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Paul Goggins (Wythenshawe and Sale East) (Lab)
I am pleased to be able to hold this debate. I am particularly pleased that my hon. Friend the Member for Stretford and Urmston (Kate Green) is with me. I hope she will have the opportunity to catch your eye later in the debate, Mr Robertson, and make a short contribution. I am also pleased to see the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) in his place, as I know that he takes a particular interest in the NHS in Greater Manchester. I look forward to hearing what he has to say in response to my comments and my hon. Friend’s.
This is a timely debate. It is expected that in the next few weeks, a major consultation will be launched in Trafford on proposed changes to the provision of hospital services in the borough. That is, rightly and understandably, attracting huge interest in the community in Trafford and elsewhere. Last week, 5 July, was the 64th birthday of the national health service. That has particular resonance in Trafford, as it was at Park hospital, now Trafford General hospital in the constituency of my hon. Friend the Member for Stretford and Urmston, where the story of the NHS began. That was the NHS’s birthplace. Aneurin Bevan went to that hospital on that day in July 1948 to launch the national health service, which remains the best health service anywhere in the world.
Last Saturday, my hon. Friend and I joined hundreds of local people in Trafford on a march and rally organised by the campaign to save Trafford general hospital. Many parts of the community were represented, including the two main political parties in Trafford—they were both represented in good numbers—and it was evident that the affection for and commitment to the national health service in Trafford remains, just like everywhere else in the country, as strong as ever.
I think that Aneurin Bevan would be truly shocked, 64 years on from that historic day when he launched the national health service at Park hospital, to learn that the life expectancy of a man who lives in the poorest part of the Trafford borough is 11 years shorter than that of a man who lives in the wealthiest part of the borough. The gap for a woman is six years. That is a gross inequality in health. Our main objective, irrespective of party, must be to reduce such massive and gross health inequalities in our communities.
The Minister of State, Department of Health (Mr Simon Burns)
The right hon. Gentleman makes an extremely valid point, in the light of which I have no doubt that he will welcome the fact that, for the first time—and, ironically, under a Conservative Government—there is enshrined in primary legislation a duty on the Secretary of State for Health to work to minimise health inequalities.
Paul Goggins
As I have said, Members of all parties should work together, although the legislation the Minister refers to contains many other elements about which I am a great deal more sceptical. In any event, tackling health inequalities should be at the forefront of our minds. If the national health services in Trafford are to be redesigned, that needs to happen in a way that helps us to tackle inequalities that blight lives and bring them to a premature end. We need a system of integrated care in Trafford that is capable of dealing with those issues and that can help us to tackle, in a meaningful way, the difficult problems of heart disease, diabetes, cancer and stroke that blight so many lives and bring them to a premature end. That has to happen. Frankly, the debate about integrated care in Trafford has gone on for long enough. We are signed up to it and it needs to come to fruition.
This time last year, there was great concern in Trafford about the future of Trafford general hospital. There had been serious financial problems at the trust and there was real fear in the community that those who run the NHS and who make decisions intended to privatise the hospital. I am pleased that, eventually, that did not happen and that Central Manchester University Hospital NHS Foundation Trust acquired the Trafford trust, so that Trafford general hospital, Stretford memorial hospital and Altrincham hospital are all still part of the NHS family. That has been widely welcomed throughout Trafford, but it is clear that further changes are on the way. It is vital that we have a full and frank consultation to inform the process of change that will, no doubt, ensue.
One particular issue—and the main focus of this debate—is the likely impact of changes to hospital services in Trafford on the nearby hospitals in the city of Manchester. If the consultation proposes to replace the accident and emergency department at Trafford general hospital with an urgent care centre, there is concern about the implications for Manchester hospitals, particularly Wythenshawe hospital, which is part of the University Hospital of South Manchester NHS Foundation Trust—UHSM—in my constituency.
