Alexandra Hospital, Redditch

Tuesday 12th February 2013 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

It is not compulsory, when a Member has a debate on their local hospital, for them to attend on crutches, but I am delighted that the hon. Member for Redditch (Karen Lumley) has arrived.

11:00

[Karen Lumley (Redditch) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the Minister for being here to listen and, I hope, to answer some of my questions about the Alexandra hospital. I pay tribute to the staff who work at the Alex. As you mentioned and as you can see, Mr Hollobone, I visited the accident and emergency department at the Alexandra hospital during the past couple of weeks. I had a good experience and was looked after well, and I did not spend too much time there. I want my constituents to receive what I received, and I hope to outline the need for a vibrant hospital in Redditch that serves not only my constituents but those in surrounding areas such as Bromsgrove, Mid Worcestershire, Stratford-on-Avon and Kidderminster.

A quick history of the hospital is vital to understand the context in which I speak, because, sadly, we have been here several times before. I will be brief, but it is important to understand how many times this hospital has been under threat, and how unsettling that is for patients and staff alike. Three attempts have been made during the past 15 years to downgrade the accident and emergency ward and the maternity wards at the Alex. On each occasion, the argument has been made that the downgrades were crucial for sustaining a high-quality, properly staffed service, and that it would better for residents if some services were concentrated in Worcester. At each attempt, the people of Redditch have fought to save their hospital, and once again they have joined together in a cross-party campaign to do so.

[Mark Garnier (Wyre Forest) (Con)]

I congratulate my hon. Friend on securing the debate, which affects my constituents as well as hers. She will be aware that a number of years ago, the same fear was in prospect for my constituents when the A and E department at Kidderminster hospital was closed. The outcome was truly tremendous, with an enormous campaign to save the hospital and the election of an MP dedicated to trying to do so. Sadly, he did not succeed, but those events reinforce the point that people feel very strongly about their local services and should be listened to.

[Karen Lumley]

My hon. Friend makes a valid point, which I will return to. I want to be here after the next election, however; I do not want to be replaced by an MP dedicated to looking after the Alexandra hospital.

I pay tribute to Neal Stote, the chairman of the “save the Alex” campaign, Ian Dipple, the editor of the Redditch Standard, and the leaders of my local councils, Bill Hartnett, Roger Hollingworth and Chris Saint, who have all worked tirelessly together with me to save the Alex. The Minister will remember his visit from members of the “save the Alex” campaign before Christmas, when he listened to the justification for retaining services at our hospital. A petition to save the hospital has received more than 50,000 signatures and there was a major rally in Redditch town centre, all of which goes to show that the residents of Redditch are united in trying to secure services at our hospital.

I want to look now at the current and historical financial position of the Worcestershire Acute Hospitals NHS Trust. In 2002, the trust posted large deficits, which rose to more than £14 million in 2003-04. The trust came back into surplus, however, and since then it has posted alternate deficits and surpluses, including in each of the past three years. The trust had a cumulative legacy debt of £18.4 million from 2000 to 2007. The Government provided a £12 million emergency loan in December 2012 to deal with the problem, but it is obvious that the situation cannot continue. For too long, the easiest course of action has been to kick the can further down the road without addressing the root causes. The current situation is a ticking time bomb. A £1.9 million deficit has to be met by April of this year. Many operations are being cancelled because of the terrible norovirus in our wards, and times will be tough for the trust.

Part of the problem is that we have an expensive private finance initiative hospital that was built in the wrong place fully to service all of the residents of Worcestershire. The Worcestershire royal hospital opened in March 2002 under a PFI deal that costs the trust £13.6 million a year at the best estimate. Indeed, Patricia Hewitt, the former Health Secretary, described the PFI deal as a disaster in 2006. The deal will, however, run until 2032, by which time it will have cost the taxpayer more than £700 million. The Alexandra hospital is not a PFI hospital; it is owned by the NHS.

