A&E Services

Gordon Henderson Excerpts

Wednesday 24th June 2015 Commons Chamber

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

It is a delight to follow the hon. Member for Birmingham, Edgbaston (Ms Stuart), who made some very interesting points. When I read the motion, what struck me most was that if I had read it having just stepped off the Mars to Earth express, I would have believed that Britain’s national health service was a total disaster and that nothing was being done to improve the services that were being delivered. Yes, there are still problems in the NHS, particularly in lots of our larger general hospitals, such as Medway Maritime hospital, which provides services for my constituency, including A&E cover. Medway Maritime has faced big challenges for a number of years, including under the previous Labour Government, and among those challenges was a failing A&E department. There were a number of reasons for the challenges, including the limitations of the site on which it is located and the demography of Medway towns in general.

Last year, those challenges came to a head and Medway Maritime was put into special measures. Following the appointment of a new chief executive and new trust chairwoman and with the buddying arrangements that have seen Guy’s and St Thomas’ NHS Foundation Trust provide Medway with advice and expertise, the hospital is beginning to see some improvement. Of course, much more needs to be done before Medway Maritime can provide my constituents with the health service they deserve and to which they are entitled.

There is general agreement that one way to relieve the pressure on the hospital is to transfer more of the services it provides into the community. In my constituency, I have two excellent community hospitals, Sittingbourne memorial hospital and Sheppey community hospital. They both provide local people with a very good service, albeit for a limited range of healthcare needs. I would like the services they provide to be expanded. Okay, we will never see a fully fledged accident and emergency department in Sittingbourne and Sheppey, but there is no reason why my two community hospitals cannot provide other services. Today’s Opposition motion contains the statement that

“the pressures on hospitals are a consequence of declining access to out-of-hospital services”.

There are a number of things going on in my neck of the woods that belie that statement, with a number of initiatives and pilots taking place that in the long term will benefit not only my constituency but the wider NHS. Let me tell Members about a couple of them.

Last week, I met managers from the South East Coast Ambulance Service, SECAMB, who told me about the vanguard initiative in which they are involved in Whitstable, just outside my constituency. It is one of several initiatives nationwide that will provide specialist out-of-hospital care in the local community and involves a SECAMB paramedic team, led by a specialist paramedic, working with local GPs to provide people with home treatment rather than their being taken to hospital. SECAMB is keen to replicate the model in other areas, including the Isle of Sheppey in my constituency.

[Dr Mathias]

Does my hon. Friend agree that with home treatments, the patient becomes the patient expert, which is another way of moving forward local solutions and the community helping itself?

[Gordon Henderson]

I very much agree, and I shall come onto that point in a moment. I am interested in getting that model on the Isle of Sheppey and I hope that NHS England will see the merit in the initiative and provide SECAMB with the necessary funding.

I mentioned earlier the excellent Sittingbourne memorial hospital in my constituency. It, too, is running a pilot that I believe should be extended into other areas. Last December, a wound medicine centre was opened in the memorial. It is a specialist service for patients across Swale who have chronic, complex or surgical wounds and it is operated under the care of the Kent Community Health NHS Foundation Trust. The centre uses telemedicine, with community nurses visiting patients in their home. By using mobile computer tablets to photograph wounds, nurses can send pictures back to specialists based at Sittingbourne memorial to provide an instant professional opinion. The system can also track the progress of healing wounds and use the data to work out the best treatment options, including the correct type of dressing. That has the potential to save the NHS thousands of pounds in the wasted procurement of unnecessary dressings.

Last month, I was honoured to open the HEM ultrasound clinic in my constituency. It is a new unit that provides a wide range of ultrasound scans and is the first static clinical ultrasound service in Medway and west Kent. Although it is a private clinic, it is just been contracted to Medway Maritime to help bring down its waiting lists. HEM is undertaking an average of 35 scans on behalf of the hospital every day, seven days a week. The cost to the NHS of the clinic’s service is the same as if the hospital undertook the scans itself. Let me tell those who accuse the Government of wanting to privatise the NHS that using facilities such as HEM is not about privatising the NHS but about the sensible use of private facilities to supplement NHS treatment and reduce waiting times for worried men and women.

