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§ Mr. Mark Simmonds (Boston and Skegness)
I am grateful to Mr. Speaker for granting me the debate and to you, Mr. Hancock, for allowing me to start so promptly. I also thank the Minister for being here to reply to the debate. There have been several similar debates during the past few weeks and I anticipate that she will be kept busy responding to further debates in the forthcoming months as health care in the United Kingdom continues to decline and deteriorate.
There are only two hospitals in my constituency: Pilgrim hospital, in Boston, which is the main one, and the community hospital in Skegness. The two hospitals are approximately 22 miles apart and are connected by a poor road, requiring a 25-minute journey by car and a 35 to 40-minute journey by ambulance. The town of Skegness is growing, and the inherent population is now some 18,000. The town has doubled in size since Pilgrim hospital in Boston was built. Many people retire to Skegness, especially from the former coalfields of the midlands, and some of them require continuing medical treatment.
Skegness is also a strong tourist destination. Hundreds of thousands of people visit the town and its immediate surrounds each year. It is no longer just a summer destination—it is visited irrespective and in spite of the weather. Butlins holds 8,000 to 9,000 people at a time and is open almost all year round. The enormous population fluctuations that used to occur are now more evenly spread throughout the year.
I am concerned about the future of Skegness and District hospital for my constituents and for those who spend their holidays in the area. With the creation of the primary care trusts and, in particular, the establishment of the proposed East Lincolnshire primary care trust from 1 April 2002, the transfer of Skegness community hospital is inevitable. It will be the responsibility of the primary care trusts to develop the future strategy and level of provision of health care. It is essential that all medical staff work with colleagues in the community, including community nurses, social services, the voluntary sector and most importantly the users, and take note of their views and concerns. I have no issue in principle with the responsibility, provision or level of health care being entrusted to the medical professionals in east Lincolnshire, with local clinicians and managers ensuring that the local services reflect the needs of the local community. That is apparently one of the thrusts of the Government's National Health Service Reform and Health Care Professions Bill.
I understand that the transfer of Skegness community hospital to the proposed primary care trust is to take place on 1 April 2003. An enormous amount of work must be done, and the purpose of this debate is to ensure that sufficient funding and importance of service are attributed to enable the hospital to remain open and guarantee that there is no diminution of service provision for the people of Skegness and its visitors. Current service provision at the hospital provides two wards, X-ray, physiotherapy, a day unit, out-patients and an accident and emergency department. It is my duty to represent all my constituents, to convey their concerns and to ensure the provision of top-quality health care.
236WH I will refer specifically to some matters. First, the accident and emergency department is an essential prerequisite for any thriving town, especially one with such an enormous and growing tourist population. I have heard medical professionals talk about the best geographical location for accident and emergency services, and the implications of that need not be spelled out. The best location is and must remain Skegness, even though it would still be managed by the United Lincolnshire Hospitals trust under the new proposals.
Second the general thrust of the proposed primary care trusts is to provide modern surgeries that are accessible, particularly by car. That is admirable, but the poor car parking facilities at the Skegness community hospital are not at the apex of the agenda for the town's many elderly retired people who have no alternative to public transport. New surgeries tend to be in fringe or out-of-town locations, so a centrally located hospital is a must. Primary and intermediate care must complement and be in addition to services in Skegness hospital—it must not replace them.
Thirdly, the two existing wards have 39 beds, 15 of which are GP led and 24 of which are consultant led. It is feared that those could be used solely for general practitioners under the proposed primary care trust. That would not allow consultants to transfer patients back to Skegness from Boston's Pilgrim hospital for aftercare treatment. That could cause further bed blocking and exacerbate already difficult problems, lengthen already unacceptably long waiting lists and increase cancellations of operations. Furthermore, if the proposed primary care trusts ran short of money, an obvious saving could be made by shutting a ward and using fewer beds. What safeguards will the Government put in place to ensure that that will not happen?
Fourthly, I am concerned that consultants' clinics and out-patient departments might be moved away from Skegness to Boston under the proposed primary care trust. That is a concern particularly because of the terrible shortage of consultants in Lincolnshire. In one recent example, the United Lincolnshire Hospitals trust had to stop the portable breast screening service because of consultant shortages. There is also an ever-worsening shortage of general practitioners—indeed, the Government's figures suggest that there were 19 GP vacancies in Lincolnshire in 2000 and 49 this year. There is a similar problem with nurses. If there is to be any improvement in service provision, staffing levels must be improved throughout. The cost of moving the outpatient department would be enormous both financially and in terms of the health of the people of Skegness.
There is an ever-growing trend in the national health service to specialise. That is understandable given the enormous cost, for example, of providing a specialist cardiac department. However, there must be scope to provide a general level of service in a community, and the Government are ultimately responsible for that.
The safety of nursing staff is not an issue that is unique to Skegness or Boston, but it concerns many of my constituents. Skegness hospital was recently broken into during the night, staff were attacked and knocked to the floor and patients were robbed. We all know that that is an unacceptable state of affairs, and I ask the Minister to make additional resources available for security and staff safety in the hospitals in my constituency. If that is not the Department of Health's responsibility, will she 237WH assure me, as the representative of the dedicated health professionals in my constituency, that she will speak to her counterpart in the Home Office or wherever else the funding comes from to secure that extra funding?