I understand that the trust needs to save money, and that certain services in our country must be centralised to provide centres of excellence. I also understand the difficulties of recruiting specialist consultants, and I realise that as a result of an ageing population and changing lifestyles, patients have more complex needs. We must recognise, however, that the trust employs more than 5,600 staff across the county and has approximately 940 beds with 140,000 A and E attendances —of which I was one—and about 500,000 out-patient appointments. The people of Redditch deserve a sustainable future for their health service. They are realistic, but they need to know what is going to happen. One of the reasons for the difficulty I have just mentioned of recruiting specialist consultants, which is a major problem facing the trust, is that the hospital cannot provide the job security that specialist consultants need because it is constantly under threat.

As I have said, this is the third time we have been in this situation, and if we do not find a solution, I have no doubt that in a few years we will be here again. Repeatedly experiencing such circumstances is damaging to the public, staff and patients, and we need a lasting solution. I welcome our Government’s introduction of clinical commissioning groups. I recognise that without them we would be in a very different place and I certainly would not be standing here asking the Minister to look at the future of my hospital. I have been working closely with the local commissioning group for Redditch and Bromsgrove, and would like to place on record its hard work on the future of the Alex, especially its support on the joint services review; it has continually stood up for Redditch in circumstances that have often been difficult.

Last week, I listened to the Prime Minister talking about the terrible situation at Stafford hospital, and especially the roles of Members of Parliament. He said:

“Like others in the community, we love our local hospitals and we always want to stand up for them, but we have to be careful to look at the results in our local hospitals and work out whether we should not sometimes give voice to some of the concerns rather than go along with a culture that says everything is all right all of the time—sometimes it is not.”—[Official Report, 6 February 2013; Vol. 558, c. 286.]

I took that to heart, as I know many of my colleagues did. I know that the NHS must change and we cannot always have everything we want where we want it. I hope I am being realistic about what we can provide for the people of Redditch.

That brings me to some good news about innovative thinking that is going on in our town. Redditch is situated in the north of our county and the majority of my constituents look to Birmingham rather than Worcester. The Minister cannot be expected to know about transport links in our county, but the links between Redditch and Worcester are fairly dreadful. If someone has to go to Worcester by train, they get on a train to Birmingham, get off at the university stop—where the university hospital of Birmingham is—and double back to Worcester. Buses are also a nightmare and often involve two or three changes. I was delighted to meet Dame Julie Moore, the chief executive of the University Hospitals Birmingham NHS Foundation Trust, before Christmas to talk about the trust providing some services at the Alex. I look forward to meeting her again next week, and to meeting Penny Venables, the chief executive of the Worcestershire trust.

[Peter Luff (Mid Worcestershire) (Con)]

I congratulate my hon. Friend on securing the debate and on the manner in which she is conducting it. I wish her well in the campaign she is conducting on behalf of her constituents, whom she serves remarkably well. Does she understand that as we look at the options for the future of the hospital services in Worcestershire, particularly for the Alex, we must be certain that no decisions that are taken in relation to the Alex have the unintentional consequence of reducing the critical mass of the health economy in the wider county and, therefore, damaging the service provided to my constituents and to those of my hon. Friends the Members for Worcester (Mr Walker) and for West Worcestershire (Harriett Baldwin)? Any loss of service provision might have serious consequences for the rest of the county. We must take the matter forward together with a single voice, because we all share the conviction that we can achieve a win-win situation for all our constituents.

[Karen Lumley]

Those who know the Worcestershire MPs know that we generally hunt as a pack; we are renowned within different Departments for doing so. I share my hon. Friend’s concerns, but obviously at the end of the day I am the MP for Redditch, my hospital is the one under threat and I must do what is best for my constituents.

There are several questions I want to ask the Minister today. First, who owns the Alexandra hospital? Secondly, if the local commissioning group wants to commission services with University Hospitals Birmingham NHS Foundation Trust, will his Department help to make that happen? Thirdly, does he agree that this uncertainty has gone on long enough, and will he encourage the Worcestershire acute trust to co-operate with the UHB trust in Birmingham? Fourthly, will he reassure staff and my constituents that he and his Department are working as hard as they can to ensure the best outcome for them?

