly equipped A and E hospital, and given that our overall infrastructure is already deemed to be pretty inadequate, it seems incredible that it is now to be further downgraded if the proposals come to pass.
Secondly, it shows an astonishing sense of political priorities that the Government can find an extra —47 million and the rest to bail out a bankrupt folly such as the dome, yet despite the substantial new money going into the NHS, it is still seriously proposed that we should not have a fully funded and properly equipped accident and emergency department in a nine-year-old hospital in a busy area.
Thirdly, the Minister will not be familiar—there is no reason why she should be—with the problems of transport and traffic in our part of Sussex. However, the assumptions that have been made with respect to bringing people through the intolerable traffic on the approach to Brighton are clearly unacceptable and inaccurate. In fact, the proposals are downright irresponsible on those grounds alone.
Fourthly, it is difficult for my constituents to understand how, with one of the biggest international airports in the world on our doorstep, emergency planners do not deem a full accident and emergency service at the Princess Royal hospital to be essential to 273WH assist in a major accident, which would have to be dealt with by the East Surrey hospital at Redhill. Finally, battle casualty receptions in the event of a war also need to be taken into consideration: at the time of the Gulf war, Gatwick was to be a major receiving station, and it would clearly be so designated again in the event of major conflict.
I was, as I said, grateful to the Under-Secretary for agreeing to see me very promptly—during her holidays, in fact—after the meeting at Haywards Heath. At that meeting, I had the opportunity to convey to her the strong feelings and profound anxiety of all those who spoke—and, I think, everyone at Haywards Heath. Mid Sussex district council, our excellent and highly valued community health council, the local town councils and many other bodies, thousands of individuals and our local newspapers have all come together to protest vigorously against the proposals. They believe, rightly, that the Princess Royal hospital must remain a major accident centre offering the full range of emergency medical and surgical services.
We are all especially anxious about whether a hospital that does not treat acute trauma and emergency surgery will be viable in future. Would such a hospital be accredited for junior doctor training, as the Princess Royal is at present; and how could the already frantically busy hospital in Brighton cope with the extra load when it is already impossibly overstretched and under extreme pressure—something that often creates difficulty for emergency and waiting list admissions?
It is difficult for me, on behalf of my constituents, to accept the premise in framework 1, to the effect that there is no choice but to move to framework 2 or 3 to secure good services in future. I agree with my hon. Friend the Member for Arundel and South Downs and my right hon. Friend the Member for Horsham that the needs of the community are not the first priority in frameworks 2 or 3. It appears to us that hospital planning is being driven by the medical royal colleges and their opinions on how and where doctors should be trained and services organised, with little regard to the impact on services for local people. My constituents rightly ask why those eminent bodies are able to exercise their considerable influence and baleful power with such profound effect when they clearly are clearly unaccountable to the taxpayer and to local people. If the NHS plan is to work and if local hospital services are to be truly sensitive to local needs and demands, the royal colleges must be challenged by the Government to work in a more open framework of public accountability.
I congratulate the Mid Sussex Times on its robust campaign to retain the important services in question and on the depth of its well informed reporting. That paper's proposal for framework 1-plus is the most acceptable for the future. That would involve retaining the full range of accident and emergency services and making further investment at the excellent and admirable Princess Royal hospital until other long-term arrangements could be made, possibly through the building of a new hospital providing the full range of emergency medical and surgical services to serve the wider area. It is difficult to understand why that was not proposed in the first place.
274WH We should focus on the Princess Royal hospital as the main acute general hospital dealing with complex trauma. Haywards Heath is close to Gatwick and the M23 and is pretty much at the centre of central Sussex, with a good road network. As I showed the Under-Secretary when I came to see her in her office, using the map that she helpfully produced, it is madness for the area's major trauma hospital to be at Brighton. Planners have seen to it that the Royal Sussex County hospital is carefully insulated from the world that it serves by a complex network of small roads and unspeakable traffic. The Princess Royal has facilities for helicopters to land to take emergencies to the Hurstwood Park neurological centre. The Royal Sussex does not have those facilities.
