Oral Answers to Questions

Baroness McIntosh of Pickering Excerpts

Tuesday 17th July 2012 Commons Chamber

[Paul Burstow]

We know from the most recent survey published by Laing and Buisson that there has been a 1.4% increase in the fees paid this year, compared with no increase last year. We also know that there is a surplus of places, which accounts for about 10% of the total number of bed places available in care homes up and down the country. So there is actually space, and it is entirely appropriate for local authorities to negotiate appropriate prices to provide good-quality care from one locality to another.

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

Following the census announcement yesterday that there are elderly hot spots, including North Yorkshire, will this is be a good opportunity for the Minister and the Government to review health and social care funding to reflect a growing elderly population in sparsely populated, isolated rural areas such as North Yorkshire?

[Paul Burstow]

My hon. Friend is absolutely right to highlight those issues and the emerging findings from the survey. It is important to say that data will be a key consideration in how the next spending review is shaped, along with the priorities that the Government will give to different demographic pressures as a result.

Oral Answers to Questions

Baroness McIntosh of Pickering Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Speaker]

Last but not least, I call Anne McIntosh.

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

The Department of Health is to be asked to sign off the business case for the transfer of services from Lambert Memorial community hospital to the new extra care housing scheme—sometimes called an extra sheltered accommodation scheme—in updated community facilities. Will the Secretary of State give me a personal assurance that there will be no sign-off until the future of Thirsk’s community hospital is guaranteed for its current purposes?

[Mr Lansley]

I cannot give my hon. Friend that assurance, not least because such decisions are led locally by local organisations. However, if the tests for service change were not met and the local authority referred the matter to me, I would of course take advice through the independent reconfiguration panel, and consider it in the light of that advice.

Oral Answers to Questions

Baroness McIntosh of Pickering Excerpts

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

My hon. Friend has raised an important point about the importance of joining up hospital care, community care and social care, which has often been overlooked. We have invested more than £300 million this year in developing more re-ablement services, and in January we invested an extra £150 million in support for them. We are also extending our plans for more tariff reform to ensure that local hospitals have the means to drive the development of such services in their communities.

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

11. What recent representations he has received on the 111 pilot telephone service; and if he will make a statement.

[The Secretary of State for Health (Mr Andrew Lansley)]

I have received representations from the British Medical Association and the NHS Alliance, both of which support the NHS 111 model, requesting an extension of the roll-out deadline of April 2013. I am actively considering that, and will be discussing it with the clinical commissioning groups who are leading the development of NHS 111 in their areas.

[Miss McIntosh]

Will the Secretary of State accept representations from me? I have used the 111 service on behalf of a family member, and I know that it is not working as well as it might, which is quite distressing. The call time and the script do not allow a person receiving a particular type of care to be fast-tracked to a clinician. I believe that there is a case for delaying its roll-out, and that the service would be infinitely better if the Secretary of State took my representations on board.

[Mr Lansley]

I will of course accept representations from my hon. Friend and, indeed, from anyone else. Pilot schemes are under way in County Durham and Darlington and in Nottingham, Lincolnshire and Luton. The system is also live in Derbyshire, the Isle of Wight, Cumbria, parts of Lancashire and parts of London. An evaluation will be published shortly by the university of Sheffield, but an interim evaluation suggested that 93% of patients were pleased with the service that they had received, and, most important, 84% felt that it had delivered them to the right place first time.

Southern Cross Healthcare

Baroness McIntosh of Pickering Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

On the hon. Gentleman’s question about the staffing of the CQC, I can confirm that last October I authorised an additional 75 inspectors’ posts to be filled by that organisation to strengthen it in the very way that he asks for.

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

Given that the change in business model seems to have led to the current difficulties, what procedures have the Government and the Department put in place to prevent similar business collapses? Is the Minister convinced that the CQC has sufficient investigative, as opposed to enforcement, powers should the problem sadly recur in future?

[Paul Burstow]

There are certainly issues arising from the current situation that we will want to consider as we go about reforming social care. However, I think it would be wrong, while we are in the midst of the restructuring that the company is undertaking, to bring forward a hard and fast set of solutions to ensure the long-term stability of the social care sector.

Future of the NHS

Baroness McIntosh of Pickering Excerpts

Monday 9th May 2011 Commons Chamber

[John Healey]

Some of the reorganisations in the 13 years of our Government played an important part in the reform and the great gains that patients saw in the NHS. However, it is also the case—and we learn from this—that reorganisations often take longer, save less, cost more and have less impact on improving care for patients than envisaged at the outset. We learned that lesson towards the end of our 13 years, which is why we had a period of important stability in the NHS, but it is a lesson that the Conservatives have failed to learn—extraordinarily so, as we all thought that they had learned it, because NHS reorganisation is exactly what the Prime Minister promised not to do before the election.