I have probably said enough now, but I will finish by saying that we are grateful to the Minister for his attention to our hospital in Redditch. We look forward to welcoming him in April to see for himself what a fantastic hospital we have—a hospital that we must not forget belongs to the residents of Redditch. We are realistic about what has to happen, but I want to put on the record today that there are two options on the table, and it is only fair to my constituents that both be looked at in a fair and open way. That is all we are asking for, and I hope that he and his Department will ensure that it happens.

[Mr Philip Hollobone (in the Chair)]

In this debate, we have not only an out-patient but a doctor. I call Dr Daniel Poulter, the Minister.

11:11

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Thank you, Mr Hollobone, for calling me to respond to the debate. It is a great pleasure to serve again under your chairmanship.

I pay tribute to my hon. Friend the Member for Redditch (Karen Lumley) for her advocacy on behalf of her constituents and local patients, and indeed for paying tribute herself to the hard-working staff at her local hospital. As she rightly points out, the future of the Redditch hospital has been discussed for far too long and I hope that, during the next few months, we can come to a conclusion that will not only be of benefit to local patients but bring higher-quality care to people in Redditch and the whole of Worcestershire. Any redesign of services must be led by local commissioners and—crucially—must also consider the best interests of local patients; those redesigning services must listen to the voices of local patients.

My hon. Friend rightly outlined in her speech the fact that no hospital or trust operates within a vacuum in the NHS, and she is also right to say that private finance initiative deals in the local area have been problematic and have left a very damaging legacy; that has happened not only in her part of the world but throughout the NHS. We must learn lessons from that in the future. It is distressing and regrettable that bad PFI deals sometimes have an impact on neighbouring hospitals, and it is a position that we, as a Government, have inherited. We will continue to do what we can, by working with trusts with difficult PFI deals, to try to mitigate those difficulties.

My hon. Friend rightly highlighted the fact that decisions about her local trust have an impact on the wider health economy in Worcestershire, and that that broader impact needs to be taken into account by those making decisions about the Alex hospital. When my hon. Friend and I met my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi)—my hon. Friend the Member for Bromsgrove (Sajid Javid) was unable to attend that meeting—the point was made clearly that many hospitals in the wider health economy of Worcestershire have natural links with Birmingham. That must be taken into account when services are redesigned for the benefit of patients.

Increasingly, clinical evidence is stacking up that some specialist clinical services need to be run from specialist centres, because those centres produce much better outcomes for patients, so the link to the major population centre for the surrounding counties should be taken into account. As I say, we need specialist centres of excellence for the benefit of patients.

My hon. Friend the Member for Redditch made the point that the Alex hospital has a historical legacy of difficulties, with big, intermittent deficits at the local trust. There have been commendable attempts to deal with those difficulties, but there has been a difficult situation for a number of years. Clearly, we want to see long-term stability for Redditch, for the local trust more broadly and for the local health care economy. Key to achieving those things is having high-quality medical personnel working in the hospital, and the ability to retain and recruit high-quality consultants.

[Peter Luff]

To be clear, for the majority of Worcestershire residents Birmingham and its services are a very long way away and very inaccessible.

[Dr Poulter]

With regard to “bread and butter” day-to-day medical services, my hon. Friend is absolutely right to say that. My point was that for some services—for example, trauma or stroke—having specialist centres brings better results for patients, and there is good clinical evidence to back that up. However, day-to-day, higher-quality “bread and butter” services for patients—such as heart care or children’s services—are often best provided locally, and he is absolutely right to make that point.

[Mr Robin Walker (Worcester) (Con)]

I congratulate my hon. Friend the Member for Redditch (Karen Lumley) on securing this very important debate.