I want to mention one particular concern. My local Swale clinical commissioning group is led by an excellent team whose members are fully committed to providing local people with more local services to reduce pressure on Medway Maritime, but Swale CCG is one of the smallest in the country and its size presented big challenges, as does the historic health deprivation in some of the wards in my constituency. Last year, Swale CCG received an above-average increase in its budget and I want to take this opportunity to urge the Government to ensure that it receives an above-average increase again this year.

Oral Answers to Questions

Gordon Henderson Excerpts

Tuesday 15th July 2014 Commons Chamber

[Jane Ellison]

That sounds like a fantastic local initiative, and I thank my hon. Friend for highlighting it. Taken together with our advice and support for families on how to use healthy food to make healthy meals, initiatives such as that are to be applauded.

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

11. What progress his Department is making on improving the performance of failing hospitals.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The new special measures regime for failing hospitals is designed to introduce honesty and transparency for hospitals in difficulty. The new chief inspector of hospitals will report later this week on progress in the first year. I am sure that the whole House will welcome the fact that the new regime has made really encouraging progress.

[Gordon Henderson]

Medway NHS Foundation Trust is not in my constituency, but is used by many of my constituents. It was announced last week that Medway is to remain in special measures because of the inadequacies of its A and E department. What steps can my right hon. Friend take to ensure that Medway receives the help needed to improve the service it provides to my constituents?

[Mr Hunt]

I thank my hon. Friend for his question. He is right that the chief inspector raised concerns about some issues that persist at Medway. It is important to praise the staff for the progress that they have made in the past year. We have put in place 113 more nurses, the Bernard dementia unit, which has made some really good progress, and a twinning arrangement with University Hospitals Birmingham, which is one of the best in the country. There are some encouraging signs. I wish to reassure him and his constituents that we will stop at nothing to ensure that we turn that hospital around

Health Provision (Sittingbourne and Sheppey)

Gordon Henderson Excerpts

Wednesday 9th July 2014 Westminster Hall

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

It is good to see you in the Chair, Mr Betts. I am grateful for this opportunity to highlight a number of concerns I have about the provision of health care in my constituency. I want to cover three main issues: the challenges facing my local clinical commissioning group; the provision of renal services to my constituents; and the difficulty in recruiting GPs in Kent in general and my constituency in particular.

Sittingbourne and Sheppey are covered by the Swale clinical commissioning group, which is the smallest CCG in Kent, if not in the country. Because of the way the management component of its budget is allocated on a per capita basis, its size puts Swale at a financial disadvantage compared with larger CCGs. That is a huge challenge. The Swale CCG faces a number of other challenges, and to highlight those I will explain something of the demography of Sittingbourne and Sheppey.

The population pattern of NHS Swale CCG is broadly similar to that for the rest of Kent and Medway, but in contrast to other areas it has a slightly larger proportion aged from birth to four; and a 68.1% increase is predicted in the population aged 65-plus, from 2011 to 2031. That includes, in the 85-plus group, an even greater predicted increase of 142.3%, from 2,600 to 6,300. In 2009 it was estimated that only 5.8% of the population in my constituency came from a black or minority ethnic group. However, that proportion has gone up over the past five years. In addition, the proportion of Gypsies and Travellers living in Swale is higher than in many other areas. Those things are all challenges.

In comparison with the population profile of England the NHS Swale CCG area has proportionately fewer people aged 80-plus, at the moment, but more people aged 60 to 69; and proportionately more young people under the age of 19. However, there is also a pattern of outward migration resulting in proportionately smaller age cohorts between the ages of 20 and 44. With the overall ageing of the population and predicted demographic change there will be an increase in the risk factors relating to increased chronic disease and, importantly, multiple morbidities. Life expectancy from birth in Swale is 79.3 years—the lowest among the eight Kent CCGs. That compares with 80.9 years for Kent and Medway as a whole. Within Swale there is a huge, 10-year gap between the highest and lowest life expectancy. In some more affluent areas the life expectancy is 84 years, while in our more deprived areas it is just 73.8 years. Indeed, Swale is the third most deprived district in Kent and is ranked 99 out of the 326 districts in England.

