Acute Hospital Services
§ Mr. Kerry Pollard (St. Albans) (Lab)
I am delighted to have secured this debate on the most important topic of acute health service provision. I want to concentrate my remarks on the provision of acute services in the Bedfordshire and Hertfordshire strategic health authority area, which of course includes my constituency, St. Albans.
A little time spent on the local health service history will help us to get the current situation into perspective. Some 25 years ago, a proposal to build a large new hospital between Hemel Hempstead and St. Albans serving both communities was thrown out, as neither community was prepared to close their respective local hospitals. The local services stared on a slow but inevitable decline. Five years ago there was a similar exercise, which was slightly wider in scope. It involved the prospect of a large new hospital—a centre of excellence—but again it would hi ye meant some re-alignment —of services at local hospitals. Once more the respective communities could not agree, and the issue was dropped. Once again it became more difficult to maintain good local services.
We come now to the latest exercise. This time, a full and comprehensive consultation exercise took place—infact, the most detailed and comprehensive that I have ever taken part in or witnessed. Finally, it appeared that a consensus was emerging, and that there was a proposal that the whole two-county community could support. However, when it came to making the decision, a single primary care trust, Dacorum, decided not to support the majority view on a purely parochial basis—that is, because Hemel Hempstead hospital would have to undergo a small realignment of it services.
All agree that the status quo is not an option. Our acute services are among the most stretched in the country. They operate from small, inefficient hospitals that are much in need of reinvestment in their superstructure, and that have difficulty recruiting and retaining high-quality staff. There are times—and this is one—when communities need to reflect on the long term, with the well-being of the whole community in view, and when all those involved in decision taking and leadership need to reflect properly on how our acute services should be developed in the next few years to give us all the services that we need and deserve. We must grasp this opportunity; it will not recur. The alternative is a deterioration of our services, a lack of morale among our clinicians, and people having to travel further and further to access decent services.
Option 2 received the support of 90 per cent. of the population. That was to include a new centre of excellence hospital, which was to be constructed on one of two sites, both adjacent to the university of Hertfordshire. In addition, a new diagnostic and treatment centre was to be built at Hemel Hempstead, and there were to be improvements to the estates of all the other hospital sites. Furthermore, it was hoped that a medical school could be opened at the university of Hertfordshire. That idea has the full and enthusiastic support of the university, which already has a very good medical training faculty in radiography and nursing. Indeed, my youngest daughter is a first-year 236WH undergraduate on a nursing diploma there. To the majority, that seems a good deal for our two counties, ensuring, as it would, high-quality health services able to recruit top-quality clinicians at all levels. That proposal would take us forward for the next 20 years with a service of which we could all be proud.
Some details of the consultation process will be helpful. More than 1,600 questionnaires were returned, and 130 members of the public responded directly in writing. Some 100 people were involved in focus group discussion, and about 6,800 people signed petitions. There were 5,000 attendees at public and staff events, and there were at least 16,000 contacts with the consultation in one way or another.
At the end of the process, Ian White, the chairman of the strategic health authority, said:Option two is not about winners and losers, it is about the benefit to whoever uses health services across the two counties".There can be no one in the two counties who was not aware of what was proposed, and there were many opportunities for people to make their views known. The local press and media were full of the issue every single week.
I took part personally in the consultation exercise, attending many meetings that were attended by the public, health representatives, local authority elected members, primary care trust workers, nurses, midwives, community health councils and local charities. We discussed at length the options included in the consultation document. There were wide-ranging responses, all in support of the recommendation in the document. Scrutiny committees for health of all local councils, including Hertfordshire county council, supported it, as did primary care trust boards, elected representatives and the vast majority of the public who responded. The only group that was against the recommendation—Dacorum primary care trust—took a full and active part in the deliberations, was listened to and put forward its representations.
No group or individual that wanted to take part was prevented from joining in. The strategic health authority went out of its way to be as inclusive as possible. That was to its credit. I am satisfied that a full and proper consultation exercise was carried out.
