Hospital Services (Shropshire)

Wednesday 9th February 2011 Westminster Hall

16:30

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

This important debate is on the reconfiguration of hospital services in Shropshire, and in almost six years as Member of Parliament for Shrewsbury, I have never received so many letters, e-mails and telephone calls from concerned constituents over a single issue. Many of those calls have been emotional, and even though the consultation process is still ongoing, I feel it is my duty to use the platform that I have in the House of Commons to highlight a few of the concerns to the Minister.

Part of the reconfiguration proposals would involve maternity and paediatric services moving from Shrewsbury to Telford. I want the Minister to imagine the geography of Shropshire and mid-Wales. The Royal Shrewsbury hospital covers not just the whole of Shropshire, but the whole of mid-Wales—a vast expanse just across the border. I am pleased that my hon. Friend the Member for Montgomeryshire (Glyn Davies) is present in the debate today.

Picture the wheel of a bicycle, and at the centre, the spokes coming into the middle. That is where Shrewsbury is in the area. Now imagine moving paediatric and maternity services right to the edge of the wheel. How would that wheel function? Telford is at the edge of the area, on the extreme eastern border close to Staffordshire. What is the sense in moving services so far away from the rest of central Shropshire and mid-Wales?

I am so passionate about this issue that I raised it during Prime Minister’s Question Time last week. The Prime Minister referred to the importance of public engagement and consultation, which he said was a fundamental aspect of any reconfiguration proposals. Therefore, I have asked the chief executive and the primary care trust for a public meeting to be held in Shrewsbury on 11 February at the football stadium in our town. I believe that hundreds and hundreds of people will attend. I intend to make a transcript of that meeting and of all questions put to the PCT and the chief executive, and I will be sending that transcript to the Minister.

[Glyn Davies (Montgomeryshire) (Con)]

My hon. Friend knows that I also have a huge interest in this issue as I represent Montgomeryshire over the border. Does he agree that the meetings that will be held in Montgomeryshire on 18, 23 and 24 February are of equal importance, and that it is crucial for the health board and PCTs to take notice of them? We also depend on the services in Shropshire.

[Daniel Kawczynski]

I agree with my hon. Friend. We are cognisant of the fact that his constituents, the citizens of mid-Wales, do not have facilities across the border and are dependent on the Royal Shrewsbury hospital. The people of Wales must be listened to equally, in the same way as the people of Shropshire.

I have slight concerns about the lack of sufficient engagement by the authorities with local people. I pay tribute to the chief executive and his colleagues. There have been public meetings, and the chief executive has met some of my constituents who have serious questions to ask on a one-to-one basis. Nevertheless, many letters and e-mails have not been answered in a timely way or to the degree that people wished for. Some people who have written in are retired senior consultants and experts in the field. I hope that all their questions will be answered.

I am also concerned about the dates of the public consultation. In began on 9 December and will finish on 14 March. I find 9 December a rather strange time to start a public consultation. We all know how stressful Christmas is at the best of times, and we would have been gearing up to buy the Christmas tree and presents and get our homes ready for festivities. A lot of people in Shropshire will not have been thinking about the consultation as intently and with as much time and focus as they might have done, because they were distracted by the coming festivities. If we are to have a public consultation, it must be held at the right time of the year and there must be sufficient time for people to make their views heard.

[David Wright (Telford) (Lab)]

I am grateful to my hon. Friend—I use that phrase pointedly—for giving way. There will be a consultation in Telford next week, and I hope that people will come to it. It is important that people across Shropshire express their opinions. Does my hon. Friend accept that under the proposals, both hospitals have to give something in order to sustain health services in Shropshire? Acute surgery would move to Shrewsbury, and some elements of paediatric and maternity services would move to Telford. There will be a balance between the two hospitals. We do not want to see services move out of the county, and if we are to sustain services in Shropshire, I think this is the best plan we are going to get.

[Daniel Kawczynski]

I will reciprocate by referring to the hon. Gentleman as my hon. Friend. We are from different parties but we are colleagues. We get on well, and across the parties we have a passion for Shropshire. I will come later to the importance of retaining services in Shropshire. However, constituents do not pay attention to services that come to their area; they are focused on those that are leaving. That is why they are pressing me to highlight these issues in Parliament.

My other concern is that there is no plan B. This is a consultation process in which the chief executive and the board come forward with proposals. However, there are no shades of grey—it is take it or leave it. I speak purely as a layman, but if there is only one option, it is difficult for a large group of people, many of whom do not have medical experience, to scrutinise that proposal. Surely, if we are to genuinely engage with local people, differences and alternative options could be put forward so that the community as a whole could come together, debate them and make recommendations.

