Ward Closures

Baroness McIntosh of Pickering Excerpts

Wednesday 17th November 2010 Commons Chamber

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

I am delighted to have secured the opportunity to debate these issues. The national health service is a national treasure. During any one year, all of us will have cause to visit a GP or hospital or to see a nurse, or we have a family member or friend who will do so. Members of my family have devoted years of service to the health service as GPs, a surgeon or nurses. I record my utmost admiration for all those working in the national health service.

The purpose of this debate is to consider the decision-making process in ward closures and other major service changes. I particularly invite the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), to address in her response the lack of consultation over the closure of Ryedale ward at Malton hospital. I regret both the closure and the lack of consultation.

I shall analyse the reasons for closing Ryedale ward at the end of the so-called pilot project and look at the consultation procedure at that stage. I shall highlight the need for services and care provision in a sparsely populated, deeply rural area, with an increasingly ageing population.

People care passionately about their local hospital and greatly value their general practitioner. Thirsk and Malton are well served by three community hospitals—Lambert hospital in Thirsk, St Monica’s in Easingwold and Malton community hospital. In addition, there are acute hospitals at Scarborough and York and Friarage hospital at Northallerton. What increasingly alarms me is the trend over recent months to remove much-needed services from community hospitals, such as the minor injuries units at Lambert hospital and Friary hospital, in the constituency of my right hon. Friend the Foreign Secretary. Diagnostic services are being removed from Malton hospital, diabetes test strip services are being stopped and there is a rumour that the operating theatre at Malton is due to close within two weeks. Furthermore, there is a threat to decommission all enhanced services in the last quarter of the year—again without consultation.

The local area medical committee has written to the Secretary of State for Health to raise those issues, and particularly to draw my right hon. Friend’s attention to the threat to decommission enhanced services locally, including chlamydia screening, smoking cessation, complex drug monitoring and other services. The primary care trust held no consultation about the cuts with local practitioners. The committee believes that the cuts are damaging patient care and that they will undermine the strategic aim to provide services at lower unit cost, nearer to patients in the community. The hard work and good will of GPs are being pushed to the limit by the expectation that GPs will absorb more and more cuts and accept an increased work load. There is a threat that the blinkered goal of financial balance and short-termism, following seven years of unchecked cuts, will cause irreparable damage to primary care and leave GP practices damaged and disengaged.

There is a definite pattern in the way that services at community hospitals are being cut without consultation. The Ryedale ward, which was one of two wards at Malton hospital, the other being the Fitzwilliam ward, had 21 beds. It was recently refurbished at a cost of £1.25 million, a quarter of which was raised locally. It opened in May this year. I had cause to visit the refurbished service during my extended election campaign. Patients in Ryedale ward received intensive rehabilitation after a fall or an operation, allowing them to return safely to their home environment.

The ward closure has been termed a pilot scheme, but I am mindful that once a ward has been closed, it is difficult to re-open it. Importantly, the primary care trust in this instance is both the commissioner and the provider of services at Malton hospital. This is most unusual. It is now frowned on as unacceptable and, I understand, is being stopped through the Transforming Community Services agenda.

The way in which the ward was closed is a textbook example of how not to proceed. First, the primary care trust claimed that there was no question of Ryedale ward at Malton hospital closing. Then, after a decision taken on 23 September, the beds were removed from the ward by stealth until there were none remaining and the ward was effectively closed on 19 October. Even at a private meeting with the Health Minister and me on 12 October at the Department of Health, the PCT could still not admit that the ward was closing. Before the closure there had been almost no consultation of the relevant GP practices across the Ryedale area, or of nurses or patients.

Yesterday I lodged a petition with the signatures of more than 1,800 residents of the Ryedale area, strongly objecting to the way that the bed closures had happened without public consultation. I have had a large mailbag from constituents and heard many testimonies of the excellent care that patients received, to their satisfaction and to that of their loved ones, in the Ryedale ward at Malton hospital. The correspondence has been universally against the closure of the ward.

Many local health practitioners are wary of the so-called hospital at home scheme replacing care on a ward. There is deep concern that no advance warning or training was given before the hospital at home scheme was announced as part of the ward closure. Some patients require hospital treatment, although others might prefer to be treated at home. The scheme may lead to patients being admitted as an emergency to an acute ward, which is distressing and more costly than care on a community ward and deeply worrying to patients and their loved ones.