In conclusion, I want health care provision in Skegness to be improved and widened to allow more patients to be treated nearer their homes, particularly because we have an ever-increasing and ageing indigenous population and an ever-increasing number of tourists. Neither I nor my constituents will be happy if Skegness hospital is turned into a glorified surgery under the proposed primary care trust. It is a hospital and must remain one.
Skegness hospital is a good, well used, well established and modernised hospital that must be maintained. Will the Minister give an assurance and an unconditional guarantee that sufficient emphasis will be placed on maintaining Skegness hospital in its totality, without any diminution of service provision? Delivery of a satisfactory level of health care is ultimately the responsibility of the Government.
§ The Minister of State, Department of Health (Jacqui Smith)
I congratulate the hon. Member for Boston and Skegness (Mr. Simmonds) on securing this important debate on the future of Skegness and District hospital. I am aware of some concerns among local people in the hon. Gentleman's constituency, as he ably outlined, about the future level of provision at the hospital. I reassure them and him that they need not fear for the future of what is an excellent community hospital: there are no plans to close or to downgrade it.
Skegness and District hospital dates back to 1913 and, as I am sure the hon. Gentleman will agree, has served its residents and the summer tourist population as a community hospital admirably since then. It has been part of the United Lincolnshire Hospitals NHS trust since April 2000, when all the acute hospital trusts in the Lincolnshire health authority area merged. As I am sure the hon. Gentleman is also aware, that was a merger of management teams rather than a reconfiguration of services. As a result, management costs have been reduced with no consequent detriment to services.
As the hon. Gentleman said, Skegness and District hospital currently provides 39 in-patient beds, 15 of which are GP run and 24 of which are consultant-managed medical beds. I will come to the issue of the primary care trust management but I assure the hon. Gentleman that there are no proposals to change the balance or use of those beds. The hospital also has X-ray, physiotherapy, out-patients, and day unit facilities and services and an accident and emergency department. As a thriving community hospital, Skegness dealt with nearly 25,000 accident and emergency attendances and almost 500 admissions or transfers into the hospital in the last financial year.
As the hon. Gentleman acknowledged, the accident and emergency department in particular experiences peaks in demand at certain times, particularly in summer with the influx of tourists, although those seasonal differences have decreased over recent years. 238WH Routine discussions are, therefore, held regularly between the United Lincolnshire Hospitals NHS trust, Boston and Skegness primary care group, Lincolnshire social services and Lincolnshire ambulance and health transport service NHS trust to ensure that accident and emergency services continue to be provided in the most appropriate manner to best meet the needs of the patients who use it.
For some time, some patients have been stabilised at Skegness hospital and then transferred to Pilgrim hospital, Boston, if their condition has allowed that. A clinical working group at the United Lincolnshire Hospitals NHS trust has just begun the process of formalising protocols that will enable ambulance personnel to identify patients who would be better taken directly to Pilgrim hospital. This might include people seriously injured in road traffic accidents or who need specialist diagnostic facilities such as CT scans. On current numbers, that might mean that up to 10 people a day who would previously have been transferred to Pilgrim hospital following stabilisation at Skegness could be taken there directly, thus speeding up their treatment.
The purpose of the proposals is to maintain the accident and emergency services at the hon. Gentleman's local hospital. In the past 18 months, the Government's commitment to the national health service has translated into leading—edge service developments at the hospital. The most obvious example of that is the introduction of thrombolytic treatment by paramedics prior to arrival at the hospital. Since it was introduced in July 2001, ambulance paramedics have been liaising directly with hospital doctors at Skegness in order to administer clot-busting drugs that give patients with suspected heart attacks the best possible chance of a successful outcome. That is on top of the fact that Lincolnshire ambulance service is consistently meeting its eight-minute response time targets in 75 per cent. of category A emergencies.
A telemedicine project in the accident and emergency department at Skegness means that more complex cases can be dealt with locally through the telemedicine link with specialists at the neighbouring acute hospital in Boston. Additional services have been added on to dovetail with accident and emergency services, such as the development of care pathways for cases of fractured neck of femur and heart attacks. Nurse practitioner training continues, and a weekly fracture clinic has been introduced.
The out-patient department continues to provide the local community with a comprehensive service, and it is always keen to create new opportunities for improving services in conjunction with its partners. Examples of that include the addition of a home blood pressure monitoring service and the introduction of the Lincolnshire visual impairment service to consultant ophthalmology clinics. This means that trained volunteers can provide patients with extra information and support on their conditions, and the benefits and aids that are available.
There are many other recent examples of improved and increased service provision at Skegness hospital. The important point is that this is indicative of a thriving hospital, with excellent services and a clear commitment 239WH from everyone in the health and social care community to continue the current level of those services at Skegness hospital.
It would appear that some local concerns about the future of Skegness hospital relate to the proposed formation of East Lincolnshire primary care trust from 1 April 2002. Under these proposals, Boston and Skegness primary care group and its counterparts in neighbouring East Lindsey and South Holland will, subject to the approval of my ministerial colleagues, come together to form East Lincolnshire PCT.
