Healthier Together Programme (Greater Manchester)

Graham Stringer Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Mrs Linda Riordan (in the Chair)]

Before the debate starts, I should say that I will allow gentlemen to remove their jackets.

[Graham Stringer (Blackley and Broughton) (Lab)]

Although it is the last day of term, it is still a pleasure to serve under your chairmanship, Mrs Riordan.

I am going to be critical of the Healthier Together programme, but one facility that it does have, of which I was unaware until about half an hour ago, is the gift of prophecy. It has just put out a press release in response to what I am about to say, which is particularly clever because I have not yet fully decided what to say. Although the programme has failed in many ways, it clearly has attributes that most of us do not have.

As it stands, the Healthier Together programme is both a shambles and a charade. I shall start by talking about the shambles. So far, more than £4 million has been spent on the process leading up to the consultation. Some of that money has gone on producing 200,000 leaflets for the consultation, which started two weeks ago. Unfortunately, as far as I am aware not a single one of those leaflets is yet in a public library—there were certainly none in the library near my office in north Manchester when I checked an hour or so ago, and I cannot believe that that library has been discriminated against. That is a failing of organisation.

That is not the only such failing. The website is complex and not easy to navigate. If someone can find the consultation document, they can download it, and they will find that at the end it says, “Please fill in the questionnaire opposite”. But there is no questionnaire opposite; it is elsewhere. If someone can continue to struggle through the website they can find it, but it is not where it is supposed to be.

I am not the only person who is critical of the consultation. The University Hospital of South Manchester wrote to me to say that the proposed changes are incomprehensible and full of NHS jargon. That is an improvement on the previous document that was produced, which was totally and completely incomprehensible. The more recent document varies between NHS jargon and “Janet and John” talk, which is almost as meaningless. There are phrases in speech bubbles saying:

“Knowing the council and the NHS will work together to look after mum.”

There is no reasoning or line of thought, just nice ideas about things that we would all hope the NHS would do. The University Hospital of South Manchester also criticised the fact that the consultation meetings—the proposed engagements, some of which may have already happened—all take place during the day. That means that the vast majority of people of working age cannot attend.

It is not only me and other members of the public who are greatly concerned about the proposals; as far as I can see, there is little clinical support for them. The chief executive of Wrightington, Wigan and Leigh NHS Foundation Trust, Andrew Foster, said that there is

“a lack of widespread support for the consultation process”,

and he went on to say stronger things as well. I have been sent information from a GP survey showing that almost 50% of GPs are concerned about the process and certainly do not support it in its current form. The University Hospital of South Manchester says that the process is “flawed and misleading”, and

“not an integrated care consultation…but rather a consultation on changes to a small number of acute providers”.

Healthwatch England has been very critical of the process, because until March this year all meetings took place in secret. It has been allowed to attend meetings since March, but, as I will explain later, many decisions had already been taken by that point. I would be interested to hear the Minister’s response to a more worrying point: according to Healthwatch England, the Healthier Together body—the combined committee of the commissioning groups—has no power to spend until the draft Legislative Reform (Clinical Commissioning Groups) Order 2014 is passed, and that has not yet been passed by either House. I would be interested to hear whether there will be a power to spend or to go ahead with the proposals, although I would be surprised if the proposals were not challenged.

There is not only the problem that legally, perhaps, the £4 million should not have been spent; the consultation document also refers time and again to hospitals co-operating with each other. However, the competition authorities ruled that the attempt by the Royal Bournemouth and Christchurch hospital and Poole hospital to work together was unlawful. If, after the consultation, it is decided that the proposals will go ahead—I hope that it is not—will they be lawful? Behind all that, £4 million may have been spent unlawfully, and could have been better spent on nurses, doctors and the health of people in Greater Manchester.

I turn to the charade aspect of the Healthier Together programme. It is a charade in many different ways. Who is conducting the consultation? The document contains statements from the chair of the Association of Greater Manchester Authorities, Lord Peter Smith, and from a number of doctors on the clinical commissioning groups, but if one looks deeper, one finds that a large multinational corporation called Mott MacDonald is involved but not declared. It has all sorts of consultancy interests in areas ranging from engineering to private and public health care. Why were we not told?

Part of the charade is that we are not told who is conducting the consultation, but the real charade is that a number of decisions have already been taken before the consultation has gone out to the public. The document itself does not show to the public the configuration of health services as they currently are in Greater Manchester; it presents a number of decisions that have already been taken without any form of consultation. I will return to that point later.