As to deprivation at the practice level, none of our GP practices is in the 40% least deprived category, but eight are in the 20% most deprived category. A number of areas in Sittingbourne and Sheppey are in the bottom 20% quintile on the national deprivation scale. That level of deprivation has been identified as contributing to lower life expectancy. The bottom 20% of the population also has a greater prevalence of preventable diseases such as heart disease, stroke, diabetes, chronic obstructive pulmonary disease and cancers. In addition, people in long-term deprivation have a higher risk of poor physical and mental health.

Deprivation is also associated with unhealthy behaviour such as higher smoking rates, alcohol misuse and decreased physical exercise. Health and social effects resulting from long-term deprivation including unemployment can last for years, and possibly a lifetime, because of the accumulation, through chronic stress, of factors that trigger the premature onset of chronic diseases. Thus demographic change and relative deprivation are likely to drive an increase in chronic disease, unless primary and secondary preventive measures are systematically put in place.

To add to the long-term challenges, the population of Sittingbourne and Sheppey is growing rapidly. That rise in population, the level of deprivation in my constituency, and the need to address health inequalities, were recognised by NHS England when it set the budgets for 2014-15 and 2015-16. Swale was one of 82 CCGs nationally that received an allocation above the 2.14% basic increase for all CCGs. For 2014-15 we have been allocated a 2.63% increase, compared with the average of 2.59% across Kent and Medway. That increase equates to an extra £3 million, for which we were grateful. However, I do not think that it properly reflects the challenges facing Swale CCG as it tries to square an ever widening circle of health inequality.

Swale CCG is doing its best, and working with other CCGs and health trusts it is implementing a two-year and five-year plan to transform services in the Sittingbourne and Sheppey areas. One of the key areas of work is the implementation of the Better Care Fund, under which money will be transferred from acute care to community care. The vision is to provide better care in the local community, which will reduce the need for hospital treatment. In Swale steps are already under way to transform health care. They include integrated primary care teams, which involve community nurses working with GP practices in a partnership approach to improving health care. Integrated discharge teams in Medway Maritime hospital and Darent Valley hospital, which, by the way, are not in my constituency, enable patients to leave hospital sooner by putting the support in place that they need in the community. Work is also being done with our rapid response services to provide support to patients with an acute crisis, to enable them to be managed safely in the community.

Improved dementia services will be helpful. Swale has been allocated two additional dementia nurses, bringing the total to five. They work with GPs and primary care teams to identify the support required by people with dementia. That multi-agency approach is making it possible to provide a more proactive response for people with dementia, and it links in with the enhanced services remit to which GP practices in Swale have signed up for over-75s. Of course the number of over-75s is predicted to rise dramatically in my area, so we will need more resources to cope.

In addition, changes are being planned to primary and community care and a consultation is commencing now on devising a new system for people in Swale and neighbouring areas. That consultation will consider how the out-of-hours service can be better integrated with walk-in centres and minor injury units to provide 24/7 care, with better joined-up care for local people, which will support a reduction in the number of people attending accident and emergency. Links are being built with the acute hospitals to facilitate that community-based approach.

To transform health care locally Swale and neighbouring CCGs are implementing whole-system change and have recognised that further support is needed to make it successful. Swale CCG would like support for several initiatives to enable the work it is doing to be completed to the highest quality. One of those is significant training and development for all health and social care staff, to help them adapt to the new health landscape and their roles and responsibilities, and support more clinically demanding care. Another is better engagement of all organisations in the health and social care economy, to ensure that they are signed up to the principles and vision of the transformation, and to break the silo mentality of provider organisations.