The Prime Minister’s broken promise on NHS reorganisation is part of the reason for the growing doubt and distrust about whether he is making the right decisions for the right reasons on the NHS. He promised to give the NHS a real rise in funding, but the Budget this year confirmed a £1 billion shortfall in England. He promised to protect front-line services, but nursing posts are already going, and the Royal College of Nursing expects 40,000 NHS jobs to go in the next four years. The Prime Minister promised a moratorium on hospital A and E, and maternity service closures, but some are now going ahead, and more will follow—without public consultation—under the Health and Social Care Bill plans.

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

I am following the shadow Minister extremely closely. The last Government opened a treatment centre in my old constituency, Vale of York. I am having great difficulty understanding what we are proposing to do, following what Labour did in York.

[John Healey]

Let me help the hon. Lady. For the first time, all parts of the NHS, including the commissioning job, will be opened up to private companies and subject to competition. As I have said, independent sector treatment centres played a part in our being able to clear long waiting lists and restore the quality of service to the NHS, as well as in supplementing the mainstream NHS, not substituting for it, which is what will happen under her party’s Bill.

Oral Answers to Questions

Baroness McIntosh of Pickering Excerpts

Tuesday 26th April 2011 Commons Chamber

[Paul Burstow]

I certainly stand by the idea that the Government provided adequate resources in the financial settlement last year, alongside efficiency savings, to ensure that every local authority could choose to maintain the current levels of eligibility and services in its area if it so wished.

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

Will the Minister examine situations in which domiciliary care contracts are awarded under the EU public procurement directives, to ensure that especially when they are awarded on price, they are not dumbed down and the level of service reduced?

[Paul Burstow]

My hon. Friend makes an important point about ensuring that competition is always based on quality, not just price. If she would like to write to me with more details about the matter, I would certainly be happy to follow it up with her.

Swine Flu

Baroness McIntosh of Pickering Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

All I can tell the hon. Gentleman is the simple truth. In the early part of last week, we asked manufacturers whether they had additional supplies. I believe that some additional seasonal flu vaccine that is licensed for use in this country probably will be made available. In any case, we have the H1N1 vaccine to support the immunisation, where required. Early last week, we did ask Scotland. The amounts that would have been available in the short run were not significant at all, so it was better for them to be retained in Scotland because there might be a continuing need for the vaccine there, rather than here.

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

Will the Secretary of State explain when in the course of the year the vaccine would normally be ordered?

[Mr Lansley]

It would normally be ordered between March and May.

Oral Answers to Questions

Baroness McIntosh of Pickering Excerpts

Tuesday 7th December 2010 Commons Chamber

[Mr Burns]

I am happy to join the right hon. Gentleman in congratulating the university hospital of south Manchester on its fantastic achievement and the award that it has won. As he knows, his local hospital did that by reducing its energy consumption and carbon emissions by 26% over the past three years in ways such as the greater use of biomass fuels. It is a fantastic achievement and the staff should be justifiably proud of it. They are a beacon for other hospitals to follow to reach the same level of sustainability, and I am delighted that a number of hospitals throughout the country are striving to reach the position of the one in his area. I am confident that through greater sharing of information and work, more and more hospitals will make their contribution to reducing carbon levels.

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

The Minister will be aware of the extreme weather conditions and extremely low temperatures of minus 17° C in and around Thirsk and in other parts of North Yorkshire where we have community hospitals and trust hospitals. Has he reviewed the impact on their funds of heating costs when low temperatures come so early in the winter and will carry on for such a long period?

[Mr Burns]

I can reassure my hon. Friend. She is absolutely right that the winter period and harsh weather impose extra costs, but I am pleased to tell her that partly through winter planning and partly through the experience of past years, hospitals are aware of that. They take into their planning and financial budgeting the possibility of weeks and perhaps longer—depending on the weather—when their costs will increase, and adjust to meet those demands. I am confident that bad weather will not impact on front-line services because of the work that hospitals do to account for it over the 52 weeks of the year.

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.

Oral Answers to Questions

Baroness McIntosh of Pickering Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Lansley]

I am grateful to the right hon. Gentleman, but in the absence of notice of that question, I fear that I shall have to tell him that I shall certainly look into that and write to him.

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

T6. The Minister of State wrote to me on 25 August to say that all future service changes must be led by clinicians and patients. How can it be that, although all the clinicians and patients oppose the downgrading and possible closure of the Ryedale ward of Malton hospital, that can proceed? Will he please use his good offices to block any such change?

[Mr Burns]

I am very grateful to my hon. Friend and would like to tell her that I have been informed by NHS Yorkshire and the Humber that NHS North Yorkshire and York has proposed incrementally to alter the balance between resources in the community and the in-patient areas by slowly reducing the number of beds open for admission and slowly transferring staff into the community. We understand that that forms part of the PCT’s ongoing strategic plan for Malton. However, given my hon. Friend’s concerns, I would be more than happy to meet her to discuss the issue further.