Public consultation on these proposals took place between 11 June and 10 September this year. The proposals were supported by the health community, local community health councils, Boston borough council, Lincolnshire county council and the vast majority of general practitioners, nurses and members of the public.
Within those proposals, and as detailed during the thorough public consultation, it is planned to transfer the day-to-day management of the community hospital in Skegness from United Lincolnshire Hospitals NHS trust to the East Lincolnshire primary care trust. However, that will not take place until April 2003, to ensure that this transfer of management responsibility to the PCT will not disrupt services, staff or patients. This has always been a top priority of the local PCT development board.
If approved, East Lincolnshire PCT will be able to commission services such as acute hospital care and directly provide community health services through its community hospitals from April 2002. It will also be able to provide health visitor services and district nursing services, so that there will be greater opportunity to integrate primary and community health services within one organisation for the benefit of local patients. Although the proposals would mean that East Lincolnshire PCT would take the lead in developing any future strategy for Skegness hospital, this will be in partnership with acute and mental health trusts.
Out-patient facilities will continue, there will be further development of intermediate care services, which will be important for the older constituents whom the hon. Member for Boston and Skegness mentioned, and there will be a new range of minor surgery procedures available based on the skills of local general practitioner specialists. Crucially, it is planned that accident and emergency provision will continue at Skegness hospital. It will be managed by the United Lincolnshire Hospitals NHS trust to continue to meet the needs of both the local and the holiday population of Skegness.
The primary care trust's vision for Skegness hospital also includes the development of a model of care that will facilitate the complete integration of community and intermediate services for the older population in particular. That will include in-patient day care with access to day hospital services, care in nursing or residential homes and the provision of care at home.
I am sure that the hon. Gentleman agrees that in a user-centred service, particularly for older people, the emphasis of primary care trusts on both modernisation and local determination of the needs of patients will be important. It is clear, therefore, that any developments in Skegness will be designed around the needs of patients 240WH with services that can be delivered and managed locally in accordance with local needs and for the direct benefit of patients in and around Skegness.
To alleviate any concerns that the hon. Gentleman may still have, the United Lincolnshire Hospitals NHS trust board has publicly made a commitment to have community focus groups or even a citizen's panel in any future discussions of the pattern of services. Any significant planned changes to service provision down the line would be subject to full public consultation and the Department of Health would monitor any changed processes to ensure that they are carried out properly in line with national policy and established rules on public, patient and stakeholder involvement.
The hon. Gentleman placed his concerns about Skegness hospital in the context of the Government's overall approach to supporting the NHS. We have set out our plans for investment and reform of the NHS. In March 2000, my right hon. Friend the Chancellor of the Exchequer announced the biggest ever investment in the history of the NHS. This unprecedented investment will allow the NHS to grow by one half in cash terms and by one third in real terms in just five years. That additional resource will fund extra investment to benefit every part of the health service. The NHS plan announced by my right hon. Friends the Prime Minister and the Secretary of State for Health on 27 July 2000 is the most fundamental and far-reaching programme of reform in the history of the NHS. Most importantly, within the NHS plan is the recognition that future care and treatment must be redesigned around the needs of patients. The investment, coupled with the plan for reform, will provide 7,000 extra beds in hospitals and intermediate care, more than 100 new hospitals by 2010 and 500 new one-stop primary care centres. There wi0ll also be increased investment in staff with more consultants, GPs and nurses in addition to the increased number of nurses and doctors that the Government have already provided in the NHS.
I take very seriously the point made by the hon. Gentleman about staff security in Skegness hospital. I understand that the incident was an isolated one, nevertheless, it is absolutely clear that staff in the NHS must be able to work without fear.
§ Mr. Simmonds
I should like to clarify the matter. The Minister is correct in saying that the recent incident at Skegness hospital was an isolated one. However, nurses' representative and nurses I have met from Pilgrim hospital, Boston are worried about the constant stream of not only verbal abuse, but often physical abuse, particularly in the accident and emergency department late on Friday and Saturday nights. It is not consistent throughout the week, but it is a matter that I should like the Minister to address, in the future if not now.
§ Jacqui Smith
The hon. Gentleman makes an important point and my right hon. Friend the Secretary of State has already announced the NHS zero tolerance campaign on violence against staff. Trusts will be able to prosecute people who are violent towards our NHS staff and I assure the hon. Gentleman that we are taking the matter very seriously.
241WH The Government and the local NHS are implementing developments locally and nationally to ensure that the future and the services of Skegness hospital are secure. The hospital will benefit from the Government's reform of the NHS and the extra investment that will ensure that the needs of the hon. Gentleman's constituents are at the centre of developments.
I thank the hon. Gentleman for giving me the opportunity to debate the development of the NHS, which is an important matter for his constituents and more widely. Given his earlier comments, I look forward to plenty more opportunities in the House to outline the Government's progress on delivery in the national health service.
§ Mr. Mike Hancock (in the Chair)
As the Minister is not yet present for the concluding Adjournment debate, our proceedings will be suspended for a couple of minutes.
§ Sitting suspended.