It is also unclear what the consultation is about. The University Hospital of South Manchester said that it thinks it is about the reorganisation of acute care in hospitals. I do not think that it is. It is not clear—it is muddled—but it could be about primary care, because there is talk of more GPs and more access to primary care services. There is no financial plan for that and it is not clear how it would happen, which is not a bad thing in itself, but it is mentioned in the consultation document without it being clear what anyone is expected to say about it, apart from their wanting better care for their relatives, mother, sons, daughters, wives or anyone else.

There is an absence of financial information in every part of the document, not just the primary care part. So is it about money? It is indicated and implied that there is not sufficient money. The background document makes it clear that, within two-and-a-half to three years, there will be a £1 billion, or 16%, black hole in Greater Manchester’s health budget of £6 billion. Is the consultation about that—it certainly is not clear—or is it a south Manchester thing? Is it about hospital reorganisation? If it is about hospital reorganisation, creating more specialist hospitals and downgrading some hospitals, why were we not consulted?

Fairfield hospital in Bury, Tameside hospital and North Manchester hospital have been downgraded to so-called community general hospitals, but that is not in the consultation. We are told that we are going to get almost immediate access to GPs, but there is no mention of what has been happening in the health service in Greater Manchester over the past few years. Fifty per cent. of the walk-in centres in Greater Manchester have been closed down, and they gave people immediate access to a GP. They have closed, but the Government are talking about improvements.

The Government are talking about improving care in the community, and specialist nurses would certainly help to keep people out of hospital and reduce costs in the long term, yet when I put in a freedom of information request to Tameside metropolitan borough council, half a Parkinson’s nurse was available for the whole of Tameside, which is shocking. One can go through the other specialist nursing services and find the same. Why have we not been told the proposals for those specialist nursing services, which are vital for keeping people out of A and E and out of long-term care within hospitals?

The proposals are a charade. In the original consultation, and when the Healthier Together people had a meeting with Greater Manchester MPs, we were told there was a guarantee that no hospitals or A and E departments would close. Why is that missing from the consultation document? Why is it not still a commitment? When the commitment was given, I did not believe it because I do not believe, when there is a looming financial crisis in the NHS in Greater Manchester and across the country, that any group of medics or health bureaucrats can guarantee that hospitals will stay open. A 16% gap is looming in the care and health service budget, and the gap might get bigger. That is equivalent to two or three hospitals in financial terms. We were given that guarantee yet, arrogantly, three hospitals have been downgraded without any consultation.

A similar guarantee was given when maternity provision was taken out of Hope hospital during a review five or six years ago. It was guaranteed that a midwife-led maternity service would continue in Hope hospital, but there is currently a consultation on removing that service. Those of us who have been discussing, debating and arguing with the health service for some time about the provision of services are sceptical about all guarantees.

There is also an ongoing trauma review in relation to Wythenshawe hospital, yet Wythenshawe hospital is being downgraded. It is an extraordinary decision to say, “We will have this discussion, but we have already taken some decisions. We want to know what should happen to these hospitals but, although two other major service reviews are ongoing, we will completely ignore them and not mention them at all in the consultation document.”

I am sure my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) will want to mention Wythenshawe hospital, so I will not steal his speech. I am an ex-chair of Manchester airport, and downgrading Wythenshawe hospital from its grade 1 status is appalling because it has the nearest A and E unit to Manchester airport. If there was an unfortunate air crash, people would want to go to the nearest hospital. The downgrading of Wythenshawe hospital is another extraordinary decision.

We have been here before with such consultations. At the moment, the Healthier Together people are saying that there is 98% support on Twitter for the proposals. They are in a feedback loop in which they are twittering to themselves, and we know what the Prime Minister thinks two twitters make. We were in exactly that position on the congestion charge. When the people running the scheme ran opinion polls and consultations, they all showed huge support for the congestion charge—anyone who talked to anybody in Greater Manchester would have found that support unbelievable—and of course when it came to putting crosses in boxes in the referendum, 80% were against the congestion charge. That is exactly the position we are in at the moment. There is an unreality about the people who are doing this, and they are trying to fiddle things. This is a scandalous fiddle.

At the end of the debate, I do not want to be accused of pretending that there are no real problems—there are. I have mentioned the financial problems, and there are also the differences between Greater Manchester hospitals. Given the survival rates for similar operations, people are clearly better off in some hospitals at certain times of the week. People are clearly better off in other parts of the country than in some Greater Manchester hospitals. That needs to be put right, but the consultation will not do that. We need to consider why there are problems—it is not just about recruitment, although recruitment is part of the problem—and try to solve those problems, rather than wishing them away with yet another reorganisation of the health service.