[Mark Pritchard (The Wrekin) (Con)]

Does my hon. Friend accept that in an ideal world, both hospital sites would have all-singing, all-dancing acute and clinical services? However, we do not live in an ideal world, but in a time of constrained public finances. Does he accept that the current consultation recognises the importance of having an accident and emergency ward at both Shrewsbury and Telford? That is a breakthrough from the original consultation process and shows that the hospital trust has listened to Shrewsbury and Telford on that important point.

[Daniel Kawczynski]

I concur with my hon. Friend and with the point that he makes in his usual eloquent way. I have been told by the chief executive, and others, that if we do not go for the proposals, we will potentially put our foundation trust status at risk. If we put that at risk, there is the possibility of losing services—and the management of those services—out of the county. Again, I speak without medical experience, but I do not understand how we could enter into a consultation process but be told that if we do not go for the proposals, services will be lost from Shropshire.

I cannot envisage a time when we have no maternity or paediatric services in the whole of Shropshire. That is unthinkable to me, so I do not understand the logic of the trust. It is saying, “Take it or leave it, but if you leave it, that’s it. We won’t get our foundation trust status and you’ll lose your services.” That position needs to be clarified because many people see it as a gun being pointed at their heads and are therefore frightened to challenge the proposals.

[Glyn Davies]

I am grateful to my hon. Friend for his tolerance in allowing me to make a second intervention. The point that he has just raised is key. Everyone, including, I am sure, my hon. Friend, recognises that there must be a reconfiguration of services. The points that have been made are crucial. However, that does not necessarily mean that the reconfiguration of services that is before us has to be the case. The argument is not about whether there should be a reconfiguration of services, but about how that should take place. In the interests of the people of Montgomeryshire, I think that services are best placed not where it is convenient for a balance in Shropshire, but where they are accessible to the people who will use them.

[Daniel Kawczynski]

I completely concur with my hon. Friend on that point.

I shall briefly relate a couple of specific cases. I have been inundated with hundreds of letters on this issue. My own daughter was born at the Royal Shrewsbury hospital, and it was the proudest day of my life when my daughter was born within the community that I represent. She is not just a Salopian; she is a Shrewsbury girl and she will have that with her for the rest of her life. For us in Shrewsbury, being a Salopian is important, but being a Shrewsbury girl? Now that is something special. I feel so passionately about that.

One constituent’s family is directly affected by the proposals, as her three-year-old son needs 24-hour open access to the children’s ward at the Royal Shrewsbury hospital because he suffers from severe haemophilia. He needs treatment to be administered every other day and any additional treatment on demand if he should cut himself. I was told that it was vital for my constituent’s son to be admitted immediately to the children’s ward via A and E and not to be sent down the motorway to the Princess Royal hospital. How can that mother of a son with haemophilia empower herself to make her views known if the overview and scrutiny committee is not minded to refer this issue to the Minister?

The issue has also been raised with me by the father of a child who was previously a cancer patient treated at the Royal Shrewsbury hospital. He talks about the appeal in 2003 for a designated children’s cancer unit at the Shrewsbury hospital. It raised £500,000 and the unit was completed in 2005. My constituent told me that

“many people across Shropshire and Mid Wales donated or gave up many hours to fundraise, only to now find that the purpose built unit will…stand unused as Children’s services are being moved to Telford with no provision for this desperately needed unit which provides an essential service to families facing unimaginable turmoil whose children are being treated for cancer.”

I have been told of the severe disruption and anguish that will result from the need for seriously ill patients to travel from Shrewsbury if it is left with no consultant-led surgery, which may result in a catastrophic delay in emergency treatment.

I also want to mention Joshua, a young boy in my constituency who has chronic lung disease. His mother, Hayley Corfield, wrote to me about him. He has had bronchial problems since birth and is now 14 and constantly in and out of hospital. I have been given the most extraordinary list, which I will send to the Minister, of the medications that this poor young boy is on. He lives in Shrewsbury. His mother tells me that there have been many near misses in the last few years in terms of saving his life—resuscitating him. She is desperately worried about the impact on her son and the chances of his survival if, suffering from this chronic disease, he has to travel for an extra 20 minutes to Telford. I am therefore raising these issues with the Minister today.