Many Trafford residents already use hospitals outside the Trafford borough for their NHS treatment. Indeed, I estimate that about 130,000 of the 230,000 people who live in Trafford consider Manchester Royal infirmary in central Manchester and Wythenshawe hospital in south Manchester to be their local hospitals—the hospitals they have easiest access to. It is also true that, if someone suffers a major trauma, a stroke or a serious heart attack, they would not be taken to the A and E unit at Trafford hospital, even if they were a Trafford resident; they would go instead to one of the local teaching hospitals in either Manchester or, perhaps, Salford.
The end result of the geographical link between Trafford residents and hospitals in Manchester—and, indeed, of the requirements of the complex conditions from which people suffer—is that more than half of Trafford residents who need to attend an A and E unit go outside of Trafford in order to do so. That means 25,000 patients who live in Trafford going to Wythenshawe hospital for their A and E treatment. That is a third of all the Trafford residents who require A and E appointments in any one year.
UHSM estimates that if the A and E unit at Trafford general hospital closed, that would mean 7,600 additional patients at Wythenshawe hospital’s A and E unit in any one year. At present, Wythenshawe hospital treats 88,000 people at an A and E unit that was designed for 70,000 patients, so there is considerable concern at the prospect of patient numbers in excess of 95,000 if the changes are introduced. In addition, half of all unplanned admissions of Trafford residents to hospital are admissions to Wythenshawe hospital. It is estimated that, if the changes are introduced and if the A and E department at Trafford general hospital closes, 1,900 additional patients could be admitted, on an unplanned basis, to Wythenshawe hospital. In total, that means an extra 9,500 patients coming in for either A and E or an unplanned admission.
Even if the integrated care system that we all want is able to divert people from hospital and reduce the number of hospital admissions, there would still be significant additional pressure on Wythenshawe hospital. I have seen some estimates of the number of patients who may be diverted from hospital as a result of the changes. Some of the professionals involved in making the assessments predict that, even if the system is successful, a 20% diversion would be heroic. That means that Wythenshawe hospital’s A and E department would need more beds, more theatre time, more examination cubicles, more resuscitation bays and even a new fracture clinic. Although the tariff arrangements may pay for patients’ treatment, the capacity and the facilities will simply not be there, which brings me to the core of my argument: the facilities have to be there if we are to see the kind of major changes that may be proposed. If we do not have additional capacity at Wythenshawe, the consequence will be growing queues and cancelled operations. Nobody wants that to happen.
The case for additional facilities is being made by the UHSM management, but the silence of the response so far from the Greater Manchester cluster is deafening. We need engagement with those who run the cluster, so that we can start to get some proper answers to the problems. It is not as though this is a new issue. Elsewhere in the north-west in recent years, when Burnley’s A and E unit closed down, additional facilities were made available at Blackburn, and, when Rochdale’s A and E department was downgraded, there was investment in the Pennine acute trust. We are asking for the same process to be applied to Manchester hospitals if the A and E department at Trafford general hospital is replaced by an urgent care unit.
As I said, I hope that my hon. Friend the Member for Stretford and Urmston will catch your eye in a moment, Mr Robertson. My constituency next-door neighbour, the hon. Member for Altrincham and Sale West (Mr Brady), who, sadly, cannot be here today, has asked me to say that he fully supports my argument. He has also asked me to say specifically:
“Wythenshawe is the most important acute hospital for most of my constituents and I share the view that any additional demand at Wythenshawe arising from changes elsewhere will need to be properly resourced.”
We are looking today for a guarantee from the Minister that the necessary funding will be made available for the expansion of facilities at Wythenshawe hospital. UHSM should not be expected to take the financial risk to provide those facilities; the money has to come from elsewhere within the NHS.
The Central Manchester University Hospitals NHS Foundation Trust will face similar issues, although perhaps to a lesser extent, because the numbers are not as great. Of course, the relationship between central Manchester and Trafford general is different, because they are now part of the same organisational arrangement. However, the issue will still be there. If more patients are presenting at central Manchester for A and E and unplanned admission, there will be an additional burden that runs the same risk of longer queues, longer waiting times and cancelled operations. I am sure the Minister does not want to see that.