The Princess Royal is an absolutely first-class hospital that is widely admired and respected. It does a superb job and has the support and—most important—the complete confidence of the community that it serves. Disappointingly, the proposals in the review document are focused too much on short-term changes to address immediate problems, and give no sense of any long-term strategic planning or thought. Such decisions cannot be taken in isolation from the situation elsewhere in the south-east, where weighty and profound issues requiring a far more strategic approach remain to be dealt with.
There is scope for the re-ordering of services, as between Brighton and Hayward's Heath. However, although we all understand the need for such operations to be achieved as effectively and efficiently as possible, the case for downgrading the A and E has not been made. Indeed, as the debate has matured. it has become clear that, given the will, there is the opportunity to expand the Princess Royal in the interests of the whole area. Will the Minister assure me that public consultation will be a genuine exercise—unlike in respect of Crawley hospital—and that the views and opinions of local people, many of whom have made it their business to become extremely well informed about the matter, will be taken into account and respected?
I beg her to examine with the greatest of care these difficult questions, which go to the heart of the future of the national health service in West Sussex and the interests and welfare of all my constituents.
§ Mr. Deputy Speaker (Mr. Nicholas Winterton)
Order. I see the hon. Member for Arundel and South Downs (Mr. Flight) rising. I presume that he is seeking to catch my eye in order to speak. As this is a private Member's Adjournment debate, I must ask him whether he has the sanction of the initiator of the debate and has notified the Minister of his intention to speak. He has not notified me, as he is obliged to, that he wishes to intervene.
§ Mr. Howard Flight (Arundel and South Downs)
I apologise for having advised neither you nor the Minister of that, Mr. Deputy Speaker, although I told my hon. Friend the Member for Mid-Sussex (Mr. Soames). Initially, I believed that I would not be able to take part in the debate, but, having managed to ensure that I am here, I should be grateful if I could add a few comments.
§ Mr. Deputy Speaker
As we started a little early, I shall use my discretion and allow the hon. Gentleman to contribute to the debate. However, I ask him to allow the Minister adequate time to reply.
§ Mr. Flight
Thank you, Mr. Deputy Speaker. I shall be brief.
I congratulate my hon. Friend the Member for Mid-Sussex on his effective, realistic and robust presentation of the arguments, and thank the Minister for her sincere and genuine involvement in the matter. What happened in Crawley has left constituents on the east side of my constituency lacking in trust in the national health service. If the Princess Royal hospital is permitted to decline, a whole community will no longer trust the NHS.
The matter has two different aspects. First, in practical terms, given that another 20,000-odd people will come to live in the area over the next 15 years, it cannot make sense to have no full A and E unit and no full-service hospital of the size of the Princess Royal. Brighton has neither the facilities nor the access necessary.
Secondly, there is the bigger issue of the presence in the community of hospitals of the size and nature of the Princess Royal. Such hospitals are desperately needed and measures that cause them to be run down because they lack crucial facilities such as A and E make no sense. Citizens cannot travel long distances to hospitals. They may need to visit, say, specialist cancer hospitals, but it is precisely such hospitals that are the strength of our health service. As my hon. Friend the Member for Mid-Sussex pointed out, if one removes an accident and emergency unit, a downward spiral is almost inevitable. The royal colleges, which often pursue policies without considering the citizenry at large, are behind the initiative, and I implore the Minister to get to grips with them.
The entire community broadly accepts the framework 1 proposal, but it is crucial that the consultation process be genuine and not a whitewash. Otherwise, the faith of an entire community in the administration of the national health service will be lost. As was said, the Princess Royal hospital is an excellent hospital. Unlike certain others, it cannot be argued that it is poorly run or inadequate. It services a fast-growing community, and every common-sense argument that the community has advanced is in favour of maintaining the current facilities.
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)
I congratulate the hon. Member for Mid-Sussex (Mr. Soames) on securing this afternoon's debate. It would appear that I am rapidly developing a reputation for getting out the map before I start any discussions, so I should point out that I am aware of the traffic problems in the area: the Labour party conference has been held in Brighton for a number of years, so I have been stuck on those roads myself.
I pay tribute to the hon. Gentleman's keen and active interest in this issue, which is of great importance to his constituents. He raised the matter with me in September and with the Secretary of State for Health during last 276WH week's Health questions. I acknowledge and appreciate the hard work that the hon. Gentleman has undertaken at his local hospital and I am well aware of the good work that is carried out there.
