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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—
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.