I look forward to hearing what the Minister has to say. I hope he is able to give a positive reassurance—indeed, a guarantee—that the facilities that will be required at Wythenshawe if the other changes go through will be made available. It would be wrong for my constituents who live in Manchester to discover that, because of changes in Trafford, they will face longer queues at A and E and operations being cancelled—that would be unfair. We have to see investment up front. We all want the integrated care model to work, but those patients will not disappear into thin air. Many more patients will be looking for their treatment outside Trafford if the A and E department becomes an urgent care centre. I hope the Minister will engage with that issue, and that we can have a positive assurance from him today.
Kate Green (Stretford and Urmston) (Lab)
I am grateful for the opportunity to contribute to this debate, Mr Robertson. I thank my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) and the Minister for allowing me to make a few remarks on behalf of my constituents.
The proposals for Trafford will clearly have a direct and significant impact on my constituents. As my right hon. Friend said, they are the cause of considerable local concern, exemplified by the substantial numbers of local people who joined the march and rally organised by the Save Trafford General campaign on Saturday. As my right hon. Friend said, they included politicians from across the political spectrum.
As we have always sought to say to the Minister, we understand that having fewer people go into hospital in the first place and, when they do have to be admitted to hospital, getting them back home as quickly as possible to recover is the outcome that we should all be striving for. We understand and welcome the integrated care approach as a means to bring that about, but that approach, which has been talked about for a number of years in Trafford without significant progress, cannot be delivered without the necessary and substantial investment in front-line community health provision and primary care. That will be even more true if, as we hope and expect, fewer patients will go to hospital in Trafford—or, indeed, in Manchester—and there is a concerted effort to undertake more preventive community health provision to achieve that result.
It is very important that the Minister gives assurances—not to me, but to my constituents—that the necessary investment in community and front-line health provision to produce an effective model of integrated health care and improve health outcomes is guaranteed. We need not only the up-front investment to enable that transition from hospital provision to more community provision, but an indication from the Minister that any savings from reduced hospital admissions and hospital stays in Trafford will be reinvested in front-line preventive care.
I understand that the proposed changes are not primarily financially motivated. We see them as motivated by a desire to achieve the very best health outcomes. None the less, it is a concern that the deficit at Trafford general has risen substantially in recent years. It would be helpful if the Minister explained how that deficit has come to grow significantly and how the proposed changes will have an impact on the ability to balance the books. The Minister will be aware that a two-stage transition is proposed for services at Trafford, with an initial reduction to below level 1 emergency care provision over more restricted hours, but ultimately perhaps moving right down to a minor injuries unit in a period of not less than two to three years. Will the Minister assure us that neither the move to option 2b, as it is called, nor the move to option 3, will be implemented unless and until the necessary community provision to make those respective models work effectively has been put in place?
I would like to raise one other matter with the Minister. Clearly, the proposed changes will lead to more patient journeys from Trafford to other nearby hospitals. I understand that the North West ambulance service expects to have additional resources in the light of those extra patient journeys. However, it would be welcome if the Minister offered guarantees that those resources will be put in place. That is a particular concern as the patient transport service, which in a sense backfills for some of the emergency ambulance cover, is out to tender. I would welcome an assurance from the Minister on that.
I endorse my right hon. Friend’s comments on waiting times and service standards at neighbouring hospitals. If the changes go ahead, we need guarantees that they will enhance, not diminish, the standards of health care at Trafford. We look forward to receiving those assurances from the Minister this afternoon.
The Minister of State, Department of Health (Mr Simon Burns)
It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on securing the debate and the hon. Member for Stretford and Urmston (Kate Green) on her contribution. Like the right hon. Gentleman, she shows a keen and continuing interest in the provision of health care in her constituency and in Greater Manchester. If I do not respond to all the points that they have made—I will seek to respond to as many as possible—I will definitely write to them as quickly as possible after the debate.
As ever with such issues, it is important to not only recognise, but pay tribute to the NHS staff in the constituencies of the right hon. Gentleman and the hon. Lady, as they do so much to improve the health and the well-being of their community day in, day out.