Finally, the CCG would like support for a more realistic expectation with regard to quick results, because whole-system change will take years to implement and CCGs should not be penalised, as they are under the current system, but incentivised with new payment mechanisms. Realistic expectations about the pace of change should be supported by transition funding to support the changes that are planned, which will take time to implement and embed. That will make it possible to provide support for the development of new services before the old ones are scaled back. Swale CCG is doing its bit, but it needs help.

The second health issue I want to raise relates to renal services, particularly the delivery of dialysis treatment. I have been campaigning for some time for a dialysis satellite unit to be set up in one of my two local community hospitals. I have some very sick patients who must travel to Canterbury, Maidstone or Medway for dialysis treatment. One very elderly patient who needed daily dialysis was so sick by the time she returned home from her treatment that she was unable to visit the renal unit the following day.

I will continue to campaign for a full-scale satellite dialysis unit in my constituency, but in the interim I am discussing with NHS England the installation in one of our local community hospitals of a bank of home dialysis machines that could be used by kidney patients who are suitable for home dialysis but, because they live alone or have insufficient room in their houses, are unable to make use of the service.

I appreciate that setting up a bank of supervised home dialysis machines in a local hospital will not help all renal patients in my constituency, but if only a handful are saved from having to make long and sometimes uncomfortable journeys to a distant hospital, it will be a worthwhile exercise. Local NHS England managers have so far been extremely helpful and are undertaking a feasibility study that I very much hope will prove that such a scheme is feasible. I wanted to raise this matter today not only to put on the record my thanks to those managers for their help, but to urge Ministers to consider making funds available so that similar units can be set up in all hospitals that do not have dialysis units.

I would like briefly to highlight my concerns about the difficulty of attracting GPs to our area. One of the problems is that because Sittingbourne and Sheppey is relatively close to London, it is difficult to attract young doctors because many of them prefer to work in the capital rather than to move out to the sticks. In Sittingbourne and Sheppey, the problem is becoming acute in some areas where practices are short of GPs and struggling to cope with a rising number of patients.

Swale has one of the highest patient headcounts per doctor in the country, and that will be made worse over the next three years because one in three of our GPs is expected to retire during that period. What steps can Government take to ensure that those GPs are replaced so that my constituents will continue to have access to a doctor and that waiting times to see a GP do not continue to rise?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) on securing this debate. He demonstrated his masterly understanding of the health challenges in his area and deep knowledge of and concern for the more deprived parts of his constituency. I thank him for that. His constituents will be grateful to know that he has such a handle on those issues.

Before I respond to some of the particular issues that my hon. Friend highlighted, I want to highlight the excellent work carried out every day by those who work in the NHS, not just in my hon. Friend’s constituency, but in mine and throughout the country. I hope we can always take the opportunity in a health debate to put on the record our thanks to hard-working NHS staff for everything they do in our constituencies.

I turn first to renal policy and particularly my hon. Friend’s local campaign. End-stage renal failure is an irreversible and long-term condition, and he was right to highlight the problems caused by more and more people living with long-term conditions, particularly when combined with other long-term conditions. It results from chronic kidney disease and needs regular dialysis treatment or transplantation.

Since 1 April 2013, NHS England has been responsible for securing high-quality care for dialysis patients as part of its specialised commissioning responsibilities. It has established a clinical reference group specifically for delivery of renal dialysis services, which brings together clinicians, commissioners and public health experts with dialysis patients and carers. It has published service specifications for both home dialysis and hospital and satellite dialysis, which my hon. Friend described. The specifications are important because they define clearly what NHS England expects to be in place for providers to offer safe and effective services. They are there to ensure equity of access in a nationally consistent, high-quality service for patients everywhere.

NHS England has recently consulted on amendments to a range of service specifications, including for renal services and dialysis. Those updated specifications are expected to be published later this year following consultation this autumn. My hon. Friend will take a great interest in that because it is obviously directly relevant to the campaigns in which he is engaged. I know that he has had meetings, and the feedback from NHS England is constructive about the excellent way in which he is engaging with it, and I am glad to hear that.