The Ryedale ward should not have closed without the agreement of the health practitioners and the local community. The Secretary of State has received the conclusions of a study of clinical activity on the Ryedale ward to assess whether identified clinical need could be managed effectively at home by the enhanced community support scheme. Those conclusions, which I should like to share with the Minister, are that, on balance, Ryedale should probably have been kept as a 10 to 16-unit, if not a 21-unit, ward for these purposes. There is general concern that the closure of Ryedale ward flouted the conclusions of that study, which I commend to the Secretary of State and to my hon. Friend the Minister.

What could the reasons for closure be? Given the predicted deficit in the primary care trust, my fear is that there is a financial motivation behind the recent trend of events and the subsequent lack of consultation. The budgets are being cut so radically that there might be insufficient funds to run all the services by the time that GP commissioning commences in 2012. I accept that there is a funding issue. The current funding allocation to North Yorkshire and York is the 13th lowest of the 152 PCT areas, and 12% below the strategic health authority average. There might be insufficient funds to run all the services at such time as the GP commissioning service commences.

If the trend of service cuts continues, our community hospitals could be reduced to a size where it is no longer viable to keep them open. In a rural area that is sparsely populated, with an increasingly elderly population, access to a local facility or service is key, and the closure or reduction of services could be disastrous. Scarborough hospital and local hospital trusts are deeply frustrated that there is now a local ward free at Malton hospital, currently unused, which could provide beds for patients entrusted to its care.

I welcome the Government’s policy that decisions should be taken locally, but not before the relevant parties have been adequately consulted. The Minister of State, Department of Health, my hon. Friend the Member for Chelmsford (Mr Burns), wrote to me on 25 August to state that the Government have pledged that, in future,

“all service changes must be led by clinicians and patients, and are not to be driven from the top down.”

In that letter, he underlined that

“the Secretary of State for Health has outlined new, strengthened criteria”

to be followed before fundamental service changes take place, and said that they must

“focus on improving patient outcomes…consider patient choice…have support from GP commissioners…and…be based on sound clinical evidence.”

In this case, each and every one of those criteria has been flouted, but I understand that Ministers are powerless to act until the end of the pilot scheme. I urge the Secretary of State, the Minister of State and my hon. Friend to look at reviewing this at the earliest opportunity.

We must ensure that any such fundamental change has the support of all those affected by it. Given that the ward is now closed, it will be harder to reopen it. I cannot see how this is simply a pilot scheme, not a reconfiguration of services. I put it to the House that the decision-making process leading up to the removal of these services was defective and has bypassed those who are most affected by the decisions. Patients must be at the heart of our health care. Local clinicians, doctors, nurses, and patients’ loved ones must support the decisions taken.

Moving forward, where do we want to be at the end of this process? Local people must have confidence in the decision-making process. In the case of the closure of the Ryedale ward, they clearly do not. It is vital that at the end of the so-called pilot scheme, there will be a full, transparent and open consultation. I ask the Minister to outline precisely what form that consultation will take. I urge her to ensure that all those most directly affected will be consulted, including GPs, nurses, Ryedale LINk—local improvement network—Friends of Malton Hospital, and all patients and their loved ones. The primary care trust must desist from the practice of not consulting on any further changes to services. We need to have a proper consultation and better co-ordination of services between the primary care trust and the local hospital trusts.

I welcome the debate, and I hope that the Minister will reassure me that my long-term ambition for the health service, both locally in North Yorkshire and nationally, will be realised and that clinical need will be at the heart of the delivery of health care.

--- Later in debate ---

[Miss McIntosh]

What my hon. Friend is saying is music to my ears, but what concerns me is how we have reached a situation in which a major reconfiguration of services has happened without any regard at all to the bottom-up principle.

[Anne Milton]

I thank my hon. Friend, who is absolutely right. I will come to that.

As my hon. Friend stated, my right hon. Friend the Secretary of State has identified four crucial tests that all reconfigurations must now pass. First, they must have the support of GP commissioners. Secondly, there must be arrangements for public and patient engagement—no, I would rather say “involvement”, because “engagement” is not a favourite word of mine. This is about involvement—people being listened to and their voices being heard, which clearly has not happened in the case that she has described. Thirdly, there must be greater clarity about the clinical evidence base underpinning a proposal. Fourthly, proposals must take into account the need to develop and support patient choice. That is a recipe not for maintaining the status quo but for locally agreed, transparent, evidence-based and clinically led change. Decisions about the services at a local hospital will be driven by local clinicians, with the consent and input of patients and local authorities, not imposed or decided behind closed doors.

On Malton community hospital, providing health services in rural areas can be challenging, and I understand that many patients in north Yorkshire have to travel for as long as 45 minutes to reach their nearest large hospital. Local health services can indeed find it difficult to meet national guidelines, particularly those involving clinical mass. I understand that it is against such a challenging backdrop that North Yorkshire and York PCT is currently considering its strategy for health services in Malton and Ryedale, ensuring that they are safe and sustainable for the future.

