(9 years, 11 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Norman Baker (Lewes) (LD)
I welcome the opportunity to discuss the local health issues affecting my constituency. Of course, the debate comes at an opportune time given the attention that has been given to the NHS locally.
I welcome the funding the coalition has given to the NHS, which is of course more than the Labour party gave or would have given had it been elected to office. I also welcome the £1 billion reduction in management costs that we have secured as a coalition and the investment in extra doctors and nurses. There are elements of the Health and Social Care Act 2012 that I strongly welcome, too, including the decision to make public health once again a local authority responsibility, to integrate better health and social care and to give more say to our local GPs in decision making. They will be in a far better place to make sensible decisions than the alphabet soup of various bodies that they replaced. I also welcome steps that the coalition has taken to end the preferential treatment for the private sector in terms of financial arrangements that the previous Government introduced.
As everybody in this House will recognise, we have a serious challenge with the ongoing costs of the NHS, including the fact that NHS inflation is always greater than normal inflation and, most recently, with the pressure on accident and emergency places, and consequently funding. The chief executive of the NHS, Simon Stevens, has called for a real-terms funding boost of £8 billion per year by 2020-21, on top of efficiency savings and further reforms to the NHS. I believe—I support my Lib Dem colleagues in this—that we should maintain the additional £2 billion that was secured in the autumn statement. In addition, as we said at our conference, we should invest a further £1 billion in real terms in 2016-17. That would be maintained in future budgets, paid for by capping pensions tax relief for the very wealthiest, aligning dividend tax with income tax for those earning over £150,000, and scrapping the shares-for-rights scheme. Of course, once we had finished the job of tackling the deficit, we would increase health spending in line with the growth in the economy.
So there are steps we can take, but we need to look at this in a more fundamental way as well. I suggest that we should prioritise, more than we have so far, the provision of primary health care in our local communities. That not only helps the people within those communities but takes the pressure off accident and emergency departments. I am particularly concerned about the pressure exerted on Brighton general hospital and Eastbourne district general hospital, which serve my constituency. My hon. Friend the Member for Eastbourne (Stephen Lloyd) has written to the chief executive of Eastbourne DGH seeking urgent assurances that it is able to cope with the demands currently placed on it. Both hospitals are failing to meet the Department of Health’s target of 95% of patients being dealt with within four hours, which is a matter of concern. One of the ways to deal with this is to have better local services and investment in primary care.
I am going to raise a number of issues with the Minister; I am not sure whether he will be able to respond to them all today. If there are outstanding matters on which time does not allow for a response or on which he is insufficiently briefed, I ask him or his officials to write to me subsequently with answers.
I am particularly concerned about the situation in Seaford, the largest town in my constituency, with a population of some 25,000, where we have had broken promise after broken promise from NHS bodies over very many years. They have always promised to improve services, to provide more local services, to introduce diagnostic testing and the like, and one after another of those promises have been broken by successive primary care trusts, strategic health authorities and the rest. I welcome the fact that we now have local GPs involved who live in Seaford and therefore have some chance, through the clinical commissioning groups that the coalition introduced, of bringing some services to the town that are not currently there.
Specifically, it is shocking that a town the size of Seaford with its population spread—there are many elderly people—has no minor injuries facility. Lewes, where I live in the constituency, does have such a facility at Lewes Victoria hospital, but Seaford, which is much larger, does not. I have been in discussions about this with the CCG and with the local ambulance trust. In my view, the local ambulance trust ought to provide paramedics to help with the provision of minor injuries facilities in Seaford, if only by stationing ambulances that are not required on urgent calls, thereby diverting people away from accident and emergency services and enabling them to stay in their own town rather than having to travel a very long way to Eastbourne or Brighton to secure treatment. My first request to the Minister is that he should have discussions with the ambulance trust to make progress on ensuring that a facility of some sort, even a mobile one, can be put in place for my constituents in Seaford so that they are able to have their minor injuries dealt with, sensibly, in the town rather than clogging up the accident and emergency unit at Eastbourne, which, as I say, is not meeting its target of delivering treatment to 95% of people within four hours.
