Tolls on the Mersey Crossings

Debate between Helen Jones and Derek Twigg

Tuesday 5th December 2017 Westminster Hall

[Helen Jones]

My hon. Friend is right about the decisions taken and the concern about traffic flows. Does he agree that evidence is now appearing that the tolling on the bridge is increasing traffic flows through Warrington, which is already very congested? And that is after the former Member for Warrington South appeared in the 2015 election in front of a big banner saying, “No tolls”, so people rightly feel aggrieved.

[Derek Twigg]

My hon. Friend makes an important point. There is increased traffic going through Warrington, which was always expected, and that is causing further congestion. Again, it comes back to this: if a bridge is tolled, some traffic will try to find an alternative route. How long that will go on for, I do not know, but it is having an impact.

The reality is that we needed a new bridge. The Silver Jubilee bridge was congested, its capacity was far exceeded, and it was having an effect on investment in the borough because people were regularly queueing to get over the bridge. Sometimes, if a vehicle broke down or there was an accident, people could be there for hours. There was a regular queue of traffic going over the bridge. It is in need of major repairs as well, which is why it has been shut for about a year to carry out the repairs. Imagine closing that bridge with no other bridge in place: there would be chaos not only in Warrington, but all round the north-west. The fact that the bridge was needed is indisputable, and we need to understand that.

There is also an issue of pollution. Communities around the Silver Jubilee bridge had to cope with all the pollution of standing traffic and huge traffic increases. There was no doubt in my mind about the need for a bridge, but as I say, I want an untolled bridge, as do colleagues. However, we have this situation at the moment, and I look forward to hearing what the Minister will say.

As part of the discussions that I had, I met George Osborne, the former Member for Tatton, along with colleagues Graham Evans, the MP for Weaver Vale at the time, David Mowat and Andrew Miller. My primary aim in having that meeting was to argue that, for Halton people, it is their local road. They use it to go to the hospital, to work and to the train station, to go shopping and simply for normal business. I do not know anywhere else in the country where a borough has a tolled road that people have to cross to get to another part of the borough. It simply does not exist. It would be totally unfair.

George Osborne eventually accepted my argument and agreed that residents in Halton should be able to travel toll-free. He put out a press statement in July 2014 to announce that. I will make this clear for the Minister. The Treasury press release stated that the bridge

“will be free to use for all Halton residents”,

with

“a small charge”

for registration. It stated:

“The extension of the discount scheme will...apply to...categories of vehicles included in the existing discount scheme.”

I have written to the Department on numerous occasions because around 425 residents in Halton are in bands G and H and, because of the discount scheme, are excluded. The fact is that George Osborne—the Treasury—said that all residents would be able to travel free. I keep getting letters back from the Minister quoting the issue about the local discount scheme, but it is not quoted here. It is clear.

I also wrote to George Osborne, and on 5 December 2015, he wrote:

“I am happy to confirm that as the Government has previously announced, tolls for Halton residents will be free once the Bridge opens.”

That is very clear. There are no ifs or buts, and no mention of excluding people in bands G and H. It is totally unfair for people in bands G and H to be denied the chance to travel free, albeit with a small charge, across the borough. Why should they have to pay? It is completely unfair and not reasonable. I hope the Minister will go away and look at this matter again, because the policy should be changed. Not all of the people in bands G and H are cash-rich. In some cases, people are not on great incomes, but that is not the point. In principle, they should not have to pay. I hope the Minister will look at that issue.

On small businesses, the then Chancellor made a statement—my hon. Friend the Member for City of Chester (Christian Matheson) referred to that. I have the press coverage here and witnesses heard him say this. As well as extending the scheme to Cheshire West and Chester, and Warrington, the then Chancellor said there would be “a special scheme” to help small businesses. He added that if firms paid nothing, taxpayers could pick up a higher bill, but he said that there will be a scheme to help small businesses. Of course, once he went, the promise to Cheshire West and Chester, and Warrington, was ditched, so I wrote to Ministers again. Halton businesses have the same issue as residents because they use the bridge a lot more. It is their local base. Again, the Minister wrote back and said there was no way that could be done, and this time used the argument about state aid rules.

I got in touch with the Library to do some research, and the Library believes there is a way of helping at least some small businesses by having a scheme in Halton. Again, the Government have ignored that, after a promise made by the former Chancellor of the Exchequer. I hope the Minister will look at that as well.

Another issue raised regularly with me is about businesses in Halton that might suffer as a result of paying the extra tolls, particularly if they are transport-heavy, such as haulage and delivery companies. Also, the constituents of my hon. Friends here today travel in and have to pay the toll. Some businesses tell me they are fearful of losing experienced and skilled staff who might go elsewhere because they do not want to pay the £1,000-a-year toll. The Minister needs to look at that issue, which has been raised with me by several companies.

