Ipswich Hospital: Orthopaedic Services

James Cartlidge Excerpts

Tuesday 7th July 2020 Commons Chamber

[Tom Hunt]

I agree with my hon. Friend. There is a national challenge when it comes to tackling waiting lists for hip and knee replacements. There is not one hospital across the country that does not have to meet that challenge, but in meeting that challenge, we need to keep services as local as possible for the people who depend on them. That is what I am arguing for this evening.

So far, neither the hospital trust nor the CCG has presented sufficient detail about how vulnerable patients will be supported in making the journey to Colchester, and the reassurances we have received about joint working and engagement with the public just do not cut it. There is major concern among my constituents about the plans, and it is no surprise that people do not support them while this crucial element is not in place.

Secondly, Ipswich Hospital is currently ranked in the top 10% in the country for both hip and knee replacements, and I would like to thank all the surgeons and staff who work in the orthopaedic services. There are real concerns that the fine quality of care currently available to patients in Ipswich will be diminished when combined with the practice in Colchester. Many of my constituents are currently going through an anxious wait for hip and knee replacements during covid-19, but the knowledge that they will receive first-class surgery at their town’s local hospital provides a great deal of reassurance. Under these plans, however, the surgery would certainly not be at their local hospital, and there are fears that the standard of care could be lower too.

[James Cartlidge (South Suffolk) (Con)]

I am grateful to my hon. Friend and neighbour for giving way. It was great to campaign with him in the election; I knew that he would be a doughty fighter for his constituents, and he is showing that tonight. Does he agree that, however we configure services, the priority must be the people he is talking about who are waiting for elective surgery that has been cancelled or shifted back many months because of covid, and we need to focus on bearing down on that backlog?

[Tom Hunt]

I thank my hon. Friend. As I said to my hon. Friend the Member for Keighley (Robbie Moore), I am not blind to the fact that covid-19 is putting huge pressure on the NHS and hospitals up and down the country, including Ipswich Hospital, where the frontline staff have gone above and beyond to serve my constituents. We need to deal with these waiting times, but we need to do so in a way that keeps services closer to people. That is very important.

Under the current proposals, most of the surgeons in Ipswich Hospital’s orthopaedic team would split their time between Ipswich Hospital and the new centre in Colchester. In many cases, this would mean that the surgeon who operates on a patient in Colchester one day will not be there to make crucial check-ups on their patient in recovery over the following days. Only the operating surgeon is best placed to see how their patient is responding to the surgery that they carried out. These personal check-ups are also an important source of confidence for patients. This important aspect of high-quality care would largely be lost under the current plans. Questions have also been left unanswered about the impact of the plans on the highly rated emergency orthopaedic practice, which would remain at Ipswich Hospital, with doctors and resources diverted elsewhere.

This all feeds into a third main concern, which is about the wider effect of these plans on the reputation and standing of Ipswich Hospital. Addenbrooke’s Hospital, Peterborough City Hospital, Hinchingbrooke Hospital, Norfolk and Norwich University Hospital, Queen Elizabeth Hospital, Princess Alexandra Hospital, Colchester Hospital, West Suffolk Hospital and James Paget University Hospital are all general hospitals in the east of England that provide elective orthopaedic surgery. Under the current plans, Ipswich Hospital would become the only hospital of its size in the eastern region not to provide a full complement of orthopaedic services. In fact, James Paget University Hospital in Yarmouth serves a population under half the size of Ipswich Hospital.

The question is, why should Ipswich Hospital be stripped of its first-class elective orthopaedic surgery and placed in such an unusual position? More and more people in Ipswich are beginning to answer that question by looking at whether the merger of Ipswich and Colchester Hospitals has been beneficial to Ipswich Hospital and whether the promises that were made about both hospitals improving together have been kept.

In fact, there are significant doubts that the hospitals trust fully explored the options that would allow both Ipswich and Colchester Hospitals to improve their orthopaedic care together, without one hospital losing core services. My understanding is that a full assessment was not made of repurposing space at Ipswich Hospital, to open up room for two additional operating theatres, and the borough council’s two alternative proposals to the Colchester centre were essentially dismissed out of hand.

The hospitals trust has insisted, the whole way through, that the Colchester centre is the only way to create enough capacity to cut waiting times and cancellations to planned surgery. I have spoken to the hon. Member for Strangford (Jim Shannon) about what we have to do on that across the country.

I ask what justifies these sweeping plans, for many, including within the hospital itself, have doubts that the plans are even justified on their own terms. The proponents of the plans have highlighted that five new operating theatres for hip and knee replacements would be added, and that these would simply replace five existing operating theatres currently in use at Ipswich and Colchester. Cutting waiting times and delays is undoubtedly an important aim, and I am sure, as I said, that there is no hospital in the country where the pressure on waiting lists for hip and knee replacements has not increased due to covid-19. As I mentioned, these plans would largely replicate existing services, at great financial expense and at the unquantifiable cost of moving them further from where people live. It is therefore disappointing that some in north Essex—some of my colleagues in north Essex—cannot see how important it is that both Ipswich and Colchester improve together side by side.