We have a new facility in Seaford—the Horder centre, which I argued for and which is now delivering some services. It has taken over from Seaford Day hospital, which was a mental health facility. However, its range of services is inadequate, and I would like more NHS business to be put through it, given that there is capacity in the building. My second request to the Minister is to engage with the Horder centre to find out whether we can extend the range of services in that building to ensure, again, that pressure is taken off A and E departments.
Another issue relates to the Newhaven Downs facility, which is just to the west of Newhaven and not very far from Seaford. This is a relatively new facility and is of quite a good standard, but it is chronically underused. I want to know why, when we are short of money, we have a good facility that is not being used to anything like its maximum potential. It could be used to deal with people from Newhaven and Seaford in my constituency and from Peacehaven in the constituency of the hon. Member for Brighton, Kemptown (Simon Kirby). What is the forward plan for improving and increasing the use of the Newhaven Downs facility?
I am conscious that one of the problems is that if we are to invest locally in primary care, we have to keep the A and E facilities and the acute hospital money there while the improvements are made. There is therefore a need for a one-year investment programme to ensure that both angles are covered until the primary care facilities take over. I imagine that this is a problem not only in my constituency, but elsewhere, so is there a plan to implement the Government’s aim, which I very much welcome, for far more people to be treated locally in their own communities? That is the right policy, but it needs pump-priming to ensure that it can occur. The question is how that happens when A and E departments and acute hospital trusts are still being funded as they have been.
The problems of the need to travel to acute hospitals have been exacerbated by the transfer of services from the Eastbourne district general hospital to the Conquest hospital in Hastings. The East Sussex Hospitals NHS Trust runs those two facilities, which are some way away. The sad fact is that we are now seeing a two-tier acute hospital service in East Sussex, with Brighton and Hastings having pretty much the full range of services, and Eastbourne being downgraded. That is a matter which my hon. Friend the Member for Eastbourne is very worried about, as is the local population.
My constituents in Seaford and Polegate are sometimes asked to make extraordinarily long journeys to Hastings, which is a very long way away. The hospital in Hastings is nowhere near the train station and is very difficult to get to. We have already seen maternity services transferred there—by sleight of hand, I might say— with a so-called temporary transfer which then became permanent, bypassing the normal consultation arrangements, not to mention bypassing public opinion. I have to say to the Minister—I do not say this lightly and I have not said it before in 18 years—that I do not have confidence in the management of that NHS trust to deliver the right thing for the people of my constituency or even to play straight with them. That is a matter of great regret to me.
If, at least for the short term, my constituents are required to travel a very long way for very basic services, which I hope will change, the NHS trust in Eastbourne and Hastings which has been responsible for that situation needs to take some responsibility for the transport implications. Will the Minister set out what he believes are the responsibilities of the NHS trusts that generate extra transport requirements, but then wash their hands of the consequences and say it is a matter for the county council as the transport authority, the commercial bus company, the rail company or somebody else—anybody apart from them—to pick up the pieces?
The hospital in Brighton, the Royal Sussex County hospital, which also runs the Princess Royal hospital in Haywards Heath has accepted that there is a need to do something about that. It has organised a bus running between Brighton and Haywards Heath, which is a good service used by patients and by those who work in the health service as well. No such arrangement has been put in place between Eastbourne and Hastings and I want to know why not. It is not sufficient to say that people can get the bus, because my constituents sometimes have to pay extraordinary amounts of money to get taxis from where they live to Hastings, and no money is paid back. Some of these are poor people who cannot afford to pay for taxis. That is an outrageous situation for them to be in. I ask for the Minister’s help in dealing with that important transport issue. I hope he will accept the principle that if an NHS trust causes a transport problem, it has a responsibility to deal with it, rather than washing its hands and pushing it on to somebody else.