The Minister needs to look seriously at some of the promises that were made and should revisit them. Although I want free tolls for everybody, the key issues for me are my constituents in bands G and H, small businesses, staff travelling into Halton and the impact on businesses. Most businesses think faster speed and lack of congestion are great. They are happy with that, but some have expressed concern about paying the toll.

Brain Tumours

Debate between Helen Jones and Derek Twigg

Monday 18th April 2016 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

I beg to move,

That this House has considered e-petition 105560 relating to funding for research into brain tumours.

It is a great pleasure to be here under your chairmanship, Sir Edward, and to see so many colleagues present for this debate on funding for research into brain tumours, which was the subject of the first report by the new Petitions Committee.

We began this inquiry in response to a petition that was started by Maria Lester, whose brother, Stephen Realf, died following a brain tumour. It is fair to say—I think my colleagues would agree—that we began in a state of ignorance. We did not know a great deal about brain tumours or their impact, but, as we proceeded with the inquiry, we were humbled and shocked. We were humbled by the people who came forward to give evidence to us, whether in person, in writing or on the web; it is a measure of the interest in this topic that we received more than 1,100 posts on our web thread in 10 days. All those people had been either directly or indirectly affected by brain tumour and wanted to use their experience to improve other people’s chances. We were also shocked at the number of life years lost to this dreadful disease, the impact on children and the pitifully small amount of research funding devoted to it.

For that reason, we have made our report slightly different from some Select Committee reports; there are many individual stories in it and pictures of those affected. That is because we want to make it clear that this is not just a matter of statistics. Real lives, real people and real families are affected, and they are let down at almost every stage of the process, because, despite the excellent work of the doctors in this area, the system is underfunded and not properly structured, and has been so for years. That is our collective failure, because the neglect has gone on under different Governments, even though brain tumours are the biggest cause of cancers in children and in the under-40s. They account for between 15% and 25% of cancers in the under-25s and, if we look at the statistics overall for all age groups, we see that about 60% of cancers involve the brain at some stage, meaning that there has to be treatment for that if people are to recover. Because of the age groups that are generally affected, the number of life years lost to this cancer is greater than for any other cancer, and, of course, when children are involved, the situation is particularly tragic.

A number of parents came forward to tell us what had happened to their children. A number of those children suffered from a type of tumour called diffuse intrinsic pontine glioma, or DIPG, which is almost universally fatal. In this country, a child is diagnosed with one every nine days, yet few people have even heard of it. I suggest that, if they had, there would be much more pressure to increase funding for research in that area.

Those who survive, whether children or adults, face a huge burden from this disease. Many survive with serious disabilities, including physical disabilities or other things such as memory loss, personality change or cognitive disorders. Because of the huge burden of the disease, in terms of life years lost and significant disabilities among those who survive, we have made the recommendations that we have and we believe that it is time for a step change in how we deal with this most awful cancer.

That change has to begin, of course, with diagnosis, with which there are major difficulties. GPs may see only two or three cases in their professional lives, and in its early days brain tumour can mimic the symptoms of other diseases. However, 61% of people are diagnosed in A&E when they reach a crisis. We heard time and again from people who went back to their GP and went back to other doctors, often knowing that something was seriously wrong with them or with their child, but they were still not able to get a diagnosis. I suggest that we would not accept 60% being diagnosed in A&E for any other cancer and we should not be accepting it for this one.

Early diagnosis matters, because it affects the treatment options and the outcome. If we were able to diagnose people earlier, more would survive, especially among children, and there would be better outcomes for patients, with fewer survivors left with significant disabilities. That is why, I say to the Minister, we were concerned to note that the Government’s Be Clear on Cancer campaign did not include brain tumour. We understand that that is because the number of life years lost is not taken into account in deciding which cancers are included, and we believe that has to change.

There are important things happening. For example, the HeadSmart campaign, which seeks to raise awareness among GPs and lists the symptoms that can be seen in different age groups, has managed to improve the time taken between people presenting to their GP and diagnosis. Again, however, we are concerned that the guidelines issued by the National Institute for Health and Care Excellence in 2015 do not include lists of different symptoms for different age groups. We think that needs resolving.

[Derek Twigg (Halton) (Lab)]

Why does my hon. Friend think that NICE guidelines did not take that into account and include the information that we feel should be included?

