Accident and Emergency Services

Iain Wright Excerpts

Tuesday 14th September 2010 Westminster Hall

[Mr Iain Wright (Hartlepool) (Lab)]

It is a pleasure to serve under your chairmanship for the first time, Ms Clark. I congratulate the hon. Member for Southport (Dr Pugh) on securing the debate, on what I think we all agree is an incredibly important topic. The Minister will be pleased to hear that I do not want to detain the House for too long, but I do want to question him on the provision of accident and emergency services in Hartlepool.

The Minister will no doubt recall that just before the summer recess we had an important debate on the provision of hospital services in the north-east, and I obviously focused on the University hospital of Hartlepool. I was pleased to hear the Minister say that, regarding the future of Hartlepool hospital,

“there are currently no plans to close it”.—[Official Report, 27 July 2010; Vol. 514, c. 232WH.]

That statement was very welcome, but less than 24 hours after the Minister had uttered it the local press leaked the information that the University hospital of Hartlepool accident and emergency services, in their current guise, would close. The manner in which that was communicated was not conducive to providing any reassurance to my constituents about the future of health services. This was all part of the proposed changes, which had their origins in the Momentum programme, with which the Minister will be familiar, with some provision being transferred to the new minor injuries unit—the One Life centre in the heart of town. That is very welcome, because more people in Hartlepool will be treated for a wider range of ailments closer to home, and it brings into play the notion of more community-based health services, which is encouraging because Hartlepool needs and deserves first-class community-based provision. However, as part of the proposals, some provision, particularly for the more serious type of case seen in accident and emergency, would be transferred about 13 miles away to the University hospital of North Tees.

As I listened to the hon. Member for Southport it struck me that the model of health care in his area—a two-site trust, in Southport and Ormskirk—is very similar to my situation in the North Tees and Hartlepool NHS Foundation Trust. Moving more serious cases to North Tees is very unwelcome as it is detrimental to my constituents. As I have previously mentioned to the Minister, I know that there is a balance, and often a conflict, between providing state-of-the-art specialist medical care in a centralised setting and ensuring that all communities have access to services. The hon. Member for Southport mentioned that in his opening remarks. For many of my constituents, North Tees is not easy to get to. It might appear to be only about 13 miles away, but it is a lot further away in many people’s perception, particular that of people who do not have access to a car. Car ownership in my constituency is below the national average. I therefore suggest that there would be a disproportionate reliance upon ambulance services. Is that appropriate? Is that what the Department wants? I am interested in hearing the Minister’s thoughts about the relationship between accident and emergency and ambulance services.

I understand that the North East Ambulance Service had not been informed in advance in July of the proposed change to A and E. The change would impose greater pressure on that service at a time when we need to be thinking about how we put pressure on public services, and I cannot suggest that the change would help to secure safe and effective access to accident and emergency services. I am also concerned that the proposed move will accelerate the closure of the hospital in Hartlepool, despite what the Minister said in July.

I, like the hon. Member for Southport, am no medical expert, but it seems to me, as I think it struck him, that accident and emergency services are the centrepiece of a modern district general hospital. Related and interconnected services such as emergency care, surgery, resuscitation units and cardiac response teams, link up to ensure that specialist teams work closely together, both figuratively and literally, to provide the highest-quality service for the patient. In many cases, depending on the nature of the complaint, a patient presenting at A and E will result in the use of more specialist and complex medical teams that complement what might have been done in A and E. Again, that is welcome.

As to what is proposed at the University hospital of Hartlepool, the potential loss of A and E would mean that more specialist teams and complex medical interventions would move away from Hartlepool. That would be at a time when there remains considerable confusion and uncertainty about the future of hospital services, as we outlined in the debate in July. As the Minister is no doubt aware—I imagine he will recall it well—a decision was made early in the Government’s life to cancel the funding for the proposed new hospital to serve the communities of Hartlepool, Sedgefield, Easington and Stockton. Whereas, before, the Momentum programme culminated in the opening of a new publicly-funded hospital in the borough of Hartlepool, the Government’s recent decision on funding means, as I said in the July debate, that there is a big risk of services migrating away from Hartlepool and failing to return—without the prospect of a new hospital.

