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The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Newark (Patrick Mercer) on securing this important debate on the future of Newark hospital. As he said, I was fortunate enough to visit the hospital last week. I was extremely grateful to have the opportunity to do so and I was particularly struck by the enthusiasm and dedication of all the staff and management I had the privilege of meeting during that visit. I fully understand my hon. Friend’s desire to ensure his constituents have the best possible health services. My visit last week proved extremely useful in understanding the issues there.
I would like to take this opportunity to outline briefly the Government’s approach to service reconfiguration. We believe that the best decisions are local decisions, and that change should be driven by local clinicians, not imposed by politicians or decided by managers behind closed doors. The Secretary of State has identified four crucial tests that all reconfigurations must now pass. First, they should have the support of GP commissioners; secondly, arrangements for public and patient engagement, including local authorities, should be strengthened; thirdly, there should be greater clarity about the clinical evidence base underpinning any proposals; and fourthly, any proposals should take into account the need to develop and support patient choice.
To ensure the long-term future and sustainability of health service provision in Newark, a range of NHS services in the area have been reviewed. Those include unplanned and emergency care as well as in-patient dementia care. I understand that clinicians from primary and secondary care are in unanimous agreement that Newark hospital cannot provide a full accident and emergency service—I am grateful to see my hon. Friend nodding in agreement to that. They have concluded that, for the sake of patient safety, the hospital should no longer care for patients with acute medical conditions. The hospital should also be named more accurately to avoid public confusion, ensuring that patients go to the right place first time and are not put at additional and unnecessary risk by going as a first destination to a unit that is not able to look after their degree of injury.
The main reasons for that are as follows. First, every tier 1 accident and emergency department needs an intensive care unit, emergency operating theatres and 24/7 anaesthetics to provide back up for the A&E and acute medical conditions. Unfortunately, Newark does not have those and has not had them. Secondly, acute emergencies require specialist skills, which are not and have not been available in Newark. Thirdly, doctors agree that avoidable transfers are associated with poorer health outcomes and worse patient experiences. In 2009/10, the PCT reports, a significant number of patients had to be transferred, many due to a deterioration in their condition.
The local NHS ran a consultation exercise earlier this year to garner the views of local people. The majority were in favour of changes to urgent and emergency services at Newark hospital. I know that there is a view, expressed by some campaigners, that the consultation was rushed, too small to be properly representative of the local community’s views and that the full implications of the review have not been sufficiently drawn out. The NHS must not take local support for granted and must continue to engage fully with clinicians, the public and the council’s overview and scrutiny committee. If a consultation is inadequate, it must be improved and should provide as much relevant information as possible. The overview and scrutiny committee continues to review the implementation of planned changes, which is essential to help to ensure democratic scrutiny.
The strategic health authority has told me that Nottinghamshire County PCT engaged with the overview and scrutiny committee throughout the Newark review and that evidence of that engagement was presented at the PCT board meeting on 17 June. Yesterday, the PCT met with the overview and scrutiny committee to decide the next steps. I understand that it does not intend to refer the proposals to the Secretary of State.
I will turn now to one of the problems with the reconfiguration: the naming of the unit that will deal with injuries, which my hon. Friend mentioned. It is of course important that the facility at Newark hospital is appropriately named. I know that some people would prefer it to be known as a minor injuries-plus unit, while others would prefer to call it an urgent care centre. As he will appreciate, it is not for me to intervene in that issue in a top-down manner. The choice of a name must be agreed locally and should clearly reflect the nature of the facility, so I hope that the matter can be resolved locally through ongoing discussions.
On A and E services, I understand that Newark hospital has never had a full A and E department. Confusion has arisen in part because there is an A and E sign outside the building, but that does not reflect the nature of the services provided inside. Having a local A and E department on one’s doorstep can feel reassuring, but the reality is that receiving the best care does not always mean being taken to the nearest hospital. Some patients might be treated at the scene and others might be taken to Newark for treatment, but those who have suffered major trauma will be best served by being taken directly to specialist units, receiving care en route to the hospital that has the most suitable facilities.