Vascular Services (Warrington)

Debate between Helen Jones and Derek Twigg

Monday 28th November 2011 Commons Chamber

[Helen Jones (Warrington North) (Lab)]

I am very grateful to have the opportunity to discuss vascular services in Warrington, and in particular the decision not to locate a vascular centre there. The review of vascular services conducted by the NHS in Cheshire and Merseyside was fatally flawed. It has no proper evidence base. It failed to engage clinicians in Warrington and Halton and it demonstrated a singular lack of transparency. It failed to adopt the open and transparent procedures used elsewhere and instead held only two meetings—one for staff and one for the public—to cover the two counties. The survey it carried out was on the internet, thus excluding many of the people in the centre of Warrington and in Halton who do not have internet access. The conclusions it drew from that survey were rather bizarre. Although people said that they valued safety first, it does not mean that the position adopted by Cheshire and Merseyside NHS makes things safer. Anyone who follows that flawed logic should not be conducting a review of services in the first place.

We have been left with a decision that will damage service at Warrington and Halton Hospitals NHS Foundation Trust and dismantle the partnership working that has been built up with St Helen’s and Knowsley NHS Trust over the years. It has left unanswered some serious questions about co-dependent services and about possible increased risk and mortality elsewhere. This is a shabby little stitch-up that cannot go unchallenged. If the Minister wants to champion local decision making, it is his duty to ensure that those decisions are properly based on evidence and are reached through due process. That has not been the case here.

This review started by looking at “evac” procedure. It then mutated into a review of vascular services as a whole. It is never a good sign when that sort of slippage occurs. The review then decided that any centre must carry out a minimum of 50 open aortic aneurysm repairs and 100 carotid endarterectomies. Where is the evidence for these figures? The Royal College of Surgeons has never recommended them and many other centres operate using different minima. The suspicion is that the figures were chosen to bolster the case for two centres rather than three, yet Great Manchester will have three, as will Cumbria and Lancaster. Unless the Minister is prepared to argue that centres operating on different minima are unsafe—I do not believe that he is prepared to argue that—there is no evidence base for these figures.

[Derek Twigg (Halton) (Lab)]

I congratulate my hon. Friend on securing this debate and on making an excellent speech. She said that the Minister will probably argue that this is a matter for local decision making but she has shown that there is no clear evidence base, so one would hope that the Minister would ensure that the matter is reconsidered.

[Helen Jones]

My hon. Friend is right. I want to come to some of the other evidence and how the review was carried out. The decision was eventually taken that one centre would be located in Liverpool and one at the Countess of Chester hospital. Originally, the review panel allowed both Liverpool and Chester to take away their submissions and rewrite them from June until October, but it did not allow the same leeway to Warrington and Halton NHS trust. After protests from overview and scrutiny committees, it allowed them only seven days. That is not a fair process.

It is also clear that the review panel originally had reservations about locating a centre at Chester in partnership with Wirral university hospital. It said that

“there were a number of outstanding questions about how the proposed arterial centre would work clinically”.

However, when we asked how those clinical problems have been resolved, answer comes there none.

There were other questions about the skills base, co-dependent services and possible increased mortality rates elsewhere, which it is clear from the impact assessment carried out for Warrington have not been resolved. We were left with the decision to base a centre at Chester—a decision that, I understand, was queried even by its partner at Wirral university hospital NHS trust—that has been designated the south Mersey centre. I have to tell the Minister that I was born and bred in Chester, and it is not on the Mersey but on the Dee, and it is difficult to get to it from elsewhere in the region.

The result of this decision is that centres are concentrated in a relatively small area—one in Liverpool, one in Chester and a satellite one in the centre of the Wirral. There is nothing in the review for those who live in north or east Cheshire, and as a result emergency patients from the Warrington area will now have to travel 30 miles by emergency ambulance instead of the maximum eight miles as before. Those who wish to travel by public transport will, because of the different combinations of buses and trains, be facing a journey of three to four hours. That is important because car ownership in Halton and the centre of Warrington is lower than the national average—people are reliant on public transport.

The questions about access, which were deemed to be important, have not been resolved but there are other troubling issues. It seems that the review—based, after all, on flawed evidence—will form the basis for decisions on other specialties. For example, the review stated that it was highly desirable, if not essential, that hyper-acute stroke units be located with vascular centres. That indicates that Warrington’s chances of getting these services in the future are limited. However, the review also undermines existing stroke services in Warrington—services that are highly rated and delivered in partnership with St Helens and Knowsley trust. If a vascular surgeon is not to be on site, those stroke services will be undermined.

The same is true of trauma care. The review thought it desirable that in the future trauma centres be co-located with arterial centres. That would seem to be pre-judging where those services will be located in future.

As things stand, Warrington often deals with serious cases because it is at the centre of a motorway network. Many will need a vascular surgeon, as well as other specialties. The response from the review was that patients could be stabilised by a general surgeon and that a vascular surgeon would be on site within 30 minutes. Frankly, anyone who knows Warrington’s traffic will know that that is absolute nonsense. The North West Ambulance Service gave evidence to the impact assessment panel about gridlock in Warrington. If the service cannot guarantee that it can get an emergency ambulance through, there is little chance of getting a surgeon through. Indeed, I have done the journey from Chester to Warrington many times, because I still have relatives there. It is not possible to do it in 30 minutes at peak time—one has to get through the traffic in Chester, go along a congested motorway and then get through the traffic in Warrington. Where on earth have those figures come from and how have they been validated?