I draw the Minister’s attention to another problem on which I would welcome some help. It relates to a retirement development called St George’s Retreat at the far north-western corner of my constituency. Hundreds of retired people are living there in a pleasant community, but it is right on the border. Those people naturally look across the border to West Sussex for their health services, but West Sussex does not want to know about them because they are technically in East Sussex, and East Sussex says that they are so near the West Sussex border that they should be accessing West Sussex services.
How can that particular conundrum be solved? People are in limbo without proper services. One approach—this is a bit like the solution for minor injuries—would be for a district nurse and other health visitors to pick up some of the casework at that large facility once a week, rather than expect people to travel very long distances because of where they happen to live.
I am also concerned that pressure on A and E in Eastbourne is being caused by the lack of facilities in Polegate, which is a long-running issue. Polegate is in my constituency to the north of Eastbourne. It has two doctors’ surgeries in Manor Park and Downlands, and they are chronically short of space. The doctors are ready, willing and able to deliver more services locally, which, quite rightly, is what the Government wants, but they are unable to do so because they simply have no space. When I visited those surgeries I was horrified by the lack of space.
There have been plans for a very long time—we have been let down by successive primary care trusts—to improve the facilities and have a new medical centre in Polegate by combining the two surgeries. That is a sensible suggestion and the Minister’s colleague, the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), came to look at the situation. The reality is that my constituents and, indeed, the doctors are being held back and asked to deal with an inadequate situation in inadequate conditions because of the lack of a medical centre. What pressure can the Minister bring to bear on the clinical commissioning group to ensure that the problem is dealt with?
The Lewes Victoria hospital, which is in my constituency, is in the county town of East Sussex and has a minor injuries facility. It is much loved, very well respected and hugely supported by the friends of the hospital, who have done so much over the years to make sure that it is a lovely place to be. I had a minor op there myself recently and I was extraordinarily impressed by the level of care and compassion shown by all the staff, to whom I am very grateful. I want to put that on the record.
Unfortunately, the hospital is also technically run by the East Sussex Hospitals NHS Trust, which has no particular interest in the place. It is outside its catchment area. It was left standing when the music stopped and it should not be in the trust’s purview. I want the arrangements to be changed and for the Victoria hospital to be transferred to somewhere that has more interest in it than the trust. Will the Minister consider that? My view is that there should be a community trust across Sussex. Failing that, the hospital should be handled by Brighton, which is more local to it.
The hospital is losing facilities, such as the pacemaker clinic, which is shocking. At a time when we want to get more, not fewer, facilities in towns, they are disappearing. That simply clogs up A and E and other hospitals, where parking is particularly difficult.
My last point, which was raised with me by the chief executive of the South East Coast ambulance service, relates to a curiosity to do with ambulance waiting times. I would be grateful if the Minister looked at it and came back to me. Ambulances are being left waiting outside the A and E section of the hospital in Brighton. Why is that happening? The hospital does not want to accept the cases because they worsen its figures for the time people wait in A and E. Therefore, in order to, in effect, fiddle the figures, ambulances are wasting their time and patients are kept there until the hospital is confident it can see them within the four-hour limit. That is not sensible, and nor is it what the Government and Health Ministers want. Will the Minister look at that? In my view, the clock should start ticking as soon as the ambulance arrives on the forecourt or on the premises of the acute hospital. If he could give me an assurance that that will be the case in the future, I would be grateful.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
My right hon. Friend the Member for Lewes (Norman Baker) has raised a number of issues and I will do my best to address them in the limited time available. I will, of course, write to him about any issues I am unable to get on to today.
I congratulate my right hon. Friend on securing the debate. A number of the points he has made are of great importance to both him and his constituents. Before I continue, I want to highlight the extra work carried out every day by all those who work in the NHS in his constituency, including staff alongside whom I have worked during my time in the NHS. During a busy time in winter, we should be proud of our front-line staff and the hard work they continue to do, even with the increased demand caused by winter pressure on our health service.