I was therefore particularly disappointed when a group in Hemel Hempstead decided to call for a judicial review of the consultation process. As I said earlier, I have never experienced or taken part in a more detailed and comprehensive consultation exercise in all my years as a public representative. I commend Ian White and his team, who undertook all that hard work.
I believe that the judicial review will conclude that everything that should have been done, was done. The process was open, clear and fair, and the conclusion arrived at was supported by the overwhelming majority of the primary care trusts and their constituent public.
I also hope that once the review—which I believe will totally vindicate the strategic health authority-is complete, those who have brought that frivolous call for a review will be surcharged for the cost of the whole judicial review exercise. It has been estimated that £250,000 could be spent on legal representation alone. That money would pay for hundreds of much-needed operations, many on the elderly. It is outrageous that 237WH that amount of money should be wasted so flagrantly. I would be failing my constituents if I did not call for that money to be recouped from those who have brought the action.
I have sought advice from the Department for Constitutional Affairs on the prospect of recouping the money expended from those who brought the matter to court. The head of the civil initiatives branch tells me that it is normal practice for the loser to pay for both sides. That means that, when the court finds in favour of the strategic health authority—as I believe is inevitable—a judge can, and in my view should, order that those who brought the issue to court will have to pay the costs of both sides.
It is not just the money for legal representation that concerns me, but the amount of time that senior staff at the strategic health authority will have to spend on preparing their defence against the review. The action by the group in Hemel Hempstead is potentially damaging the whole acute service throughout both counties, and at its worst that could mean that there will be no new acute services there.
The people of Hemel Hempstead have not been told the full facts by those who are pursuing the judicial review. Their hospital will not close. A new diagnostic and treatment centre will be built, and apart from the most acute trauma, all cases will continue to be treated at their own accident and emergency unit. Recently, the Hemel Hospital action group has been orchestrating a personal attack against me. The latest incident was a letter to our local press attacking my honesty and integrity. Those are desperate measures from desperate people. Should they continue, I may resort to the courts on my own account.
In summary on this part of my speech, it is recognised that the Herts and Beds is now lagging behind in the provision of good hospital services. That needs to be addressed. Investment in a new hospital, in diagnostic and treatment centres and in upgrading minor injuries and day surgery units must proceed as soon as possible. There cannot be anyone in the two counties who has not heard of the proposals. All have had their opportunity to take part in the fullest and most comprehensive exercise that I have ever witnessed. The judicial review is under consideration and my hon. Friend the Minister will not be able to comment on that matter.
I should now like to outline some of the major improvements and new building at my local hospital in St. Albans. Since 1997, there have been many improvements at our city hospital. One of my first acts on being elected to Parliament was to turn the first sod on a new hydrotherapy facility. Two years later it was opened, providing much-needed hydrotherapy for those suffering from the effects of strokes and other conditions such as amputations. Shortly after that, a disused operating theatre, which had been used as a storeroom, was brought back into full use, and I had the privilege of formally opening it. In addition, a new orthopaedic ward was opened to support the work of the new theatre.
The day surgery unit has been upgraded and I visit it regularly. The last time was when I visited one of my sons, who was having an operation on his knee. The 238WH atmosphere is comforting: tea and toast on tap, with light background music. Senior sister Eileen Kent is the driving force behind this excellent service, a model for others to follow.
There have also been major improvements to the minor injuries unit, which is led by senior sister Rita Dunkerly, who has a first-class team of nurse practitioners helping her. One waits only minutes at the unit. Of particular note is the directly employed cleaner, who keeps the place spick and span and takes real pride in her work. It is recognised by one and all how vital cleanliness is to the well-being of the unit.
A few months ago we were fortunate enough to receive a visit from the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman), who has responsibility for regional health. He toured the whole hospital as part of a fact-finding tour. More recently, a further newly built operating theatre was opened by my right hon. Friend the Secretary of State for Health. That theatre will be used to reduce orthopaedic waiting lists. Its opening was followed by the expansion of the previously opened orthopaedic ward to enable more complex operations to be carried out.