My hon. Friend mentioned the possibility of a satellite dialysis unit at Sheppey or Sittingbourne community hospital, but I gather that to date it has not been possible to provide such a unit because there is concern that not enough people in the area need that service. However, he is rightly pressing local NHS officials on that. One issue that comes into the calculation about setting up such a unit is the safe level of staffing to meet patient need, as well as viability and efficiency. Those are important calculations to ensure that any service meets needs.

[Gordon Henderson]

The point about what I am trying to achieve is that renal services are trying desperately to get more people into home dialysis, because that is an inexpensive way of providing dialysis. All I am suggesting is that when patients cannot have it at home because they live alone, it should be available at the local hospital. I do not believe the cost should be too much of a factor.

[Jane Ellison]

That is a fair point and one that my hon. Friend has raised in the discussion. NHS England is exploring the possibility of a self-care unit in the area. Such units have been developed in a few places around the country and, as he outlined, those units are particularly useful for people who can get themselves on and off machines or bring carers with them to help because they tend not to be staffed units. It is similar to home dialysis but, as he rightly said, can be used by people whose homes are not suitable for that.

I encourage my hon. Friend to continue the discussions. I met local NHS officials yesterday and encouraged them to continue to keep in regular touch on the matter. I understand that the area director for Kent and Medway will write to my hon. Friend shortly following his recent meeting. I would be happy if he kept me informed of how the discussion goes because I am interested in it.

My hon. Friend rightly highlighted in great detail a particular challenge with local funding. Obviously, the Government have protected the overall health budget for the NHS in England and NHS England in turn has ensured that every clinical commissioning group in England will continue to benefit from stable real-terms funding in the next two years. Reflecting changes in population around the country and better targeting is key. Something that often comes across my desk as public health Minister is the challenge of getting that right where there are pockets of deprivation, particularly deep deprivation, in areas that might not flash up on the radar when looking at how resources are meted out. We want the NHS to be in a good position to offer the best services to patients where they can do the most good and meet need. Responsibility for CCG allocation rests with NHS England, but the Government’s mandate to NHS England makes it clear that equal access for equal need is at the heart of the approach to allocation.

NHS England’s decisions in December last year mean that over the next two years every CCG should receive real-terms funding growth. The purpose of doing that for the next two years instead of just one was to try to provide stability and certainty so that local commissioners can plan services. The sort of issues that my hon. Friend highlighted and the long-tem problems associated with deprivation, such as co-morbidity, over-indexing on smoking and so on, need stability of commissioning because they need long-tem consistent intervention in many cases to ensure that we are meeting patients’ needs. That means that every CCG will receive cash growth in funding of at least 3.9% over the next two years, and those with the fastest-growing populations will get more. Swale CCG’s funding allocation increase of 2.63% in 2014-15 is just above the national average and its increase of 2.05% in 2015-16 is just below the national average. That real-terms growth was given to all as a minimum of 2.14% in 2014-15 and 1.7% in 2015-16.

In order that the issue is looked at objectively, free from political considerations, the Health and Social Care Act 2012 made how health funding is allocated between different areas a responsibility of NHS England. NHS England has taken an evidence-based approach that balances the demands of growing populations and looks at historical underfunding, which is probably one of my hon. Friend’s great concerns, and at maintaining stability.

NHS England has also decided to leave the weight given to the inequalities indicator unchanged at 10%. The new indicator has less variation in it than the old indicator when looking at variation across CCGs, and it is now able to pick up pockets of deprivation within CCGs. That adjustment should favour my hon. Friend’s area for the very reasons that he outlined, and NHS England has accepted the advice it has been given by an independent committee that that is a better measure of inequality for this purpose.

NHS England’s consultation on the impact of the new formula earlier in the year did not have an inequalities weighting at all, which led some people to jump to the wrong conclusion, but it does not reflect the final decision, which is to include an indicator of inequality with a weighting of 10%. They are finely balanced judgments, particularly around the progress of the pace of change towards the right amount for a particular area.

