Minor Injuries Services (Devizes)

Duncan Hames Excerpts

Tuesday 13th July 2010 Westminster Hall

[Claire Perry]

I thank my hon. Friend for that important point. We have built hospitals following the sound principle of encouraging local travel and walk-ins, but the major service review forgot that most bus services do not run to the existing services from the places where minor injuries services used to be provided. In fact, it is impossible to take a bus from Marlborough to any of the six suggested units for minor injuries services.

I was interested to learn what the current PCT guidance recommends, so last night I phoned NHS Direct and asked what I was to do if I had a bad cut and lived in Pewsey, which, as many will know, is in the centre of my constituency and, as home to around 4,000 people, one of the largest villages in the area. I was advised to go to Swindon hospital’s A and E unit, which is considered to be a journey of only 16 miles. However, as we know, the concept of “as the crow flies” does not give a good indication of distance in rural constituencies. In fact, a simple search on Google maps reveals that that journey takes between 38 and 46 minutes by private car, which is far too long for a mother of a child with a bleeding head wound, or the carer of an older person with a fracture that needs immediate attention.

Let us consider the journey that the residents of Honeystreet, a lovely village in the heart of my constituency, would be advised to take to get to the nearest service. By private car, it would take them 37 minutes to get to Chippenham hospital, or 40 minutes to Trowbridge hospital. In fact, there is only one other constituency with a lower population density and no minor injuries provision: South West Norfolk. Most of the other spread-out rural constituencies are blessed with more than one such unit. Indeed, they trumpet their facilities as being appropriate for populations in a rural area. North Devon has four units, Rutland and Melton has three, and the nearby constituency of The Cotswolds also has three units. Those constituencies all have population densities that are similar to or slightly lower than that of Devizes.

We might all be asking how the situation has arisen. I submit that it is because decisions about our local health care have been taken by decision makers who were unelected and unaccountable, and often uninterested in the local consequences of their actions. It was not because they were bad, malicious or unintelligent—there are many good and dedicated health care professionals in the PCT—but because the whole system rewarded top-down compliance with central Government diktat and ignored the needs and wishes of the population. Indeed, when I went to see the head of Wiltshire PCT only last week about the proposals in the White Paper that we have heard about, he said that he had no intention of reopening the minor injuries units that we have lost and that there was no case for doing so. I would like the Minister’s opinion of whether a case can be made for those services.

I would like to cite four facts to frame the debate. The population in my constituency, as is the case across much of rural Britain, continues to grow. There is a population flow from the cities to the villages and hamlets of the UK. The population in my constituency has increased by 5% since the turn of the decade. Indeed, part of the support for the redevelopment of Savernake hospital resulted from the prediction of 20% population growth in the Swindon area.

The Alberti report “Emergency Access”, which was published by the NHS in 2006, suggested that it was better clinically and more cost-effective to send patients out of A and E departments and into local urgent care centres where more nurses, paramedics and nurse-led emergency care practitioners could be used to treat them. I am grateful to the PCT for providing data showing that, in the past year, there have been 17,086 attendances by patients registered in my constituency at the minor injuries units in Trowbridge and Chippenham, and the A and E departments in Salisbury and Bath. As I have already stated, the journeys that people have to take to access those facilities are unacceptable. The cost of providing the services at the current tariff is £1.352 million.

With our new localism agenda, and given the cost that the PCT is paying for minor injury services for my constituents, surely a business case could be made for restarting a minor injury service in the constituency, as long as the total cost was below the current tariff. Some doctors in Devizes and Marlborough have expressed an interest in restarting the service and having it delivered by nurse practitioners located in their practices. Premises are certainly available in which the service could be located, including the half-empty and shuttered Savernake hospital.

Will the Minister tell us how, in the light of our NHS reforms, we can move the process forward? The current PCT, which will be in existence for at least another two and a half years, has no interest in recommissioning the service, so can we go around it in the interim period and use sustainable communities legislation, for example, to get back those services that we so desperately need?

[Duncan Hames (Chippenham) (LD)]

I commend the hon. Lady on securing the debate. Some years ago, when the closures first happened, we petitioned Wiltshire county council’s health overview and scrutiny committee to intervene on our behalf. I will be grateful if the Minister indicates whether it had a role to play in standing up for the residents, constituents and patients who have written to the hon. Lady and me. Melksham in my constituency has lost its minor injury unit, and it was far closer to her constituents than the one in Chippenham.