The last major concern I want to mention is that key voices within Ipswich Hospital have been muffled on this issue. The chief executive of the hospitals trust has claimed that the plans are clinically led and that only three out of 27 consultants are opposed to them, but it is my belief that the cards have been stacked in favour of this position. I understand that the 27 consultants he refers to include spinal surgeons as well as surgeons in Colchester. He has also assumed that surgeons who have not directly expressed their opposition to the plans must be in favour of them. Following the private conversations I have had with senior representatives at the hospital who have approached me, I understand that nine out of 12 surgeons at Ipswich Hospital who deliver non-spinal elective and emergency orthopaedic care do not support the proposals, but, understandably, many of them do not want to put their career at risk by speaking out publicly. However, two surgeons did speak out publicly during one of the consultation events, which turned out to be the only one where the audio recording of a public meeting was not uploaded online. It was eventually put online only when the surgeons themselves pointed this out.

To summarise, the plans are incredibly unpopular in Ipswich. The concerns for patients within Ipswich Hospital’s core service are real, and the decision-making process seems to be nothing more than a rubber-stamping exercise to push through the plans against the wishes of my constituents. When I stood for election and won the great honour of being elected as the Member of Parliament for Ipswich, I said to my constituents that I would fight for them with everything that I have. I love my constituency and I love my constituents, and I know how important the hospital is for them.

That is why it is really important for us to be here today. We do need to deal with the waiting lists, and we do need to make sure that people do not wait in pain for hip and knee replacements, but we need to do so in a way that keeps services closer to people. The merger needs to be about Ipswich and Colchester hospitals thriving together side by side, and I will work with my colleagues across the region to make sure that that is the case. At this late stage, I ask the Minister to look into the matter, reflect upon it, and meet me to discuss my concerns before the decision on 14 July.

[The Minister for Health (Edward Argar)]

I thank my hon. Friend the Member for Ipswich (Tom Hunt) for securing a debate on the important topic of orthopaedic services at Ipswich Hospital. His commitment to his constituency is commendable and well known. He raised this issue with me when we met very recently, and in his recent letter. I pay tribute to the persistence that he has shown in ensuring that his constituents’ voices are heard on this topic, as on all others.

If I recall correctly, when my hon. Friend last spoke in the House on this matter and I responded, he secured my commitment to visit, which I had the pleasure of doing, with him, in February, and it was a visit that I greatly enjoyed. He is undoubtedly a strong voice for his constituents. Of course, when circumstances allow it, I will be very happy to visit Ipswich once again. I also had the opportunity, that same day, to visit Colchester with my hon. Friend the Member for Colchester (Will Quince), who is a similarly strong voice for the interests of his constituents, his local hospital and the needs of his county, and I pay tribute to him.

[James Cartlidge]

Many of my constituents use both Ipswich Hospital and Colchester Hospital, and I pay tribute to their staff for the incredible effort they have put in throughout the pandemic to look after my constituents, and those of my hon. Friend the Member for Ipswich, to ensure that we get through this keeping our NHS intact. We should be proud of that.

[Edward Argar]

I am grateful to my hon. Friend, whom I have known for many years. As ever, he puts his finger on exactly the right point. I join with him in paying tribute to all the staff at Ipswich Hospital, Colchester Hospital and across our NHS for the amazing work they do day in, day out, particularly at this time.

My hon. Friend the Member for Ipswich set out his case very clearly. I would say that his hospital has no greater friend than him. I reassure him that there is no question of Ipswich Hospital continuing to be anything other than the first-class hospital it is today. He highlighted in outline a little of the background on this issue. In 2015, Suffolk and North East Essex sustainability and transformation partnership concluded that change in the organisation of services was needed, particularly in orthopaedic planned surgery. Since then, East Suffolk and North Essex NHS Foundation Trust has been developing a proposal for an orthopaedic elective surgery centre. As he touched on, the proposal outlines that the centre would see a roughly £35 million investment in orthopaedic surgery services for the population, offering at least 48 new beds and up to six state-of-the-art ultra-clean operating theatres, providing additional capacity for emergency patients across the area. The NHS in Suffolk and Essex ran a consultation, between 11 February and 1 April 2020, on the specifics of the proposal to create an elective orthopaedic care centre in Colchester, but, as I have set out, those plans have been in genesis for many years and have been extensively and widely consulted on.

I note the points raised by my hon. Friend in his speech and, indeed, those raised in his letter to the chief officer of Ipswich and East Suffolk clinical commissioning group recently. I encourage the clinical commissioning group to take that letter seriously and to respond fully to my hon. Friend, as part of the local accountability which is so important to all our public services. Let me be clear—I will emphasise this again later—that this is a process and a proposal that is rightly driven by the NHS at a local level in his and my hon. Friends’ constituencies. He is right to commend the performance of Ipswich hospital over recent years. I appreciate that he wants to ensure that for his constituents, and, indeed, for all those who use the hospital, the reconfiguration does not in any way diminish the achievement of his hospital and its staff, or have any impact on its other services.