In the immediate future, I am due to open formally a block of key-worker housing units on the hospital site, which will provide vital housing for some of our key staff. Only two years ago, our nearby special care baby unit was shut down because qualified staff could not be recruited. The overriding reason for the lack of applicants was the high cost of housing and the lack of affordable key-worker housing units. Under the chairmanship of Rosie Sanderson and with chief executive Val Harrison, the trust took the decision to construct the key-worker unit. That will help immensely with the recruitment of key staff.
I have mentioned a few key players at our local hospital, but I must commend all staff—medical, nursing and ancillary—who are dedicated to providing a first-class service on behalf of my constituents, the people of St. Albans. I offer them my sincere thanks for all their hard and dedicated work.
Our primary care trust is chaired by John Bennet and its chief executive is Steve Knighton. It is ready to take over responsibility for running our city hospital as soon as practically possible. I believe that our hospital could and should become a foundation hospital. I have every confidence in the ability of my fellow citizens to manage our hospital facility locally, and I give the proposal my full support. Local services managed by local people: a winning combination.
Finally, our acute services are on the verge of great things. We need to be bold and decisive and look to the long term and to the well-being and advantage of the whole community. If we do that, we can have a service that is the equal of any, and in which we can have confidence and pride.
§ The Minister of state, Department of Health (Ms Rosie Winterton)
I congratulate my hon. Friend the Member for St. Albans (Mr. Pollard) on securing the debate. I know that it relates to a matter of great concern to him and his constituents. I am extremely impressed by the depth of his knowledge of local staff and services. He 239WH has done a lot to praise local people for their hard work in providing those services, but I am sure that they are proud to have an MP who works so hard on their behalf. I know that my hon. Friend wants to see provided locally the high-quality health services that his community expects and deserves. That vision of the health service is shared by the Department of Health and the local NHS in Bedfordshire and Hertfordshire.
My hon. Friend has referred to many changes that have been made locally, and I want to draw attention to other changes, particularly in funding, that have come about since the Government came to power. My hon. Friend will know that since 1997, total funding for the NHS in England has increased by £34 billion. In his 2002 Budget, the Chancellor announced the largest sustained increase in funding of any five-year period in the history of the NHS, with a real-terms increase in resources of 7.4 per cent. each year between now and 2007–08.
What does that mean locally? St. Albans and Harpenden primary care trust will receive an increase of £28.35 million over the three years to 2006, which represents a cash increase of 29.43 percent, for the same period. Those allocations have been made directly to primary care trusts as part of the process of shifting the balance of power so that more resources and responsibilities are in the hands of front-line services. PCTs now control more than 75 per cent. of the NHS budget.
That substantial increase in investment has brought with it the need to review services within the Bedfordshire and Hertfordshire area and ensure that they are modernised so that the best use is made of the new resources. As my hon. Friend s aid, the decision to review acute services for Hertfordshire and South Bedfordshire was taken in January 2002. That review was later widened to encompass all of Bedfordshire and Hertfordshire, with the aim of securing an holistic approach to managing health services and a stronger emphasis on the interface between specialist, acute, intermediate and primary care services. Indeed, the local strategic health authority has already invested heavily in the local health economy.
As my hon. Friend said, Bedfordshire and Hertfordshire's preferred choice was option 2, but that has been subject to a legal challenge by the Dacorum health action group, which is seeking leave for judicial review. I am afraid that, as my hon. Friend recognised, I am unable to comment further on the proposed reconfiguration of services in the area in view of those legal proceedings, because the matter is clearly sub judice.
The reconfiguration of hospital services is often controversial, and my hon. Friend referred to the interest that local people were taking in it. However, within the "Shifting the Balance of Power" initiative we are trying to devolve funding decisions to a local level—to primary care trusts working in partnership with strategic health authorities and other local stakeholders. We believe that they can determine how best to use their funds to meet national and local priorities for improving health and tackling health inequalities while also modernising services. They are in the best position to do that because of their knowledge of the local community. The guidance "Keeping the NHS Local" was published by the Department of Health in February 2003. It is not 240WH a blueprint for hospital design, but it empowers local NHS services to work with local populations, helping them to decide together what pattern of local services will best meet everyone's needs.
