The Parliamentary Under-Secretary of State for Health (Anne Milton)
I congratulate my hon. Friend the Member for Thirsk and Malton (Miss McIntosh) on securing the debate. I can fully understand her desire to ensure that the best possible health services exist for her constituents, which came across strongly when she met the Minister of State on 12 October to discuss Malton community hospital.
My hon. Friend is right to say yet again—we say it often, but we cannot say it often enough—that the NHS is a national treasure. It is much loved and much relied upon by all of us, and from my own point of view it was my employer for 25 years. As she rightly stated, patients are at the heart of the service, and need to continue to be. I am sad to say that the story she told this evening is not dissimilar to my experiences in my own constituency, and it shows a big gap: what managers in charge of the finances and commissioners are trying to achieve is very distant from what local people feel.
I wish to say a little about where we are, because I think I can reassure my hon. Friend that our vision of the health service is well aligned with her own. This Government trust professionals in the NHS, and our White Paper, “Equity and excellence: Liberating the NHS”, is about putting that trust into action and sweeping away the old system, which serves only to hamper and curtail the professional judgment of clinicians. We are replacing politically motivated process targets such as how many people are seen and the length of time they wait, which lump all patients together whatever their ailment, and introducing clinical standards generated by the professionals themselves, to hold them to account for the quality of care and outcomes that they provide. My hon. Friend also referred to the vital importance of professionals leading that process.
The future of local health services will not be dictated from the centre. They will not be directed by strategic health authorities or primary care trusts, they will be designed and commissioned from the bottom up by GPs and their colleagues across the health service, such as clinicians and managers, working in partnership in independent trusts to improve the quality of care. Patients will be armed with unprecedented levels of information and powers of scrutiny, and there will also be input from democratically elected local councillors. That bottom-up approach is important to prevent the present situation from happening again.
Miss McIntosh
What my hon. Friend is saying is music to my ears, but what concerns me is how we have reached a situation in which a major reconfiguration of services has happened without any regard at all to the bottom-up principle.
Anne Milton
I thank my hon. Friend, who is absolutely right. I will come to that.
As my hon. Friend stated, my right hon. Friend the Secretary of State has identified four crucial tests that all reconfigurations must now pass. First, they must have the support of GP commissioners. Secondly, there must be arrangements for public and patient engagement—no, I would rather say “involvement”, because “engagement” is not a favourite word of mine. This is about involvement—people being listened to and their voices being heard, which clearly has not happened in the case that she has described. Thirdly, there must be greater clarity about the clinical evidence base underpinning a proposal. Fourthly, proposals must take into account the need to develop and support patient choice. That is a recipe not for maintaining the status quo but for locally agreed, transparent, evidence-based and clinically led change. Decisions about the services at a local hospital will be driven by local clinicians, with the consent and input of patients and local authorities, not imposed or decided behind closed doors.
On Malton community hospital, providing health services in rural areas can be challenging, and I understand that many patients in north Yorkshire have to travel for as long as 45 minutes to reach their nearest large hospital. Local health services can indeed find it difficult to meet national guidelines, particularly those involving clinical mass. I understand that it is against such a challenging backdrop that North Yorkshire and York PCT is currently considering its strategy for health services in Malton and Ryedale, ensuring that they are safe and sustainable for the future.
I am happy for my hon. Friend to come back to me on any points that I may raise. I understand that the PCT’s emerging strategy for future hospital service provision is based on four themes: prompt local access to assessment and treatment for those needing urgent care; local access to a range of rehabilitation services, delivering intensive rehab and support effectively to re-able patients; prompt and local access to diagnostic tests and, where desirable and feasible, minor surgery; and specialist out-patient services to promote access and to support patient management by local GPs.
I am also aware of press speculation that Malton community hospital may be closed. The PCT has made it clear that it sees the hospital as an integral part of local health services and that it has no intention of not having a community hospital in Malton. I do not know whether that will reassure my hon. Friend. Judging by the expression on her face, I fear that it may not.
North Yorkshire and York PCT is currently piloting a scheme of enhanced community service in the Malton and Whitby area. The PCT believes that treating patients closer to home will provide better outcomes and encourage patients to retain their independence. I gather that that pronouncement has been greeted with the same cynicism with which it is greeted in many areas around the country.
Miss McIntosh
No one believes a word that the PCT says any more. There was a cohort of patients—21 at a time—who were treated intensively and given rehabilitation on a ward. They will now not be treated as intensively, and will be less safe when they return home after a fall or a major injury. It is that cohort of patients who will not benefit from hospital at home.
Anne Milton
I understand what my hon. Friend is saying. One of the problems is that we will have to let the pilot run. It is using existing hospital staff to provide hospital care in patients’ homes. I gather that there will be no reduction in nursing staff, but delivering care in people’s homes is a very different process from delivering it on a hospital ward. Because of financial constraints, it is not possible to run concurrent hospital and community services, so as part of the pilot, the wards have been temporarily closed. I understand that there will be deep cynicism about the prospect of their ever opening again. However, I am assured by the PCT that this is a pilot, and that a full assessment will be made at the end of it.
The project implementation team meets each week to assess the ongoing impact of the ward closure and bed reductions, and that team includes community provider staff, community hospital matrons and representatives from the community nursing team. I hope that that will continue, and go some way towards reassuring my hon. Friend. The pilot scheme will finish at the end of March 2011, and a full evaluation will take place in April 2011. The PCT has developed criteria for its evaluation—with, I hope, full consultation of local people.
I reiterate that no final decision has been made about the future of Ryedale ward. If the pilot leads to proposals for permanent service changes, the PCT will need to conduct a full public consultation, underpinned by the principles that I have set out. I hope that the PCT may learn a little from this debate, and from the letters that it has doubtless received, and ensure that local people feel that the consultation is real. I understand that the strategic health authority is working closely with the PCT to ensure that proper process is followed.
The need to improve clinical outcomes means that local health services will need to evolve, but I hope that, unlike previous changes, any future changes will have the confidence of local communities and clinicians. People must feel that their voice is properly heard; that is what the new arrangements are about. It will not always be easy, but if the process is clear and transparent, and, crucially, if it is led locally by clinicians, it will have the confidence of local people.
The commitment and tenacity that my hon. Friend shows in fighting for local health services is commendable. I note that she is due to discuss the matter further with the PCT on 19 November. I know that she will continue to work with the local NHS and ensure that her constituents’ voices are properly heard and represented, as she always has done.
The list of enhanced services that my hon. Friend described is particularly significant in the light of the publication of the White Paper. The description of the way in which the ward was closed gives rise to concern and cynicism among local people. It is not useful when organisations act in such a way, because it simply fosters a belief that the PCT is trying to drive something through. We have to let the story run and let the pilot be properly evaluated against the criteria that my right hon. Friend the Secretary of State has outlined.
Miss McIntosh
I am most grateful for my hon. Friend’s full reply from the Dispatch Box. On the particular, indeed unique, point that the PCT is both commissioner and provider of the services, will she give me an assurance that the functions will definitely be separated and that such a position will never arise again? It causes undue confusion for all concerned.
Anne Milton
My hon. Friend is right to draw attention to the issues surrounding the commissioning and provision of services. We have grappled with that for some time and we will fully address it. The consultation on the White Paper that we published in July is now finished, and we need to guard against exactly that sort of problem. If there is no Chinese wall or division between commissioning and provision, cynicism and deep suspicion of the commissioning decisions ensue.
I know that my hon. Friend will continue to make representations and watch the process closely. I assure her that our door will be open to hear any representations that she wants to make.
Question put and agreed to.