I shall do my best to allay any concerns that the hon. Gentleman may still have, but before I discuss central Sussex, I should like to comment in general on what is happening in the national health service. When the Government took office in 1997, we inherited an NHS with many recognised problems: standards were too variable, there were too few staff, and they were frequently rushed off their feet. That was owing to years of underinvestment and neglect, but we are now putting that right.
The hon. Gentleman will be aware that, in July, the Government published the NHS plan, which set out the most fundamental and far-reaching programme of reform in the history of the NHS. It is a 10-year plan that is designed to improve every aspect of the health service. It provides for the extra resources needed to support the programme of change, but it also provides for modernisation of the way in which the NHS is run. A fortnight ago, my right hon. Friend the Secretary of State for Health announced further funding to speed up the pace of implementation. The announcement confirmed that, from April next year, health authorities will receive an average cash increase of some —29 million. In 2001-02, the West Sussex health authority will receive —552 million"a real-terms increase of —40 million on the preceding year.
In addition, next month the Government will publish a detailed NHS plan implementation programme not only for health, but for social services. It will set out the investment and progress that will be necessary in the coming year. It is becoming increasingly clear that good health care involves health services and social services working closely in partnership.
On the question of what has been happening in central Sussex, in the Mid Sussex NHS trust, a new consultant surgeon has been appointed at the Princess Royal hospital to support emergency surgical care. A new admission and discharge team has also been appointed to help manage capacity at that hospital. The trust is working with the Mid Sussex primary care group and social services to develop intermediate care services. That has enabled the creation of a 6-bed step home unit at the Princess Royal hospital and a community rehabilitation service that provides additional therapy support.
Of the —63 million in additional funding that the Government provided for this winter, —382,000 is being spent on initiatives in central Sussex, including extra district nurse cover, extra GP out-of-hours cover, extra patient transport service cover and increased day hospital hours. West Sussex is one of the areas in the south-east that qualified for additional cost-of-living allowances for qualified nurses, midwives, health visitors and professions allied to medicine. West Sussex will receive —2.2 million additional funding for that initiative. There is much to build on in central Sussex, as I hope the hon. Gentleman acknowledges.
On the provision of acute hospital services in central Sussex, the central Sussex review concluded at the end of 1999 that the Brighton Health Care NHS trust and the Mid Sussex NHS trust should work more closely 277WH together to make better use of existing facilities. The review also found that they needed to ensure that they served a sufficiently large population to provide a full range of services. In early 2000, the central Sussex partnership programme was set up as the successor to the central Sussex review to implement its findings. The CSPP produced a discussion document entitled "Modern Hospital Services for Central Sussex—A challenge for us all" in which it set out how hospital services were changing and why it was necessary to plan for the future. That is sensible: the NHS cannot remain static.
The document was launched on 21 August and written comments were sought by 13 October 2000. It produced a huge local response. The press release on 30 October stated that the CSPP had received 150 letters, and a petition to save the accident and emergency department at the Princess Royal hospital attracted 147,000 signatures. I am in no doubt about local feeling on the matter.
The document set out three potential frameworks for the long-term provision of services in central Sussex. Each was based on the Princess Royal hospital and the Royal Sussex County hospital. The CSPP favoured the third framework, whereby all trauma treatment and emergency surgery would be carried out at the Royal Sussex County hospital and all other medical emergencies would be treated nearest to where patients live. The welcome purpose of the discussion document was to ensure that local people had an opportunity to help to shape developments at the start of the planning process.
I would like to take this opportunity to put on the record that no formal proposals for change have been made in central Sussex. No decision has been made or will be taken on the basis of the discussion document. I do not, therefore, intend to defend those frameworks. However, I can give an undertaking to the hon. Members for Mid-Sussex and for Arundel and South Downs (Mr. Flight) that their views will be passed to the CSPP. It has acknowledged that more detailed work is needed to examine the evidence and present people with more facts. The comments received and discussions held so far will be invaluable in shaping the next stage of the programme.