I could give more examples, but time is limited. The current booking system in Greater Manchester must waste many millions of pounds a year. The NHS authorities regularly criticise patients who do not turn up for appointments, but they do not criticise themselves when they fail to organise appointments properly. From the past 12 months I can give five examples from my close family, and from my constituency casework, of where the booking system has been appalling. I know of people who have been sent to closed service centres in hospitals and people who have been told that the plaster on their arm would be examined to see whether it has set when, in fact, the plaster should have been taken off. I could go on about the booking system’s failings. Addressing those failings would save millions.

Cleanliness is not a cost issue directly, but it is a health issue, and there is a massive difference in cleanliness levels both within hospitals and between hospitals, which could be addressed. There could be improvements in other areas. There are big decisions to be made on hospital configuration, finances, how much money should be put into primary care and the structure of the health service. Those questions will not be addressed by the current process. There are genuine differences between the Labour and Conservative parties on how those issues will be resolved, and those differences will be resolved at the general election.

The process is trying to do two things. First, it is trying to usurp the political process at the general election, when those big decisions will be taken. Secondly, it is asking for a blank cheque. If the Government put out such a rubbish consultation document that people do not know whether it is about primary care, secondary care or hospital reorganisation, and if Healthier Together is already saying that it has 98% support, what do they want to do? They are asking for a blank cheque to do whatever they want, and it should not be given to them.

I will finish with another quote from University Hospital of South Manchester, which I completely agree with, although I would add other things to it:

“Wait until the trauma review is finished and do the consultation properly.”

In other words, withdraw this consultation, do it properly, wait until the review of maternity and trauma services is in, wait for the general election and then we can have a serious, proper and grown-up discussion about how we can make health services in Greater Manchester better.

--- Later in debate ---

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I thank my hon. Friend the Member for Blackley and Broughton (Graham Stringer) for securing the debate. It is particularly useful that we can express our views before the summer recess. I do not want to speak for too long. I will echo my colleagues’ sentiments about the quality of the consultation process, but I want to give a view from the eastern part of the conurbation, Tameside, and make a couple of additional observations.

A lot is going on with the NHS and health care in Greater Manchester at the moment, so the timing is not very conducive to running such a consultation. The changes to Trafford A and E have already been mentioned. Passenger transport has been privatised from the NHS ambulance service to Arriva. Most of the walk-in centres that I am aware of have gone. I do not know about the situation in other constituencies, but in mine GP access is a huge issue—people regularly wait a fortnight for access to a GP in Stalybridge. Of course, in Tameside there are particular challenges because of the Keogh review in Tameside hospital. All the Tameside MPs warmly welcome that. It has been a positive process enabling a light to be shone on many of the things that we have been discussing for several years. However, when all the factors I have mentioned are added together, it is a difficult time to carry out a consultation on any part of the NHS and particularly on hospitals, because the public are most sensitive about them in many ways.

I understand the need for specialisation. I echo the remarks of my hon. Friend the Member for Stretford and Urmston (Kate Green). Even if we had substantially greater resources, it would be difficult to recruit the people we would need to meet the standards now required for hospitals in the conurbation. With the financial modelling that has been done in Tameside, we are perhaps a little more advanced in our forward projection work than some other boroughs, and I think that we are in a perfect storm. We have had to spend a lot of money at the hospital to try to meet the higher standards that people should expect by correcting some of the processes that the Keogh review highlighted as wrong. On top of that, the council was always one of the leanest in the country, let alone in Greater Manchester, so it suffered the worst from the severe reductions made by the coalition in northern local authorities. Our clinical commissioning group is in a relatively good position, but clearly it is not to anyone’s benefit simply to use that financial picture to prop up other parts of the system that are not working so well.

History will be hard on the coalition for prioritising such a big ideological reorganisation at a time when the figures show that the situation I have described is the challenge that incoming Health Ministers should have concentrated on. The promise that no A and E departments in our hospitals will close is welcome news, but I wonder whether the scale of the rhetoric around Healthier Together justifies or validates that promise. Either we shall not produce the results that have been promised, or that promise on the long-term future of hospitals and A and Es may not be honoured in the way we expect.

[Graham Stringer]

My hon. Friend is right to say that that commitment was given when we met the Healthier Together people and in some background documents. Does he agree that it is worrying that it is not in the consultation document, whatever credibility we give to the commitment itself?