[Gordon Henderson]

While the Minister is talking about the funding and the formulas, I point out that there is an anomaly, which goes back to the dialysis treatment. The CCG is not responsible for the commissioning of dialysis, so it cannot control where the patients go, but it is responsible for funding the transport of those patients to the hospitals. It seems a bit of an anomaly that the CCG has no control over where the patients go, but is expected to fund the transport. I wonder whether that could be looked at.

[Jane Ellison]

It is a fair point, and I will ask the NHS team in my hon. Friend’s area to consider that as part of his ongoing discussions with it. As I said, getting the funding formulas right is not a perfect science, but the new formula is more responsive to pockets of deprivation. However, he has highlighted some challenges around smaller CCGs in a fair way.

My hon. Friend also highlighted issues and concerns about GP recruitment, and I know he has raised them before. A number of GPs in Swale are due to retire in the next few years. That is a challenge we see elsewhere in the country, and it has also been reported that Swale has a higher ratio of patients per GP than some other areas, so we recognise that that is a potential challenge. GPs work hard and do a vital job, so we are all concerned about making sure that we have the right number of GPs in our area. At a national level, despite a decrease in headcount, there has been a small increase of 1.2% in full-time equivalent GPs since 2012, and the number of practice nurses and other practice staff has also grown. My hon. Friend talked about the great public health challenges, such as co-morbidities, and there are many things that practice nurses increasingly deliver and their interventions can be extremely effective.

However, we recognise that the work force need to grow to meet rising demand. In our mandate to Health Education England, we have required it to ensure that 50% of trainee doctors enter GP training programmes by 2016. The Government will also be working with NHS England, Health Education England and the professions to consider how we improve recruitment, retention and return to practice in primary and community care. That is something that my ministerial colleague, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), is very closely considering and is engaged in active discussions on.

I understand that the Kent and Medway area team from NHS England are working closely with the local CCGs, GP practices and HEE to improve the overall recruitment and retention levels of qualified doctors entering general practice as a specialty. I also understand that Swale clinical commissioning group has set up the north Kent education, research and innovation hub, which met in June and is meeting bi-monthly. The hub will be looking, at a local level in particular, at what needs to be done to address expected shortages. That is right because, with the best will in the world, these things cannot be solved with a grand plan in the centre. We also need to address some of the local issues and some are very granular with regard to what can help to attract GPs to particular areas. It is right that that is being done at a local level.

In the few minutes remaining, I want to touch on proposals for out-patient care, because, again, my hon. Friend the Member for Sittingbourne and Sheppey highlighted the value of early intervention and community health services, and of keeping people well in their own homes. In particular, as well as being good for individuals, that takes pressure off A and Es. We do not want to see routine conditions presenting in A and E at an acute stage, so it is really important that we get out-patient care right.

Proposals in my hon. Friend’s area include consolidating services into six co-ordinated out-patient clinics from the current 15 sites. The benefits of that include value for money from modern facilities and equipment, a wider choice of appointment times, and a greater ability to perform enhanced diagnosis—the Government have made early diagnosis a real priority; far too many conditions are still being diagnosed at an acute stage in A and E, so early diagnosis is critical. A greater proportion of his local population will also be within 20 minutes of an out-patient appointment, which is important. The East Kent Hospitals University NHS Foundation Trust is working with the NHS Canterbury and Coastal clinical commissioning group in consultation. A public consultation on out-patient services was completed in spring this year. I know that my hon. Friend will have been very engaged with that and that those proposals have now been brought forward.

A number of other workstreams are in place to address the issues that my hon. Friend outlined. I encourage him to talk with the public health directors in local authorities. The public health lead now sits in local authorities, and I am seeing some great innovation around the country from local authorities and directors of public health to address some of the really deep-seated challenges that he outlined. Many of the figures that we are seeing for public health are going in the right direction at a population level, but they often mask what is happening with smaller sub-groups of the population, for whom the figures are not moving in such promising directions. That is exactly what my hon. Friend was describing, so along with all the other people he is engaging with, I encourage him to make sure he engages with directors of public health and, in particular, the local Public Health England teams.