I have today received a copy of a press statement issued on 27 November, which I hope hon. Members will welcome. It is headed "Local people to be involved in planning hospital services" and states that the CSPP has asked two
independent facilitators … to help. Both have … national experience of involving local people in having a say about how public services are run.That should be seen as recognition that more work is necessary and a commitment that that work should be done. It would be inappropriate for me to comment on the frameworks at this early stage, but I assure the hon. Gentlemen that the Government are committed to ensuring that all those who need]services have access to them, wherever they live.
The hon. Member for Mid-Sussex spoke passionately about accident and emergency departments. They have an important role and that is why we have invested 278WH —115 million in their modernisation. That investment will provide new assessment and observation wards, improved resuscitation facilities, better links between and A and E and primary care, and better diagnostic facilities. It will also enable improvements to be made to the general redesign and to looking after the needs of staff.
However, we owe it to patients to ensure that we make the best use of the services we have. Many people who attend A and E have minor injuries that could be treated by telephoning NHS Direct and receiving advice from appropriately trained primary care staff. Thankfully, the majority of patients who attend A and E do not have life-threatening injuries or illnesses requiring immediate attention, but those who need such attention must be confident that they will see suitably trained staff with access to support and back-up from appropriate clinical specialties. That is why we must consider new technology, the skills mix and the evolving role of emergency ambulance services, which will play a key role. In some areas they are already providing a fast and responsive service, and we need to roll that out everywhere.
Better information and communication systems will also improve matters. For example, access to medical histories, improved clinical skills and developments such as telemedicine will give paramedics greater choice about the most appropriate care for individuals and the most appropriate place for care or treatment. New technology and better organisation are not threats to the NHS. The information revolution will transform the way in which its services are delivered.
Both hon. Gentlemen expressed concern about the influence of the royal colleges. I want to say straight away that the training of NHS staff is important: we must ensure that all our staff are trained to the standards needed to provide the services that NHS patients deserve. However, we must balance training needs with the needs of the service, and we will not let the training needs of doctors, as defined by the royal colleges, dictate how services are to be provided. We must not forget that the reason for training NHS staff is to provide quality service to NHS patients. That is our priority, toward which all our efforts must be directed.
The medical royal colleges encompass great expertise in medical training, but, rightly, they have no role in deciding service provision. Moreover, it is not their job to approve medical training in hospitals—that role is given to the specialist training authority. However, the STA consists almost entirely of royal college representatives; there is no point at which the voice of the patient, or even the voice of the NHS, can be clearly heard. When colleges have visited hospitals on behalf of the STA to look at medical training, it has sometimes proved difficult to demonstrate that the needs of patients and of the service have to be put first. That is simply unacceptable.
The hon. Member for Mid-Sussex will be aware that the NHS plan established our intention to replace the bodies that deal with postgraduate medical training—the STA and the joint committee on postgraduate training in general practice—with a new unified body: the medical education standards board. Setting up the MESB will require considerable change, especially in legislation. Simply combining the two bodies would merely replicate existing problems. We will ensure that 279WH the MESB takes full account of the importance of ensuring high quality, locally accessible services for patients and that its methods are clearly accountable, both externally and internally.
I hope that the hon. Gentleman is reassured about our intentions regarding the direction of training. While it plays an important role, it must serve patient needs within the NHS framework. The MESB will decide whether individual doctors have reached the required level of skill and competence to work independently in the NHS. That is an important role. It will, of course, need the advice and opinions of the medical profession—but that must always be directed towards patients' needs rather than doctors' wants.
I acknowledge the strength of local feeling that arises whenever changes are proposed in the NHS and I want to know what the hon. Gentleman's constituents have to say. The central Sussex partnership programme must listen to their concerns and take them on board in a way 280WH that is not only responsive, but is seen to be responsive. I was grateful to the hon. Member for Arundel and South Downs for making the point that unless the people whom we serve are confident that their voices are being heard, we will all have failed.
Whatever the final proposals, I stress that they will not be about cutting services, but about reconfiguring them within the entire population area so that they best provide the appropriate services. We are committed to ensuring that the services in central Sussex are comprehensive, high quality, accessible and, above all, safe. I give the hon. Member for Mid-Sussex and his constituents my commitment that we will make no changes that would jeopardise their medical services and that we shall take careful note of the results of the consultation.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to One o'clock.