The suspicion is that the review has been carried out in a cavalier manner in order to fit a predetermined outcome. Indeed, there are also concerns arising from the impact assessment, because the points put by clinicians in Warrington appear to have been accepted, yet nothing has been done about them. For instance, the review panel received evidence that the vascular services in Warrington were well developed and had worked over 10 years in partnership with St Helens and Knowsley trust. The panel accepted that it was desirable to maintain that partnership and that disrupting it was contrary to practice elsewhere in the NHS. The panel said that it hoped that the partnership would be maintained. However, the clinicians in the St Helens and Knowsley trust had already given the panel evidence showing that it could not be maintained if the recommendations of the review were accepted, because transfer times and transport difficulties would mean having to partner with Liverpool.

Similarly, the North West Ambulance Service gave evidence showing that it could not guarantee ambulance response times in Warrington if it had to transfer patients from Warrington to Chester. The service’s figures were accepted by the impact assessment panel, which then said that it was drawing the matter to the attention of commissioners as a cost not yet planned for. Where will the extra money come from to fund extra ambulance services in Warrington, given that the NHS is already expected to take cuts of £20 billion? If the Minister wants to get up and promise us extra money for Warrington ambulance services, we would be very pleased to hear from him, but I do not think he can.

Similarly, the ambulance service drew attention to the fact that Warrington is uniquely prone to gridlock, because if an accident happens on the motorway system, it can gridlock the whole town. The response from the panel was that gridlock was “challenging”. Not being able to get an emergency ambulance through is not challenging; it is life-threatening. Indeed, it is really quite arrogant to dismiss the concerns of those responsible for transferring patients in that way.

However, worse was to come. The clinicians from Warrington and Halton—who, at this stage in the process, were now being consulted for the first time—gave evidence about the impact of removing vascular services on other specialities. In particular, they were concerned about the problems of ensuring support for vascular injury in other surgical procedures and invasive specialities. The panel then said that the volume of patients needing to be transferred could become “unmanageable”. It also said that the number of patients whose services would be disrupted might be greater than the small number who would see an improvement. All that was asked of the review panel was that it should publish its evidence at the same time as its implementation plan. Frankly, that is the wrong way round: if the evidence is not there, there should not be an implementation plan to start with.

--- Later in debate ---

[Derek Twigg]

My hon. Friend is most generous in giving way again. I am sure that she will discuss this further, but the areas covered by the two hospitals—Whiston, Warrington and Halton; and Knowsley, St Helens and the centre of Warrington—are some of the most deprived boroughs in the country, and yet the services are being transferred to one of the most affluent parts of the north-west. Does she not think that an odd way to deal with populations that suffer the most ill health?

[Helen Jones]

I agree. One thing that the review appears not to have looked at properly is the incidence of these sorts of vascular illnesses and where the centres should be located to deal with them.

Another interesting issue is that clinicians told the panel that more and more patients would need to be transferred over time as a result of not having vascular services on site. In fact, one clinician on the panel expressed the view that the

“lives at risk in these situations, equalled, or outweighed those saved by the anticipated improvements.”

I have to ask what sort of service improvement it is that can put more lives at risk. Evidence was also given about the difficulty of maintaining cancer services without support from vascular surgeons—Warrington is a centre for renal cancer—about the difficulty of maintaining limbs compromised by diabetes without having those surgeons on site and about the waste of resources, with Warrington having invested in new facilities. It has the most modern vascular lab in the region and the only fully compliant one. That will go to waste if vascular services are transferred, and we will spend millions elsewhere in providing new services on another site.

In short, what we have is a proposal that breaks an existing working partnership—one that has provided highly rated services—that could harm co-dependent services, that could impact on ambulance transfer times in a way that puts other patients in Warrington at risk and that wastes services. In the end, it will seriously damage services at Warrington hospital. In fact, I am told that a consultant interventional radiologist who had already been appointed has now declined to come because of this decision. Yet an implementation plan is going ahead even before we have begun the consultation. That is no consultation at all.

I ask the Minister to look at this seriously. I will support changes in services where they can be shown to improve patient care. I cannot support them where there is no evidence that they will improve patient care and there is a lot of evidence that they will damage patient care in other specialties. The ultimate responsibility, I say to the Minister, is his. I have agreed with Mrs Thatcher on only one thing—when she said:

“Advisers advise, and Ministers decide.”

He has to look very seriously at what has been going on here and he needs to act before other services in Warrington are damaged.