My hon. Friend should ask them what they are seeing in areas around the country that is really working. Some of the places I have visited, with similar demographic challenges and similar public health challenges, are piloting interventions that are really effective. One of the great opportunities of more devolved public health is that it gives rise to local innovation, and we see that imaginative approach being brought to bear by people who really know their populations. However, one slight challenge is how we identify good and emerging best practice and ensure that we get it promoted more widely. I encourage my hon. Friend to ask questions of his local public health specialists, and in terms of the population challenges he faces, he should ask about things that are being piloted elsewhere that might effectively be brought into his area.

I end by congratulating my hon. Friend again on being a really effective champion with regard to the local health challenges his community face. It is great to see a constituency Member with such a grasp on the range of challenges. I often respond to debates on the reconfiguration of bricks and mortar, but understanding the deep health challenges that a particular population face, and doing so at a granular level, is also really important in how we shape services for the future, so I congratulate him on that. His constituents have a great champion in Parliament for their health needs. I am very happy to continue to engage with him, and I encourage NHS England in his area and his CCGs to continue the constructive dialogue that they have had—and continue to have—to provide the best services to his constituents.

health

Gordon Henderson Excerpts

Tuesday 18th September 2012 Commons Chamber

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

One of my constituents, Mrs Collette Pridmore has three children, one of whom—her son, Jacob— suffers from a rare lung disease. Jacob is just eight years old. When Collette got in touch with me, she was extremely worried about her son’s future because she had discovered that the care Jacob receives at the Royal Brompton hospital in London was under threat. Because of the serious nature of his condition, little Jacob needs to spend many weeks each year at the Royal Brompton, where specialist clinical teams have the necessary skills to help him.

Collette suggested I visit Jacob at Royal Brompton and during my visit she arranged for me to meet the doctors and nurses who care for her son. To say that I was impressed would be an understatement. I am sure that many right hon. and hon. Members will know of the good work done by the Royal Brompton, but for those who do not, let me explain something about the services they provide.

The respiratory children’s unit at the Royal Brompton treats some of the most vulnerable children in our country—those with serious lung disease and breathing problems. The Royal Brompton is home to the country’s largest children’s cystic fibrosis unit and the hospital’s experts treat children with muscular dystrophies, severe drug-resistant asthma and a range of other respiratory conditions. These conditions are quite rare, but the concentration of clinical expertise in one place means that knowledge is accumulated and shared, creating the best possible conditions for the care of children such as Jacob. The hospital also carries out research with Imperial college constantly to improve the treatments available.

My visit to the Royal Brompton was inspirational. I saw the very best that the NHS has to offer—the best specialist skills and an incredibly caring environment. These services provided by the Royal Brompton, however, are now at risk. Why? In one word—reorganisation. The threat to close the Royal Brompton’s children’s respiratory services is really not the finest hour for health service reorganisations. This is not an academic exercise; it is about the future welfare of some pretty sick and vulnerable children such as Jacob.

Unfortunately, Jacob’s doctors do not think they will be able to carry on caring for him in the long term, because their intensive care unit is being closed. Without the back-up of intensive care, they will not be able to offer the expert services they do now, because they think it will be unsafe to do so. So why is the intensive care unit being closed? Is it to save money? Is it because it is not a very good unit? Is it because no one needs it? The answer is none of those.

On 4 July this year, a committee of primary care trust chief executives, as part of the reorganisation of children’s heart services in England, made the extraordinary decision to end children’s heart surgery and intensive care at the Royal Brompton. As one of the best-performing and largest centres in England, many Members will have had constituents who have been treated there. The proposed closure will have severe knock-on effects on children’s respiratory medicine.