The guidance sets out three core principles that should be followed when a major change to services is considered. Principle No. 1 is that options for change should be developed with—not for—patients, staff and local people. That means sitting down with the stakeholders at the outset and ensuring that everyone's priorities within an area are understood.
Principle No. 2 is that where possible services should be redesigned rather than relocated. In many cases, the redesign of services can provide new options for maintaining services locally. Principle No. 3 is about taking a view of the whole system; hospitals and other health and social care providers working in partnership can support each other with genuine integration and joint planning of services.
A legal framework underpins these principles for patient and public involvement in health. There is the statutory duty to involve and consult, which commenced on 1 January 2003. The Department's guidance, "Strengthening Accountability", which was issued in February 2003, sets out a range of suggestions for practical ways of involving the public in an accessible and rigorous way.
The Health and Social Care Act 2001 gave new powers to the overview and scrutiny committees of local authorities to review and scrutinise the planning operation and development of health services, so that democratically elected representatives of local people with responsibility for their well-being exercise proper influence over the NHS on their behalf. We have given the overview and scrutiny committees the right to refer proposals to the Secretary of State if they consider that public involvement has been inadequate or that the process itself is flawed. "Investing in Your Health" went through two local scrutiny processes and, as my hon. Friend knows, both confirmed that they were happy with the process and the outcome.
We have tried to put in train measures to ensure that in local areas where there is a reconfiguration of services there is proper patient and public involvement, and that those decisions are taken at local level, secure in the knowledge that local people will best be able to determine the priorities of their local communities.
My hon. Friend referred to Ministers' visits to his constituency. The Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman), and my right hon. Friend the Secretary of State have taken a keen interest in the Bedfordshire and Hertfordshire services. They have visited them in recent months and they were incredibly impressed by the enthusiasm and dedication of local staff working on the front line.
As my hon. Friend the Member for St. Albans said, on 27 November, my right hon. Friend the Secretary of State opened a modular theatre costing about £850,000 at St. Albans, which provides an additional day-surgery theatre; in total there are five such new facilities. By opening those facilities, the West Hertfordshire Hospitals NHS Trust will ensure that it meets the target of a maximum nine-month wait for surgery by March 2004 and a six-month wait by 2005.
241WH The West Hertfordshire Hospitals NHS Trust has also drawn up proposals for the centralisation of breast services and for the relocation of ophthalmology services. The centralisation of breast services will provide access to clinics for four days every week for women in West Hertfordshire. That will ensure a speedy response to referral and access to surgery on an elective site, reducing the anxiety that women experience once a breast lump has been found. The ophthalmology service will concentrate on the provision of cataract surgery in an environment that lends itself to such a service.
As I said, my hon. Friend the Member for South Thanet visited the four acute trusts in Bedfordshire and Hertfordshire and saw areas in which investment had already been delivered. For example, a state-of-the-art magnetic resonance imaging, fracture clinic and dermatology treatment centre opened its doors to patients at Hemel Hempstead general hospital in March. That investment means that patients and staff have a new treatment area. The final phases of the project to construct an X-ray reception opened at the end of July. The Hemel birth centre, which opened on 31 March 2003, is a self-contained unit run by midwives, which offers a supportive "home from home" environment in which mothers can give birth.
As I have said, new investment is being made in the constituency of my hon. Friend the Member for St. Albans. He is obviously supportive of that and is working with the local primary care trusts, the strategic health authority, patients and the public in his constituency to ensure that the priorities that are decided reflect local needs. At national level, we provide extra investment. My hon. Friend will know that improving health services is a key priority of this Government. The success with which improvement is taking place in my hon. Friend's constituency has impressed my hon. Friend the Member for South Thanet and the Secretary of State.
I know that the issue that my hon. Friend the Member for St. Albans raised is a matter of great concern, and that he understands the difficulty that I have in further commenting on it. However, I hope that he would agree that the changes that we are making are delivering real improvements for patients and the public.