The Minister kindly wrote to me. In his letter, he notes that I am planning to call a public meeting and encourages me

“to ensure views from that meeting are fed back to the local NHS via the consultation mechanism, so local concerns are fully taken into account.”

The next part is the bit that I am excited and happy about and grateful to him for—I know that he is one of the best Ministers we have. He says:

“The Department will be watching the outcomes from the consultation exercise with interest.”

I know that he cannot get involved at this stage, but I am extremely grateful that he has said that he will be watching with interest the outcome of that consultation process.

I have today written to all the general practitioners who practise in Shrewsbury and Atcham. Again, the Prime Minister stated at Prime Minister’s questions, and it was reconfirmed to me by my right hon. Friend the Secretary of State for Health, that the views of local general practitioners would have to be taken into account before any reconfiguration process could occur. I wanted an independent assessment of their views, rather than it being handed to me by the PCT or anyone else. I have therefore written today to all the general practitioners in my constituency and I urge my hon. Friends to do likewise if they so wish. I will compile the results of the views of local general practitioners in Shrewsbury and will share their views anonymously. I will not refer to specific people, but I will share their views with the Minister.

I am extremely grateful for the 15 minutes that I have had and for the constructive way in which we have debated this issue. It is extremely emotive. I do not want to get into a Shrewsbury-Telford pillow fight. We have had enough of that over the years. I want to work constructively with my colleagues and with the trust to come up with the best possible solution for our beautiful county.

16:47

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate on hospital services in Shropshire. I am sure that his constituents will be pleased to know that he has raised an issue of such great importance to his local community. I also pay tribute to the staff of the NHS across the whole of the county of Shropshire, who do such an incredible job caring for the constituents of my hon. Friend and the hon. Member for Telford (David Wright). They deserve and will receive the Government’s full support.

Before I come to the specifics of Shropshire, I shall set out the Government’s general approach to the reconfiguration of health services, as my hon. Friend referred to the answer that he received from my right hon. Friend the Prime Minister last week. The Government passionately believe that local decision making is essential to improve outcomes for patients and to drive up quality. We do more than just talk about pushing power to the local level; we are doing it.

In May 2010, my right hon. Friend the Secretary of State for Health identified four crucial tests that all reconfigurations must pass. First, they must have the support of GP commissioners. Secondly, arrangements for public and patient engagement, including local authorities, must be further strengthened. Thirdly, there must be greater clarity about the clinical evidence base underpinning any proposals. Fourthly, any proposals must take into account the need to develop and support patient choice.

I understand that NHS West Midlands has given an assurance that the case for change is underpinned by those tests. Let me be clear what that means. Hospital closures that do not have the support of GPs, local clinicians, patients and the local community should not happen. There should be ample opportunity for patients, local GPs and clinicians and local councils to have a far greater role in how services are shaped and to ensure that these changes will lead to the best outcomes for patients.

It is important to remember that local public consultation is the vehicle through which to ensure that everyone with an active interest in proposed changes to their local health service gets their say. In this case, local consultations began on 9 December 2010 and are scheduled to conclude on 14 March 2011. My hon. Friend mentioned it, but if it is any consolation to him, Christmas and the new year holidays came during that period. The normal consultation time is 12 weeks, and if my maths is right this consultation process will take 13 and a half weeks including the holidays.

It should be stressed that consultation is by no means a fait accompli. It is a democratic process that allows full and open participation in considering all the options for service change. If an overview and scrutiny committee is not satisfied that adequate NHS consultation has taken place, or decides that proposals do not meet the needs of the local community, it may refer the matter to the Secretary of State for Health.

I understand that there has been a long history of debate on the best way to organise hospital services in Shropshire. A previous review failed to provide a lasting way forward for the county. Local organisations are now taking this review forward, and they believe that changes need to be made in the near future to ensure that services continue to be provided safely. Over the last decade, the NHS in Shropshire has identified a number of services, including accident and emergency, acute surgery, maternity, neo-natal, in-patient, paediatrics and urology, that face an increasing challenge in trying to provide 24-hour cover by senior medical staff at local hospitals.

As the public consultation document explains, there are five main reasons for that. First, the increasing specialisation of staff means that fewer consultants are able to provide general emergency cover. That is a particular problem in general surgery if it is split between two sites. Secondly, out-of-hours arrangements mean that some consultants have to cover a number of services and sites at the same time. That places unrealistic pressure on staff, and it can put patients at risk. Thirdly, the European working time directive limits the time that medical staff are allowed to work to an average of 48 hours a week. Fourthly, due to the relatively spread-out nature of the Shropshire sites and the area’s rurality, it can be difficult for junior doctors to see the wide range of patients necessary for their training. Fifthly, those factors collectively could make it difficult to recruit high-quality medical staff, particularly consultants.

