Accident and Emergency Departments

Debate between Jim Dowd and Stephen Lloyd

Thursday 7th February 2013 Commons Chamber

[Stephen Lloyd]

I thank my hon. Friend for her intervention. That is a very important point and I shall be covering it in more detail later in my speech.

Last October, a group of 140 senior doctors wrote to the Prime Minister expressing alarm over proposals to close and reconfigure A and E units around the country. In their open letter, they said that they had yet to see evidence that plans to centralise and downgrade A and E services were beneficial to patients. A 2010 report by the National Confidential Enquiry into Patient Outcome and Death showed that the reason people often die after surgery is not that the surgery was difficult but that there was a delay in getting them to an emergency operation. I fear that that will be worse if more A and Es are closed as there will be no surgeon on site, or the patient will face an over-long travel time to a fully functioning and adequately staffed emergency department. The report was clear, suggesting that applying one-size-fits-all medicine to a heterogeneous population with varying needs fell short in ways that were both predictable and preventable. Crucially, it stated:

“Delays in surgery for the elderly are associated with poor outcomes”.

The letter to the Prime Minister also backed this view:

“Not only do many people in some of the country’s most deprived areas face longer journeys to hospital, but those in rural areas face longer waiting times for ambulances and crowded A and E departments when they arrive.”

Let me point out the obvious: that will mean more delay for what should be routine emergency surgery.

That is in contrast to how I foresaw developments in May 2010 when the coalition Government came to power. Unlike Labour, the coalition ring-fenced NHS funding.

[Jim Dowd (Lewisham West and Penge) (Lab)]

How can sums be ring-fenced if at the same time the Department insists on a 1% surplus—that is, money that cannot be spent?

[Stephen Lloyd]

The key difference is that the coalition Government ring-fenced it whereas the Opposition were considering a 20% cut—that is quite substantial.

Four reconfiguration tests were designed to build confidence among patients and communities as well as within the NHS. The right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) has already listed them, so I do not need to repeat them. In Eastbourne, my local hospital is run by East Sussex Healthcare NHS Trust, which also manages the Conquest hospital in Hastings. Last year, it consulted on the provision of orthopaedics, general surgery and stroke care in East Sussex. In my view and that of the cross-party Save the DGH campaign group, led by our remarkable and hard-working chair Liz Walke, it was clear from early on that the trust’s aim was to remove core services from my local hospital, the Eastbourne district general hospital, irrespective of the consultation.

This was not the first time the trust had tried to remove core services from Eastbourne. Only five years earlier it had tried, unsuccessfully, to downgrade our maternity services. At the time the trust claimed that that would provide safer and more sustainable services for the people of East Sussex. However, after much local opposition the independent reconfiguration panel found against the trust’s proposals, so when my local hospital trust again consulted on health services in East Sussex, my constituents and I were very worried. I was uneasy, as so many local clinicians started to share with me confidentially their deep concerns about the trust’s proposals.

I reassured constituents that we were in a stronger position than last time because the coalition Government had shown their commitment to the NHS by ring-fencing the NHS budget at a time of deep financial constraint. In addition, the Prime Minister and the then Health Secretary, the current Leader of the House, had continually stated that the NHS would be led by the public and clinicians, and to ensure this they had introduced the four reconfiguration tests that were mentioned earlier.

Imagine my horror when, just before Christmas, my NHS hospital trust had its proposals confirmed by the East Sussex health and overview scrutiny committee and was given the go-ahead for its plan to remove emergency orthopaedics and emergency and highest-risk elective general surgery from Eastbourne district general hospital and site them only at the Conquest hospital in Hastings, as much as 24 miles from some of my constituents.

The consultants advisory committee, the body which represents consultants at Eastbourne DGH, conducted a confidential survey of its members’ views on the trust proposals. More than 90% of DGH consultants responded to the survey, with 97% of those respondents opposed to the proposals. I remind colleagues in the House of the four tests. A confidential GP survey was also conducted and 42 GPs in the town also opposed the trust’s plans. In addition, 36,766 local people signed a petition against the proposals.