As the hon. Member for Southport said, you cannot get much bigger and more symbolic than accident and emergency, in the matter of reassuring a community about health services. I hope that the Minister will provide more information. Does he share my fear that the loss of an accident and emergency service will put a question mark against the long-term viability of a modern district general hospital? I should in particular be interested in any guidance that his Department provides about the relationship between accident and emergency and related services in a modern hospital.

As I mentioned, all that I have described is taking place against a backdrop of uncertainty and confusion about the future of health services in Hartlepool, because of the Government’s decision. I am concerned in particular about the confusion that the movement of accident and emergency will produce. I welcome, and would reiterate, the comments of the hon. Member for Southport about what happens if there is an accident.

At the moment there is relative simplicity and understanding. Someone who has an accident can feel reassured that they can present themselves at Hartlepool hospital’s A and E. However, although I welcome the introduction of the new One Life centre, I think that adds confusion to the mix. If, say, a child has an accident and bumps their head—which has happened to one of my children—or if, as has also happened, someone drops a lead bar on their head or gets pins and needles in their left arm, what happens then? Where should a Hartlepool constituent go? Should it be to the One Life Centre, the University hospital of Hartlepool or the University hospital of North Tees? As I asked before, what happens when those people do not have a car? Should we rely on the ambulance service? Should we rely on NHS Direct to give the first pointer about where to go? I suspect there is considerable confusion about the future of NHS Direct. In my part of the world, the north-east of England, there is a new provision—the 111 number that is part of the County Durham and Darlington NHS Trust. However, that is not particularly close to my constituency. What will happen—when will that be rolled out?

In all that is happening there is considerable local disruption and national uncertainty. I am concerned that the new service will not bed in properly and effectively until people are fully reassured that they know where to take their loved ones in the event of an accident. I was taken by the point that the hon. Member for Southport made about schoolchildren. Where would a teacher go if an accident happened at a school in Hartlepool this morning? I am not convinced that the acute trust in Hartlepool has sufficiently clear and robust communication plans to enable it to provide reassurance. Can the Minister do anything else to assist?

I pay tribute to Councillor Stephen Akers-Belcher, who chairs Hartlepool borough council’s health scrutiny forum, which, in the summer, challenged and questioned the trust management on the issue in question. I am pleased that as a result of that intervention both minor and major injuries will continue to be seen by medical staff at the University hospital of Hartlepool. The scrutiny forum will closely evaluate how the proposed changes to A and E are managed. That is a good example of councillors holding the local NHS to account, which relates to the point that the hon. Member for Southport raised about the democratic deficit.

The fact remains that there is considerable confusion and uncertainty about the provision of health services and A and E in Hartlepool. While that persists it is not a good idea to move accident and emergency services away from Hartlepool. I should welcome the Minister’s comments, and hope he will ensure that despite the confusion and uncertainty he will provide my constituents with the best possible access to accident and emergency services.

--- Later in debate ---

[Mr Burns]

Sorry, the shadow Minister. I was trying to make the hon. Lady relive old glory days.

[Mr Iain Wright]

Happy days.

[Mr Burns]

Obviously they were not happy for the country, or the hon. Lady would not be a shadow Minister now. But there we are; that is life. I pay tribute to the many members of NHS staff in the constituency of the hon. Member for Southport for all the hard work that they do to provide dedicated, committed health care to his constituents and those of other hon. Members in the neighbourhood who are served by the facilities there.

This Government were elected on a platform of reform of the national health service. Our White Paper, to which the shadow Minister alluded, sets out our plans. More than any other Government in the history of the NHS, we will devolve real power to patients, GP commissioners and all clinicians working on the front line. As the NHS becomes increasingly locally led, it will become locally accountable to local authorities and health watch groups. As the White Paper unfolds and reforms are implemented, subject to current consultations, I hope that that commitment will give some reassurance to all those hon. Members who mentioned democratic accountability. Local authorities and health and well-being committees will have a significant role, in terms of democratic accountability, in a way that primary care trusts and strategic health authorities did not.