The current configuration of services results in duplication between the Royal Shrewsbury and Princess Royal hospitals. It also limits the ability to develop the more specialised services that could be provided in Shropshire, Telford and The Wrekin. That is not sustainable.

This is the opportunity for all those with an interest in making changes to local health services to become involved. My hon. Friend has called for an additional public meeting in Shrewsbury; that takes place on Friday 11 February. As I said in my letter, I strongly encourage my hon. Friend to note the views raised at the public meeting, so that they can be fed in to the consultation process. Before a final decision is made following the conclusion of the consultation process, those views will have been heard and considered.

The consultation document explores four options. Option 1 is to do nothing. That is not considered feasible by the local NHS. A second option is to concentrate all major and emergency activity on the site of one or other of the existing two hospitals, with planned activity at the other. That has been looked at carefully, and I understand that that is not considered feasible either. A third option is to build a new hospital, but that has been discounted because of the financial climate. A fourth option, the preferred local NHS option, means moving services between the two sites to make the most effective use of staff, equipment, and buildings.

The consultation document suggests that this is likely to mean that the bulk of in-patient, children and maternity services—

16:54

Sitting suspended for a Division in the House.

17:08

On resuming—

[Mr Burns]

As I was saying when we broke for the Division, the consultation document suggests that this is likely to mean that the bulk of in-patient, children and maternity services will be provided at the Princess Royal hospital in Telford. A range of acute surgery, including trauma and orthopaedic surgery, and various surgical and other services would remain at, or move to, Shrewsbury. Both sites would continue to provide midwife-led maternity units, with improved accommodation provided for the midwife-led unit at the Royal Shrewsbury hospital site. All pregnant women who are assessed as being likely to have a low risk of complication in the later stages of pregnancy would still have the opportunity to choose to have their baby in a midwife-led maternity unit or at home.

Gynaecological services and antenatal out-patient and day care services will continue to be available at both sites, as will children’s out-patient services. It is proposed that a number of specialist surgery services, whether for planned or emergency operations, would be concentrated at the Royal Shrewsbury hospital: vascular surgery; colorectal surgery, and upper gastro-intestinal surgery. I also understand that funding will be made available so that the Royal Shrewsbury hospital will gain phase 3 status as a specialist aortic aneurism centre.

The consultation states that most surgery for life-threatening trauma is already carried out by surgeons at the Royal Shrewsbury hospital and that would continue to be the case under these proposals. Also, 24-hour accident and emergency services will remain at both hospitals. Therefore, proposals in the consultation document appear to point to a vision of both hospitals providing a diverse range of services that complement each other.

This review has been led by clinicians. Proposals are based on work led by senior doctors, nurses and other health care professionals in the county, working with partners from local authorities, community and voluntary organisations, and patient and public representatives. I understand that the local NHS has involved a number of clinical staff in its local assurance process, including clinical experts from outside Shropshire, such as the director of nursing from Leicester Royal Infirmary and a consultant paediatrician from Manchester, as well as a number of clinical staff with related experience who work within the trust but who had not been involved previously in developing future options.

I am assured that NHS West Midlands will consider results of the public consultation, as is appropriate, before any results are presented to the local NHS boards. I also understand that the local NHS is keeping all local MPs briefed on the consultation process.

I know that my hon. Friend the Member for Shrewsbury and Atcham has campaigned vigorously in the past for retaining services at his local hospital. May I assure him that I fully appreciate his desire for a process that is open and transparent, one that does not end with decisions made behind closed doors after only a derisory nod to public consultation? His constituents, like those of all right hon. and hon. Members, deserve local health services that have the confidence of local GP commissioners and of local people themselves.

I also point out to my hon. Friend that because we are in the middle of a consultation process it would be totally inappropriate for me to seek to influence or compromise that process by becoming directly involved. There are avenues open through the consultation process, as my hon. Friend knows well, and I know that he is working vigorously, as demonstrated by his holding a meeting in Shrewsbury on 11 February, to make sure that the voice of his constituents is heard and considered as part of what is a very important consultation process for the whole county of Shropshire, to ensure the right configuration of services in local hospitals to meet the needs of local people.

Question put and agreed to.

17:13

Sitting adjourned.