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The Minister of State, Department of Health (Mr Simon Burns)
It is a pleasure to serve under your chairmanship, Mrs Brooke. I congratulate the hon. Member for Eastbourne (Stephen Lloyd) on securing the debate on an issue that I know is of considerable concern to him and his constituents, and to other hon. Members attending today.
Before I address the issues raised, I would first like to pay tribute to all those who work in the national health service in Eastbourne, whose dedication, determination and commitment provide first class care to the hon. Gentleman’s constituents and those of other hon. Members. I know the hon. Gentleman is committed to ensuring that his constituents have access to high quality health care whenever and wherever they need it. I also appreciate that when any changes to local services are mooted, people can become anxious and feelings can run high.
As lifestyles, society and medicine change, the NHS must continually adapt. The NHS has always had to respond to patients’ changing expectations and to advances in medical technology. Reconfiguration is about modernising the facilities and the delivery of care to improve patient outcomes, to develop services closer to home, and, most importantly, to save lives. The Government are very clear that the reconfiguration of front-line health services is a matter for the local NHS. Services should be tailored to meet the needs of local people and to provide them with the best possible outcomes. That is why we are putting patients, carers and local communities at the heart of the NHS, placing decision making as close as possible to individual patients by devolving power to professionals and providers, and liberating them from top-down control.
Those principles are further enshrined in the four tests introduced in 2010 by my right hon. Friend the Secretary of State. Local reconfiguration plans must demonstrate: support from GP commissioners; strengthened public and patient engagement; clarity on the clinical evidence base; and support for patient choice. Our reforms allow strategic decisions to be taken at the most appropriate level. We are enabling clinical commissioners to make the changes that will deliver real improvements in health outcomes, and we will provide incentives to providers to deliver higher quality and more efficient services.
We are also aware that the reconfiguration of services works best when there is a partnership approach between the NHS, local government and the public. That is why we are strengthening local partnership arrangements, under the Health and Social Care Act 2012, through health and wellbeing boards. They will provide a forum where commissioners, local authorities and the local HealthWatch can discuss and plan the future shape of services to meet the health requirements of the local health economy.
NHS Sussex and local clinical commissioning groups, such as the commissioners of East Sussex Healthcare NHS Trust, have been working with NHS South of England, with support from the National Clinical Advisory Team, to ensure that there is full and proper scrutiny of the proposals to reconfigure some services. That has included assessing the readiness of the local NHS to go out to formal consultation, including reviewing the case for change and understanding whether the four tests, as laid down by my right hon. Friend the Secretary of State, for service change have been met.
The services under consideration for reconfiguration at the trust’s two acute sites at Eastbourne District General hospital and the Conquest hospital, Hastings are: orthopaedics, higher risk and emergency surgery only; general surgery, higher risk and emergency surgery only; and stroke, hyper-acute and acute only. Those are the only services being consulted on under the proposals. The local NHS agrees that hyper-acute and acute stroke services, all emergency and higher risk elective general surgical procedures, and all emergency and higher risk elective orthopaedic procedures can no longer be provided at both of the trust’s acute hospital sites. I understand that the proposed changes were approved on 30 May by the two local clinical commissioning groups—Hastings and Rother; and Eastbourne, Hailsham and Seaford. NHS South of England strategic health authority formally reviewed those proposals and assured itself that the Secretary of State’s four tests have been met and will continue to be met. The trust will now look to launch a 14-week public consultation exercise, which it anticipates will commence on 25 June, or shortly thereafter.
The hon. Gentleman raised concerns about maternity services, and I will seek to reassure him. For the sake of clarity, the current proposed consultation will not include maternity services. I understand that maternity services will be included in a separate programme known as Sussex Together, which is still being developed. That will look at maternity services across the county as a whole. The proposals are focused on enabling the local NHS to deliver directly clinically safe and sustainable services for patients, now and into the future. I am sure the hon. Gentleman agrees that this is something we all want and expect from the NHS.
A great deal of work is taking place to develop a local clinical strategy, one that will ensure the future sustainability of health services in the county and the best possible outcomes for local patients. The clinical strategy centres on eight areas of care, described by the trust as primary access points, covering 80% of service delivery. They are: acute medicine; cardiology; emergency care—A and E; general surgery; maternity; musculoskeletal, trauma and orthopaedics; paediatrics and child health; and stroke. For each one, a report on current challenges, the case for change and the proposed option has been produced.