My right hon. Friend was right to say that there is now less bureaucracy in our health service and more money for the front line. Thanks to our having stripped out some of the bureaucracy, we will have £6.5 billion more for front-line care over this Parliament than we would otherwise have had. That has been independently audited, and I am sure that all patients in Lewes and elsewhere are very pleased with that.
Primary care trusts have been replaced with clinical commissioning groups. My right hon. Friend talked about some of the historical frustrations with PCTs in his constituency. I hope that the changes made on the introduction of CCGs—their clinical leadership is provided by clinicians who have actually looked after patients and understand their needs—will already have led to improvements in care in his constituency. The fact that some of the reviews now taking place are led by clinicians who run the process of allocating local health care funding will ensure that the right decisions are made about local health care priorities and about meeting the needs of patients.
Health and wellbeing boards now ensure that health and social care services are better joined up, which is important for looking after vulnerable patients, the disabled and the frail elderly. Health and wellbeing boards provide an opportunity to integrate services further, which is particularly important in a very diverse county, such as East Sussex, with rural as well as urban areas. East Sussex health and wellbeing board is grasping the opportunity to join up the local provision of primary community care, the acute sector and social services care.
An important part of meeting some of the challenges faced by the local NHS—my right hon. Friend mentioned the issue of the throughput of patients at Brighton—is to join up adult social care with NHS services better to ensure that acute beds can be freed as quickly as possible for those who are the most sick, with others being transferred into the most appropriate care setting. I know that the local health and wellbeing board takes an active interest in that issue.
My right hon. Friend raised issues about health services in Seaford and Polegate. As he rightly outlined, high-quality premises are an important part of ensuring high-quality primary care services. I understand that NHS England’s Surrey and Sussex area team is working with the Old School surgery in Seaford to explore options for the improvement of its facilities. The capital funding to create new consultation rooms for the Downlands surgery in Polegate has been agreed, and the work is intended to be completed by April 2015. That will bring improvements to patients who attend that surgery. I understand that there have been some quality issues with the premises of another practice in Polegate, the Manor Park medical centre. From memory, it is on a crossroads in the town centre. That issue is in the forefront of the mind of the Surrey and Sussex area team, which reassured me yesterday that it is looking at how to improve the situation.
Such issues are not just for the local clinical commission group; there might be a role for the local authority—perhaps with contributions from developers, where available—to support the local NHS by building new facilities. In areas of housing growth, such as around Eastbourne, the local authority could work collaboratively to collect developers’ contributions to put in place local infrastructure for schools and the local NHS. I am sure that that will be considered as a result of this debate. There is also an opportunity for the local NHS to work more collaboratively with the local authority to address some of the premises issues and to improve the quality, size and capacity of places in which local patients are treated.
As I have said, local clinicians and local authorities have been empowered through the creation of clinical commissioning groups and health and wellbeing boards to bring together health and social care. That is particularly important in the context of the issues relating to Seaford that were raised by my right hon. Friend. I am aware of the changes made at Seaford day hospital, and he outlined some long-standing frustrations with earlier decisions made by the PCT. I understand, however, that Horder Healthcare has taken over the hospital to run services, and that physiotherapy services are being provided there, which is at least a step in the right direction.
As part of the East Sussex Better Together programme, plans are being developed to bring as many services as possible, such as out-patient and diagnostic services, closer to people’s homes and communities. It is particularly important to minimise the travel that frail and elderly patients have to undertake when they need access to local health care services. Seaford is one of the key local communities that is under consideration as part of the Better Together programme. More generally, the Better Together programme is about the three local CCGs in East Sussex and the county council working together to ensure that there is a more integrated approach to delivering more community-based care across the county. That is a welcome step forward.