[Jonathan Reynolds]

I do agree. That is a matter of extreme concern to me. My understanding is that we have been given a cast-iron pledge that there will be no hospital or A and E closures as part of Healthier Together. The problem with all hospital reconfigurations anywhere—it happened with the maternity services consultation—is that they always appear to people to be about cuts. It is hard to get across the argument that they are about improving services. There is some mixed messaging about the primary outcome of such a process.

My principal problem with specialisation is the one that arises with specialisation in any field. Greater Manchester’s geography makes it hard to get from one borough to another. Public transport and the railway system are not configured to operate in that way. I should love the opposite to be true—if we had the resources and local autonomy to make public transport work differently. That will come one day, I think, but it is not true at the minute. I did not by any measure expect to become an MP in the 2010 general election, and my daughter was booked in to be born at St. Mary’s, because I worked in the centre of the city and it was easier to have appointments there than to get back to Tameside for them. Frankly, we were concerned about the possibility of labour starting in Tameside at the wrong time, because of the journey to get to St Mary’s and what that might mean. I think that that would be the same for many people, whatever the health issue: the journey is not easy in a car, but by public transport it is almost untenable. That would be people’s primary concern when they thought about the outcome of such a consultation

--- Later in debate ---

[Norman Lamb]

To be fair, when I indicated earlier that the issue is about process, the hon. Lady came back at me—as is her right—to say that it is not just about process but about the model of separating specialisms from general hospitals. I therefore quoted what the shadow Secretary of State for Health had said in that regard.

I turn to the specific case raised by the hon. Member for Blackley and Broughton in this debate. Healthier Together was launched by the NHS in Manchester in February 2012 and is part of the Greater Manchester programme for health and social care reform, which seeks to improve outcomes for all Greater Manchester residents. The scheme is substantial, involving 12 CCGs and 12 hospital sites across Greater Manchester. As the consultation sets out, the case for change aims to improve access to integrated care and primary care, community-based care and in-hospital care services, including urgent and emergency care, acute medicine, general surgery and children’s and women’s services.

The House should appreciate that although those are the services being looked at, there are interdependencies with the core in-hospital services, including anaesthetics, critical care, neonatal services and clinical support such as diagnostic services. Changes in one area might have consequential effects elsewhere, as hon. Members have pointed out, and those effects have to be fully understood.

I should also repeat that the proposed changes are not a top-down restructuring. They are led by local clinicians who know the needs of their patients better than anyone. They believe that the clinical case for change—

[Graham Stringer]

Will the Minister give way?

[Norman Lamb]

I am conscious that I have only three minutes left. I have tried to be generous.

Local clinicians estimate that across Greater Manchester around 1,500 lives could be saved over five years as a result of implementing the proposed changes; that is not my assessment, but that of local clinicians. That would be an impressive improvement in health care, touching and affecting the lives of thousands of ordinary people—not only the individuals concerned, but their families and friends. It is because of the area’s current performance: if all trusts in Greater Manchester achieved the lowest mortality rates in the country, the CCGs believe that the number of deaths in Manchester could reduce by some 300 per year, equating to saving 1,500 lives over five years. That is an objective that we should all sign up to.

I am sure hon. Members will agree that it is not an unrealistic aim for hospitals in Greater Manchester to want to be the very best in the country. I am also sure all hon. Members want the very best for their constituents. Greater Manchester has some of the best hospitals in the country. However, not all patients experience the best care all of the time. In particular, the consultation sets out evidence that suggests that for the sickest patients who need emergency general surgery, the risk of dying at some Greater Manchester hospitals might be twice that at the best hospitals. That is simply not acceptable.

There is a shortage of the most experienced doctors in services such as A and E and general surgery, leaving some hospitals without enough staff. Only a third of Greater Manchester hospitals can ensure a consultant surgeon operates on the sickest patients every time; similarly, only a third can ensure a consultant is present in A and E 16 hours a day, seven days a week.

Healthier Together aims to ensure that all patients receive reliable and effective care every time. The programme is endorsed by the independent National Clinical Advisory Team, which offered strong support for the programme’s ambition, vision and scope, as well as its impressive public and clinician engagement. The NCAT felt that the programme’s approach was an exemplar of how the NHS should try to improve safety, value and sustainability.

I have not had time to say everything that I wanted to. I am conscious that hon. Members raised specific issues that I should respond to and am happy to write to all Members who have taken part in the debate. I hope my remarks have been of some help.