With those plans, the local NHS in Sussex wants to achieve greater integration across health and social care services, to provide more care within communities, together with, where appropriate, shorter stays in hospital and better support when patients leave hospital, to provide care that continues to meet national clinical standards and best practice, to improve patient access to clinical experts at the earliest appropriate opportunity and to deliver the best outcomes for local patients.
Stephen Lloyd
I appreciate what the Minister says. I share his belief that the broader we go on the consultation, the better it will be. I support the health and wellbeing boards, introduced under the Health and Social Care Act 2012, because they are a good idea and will have some clout under the legislation. Does he agree that as the ESHT goes through the consultation, our new health and wellbeing board should be part of that consultation?
Mr Burns
Yes. Anyone and anybody should contribute to the consultation on any proposed reconfiguration. A key role of the health and wellbeing boards, particularly when fully established and operating in their own right, rather than in their shadow form at the moment, will be to ensure that the interests of the local health economy and patients are met. I would be surprised if the health and wellbeing boards did not show an interest in any reconfiguration, whether affecting the hon. Gentleman’s constituency or elsewhere. I am sure that they would form a view about any proposals.
The plans have been developed by local clinicians, including input from local clinical commissioning groups, with involvement from patient representatives, local people and other stakeholders, taking into consideration national best practice. Local clinical commissioning groups are also working alongside NHS Sussex to lead work on assuring the plans. The local NHS says that it believes that the majority of the changes required can be achieved by redesigning services and introducing greater integration and productivity within and between services. The proposed changes should enable the trust to deliver best practice, such as early access to senior clinicians, dedicated units, with specialist support staff and facilities, and improved multi-disciplinary teams.
Under the preferred options, surgery and orthopaedic services would be provided from the same site to support trauma unit designation. However, stroke services would not necessarily have to be on the same site as those services.
As I have said, reconfiguration is a matter for the NHS locally. I hope that the hon. Gentleman accepts that it would be inappropriate for Ministers to intervene in local due process, because the ethos of NHS reform is to put an end to the constant interference and micromanagement of the day-to-day running of the health service by Ministers like me or civil servants in the Department of Health in Whitehall. The nub of our reforms is that decisions on local issues—the local provision of health care—should and must be determined locally within the local health economy.
Stephen Lloyd
I appreciate where the Minister is coming from. Again, I genuinely and profoundly agree with him. That is why it is so significant that the majority of senior clinicians, as well as the public, are singing broadly from the same hymn sheet. The significance of the changes in the Health and Social Care Act 2012 is, as our colleague the Under-Secretary of State for Health says, that they must be led by clinicians and patients. That is why I made the point in my speech. I am gratified that the Minister has reiterated that.
Mr Burns
Let me mention something that will be of some comfort to the hon. Gentleman when the proposals get to the appropriate part of the process. The local authority health overview and scrutiny committee, which comprises democratically elected members of the council, has powers to refer a service reconfiguration to my right hon. Friend the Secretary of State if it is not satisfied that the proposals are in the interest of the health service in the area and in line with the content of the consultation or the time that has been allowed for it and that the consultation has been conducted appropriately.
As this consultation has not yet even begun, the HOSC has obviously not yet had the opportunity to make any such decision on whether it has been conducted appropriately. I therefore encourage the hon. Gentleman, his constituents and other interested parties who may be affected by the proposals to engage fully in the consultation when it commences to ensure that their views are fully taken into consideration.
If a decision flowing from the consultation does not find favour with the overview and scrutiny committee, it will be open to that committee to write to my right hon. Friend the Secretary of State to express its concern and dissatisfaction with the process, the decisions taken and the conclusions reached and to request that he refer it to the independent reconfiguration panel. That is a number of stages down the road, because we have not yet even commenced the consultation.
I urge the hon. Gentleman and every other interested party in East Sussex and even further afield if they might be affected by this reconfiguration to engage fully in the process, so that their views and concerns and their ideas of the best way to provide local health services are met.
Question put and agreed to.