I am happy for my hon. Friend to come back to me on any points that I may raise. I understand that the PCT’s emerging strategy for future hospital service provision is based on four themes: prompt local access to assessment and treatment for those needing urgent care; local access to a range of rehabilitation services, delivering intensive rehab and support effectively to re-able patients; prompt and local access to diagnostic tests and, where desirable and feasible, minor surgery; and specialist out-patient services to promote access and to support patient management by local GPs.

I am also aware of press speculation that Malton community hospital may be closed. The PCT has made it clear that it sees the hospital as an integral part of local health services and that it has no intention of not having a community hospital in Malton. I do not know whether that will reassure my hon. Friend. Judging by the expression on her face, I fear that it may not.

North Yorkshire and York PCT is currently piloting a scheme of enhanced community service in the Malton and Whitby area. The PCT believes that treating patients closer to home will provide better outcomes and encourage patients to retain their independence. I gather that that pronouncement has been greeted with the same cynicism with which it is greeted in many areas around the country.

--- Later in debate ---

[Miss McIntosh]

No one believes a word that the PCT says any more. There was a cohort of patients—21 at a time—who were treated intensively and given rehabilitation on a ward. They will now not be treated as intensively, and will be less safe when they return home after a fall or a major injury. It is that cohort of patients who will not benefit from hospital at home.

[Anne Milton]

I understand what my hon. Friend is saying. One of the problems is that we will have to let the pilot run. It is using existing hospital staff to provide hospital care in patients’ homes. I gather that there will be no reduction in nursing staff, but delivering care in people’s homes is a very different process from delivering it on a hospital ward. Because of financial constraints, it is not possible to run concurrent hospital and community services, so as part of the pilot, the wards have been temporarily closed. I understand that there will be deep cynicism about the prospect of their ever opening again. However, I am assured by the PCT that this is a pilot, and that a full assessment will be made at the end of it.

The project implementation team meets each week to assess the ongoing impact of the ward closure and bed reductions, and that team includes community provider staff, community hospital matrons and representatives from the community nursing team. I hope that that will continue, and go some way towards reassuring my hon. Friend. The pilot scheme will finish at the end of March 2011, and a full evaluation will take place in April 2011. The PCT has developed criteria for its evaluation—with, I hope, full consultation of local people.

I reiterate that no final decision has been made about the future of Ryedale ward. If the pilot leads to proposals for permanent service changes, the PCT will need to conduct a full public consultation, underpinned by the principles that I have set out. I hope that the PCT may learn a little from this debate, and from the letters that it has doubtless received, and ensure that local people feel that the consultation is real. I understand that the strategic health authority is working closely with the PCT to ensure that proper process is followed.

The need to improve clinical outcomes means that local health services will need to evolve, but I hope that, unlike previous changes, any future changes will have the confidence of local communities and clinicians. People must feel that their voice is properly heard; that is what the new arrangements are about. It will not always be easy, but if the process is clear and transparent, and, crucially, if it is led locally by clinicians, it will have the confidence of local people.

The commitment and tenacity that my hon. Friend shows in fighting for local health services is commendable. I note that she is due to discuss the matter further with the PCT on 19 November. I know that she will continue to work with the local NHS and ensure that her constituents’ voices are properly heard and represented, as she always has done.

The list of enhanced services that my hon. Friend described is particularly significant in the light of the publication of the White Paper. The description of the way in which the ward was closed gives rise to concern and cynicism among local people. It is not useful when organisations act in such a way, because it simply fosters a belief that the PCT is trying to drive something through. We have to let the story run and let the pilot be properly evaluated against the criteria that my right hon. Friend the Secretary of State has outlined.

[Miss McIntosh]

I am most grateful for my hon. Friend’s full reply from the Dispatch Box. On the particular, indeed unique, point that the PCT is both commissioner and provider of the services, will she give me an assurance that the functions will definitely be separated and that such a position will never arise again? It causes undue confusion for all concerned.

[Anne Milton]

My hon. Friend is right to draw attention to the issues surrounding the commissioning and provision of services. We have grappled with that for some time and we will fully address it. The consultation on the White Paper that we published in July is now finished, and we need to guard against exactly that sort of problem. If there is no Chinese wall or division between commissioning and provision, cynicism and deep suspicion of the commissioning decisions ensue.

I know that my hon. Friend will continue to make representations and watch the process closely. I assure her that our door will be open to hear any representations that she wants to make.

Question put and agreed to.