I would like to provide some context to the right hon. Gentleman’s concerns about health services in Trafford. I am sure that he will appreciate that the local NHS, working with commissioners, clinicians and local authorities, needs to determine for itself how best to meet the needs of local people. I am sure that he will accept that it is not for Ministers to intervene at that level. To ensure that all local NHS bodies can do so, we not only protected NHS funding, but actually increased it in real terms, albeit a modest real-terms increase, and that will continue throughout this Parliament. The extra money means better services for patients and, ultimately, healthier communities in the right hon. Gentleman’s constituency and beyond. In his constituency, Trafford primary care trust will receive more than £389 million in the current financial year, which is an increase of £10 million on last year. Manchester PCT will receive more than £1 billion, which is up by more than £29 million on the previous financial year.
Those increases come with a significant challenge, which was referred to by the right hon. Gentleman and the hon. Lady. The NHS as a whole needs to spend its money better. Nationally, it needs to find £20 billion of efficiency savings in the next few years to meet the rising demand for services. The right hon. Gentleman’s party made that commitment when they were in government, and we recognised it as the right thing to do and have adopted what has become known in some circles as the Nicholson challenge.
The hon. Lady asked whether the savings will be reinvested in front-line services. I can give her that commitment: all the quality, innovation, productivity and prevention Nicholson challenge savings will be reinvested in front-line services, not only in Manchester, but throughout the country.
It is to their immense credit that the NHS organisations, teams and individual members of staff are on track to meet that target. In 2011-12, the NHS made £5.8 billion in efficiency savings, which is testimony to the hard work that was put in by staff, managers and administrators throughout the NHS. However, let me be clear that by efficiency savings I do not mean savings that flow straight back to the Treasury, lost to the NHS. Instead, I am talking about efficiency savings where every penny will be reinvested to make care better. Of course, some parts of the NHS therefore face tough decisions, and that is true for the NHS in Trafford.
The right hon. Gentleman is concerned about how service changes in Trafford might affect the quality of services for his constituents. I am sure that he is aware that the NHS in Trafford and Greater Manchester has developed proposals for service changes affecting Trafford general, which are planned for public consultation later this summer. Following the consultation, a final decision about the changes will be made by the end of the year, with plans put into practice by April 2013.
The board of the Greater Manchester PCT cluster approved the proposals at its meeting in June 2012, and they will now be considered by the board of NHS North of England on 12 July 2012. I hope that the right hon. Gentleman understands that I do not want to—it would be wrong to—pre-empt or bias the local process before the consultation. However, I will try to address, as best I can, some of his concerns within that straitjacket.
The former Trafford Healthcare NHS Trust was acquired by Central Manchester University Hospitals NHS Foundation Trust in April 2012, so that the trust could move to foundation trust status, which it could not do independently. The acquisition also ensured that the trust was sustainable, so it could carry on providing health services to the people of Trafford.
Sustainability—the guarantee that the NHS will carry on providing high-quality safe services—is at the root of the right hon. Gentleman’s concerns. Trafford is the birthplace of the NHS, where Nye Bevan famously launched it just 64 years and four days ago. Unfortunately, history is not enough. Every corner of the NHS needs to be on sound financial footing, so that it is a viable service for years to come. That is what we all want, regardless of which side of the House we sit on.
Clinicians and general practitioners across Greater Manchester have developed proposals for a model of care that maintains high standards and improves value for money. Those proposals are called the new health deal for Trafford. Local people and local NHS organisations have been involved. The right hon. Gentleman might be aware that in 2008 the local NHS started work on a new integrated services model that aimed to deliver more care in the community and reduce admissions to hospitals.
The hon. Lady is concerned and wants the proposals for delivering more care in the community to be put in place properly, so that there is no fragmentation or disruption in the delivery of service. I share her concern and agree that such proposals must be part of driving the NHS to a more integrated programme and a policy of delivery and seamless provision of care. That is a challenge for the NHS, as it always is when moving on a part of the delivery of care, but Manchester is acutely aware of that and is working steadfastly to ensure seamless delivery of care and to meet the new challenges of the most appropriate care for patients in Greater Manchester. The right hon. Gentleman is interested in that model.