The Minister mentioned the issue of recruitment of clinical staff. One thing that the NHS in Worcestershire has worked very hard on is a cancer strategy to keep cancer care within the county and to make the Worcestershire Royal hospital a centre of excellence for cancer care. We are looking to secure a radiotherapy unit in the near future. I urge the Minister, in taking whatever decisions are necessary to ensure that the county has the strongest, most sustainable NHS, to pay attention to that work and to the importance of having a cancer service for the county.

[Dr Poulter]

My hon. Friend is absolutely right to praise the high-quality work done in Worcester to look after cancer patients. It is exactly the point that I was making in response to the intervention from my hon. Friend the Member for Mid Worcestershire (Peter Luff): the high-quality day-to-day services that patients need must be delivered locally, but more specialist operations—such as for head and neck cancer—might be carried out at a specialist site that is geared up for such operations. Day-to-day oncology care, however, is often best carried out locally, particularly when people are unwell with cancer and receiving sometimes very intensive treatment. In those situations, they need to be looked after locally.

It does not benefit patients, for medical and many other reasons, to have very long distances to travel. However, when surgical outcomes might benefit from operations being carried out at specialist centres, we must differentiate day-to-day treatment from the more specialist care that may be required as a one-off surgical intervention. We should do that when the evidence stacks up that specialist centres for such surgical interventions often deliver better results and better care for patients. Nevertheless, my hon. Friend is absolutely right to pay tribute to his local trust for the work that it does on cancer care in Worcester, which I know is very important to him personally.

I will now respond specifically to some of the points that have been made in the debate, and consider how we go forward from where we are now. Hon. Members, particularly my hon. Friend the Member for Redditch, have made us well aware, through their articulate contributions, of the challenges that are faced by the local health care economy. Such ongoing uncertainty about the future of local health care services is wrong and completely undesirable. When local commissioners bring forward proposals for the two options that are likely to be considered later in the month, I urge them to move forward as promptly as possible to bring certainty to the situation. That will allow consideration of important issues, such as the need to have high-quality professionals working in hospitals. When there is uncertainty about the future of a trust or a particular site within a trust, it can be difficult, as my hon. Friend rightly outlined, to recruit high-quality staff to work in that trust. That is not in patients’ best interests, so the sooner we can have certainty, the better. I know my hon. Friend will join me in urging local commissioners to bring things forward as expediently and quickly as possible.

As we know, the trust is committed to providing the best-quality care for patients. That is essentially about finding the best solution for the people of Worcestershire so that they receive the best care in the future. As my hon. Friend outlined, Worcestershire Acute Hospitals NHS Trust and the West Mercia cluster have jointly commissioned a strategic review of services in the area. The review is essential to secure the clinical and financial sustainability of high-quality services for local people. That is about looking not just at getting through the next couple of years, but at what will be right for the local health economy in five or 10 years’ time.

I understand my hon. Friend’s concern that there have been delays with the review, and I once again urge local commissioners to take things forward as expediently and quickly as possible. The Worcestershire joint services review started in January 2012, and it was expected to be completed by November 2012. I hope my hon. Friend is somewhat reassured that we will move forward more quickly, notwithstanding a patchy history on resolving local health care issues. There is a need for certainty locally, and we must make sure that the time line is met and that we have a firm conclusion.

Importantly, the review involves clinicians and commissioners across the area and the NHS. It engaged with local people last summer to inform the development of proposals. As we know, developing proposals for the future of local services is about clinical leadership and about clinicians saying what is important and in patients’ best interests, but it is also about local involvement and engagement. When I met my hon. Friend before Christmas, we discussed that. The local newspaper has played a tremendous role in promoting local patients’ needs. My hon. Friend and the local population should be proud of the cross-party consensus on the importance of Redditch’s future.

Through the review, local people will have made, and will continue to make, their voices and views clear. That is important for the Government and for our four tests for reconfiguration. It is also important that local health care providers, the local trust and the trust’s board listen to local people and local health commissioners to make sure that their views are informed by what local patients want and need and by what local clinicians say is in patients’ best interests.