My hon. Friend will appreciate that in winter the number of emergency admissions is much higher than it is during the summer. One aspect of this consultation is that it seeks to address planning for that by enabling more beds across the hospitals to be used to meet that demand. I would not seek, and nor should I seek, to prejudge the decision that will be reached next week by the CCG on this matter—it is rightly its decision—but I will set out its rationale in putting the proposals forward. It states that, in practice, if the orthopaedic centre were built at Colchester, it would release 24 in-patient beds at Ipswich, where they are indeed needed. The new orthopaedic centre would be adjacent to the main Colchester Hospital, but away from the emergency department.

I greatly appreciate the insight my hon. Friend has shared from his constituents in Ipswich, who are thankful for the brilliant surgeries they have been able to access in the NHS. Indeed, that was something he highlighted again when I went to wonderful Ipswich with him. When the CCG considers this matter, I would of course expect it very carefully and respectfully to reflect on the points that he and his constituents have made. The proposals reflect the importance of the surgeries. I hope he and his constituents will welcome the fact that the proposals will not remove access to orthopaedic services at Ipswich Hospital. Of nearly 46,000 in-patient day cases and out-patient appointments completed for orthopaedic patients at Ipswich last year, only about 3% would move to the new centre at Colchester under what the trust is proposing. In its proposal, the trust sets out that day surgery, including shoulder and elbow joint replacements, would remain at Ipswich Hospital, as would services for emergency patients, such as joint replacement after a hip fracture.

As I just mentioned, my hon. Friend described the life-changing impact such surgeries have had on constituents who have been treated at his hospital. This proposal, as the trust sets out, seeks to achieve shorter waiting times for surgery and shorter stays in hospital, so that patients can seek the comfort of home more quickly, and to minimise the risk of cancellation of surgery, as the proposed centre will be built safely away from the emergency department and the knock-on impacts that a busy emergency department can have. It also seeks to achieve improved clinical outcomes in terms of reliability from the standardisation of care and provide training, education and research opportunities for clinicians. The trust maintains that it is on that clinical basis that it is putting forward the proposals, which, it states, seek to support the excellent performance of hospitals in the area by organising services in a sensible way so that necessary elective operations can take place while the system supports patients admitted in an emergency.

My hon. Friend also mentioned the merger of Ipswich and Colchester in June 2018. At the time, NHS England outlined several service improvements that the merger would bring about. As well as improvements in various services from paediatrics to emergency ambulatory care, the enlarged organisation would also have an expanded catchment area, leading to improved opportunities for training, providing a more attractive option for clinicians, resolving a number of historical recruitment and retention issues at both trusts and improving finances. It is important, however, as my hon. Friend alluded to, that the trust is held to account for those promises and that it ensures, by the merger, that both hospitals continue to improve.

I briefly touched on the consultation earlier in my remarks, and my hon. Friend raised several points about the process. He is absolutely right to say that important decisions are made with the best interests of patients from across the area in mind, and that the views of local clinicians should not be diminished. There has been much lengthy consultation. As well as the formal process, my hon. Friend highlights the petition, which has been signed by many of his constituents and, I suspect, more widely. It is absolutely right that everyone has their say, and I commend him for what he is doing to ensure that they have their say. Again, such views should be considered with respect and care when decisions are reached.

My hon. Friend also rightly raised the issue of patients and transport, and that they must be supported to travel should the plans go ahead. He has raised the need for a comprehensive plan, both locally and with Ministers, to ensure that all patients can be supported to access the right care. Access to the current patient transport scheme will, the trust states, be available for those unable to make the journey themselves. Under the proposals, pre-surgery and post-surgery appointments would still take place at the patient’s normal point of care at Ipswich or Colchester. Indeed, I pay tribute to my hon. Friend for fighting his constituents’ corner, should the decision not turn out the way he wishes, and for playing an important part in highlighting that issue as well. The only change for patients would be the actual site travelled to for the planned surgical procedure, which would involve a lengthy stay of three days in hospital. I have also been reassured that local partners completely recognise that, alongside these provisions, additional support will be needed for some patients and, should the proposal be approved, further work is already under way to address that.

Being conscious of the time, I reassure my hon. Friend that the Department of Health and Social Care recognises how important these decisions are and recognises that the right accountability, consultations and people must be included in the process of discussing proposals to change services. This is, of course, not a decision for me or, indeed, for the Secretary of State. The next step, as my hon. Friend said, is the final decision, which will be made locally by the CCG on 14 July, but the proposal is not to downgrade or diminish Ipswich, but to promote an alternative way of delivering clinical services. I have no doubt that the CCG will have heard my hon. Friend’s case today, as will his constituents, in whose interests he has spoken so eloquently. I again encourage the CCG to ensure that it carefully considers his words and the representations in making its decision.

I conclude by thanking my hon. Friend and congratulate him on securing this debate. I also thank those other Members who have intervened. My hon. Friend has set out his case powerfully and his constituents are lucky to have him as their Member of Parliament.

Question put and agreed to.