At the moment, Trafford provider services, which is part of Bridgewater Community Healthcare NHS Trust, delivers community services across Trafford. I understand that Trafford PCT launched a tender exercise for providing community services in Trafford, which should be completed by August 2012.
Clinical commissioners in Trafford are still keen for integrated care to go ahead. For that to happen, clinical services are being redesigned across Trafford, including the secondary care services provided by Trafford general. At the moment, Trafford general provides a full range of acute services, including A and E, as the right hon. Gentleman mentioned. The local NHS worked on several options for services that the hospital might offer in the future, spoke to clinicians, commissioners and public representatives to identify the right model of care and chose the following model. A and E services will be replaced with an urgent care centre, opening between 8 am and midnight, changing to a minor injuries and illness unit within two to three years; acute surgery will not happen there anymore; some parts of acute medicine provision will be removed but some will remain; and in-patient surgery will no longer be provided at Trafford general. The hospital will still provide elective orthopaedic surgery, including the development of an elective orthopaedic centre of excellence, day-case surgery, out-patient services, diagnostics and rehabilitation.
As I mentioned earlier, these proposals were approved by the Greater Manchester PCT cluster in June 2012. I understand that the PCT intends to submit them to the strategic health authority for approval and for a public consultation in which everyone will be able to have their say. I understand that the national clinical advisory team has reviewed the proposals and supports the clinical case for change. I also understand that a series of public events were included in the whole process, so that people could find out more and voice their concerns. There were regular meetings with local health overview and scrutiny committees, and local Members of Parliament have been briefed on what is and was going on.
Paul Goggins
I agree that full and frank public consultation is essential, but people need to have all the information. The Minister promised me earlier that he would write to me with further details that he is not able to cover in his speech. Will he undertake now to look in detail at the case made by UHSM for the additional facilities at the accident and emergency unit and elsewhere, at an estimated cost of £11.5 million, and will he comment on that?
Mr Burns
I will try to do better for the right hon. Gentleman by commenting on that in the remaining three minutes. I have an answer.
The consultation process has to be carried on within the setting of my right hon. Friend the Secretary of State’s four tests. The right hon. Member for Wythenshawe and Sale East is concerned about the impact of the proposed changes at Trafford on other hospitals, particularly Wythenshawe hospital. Local commissioners have assessed the potential impact of the changes in developing their proposals. However, the proposals are still at an early stage and have yet to go to public consultation. I am informed that local commissioners will continue to look at this issue. Ultimately, when the consultation is over and the responses have been considered and a final decision is made locally, if the local authority overview and scrutiny committee does not share the analysis and agree with the decisions that have been taken, it is open to it to write to my right hon. Friend the Secretary of State to request that he refer the decisions to the independent reconfiguration panel.
The right hon. Gentleman mentioned the £11.5 million for expansion of A and E at Wythenshawe hospital. I can give no such guarantees on that, for the following reason. Local commissioners have assessed the impact of the proposed changes at Trafford on other hospitals, including Wythenshawe. However, the plans are still at an early stage and are yet to go fully to public consultation, which will happen shortly. I am informed that local commissioners will continue to review the impact of the changes on other hospitals, including Wythenshawe. In that respect, I can give a commitment, but I cannot go the whole hog, as the right hon. Gentleman would like me to, and commit £11.5 million, or whatever other figure might arise, because that is not in my gift. These are local decisions freed from ministerial interference, which I think the right hon. Gentleman would agree is the right way forward.
The right hon. Gentleman, the hon. Lady and other hon. Members met Trafford PCT on 6 July 2012 to discuss the proposals. I hope that they found the meeting useful and helpful, and I hope that the right hon. Gentleman and other hon. Members in the area affected by the consultation continue to speak to the local NHS. I urge the right hon. Gentleman and his colleagues, constituents and everyone else who is interested in strengthening and improving the local NHS provision of service in Trafford and Greater Manchester to contribute to the consultation process, so that all views and opinions can be considered and that the decision can flow as a result of direct involvement by those people.