[Claire Perry]

I thank the hon. Gentleman for that excellent point. It is interesting that a subtopic of the debate is the PCT’s failure to deliver a new primary care centre in Devizes, which was promised as part of the quid pro quo when the closure announcements were made. When I suggested last week that perhaps the time had come to rip up the original plans that seem to be stymieing progress, return to the drawing board and ask whether we can deliver a hospital in Devizes under the current constraints, I was referred back to the council’s overview and scrutiny committee, which clearly has an important role to play in defining the services that we need for our local community. Will the Minister say whether, instead of waiting until 2013, we can submit pilot proposals to the national commissioning body when it is up and running and start to make progress, for example by looking for voluntary sector partners to begin a pilot programme?

There are few things that unite all the people in my constituency, but the feeling that we have been short-changed by our PCT and the NHS over the past 13 years is almost universal. I am sure that we are all united in welcoming the exciting proposals that the Secretary of State announced yesterday, and I know that the ideas of equality, excellence and liberating the NHS, and the possibility of getting back some of our minor injury services, make my pulse beat a little faster.

--- Later in debate ---

[Mr Burns]

Obviously, I cannot give a commitment that my hon. Friend would be successful. I wish her well in her endeavours, but it is not for me to prejudge what might happen. She is certainly right that if she puts all her ducks in a row—as she put it—with a business plan for what she believes her constituents need, she can present it to the national commissioning board and to GP consortiums in her area. Everybody will then work together, and make an overwhelming case for what my hon. Friend wants to see delivered for the local people of Devizes and her constituency.

As my hon. Friend will accept, “The times they are a-changin’”. The Government’s approach is different from the top-down approach taken by the previous Government. We believe that local decision making is essential to improve outcomes for patients and drive up quality. We will do more than just talk about pushing power to the local level; as the Secretary of State’s White Paper shows, we are going to do it and make the dream a reality. That will be of considerable help to my hon. Friend in her campaign.

Given my hon. Friend’s experiences during her ongoing battle, she will agree that we must move away from having Whitehall dictate how care should be delivered in Devizes, Westbury or any other town or village in Wiltshire. We believe that change must be driven from the bottom up, and that the patient must be the heart of health care provision. The patient must be put first; their interests and quality of health care is the No. 1 priority, not the decisions, ramifications and shenanigans of politicians and civil servants.

In future, all service changes must be led by clinicians and patients, not driven by Ministers such as me, or civil servants from the Department of Health. Only then will the NHS achieve the quality improvements that we all want to see.

[Duncan Hames]

In his search for local accountability in decision making, it would be helpful if the Minister advised hon. Members where in the process the public’s demand for these services will be heard. Is there a role for locally elected politicians to secure influence in determining outcomes through the health overview and scrutiny committees of our local councils?

[Mr Burns]

If the hon. Gentleman refers to current arrangements, he will no doubt be aware that in late May, the Secretary of State announced changes to the criteria that need to be taken into account in any reconfigurations currently under way—providing that those reconfigurations are not so far advanced that it would be impossible to reverse them—and any future reconfigurations. The main priorities include taking into account the views of local people, clinicians and GPs and ensuring that health care is relevant for the local area.

If the hon. Gentleman is asking what will happen after the changes in the White Paper, let me say that once the PCTs are wound down and abolished, there will be a transfer of powers to the national commissioning board and all that flows downwards from that. Provision and responsibility for the commissioning and delivery of health care in a local area will be linked to local authorities, and accountability will be through local authority input with locally elected representatives. Public health is currently dealt with through the input from the primary local authority level in each area. That is where the accountability will be. The predominant point is that because one must have a locally driven health service, the wishes of the patient—not only in their individual care but in the requirements of the local community—must be fundamental to the decision about units or configurations. I hope that the hon. Gentleman and my hon. Friend are reassured by that.

In conclusion, I once again pay tribute to my hon. Friend for her commitment and dedication in fighting so hard for her constituents, not only before the election but afterwards. She has been in the House for about eight weeks, and she has already made her mark fighting for her constituents on the issue that she promised, during those long days in April, to take to Westminster. She is now in Westminster and has brought the issue to the debate today. I have every confidence that she will continue to use the means available to her in the House to pursue her agenda, and that she will mobilise support in her constituency to ensure that the issue does not go away. She will be determined to get what she believes to be the best health care for her community, and I wish her every success.