The joint services review steering group met on 12 September 2012 and, unfortunately, decided to delay the process again until it could explore all options to allow it to maximise service provision at the Alexandra hospital, including investigating the potential to work with other NHS providers—Birmingham being a case in point.

My hon. Friend will be aware that the Redditch and Bromsgrove clinical commissioning group has started initial discussions with three NHS providers in Birmingham to explore the feasibility of providing services from the Alexandra hospital: the University Hospitals of Birmingham NHS Foundation Trust, Birmingham Women’s NHS Foundation Trust and Birmingham Children’s Hospital NHS Foundation Trust. Those discussions are still in their early stages. However, my hon. Friend is right that when proposals are brought forward—hopefully, by the end of this month—we should move things forward quickly for the benefit of local patients.

No decisions have been made, and the discussions are only about the Alexandra hospital—that needs to be clearly set on the record. The Worcestershire Acute Hospitals NHS Trust would continue to provide all other services. Given the concerns my hon. Friends have raised, it is important to note that, although the services the trust provides need to be seen holistically, the ongoing discussions are about the specific future of Alex’s site in Redditch. That is an important distinction, and I hope it gives my hon. Friends some reassurance that any proposals are unlikely to disrupt local services to the patients they care about.

Ultimately, the decision is for local determination, and it would not be appropriate for me to comment on the discussions in further detail until we have firm proposals. We will continue to meet regularly. I am visiting Redditch in the near future, and will take a keen interest to make sure I can do all I can to support the right result for local patients.

[Mark Garnier]

The Minister will no doubt know what is coming: will he visit Kidderminster when he is next in Redditch?

[Dr Poulter]

I would be delighted to visit Kidderminster hospital. It might not be on the same day I visit Redditch, but I will make sure I put it on my list of priorities to visit. I would be delighted to see the excellent work done at Kidderminster hospital and, indeed, at Worcester, at some point in the near future. In addition to the bit of clinical work I still do, I prioritise going out on a Thursday as regularly as I can to see the NHS on the ground and to see what is going on. I would be delighted to visit other local trusts, when I can fit them into the diary, later in the year.

What are the next steps? If agreement is reached on a clinically and financially sustainable solution in the interests of local people, a robust process needs to follow. The Worcestershire joint services review steering committee will meet on 26 February to set out options for consultation. We are then likely to have two options regarding the way forward. One is likely to involve Worcestershire Acute Hospitals NHS Trust continuing to operate services from the Alexandra hospital. The other is likely to involve exploring the feasibility of the Birmingham foundation trust operating services at Alexandra hospital, if that is in local people’s best interests.

The final proposals will require the support of the NHS in Worcestershire. However, the local NHS has assured me that it will continue to engage with people while proposals are finalised. Of course, I would expect any proposals to meet the four tests for service change that we have clearly outlined—principally, that any changes are clinically led and have strong patient and public engagement. The local NHS expects final proposals to be ready for public consultation later in the summer. However, it is vital, as we have stressed throughout the debate, that we hold those involved firmly to their task and reach a conclusion for the sake of staff and patient certainty and for the benefit of the local NHS.

[Karen Lumley]

One of my questions was: who actually owns the Alexandra hospital?

[Dr Poulter]

As my hon. Friend will know, the local hospital is designated as part of a trust. It is a non-foundation trust, so there is direct regard to the Secretary of State in some matters relating to the trust. I hope that gives her some reassurance. Of course, the NHS is owned by all of us, which is why it was so important when we set out our four tests for reconfiguration that we made sure they were about strong clinical leadership in the best interests of patients, as well as strong patient and public engagement, so that patients and the public can clearly see that any changes to local services are in their best interests and so that they can properly engage in the process. There has been strong local feeling and opinion on this issue, and I am sure it will be listened to carefully when decisions are taken about the future.

In conclusion, I encourage my hon. Friends and local people to participate in the consultation process to ensure their views are fully taken into account. I will maintain a keen interest. I am looking forward to visiting each site in the trust in due course. I am always available to talk through matters if Members have concerns.

11:29

Sitting suspended.