Although not all Royal Brompton’s young patients need the intensive care unit, many do need it should they deteriorate very quickly. Sadly for Jacob, this has happened to him on several occasions. Jacob’s doctor, Dr Claire Hogg, told me that without an intensive care unit on site, her only option, if Jacob became particularly unwell, would be to try to get him to the specialist intensive care unit at another London hospital which, depending on traffic, could be up to an hour away. To a sick little boy or girl, this could be a lifetime away—quite literally.

A couple of weeks ago Collette Pridmore brought some of the Royal Brompton’s doctors to visit me here. I was shocked by what I learned. Dr Duncan Macrae has discovered that new figures published after the review of children’s heart services took place show that the rate of population increase, particularly the child population, is far greater than previously estimated, most specifically in London where the child population is increasing at almost twice the national average.

This decision, leaving just two centres to offer children’s heart surgery for London and the south-east, was taken using 2006-based national population projections, which have been shown greatly to underestimate the numbers. Equally worrying is the recent data from the UK central cardiac audit database, showing that the number of children having heart operations is increasing year on year. How, then, did the review of children’s heart surgery, using out-of-date statistics on both population growth and the number of children needing surgery, come to the conclusion that London and the south-east can manage with two rather than three children’s heart surgery centres?

The review decided that the Royal Brompton should close its specialist centre and intensive care unit, despite the fact that the hospital is one of the biggest and best centres in the country. Scandalously, the intensive care units and children’s heart units at the other two London centres do not currently have enough beds for Royal Brompton patients, and at least one of them will have to spend large sums of money building new facilities. At a time when the NHS is strapped for cash, that alone is a good reason for reversing the decision to close the Royal Brompton hospital.

The proposed closure is not the result of Government policy. That is not to say, however, that the new Health team, now led by the Secretary of State for Health, my right hon. Friend the Member for South West Surrey (Mr Hunt), cannot intervene. I very much hope that Ministers will agree to meet me and some of the medical staff from the Royal Brompton to discuss our concerns and to see what can be done to reverse this crass decision.

--- Later in debate ---

[Dr Poulter]

I accept that the Secretary of State has always had responsibility for the health service, and that was implicitly made clear in the Health and Social Care Act 2012. It is, however, important that we no longer have a system in this country that micro-manages the delivery of local health care services. We must listen to local doctors and nurses, and put them in charge of the configuration of local services because they are often the best advocates for the needs of local patients. Reconfiguring local services should be led—as per the four tests I outlined previously—on good clinical grounds where there is a clinical case for reconfiguration and where local communities have been consulted. That is something we should listen to and we must move away from the Whitehall micro-management of local health care delivery.

[Gordon Henderson]

Will the Minister give way?

[Dr Poulter]

I will give way one more time, and then I will make some progress.

[Gordon Henderson]

Does the Minister accept that local people wanted Royal Brompton hospital to be kept open, and that the decision to remove the intensive care unit was not taken by local people? The Minister is arguing against himself.

[Dr Poulter]

The initial process for the reconfiguration was started, I believe, by John Reid when he was Secretary of State in 2002, after listening to evidence at the time. We should remind ourselves why we are discussing congenital heart services. All speakers have accepted the principle that there is good clinical evidence—acknowledged by doctors and specialists—that having fewer units actually delivers better care for patients. That was accepted by my hon. Friend the Member for Pudsey. I am not going to go into the rights and wrongs of individual units as that is under judicial review and I will not be drawn further on that point today.

Oral Answers to Questions

Gordon Henderson Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Speaker]

I am grateful to the Secretary of State, who has put the position very explicitly on the record.

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

T2. The coalition agreement states:“Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.” That being the case, can my right hon. Friend explain why, despite national clinical guidelines, GPs in my constituency face financial penalties if they do not meet targets for reducing the cost of the drugs that they prescribe?

[Mr Lansley]

I am grateful to my hon. Friend, and I understand that Kent and Medway primary care trust is working to incentivise the optimisation of medicines usage. We provide advice through the National Prescribing Centre and in other ways, and we support that work with GPs through the structure of the quality and outcomes framework. However, this is about incentivisation for best prescribing practice, not about financial penalties.