I am sure that the important addition of clinical input now that clinicians are leading CCGs will ensure that there is more joined-up working. The Better Together programme will look at where it is possible to join up primary and community health services, as well as at where out-patient clinics can appropriately be provided in a primary care setting. As far as is possible, we should have a one-stop shop for patients, particularly older patients. There could be blood testing for warfarin control, diagnostic services, GP services and other high-quality local community health care services in one location. Where that can be offered, it is of huge benefit to patients. In my conversations with the CCG yesterday, I was very pleased to hear that the Better Together programme is looking at exactly how to achieve that in the Seaford area. I have asked it to discuss further with my right hon. Friend how it intends to take that forward over the next few months.
It is important to talk briefly about the issues that my right hon. Friend raised about the future of Lewes Victoria hospital, which I know well, having performed some day operations there in the past with my then consultant. I understand that in October 2014, High Weald Lewes Havens CCG initiated a formal procurement process to enhance and improve the community services contract. As part of the general review of services, community services will clearly play a key part in delivering services closer to home. Lewes Victoria hospital has a track record of delivering high-quality community-based care.
A new contract for the hospital is expected to be awarded in spring 2015. That will be followed by a period of transition planning, with a view to having the new community services contract in place by the autumn. The CCG has confirmed that it plans to continue providing community health services from Lewes Victoria hospital and it is keen to ensure that the skills and expertise of the existing community services staff and the three community hospitals in the area are at the heart of plans to improve patient care and experience. I am very reassured by my conversations with the CCG that the future of Lewes Victoria hospital as a centre for delivering community-based care, day case operations and other high-quality care for people in Lewes and the surrounding areas is very secure. I am sure that that will be welcomed by the people of Lewes and the surrounding areas.
In the time that is left, I turn to the services at Eastbourne district general hospital. The hospital continues to offer a wide range of services, including emergency, out-patient, medical, surgical, diagnostic and day surgery services. I am aware that some of the services provided by East Sussex Healthcare NHS Trust have been relocated since 2013 and that improvements in patient safety have been achieved through that. I will come back to that a little later.
Although consultant-led maternity services, overnight paediatrics, orthopaedics and emergency general surgery have been sited at the Conquest in Hastings, other services, such as acute stroke care and ear, nose and throat services, have been centralised at Eastbourne, so it would not be fair to say that Eastbourne district general hospital has been the loser in the redistribution of services. It has gained from the addition of acute stroke care and ear, nose and throat services. I will turn to maternity services in a moment.
Health care commissioners are assured that there have been significant improvements in patient outcomes since stroke services have been centralised at Eastbourne. Better care is being delivered to patients as a result, which is something that both my right hon. Friend and I welcome. The trust is performing above the national average against a number of standards for stroke care.
Maternity care has been a challenge for the trust, and an emotive and controversial issue locally. One historical issue concerned safe staffing levels for maternity units, because I believe that the Conquest and district general hospitals both managed fewer than 2,000 births a year. There was a particular challenge with a lack of consultant senior cover out of hours—that is important to protect patient safety—and a challenge in encouraging and recruiting junior doctors to staff the middle-grade rotas at those trusts. Although I understand that the changes are emotive and controversial, they were about ensuring that the highest quality of care could be delivered for women, and a midwifery-led unit at the DGH now promotes choice. There are ongoing enhancements to the midwifery-led unit in Crowborough, and acute obstetric services are being centralised at the Conquest.
Perhaps it will reassure my right hon. Friend to know that following the changes, the number of serious incidents at the trust decreased from 17 between June 2012 and May 2013, to six for the same period in 2013-14. Clinical evidence points to a safer and better service for women, although I understand that these are emotive issues. East Sussex county council’s health, overview and scrutiny committee continues to provide rigorous scrutiny of those services, and has agreed that the decision to single-site consultant level maternity and in-patient paediatric services was in the best interests of the health service and the residents of East Sussex.
I am running out of time so I will wrote to my right hon. Friend about the issues he raised about St George’s park and ambulance response times, but I congratulate him again on securing this debate on an issue that I know is of great importance to him and his constituents. I encourage him to liaise directly with the local NHS and to continue championing these important issues.
Question put and agreed to.