NHS Trust Merger (Dorset)

Dan Poulter Excerpts

Thursday 22nd November 2012 Commons Chamber

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

It is a pleasure to respond to the debate. I congratulate my hon. Friend the Member for Christchurch (Mr Chope) on securing it, and on being a strong advocate for the needs of his constituents and of patients throughout his part of the world. I also pay tribute to my right hon. Friend the Member for New Forest West (Mr Swayne) and my hon. Friend the Member for New Forest East (Dr Lewis), who are also in the Chamber. They, too, are strong advocates for the patients they represent, and I know that their constituents are grateful to them for that.

It is right to highlight the importance of having a good working relationship between Members of Parliament and their local hospital trusts. It is never desirable for any hospital to embark on local service changes of any kind without properly engaging with the local Members of Parliament. In this case, we are talking about a merger, rather than a service reconfiguration; there is an important distinction between the two, which I will come to in a moment. Nevertheless, from what my hon. Friend the Member for Christchurch has said, it does not sound as though the local hospital trust has engaged with him in a way that we would all consider desirable, and I am sure that it will consider that in its future relations with MPs.

That point was strongly made when my hon. Friend read out the heavily redacted document. There is freedom of information, and certain issues can quite rightly be exempted from freedom of information requests under statute. However, to present a document bearing only the heading “Maternity” is not in the spirit of co-operative and collaborative working with Members of Parliament or in the spirit of being as open and transparent as we would like. I am sure that he has already raised these issues locally, but I would also like to place on record my concern at what he has told the House. It is important that MPs, as strong advocates for our constituents and the patients in our constituencies, should always be engaged at an early stage when decisions of this magnitude are being made.

My hon. Friend paid tribute to the dedicated front-line staff at the hospitals in Poole and Bournemouth. It is worth highlighting that some very good things have been happening in both trusts. At Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, a life-saving service that treats heart attack patients within 60 minutes is now available 24 hours a day, seven days a week at the Royal Bournemouth hospital. It treats heart attack patients from across Dorset, Hampshire and Wiltshire. Also, a new combined acute and rehabilitation stroke unit opened in 2012. It is designed to improve the experience and outcomes of stroke patients by providing specialist services, with a particular focus on the rehabilitation of patients, which is an important part of stroke care.

[Mr Chope]

I am glad that the Minister cited those examples, but are they not examples of how independent trusts can innovate and thereby create beneficial change rather than have a monolithic monopoly? Surely we would not have so much innovation if all our trusts were merged into one.

[Dr Poulter]

My hon. Friend is right that trusts—in their own right, or when they are merged together as they were historically over the river at Guy’s and St. Thomas’ and at the medical school of Guy’s, King’s and St. Thomas’ of which I am a graduate—can gain and improve the quality of care available to patients without losing their distinctness. Services are offered on each site, but at the same time they can add to the services they provide to patients in the totality. I believe my hon. Friend is right to say that these innovations have come from the independence and the good work of his local hospital, but I also believe there can be distinct advantages from hospitals coming together as well. The common purpose is making sure that good local service provision is maintained, while services of clinical excellence are also developed, further improving the offer to patients—not just in those towns, but throughout the area.

I want to highlight, and not leave out, some of the good things happening at Poole hospital, as it would be wrong for me, having highlighted a number of good developments at the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, not to mention them. At Poole hospital, the standard of care for cancer patients has been rated as among the best in the country in a national survey. The 2011-12 national cancer patient experience survey found that 94% of patients rated their care as “excellent” or “very good”, giving Poole the highest score recorded among participating trusts. I know all Members, as constituency Members, would feel very proud of that hospital’s achievements.

I am sure that my hon. Friend welcomes this Government’s investment in the NHS, even in very difficult economic times, as we put an extra £12.5 billion into NHS services over the lifetime of this Parliament. I am sure we all agree that that is a good thing.

What is the current position? Let me address some of my hon. Friend’s points. As to the proposals by the foundation trusts in Bournemouth and Poole, I appreciate that when any changes to local NHS services are mooted, people can become anxious and feelings can run high. However, I must be very clear to my hon. Friend that there is no formal role for Ministers or the Department of Health in approving mergers between two foundation trusts. I fully appreciate his concern to ensure that there is appropriate engagement and consultation on any proposals for service changes that may affect his constituents. I have already put on record some of my concerns about the process and engagement so far, which I think we would all accept is not ideal.

[Mr Chope]

I was not asking the Minister to have a role in approving the merger or otherwise. What I asked him to do, on behalf of the Government, was to say to the Office of Fair Trading that this is an issue of sufficient significance that it should be referred to the Competition Commission.

[Dr Poulter]

If my hon. Friend will be patient with me for a few moments, I will address that point a little later.

In acknowledging the understandable anxiety that can be stoked when any discussions about hospital services take place, it is important to highlight the fact that, as we saw over the river at Guy’s and St. Thomas’, although there was some good preservation of the individual and distinct offers to the local populations of the two institutions in their own right, by coming together they have been better together and provided better services.

One of the big problems we face in the NHS is concern about putting more money into front-line care and about cutting back on waste and bureaucracy. Clearly, if the administration across two trusts can be shared, it will free up more money to be diverted and put into what we all care about—front-line patient care.

Let me put on record once again that the trusts have clearly stated that this is not about the reconfiguration of clinical services. That is quite distinct. My hon. Friend was quite right to mention some of the points I raised in reply to my hon. Friend the Member for Bracknell (Dr Lee) about the important and distinct challenges faced in rural constituencies, and the fact that service reconfiguration challenges are very different in rural areas where there are longer distances to travel. As I have said, however, this is not about reconfiguring services, but about trusts merging and seeking what I think we would consider to be potentially desirable results, such as economies of scale and a reduction in unnecessary administrative burdens when possible. I think that, although the process and the approach taken to engagement with my hon. Friend and other Members of Parliament have not been ideal, some very positive elements have emerged from the discussion.

As my hon. Friend said, stringent tests would be applied to reconfiguration if it were on the table. The criteria would be strong public and patient engagement, consistency with current and prospective need for patient choice, a clear clinical evidence base, and support for proposals from clinical commissioners. Clinicians should always lead reconfiguration challenges, but today we are not talking about reconfiguration; we are talking about a hospital merger. It is the first of its kind to be proposed between foundation trusts in the country, and in that respect it is new territory for the NHS. There are distinct rules, including, as my hon. Friend said, referral of the case to the Office of Fair Trading.

The OFT’s role in reviewing the merger will be to establish whether there is a realistic prospect that it will result in a substantial lessening of competition. I am sure that it will also consider the issues of rurality and the choice of services available to patients. Should it refer the matter to the Competition Commission, which it has a right to do if it has concerns, the commission’s role will be to conduct an in-depth investigation, and to decide whether the merger does indeed represent a substantial lessening of competition and choice.

Concern has been expressed about the rurality of surrounding areas, and about the fact that there are long distances between hospital trusts. That may—