The proposed changes aim to solidify the existing protocols on diverting acute patients to more appropriate hospitals, ensuring that patients go to the right place the first time and are not put at additional and unnecessary risk. I understand that the parents of a young child recently turned up at Newark hospital A and E, incorrectly assuming—understandably—that it was a full A and E department, and the child’s care was delayed as a result. I stress my earlier point about the importance of naming the unit correctly so that local people can understand easily what it does and does not do. I am pleased that during October and November there will be a public education process in Newark to explain exactly what the unit does and where patients should go in the first instance, either to Newark or to another hospital, for appropriate treatment when injured.
Patrick Mercer
Would the Minister be kind enough to inform the relevant authorities that I would very much like to be involved in that work? The whole process has been marred by poor communication and bad consultation, so I would be happy to help in any way I can.
Mr Burns
I am extremely grateful to my hon. Friend and am sure that there is a role for him to play in helping his constituents in the education process and explaining fully the role of the unit so that it receives appropriate admissions in future.
On the running down of services at Newark, we must be careful not to do the local NHS a disservice through idle talk about the future of the hospital. The proposals focus on giving patients access to safe care for urgent conditions. The people of Newark will continue to access Newark hospital if that is the most clinically appropriate place for their treatment. There will be an increased availability of same-day or next-day outpatient appointments for patients who GPs believe require urgent assessment. If a diagnostic test such as an X-ray is required, that will be done at the same time.
There is also scope for Newark hospital to undertake more planned surgery, such as hip and knee replacements. I know that that is being explored by the Sherwood Forest Hospitals NHS Foundation Trust and the PCT. It is also important to note the important role that Newark hospital plays in rehabilitating patients who are well enough to leave the facilities at Lincoln and Nottingham and can continue their care closer to home. Those proposals would also see an out-of-hours GP service available on site, which I hope my hon. Friend will welcome, as patients who wish to see a GP after midnight currently have to travel up to 20 miles to see one in Mansfield.
I am aware that the local press have reported that Newark hospital is being downgraded. The trust has made it clear that there are no plans whatever to downgrade the hospital. Rather, the plan is to make it fit for purpose and safe for patients. The trust also assures me that it is fully committed to Newark hospital and has no plans to close it. Rather, it sees the hospital as an integral part of local health services. I hope that that goes some way towards reassuring my hon. Friend and his constituents.
He also mentioned Friary ward, which was temporarily closed by Nottinghamshire Health Care Trust to assess how it can best be used in future. I gather that demand for the ward, which has 15 beds, had dwindled to two patients. More people need to be cared for in their own homes, as I suspect many patients would prefer, if that is medically and clinically feasible. I will certainly write to him with more details on what is happening at Friary ward and what will happen as a result of the trust’s assessment of the future of that part of the hospital’s activities.
On the concerns about the public consultation, the evidence I have been given indicates that there was a full engagement with the local community about the proposals that were put out to consultation prior to decisions being reached, although there will always be differences of opinion. I have no evidence to show that that was not a satisfactory and wholehearted consultation, even though I accept that some people remain unconvinced by the proposals before the trust.
In conclusion, local health services will need to evolve and become more efficient, in line with current Government policy. If we want to take people with us, we must ensure that they have full confidence in the decisions being taken and feel that their voices are properly heard. That is what the new arrangements are about. That will not always be easy, but if it is clear, transparent and led locally by clinicians, and if it listens and responds to the voices of local people, it will help to reduce the anxiety my hon. Friend has spoken about today and on which he has so eloquently campaigned over the past few months for the people of Newark. The commitment and tenacity he has shown in fighting for local health services is commendable, and I know that he will continue to engage constructively with the local NHS to ensure that his constituents’ concerns are properly heard.
I trust that something can be done through continued dialogue between all parties, including my hon. Friend, to resolve satisfactorily the differences of opinion on the name of the unit so that there is no confusion about where his constituents should go if they or their family members are involved in an accident and that they get the quickest and finest health care possible in the most appropriate setting.