Health Care (West Cumbria)

John Stevenson Excerpts

Wednesday 16th March 2011 Westminster Hall

[Mr Reed]

Before continuing, I ought to declare some interests. I shall be talking about the West Cumberland hospital today. Not only was I born there, but so was my wife and our four children; my nieces and nephews were all born there; and about a year ago it saved my life.

At best, the future provision of health care services in west Cumbria—indeed, in Cumbria in its entirety—is confused. Given the majority of representations that I have received, from ordinary people and medical professionals, at worst it is in crisis. Before the election, and immediately after it, the development of health care services in Cumbria was praised by the Secretary of State for Health and those sympathetic to his views as a model for the rest of the country. I shall return to this aspect in due course, but suffice it to say that the Secretary of State has stopped using Cumbria as an example of best practice; surely even he realises the chaos that is being caused there by the top-down, unwanted and unwarranted reorganisation of the NHS that he is inflicting on us.

First I shall give a brief history. In 2007-08, NHS Cumbria, the primary care trust for the area, undertook a huge public consultation under the closer to home initiative. It was an enormous task; 140,000 people contributed to the consultation, a huge proportion for any consultation, let alone for a county with a total population of just under half a million. It identified the need to redevelop the West Cumberland hospital and to integrate and improve primary care services as part of the closer to home deal.

During a period of record and sustained funding for the NHS, the public reluctantly agreed to a reduction in the number of beds at the West Cumberland hospital. I have no doubt that the Minister will say that beds do not equal services, and I accept that from the outset. Negotiations with the public were incredibly difficult, but the change was accepted with two provisos. First, the reduction in the number of beds would result in more complex surgery and tertiary-level care coming back to Cumbria from the north-east, taking place at the Cumberland infirmary in Carlisle; that would reduce travelling times for people in my constituency and west Cumbria and help with family concerns for those requiring tertiary-level services.

Secondly, the reduction would effectively result in the building of a new hospital on the site of the West Cumberland hospital. The hospital would retain its acute status, its consultant-led maternity, paediatric and anaesthesiology services, develop specialisms not available at Carlisle, and develop its teaching function. Crucially, it would be surrounded by a network of refurbished or even entirely rebuilt community hospitals in Millom, Keswick, Cockermouth and Maryport, with a brand-new health centre in Cleator Moor; together, they would be able to deal with an increased level of primary-care needs, to allocate resources better, to sign-post acute care when necessary and, importantly, to provide care closer to home.

After real difficulties, hospital consultants from both hospitals in north Cumbria—the West Cumberland hospital in Whitehaven and the Cumberland infirmary in Carlisle—began to forge an effective working relationship with local GPs. I brokered many of their meetings, chaired them and tried to help navigate a route towards an integrated provision of local health services in west Cumbria—one that was outcomes driven in the best interests of patients and that would underpin the future professional and economic stability, viability and sustainability of the local NHS. I believe that it was achieved, albeit imperfectly.

Collectively, the local community and primary and acute medical practitioners were developing a model that would best fit Cumbria. I am delighted to see my hon. Friend the Member for Workington (Tony Cunningham); he had a huge part to play in those developments. So advanced was the relationship, and so strong was the plan, that we were able to insist that a publicly funded, privately operated clinical assessment and treatment centre was not introduced in the area. We knew that it would destabilise the local NHS. My right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), then Secretary of State for Health, listened and did as we asked. It seems that times have changed—and significantly for the worse.

A funding package was developed for west Cumbria, through the west Cumbria strategic forum, and the principle of “west Cumbria proofing” was consistently implemented by the previous Government. That funding was meant to provide £100 million for the West Cumberland hospital and up to £80 million for the community health facilities that I mentioned earlier. Do the Government and the Department of Health remain committed to “west Cumbria proofing”, and the memorandum of agreement that underpinned it?

After the election, these moneys were arbitrarily withdrawn, despite the fact that demolition had already begun on the site of the West Cumberland hospital. The events in my constituency on 2 June 2010 caused me to ask the Prime Minister to visit the hospital and to see for himself the extraordinary clinical work being undertaken by the accident and emergency team in the face of quite unprecedented events. I also used the opportunity to lobby for the money that had been taken from us. Eventually, the Department of Health returned £70 million to the project.

[John Stevenson (Carlisle) (Con)]

Finance is obviously an important part of health care in north Cumbria. Does the hon. Gentleman agree that the PFI scheme has been a burden to the area?

[Mr Reed]

I would like to examine our PFI scheme forensically and try to discover why other PFI schemes around the country work so well. What is it about the Carlisle scheme that causes such difficulties for the health economy of our area? However, the burdens that it imposes pale in comparison with the GP fundholding system that we face.

The North Cumbria University Hospitals NHS Trust remains committed to its £20 million investment. However, the abolition of the north-west regional development agency and the instruction from Downing street that incomplete projects were to have RDA funding withdrawn has led to a £10 million shortfall in the new-build budget. Will the Minister please reinstate that missing £10 million? If not, will she and her Department help me to identify money to cover that shortfall from other sources—even, perhaps, not from the Department of Health? Can she help expedite the detailed business case approval for the West Cumberland hospital?

Already £10 million down, the trust and NHS Cumbria have also been instructed to make 4% annual recurring cuts. That would be an incredibly difficult situation for the west Cumbrian health economy at any time, but we have not yet approached the real horror that threatens to hole it below the waterline.

At Prime Minister’s Question Time today, the Prime Minister made a Freudian slip when referring to GP fundholding. The Department of Health prefers to call it GP commissioning, but GP fundholding is the practice that brought hospitals to their knees and that almost bankrupted the NHS in the 1980s and 1990s. That is precisely what GP commissioning is. There is all the difference between GPs commissioning and designing services in an integrated way with their hospital colleagues, and GPs being forced to hold the purse strings for the provision of each hospital service upon which their patients rely.

Will the Minister tell us what limit, if any, will be placed on GPs’ remuneration under the new system? Does she have any fears relating to soaring salaries and the fact that the bond of trust between patient and doctor could become severed as a result? Does she have any concerns with regard to the imbalance now between GPs and their acute colleagues and does she think that that will affect future recruitment and the provision of services within the NHS?

With GP fundholding effectively in place in Cumbria—in shadow form—we are witnessing a massive cut to the North Cumbria University Hospitals NHS Trust and to the West Cumberland hospital. Last year, the hospitals trust provided acute hospital services worth some £183 million across its sites. Under GP fundholding, that is being reduced, in the space of one year, to £153 million, which is bound to affect the provision of acute hospital services at the West Cumberland hospital. Does the Minister agree that such a financial hit cannot be absorbed without affecting front-line services?

The shortfall has plunged the trust into chaos. It is now unable, not unreasonably, to meet the foundation trust status qualifying criteria deadline of 2013-14 and that has caused it to seek a merger with another trust or any other willing provider. I hope that the Minister will be able to tell us categorically what the Department means by “any other willing provider”. Minutes from meetings of senior consultants across the North Cumbria University Hospitals NHS Trust, which have been leaked to me, show that those consultants fear that this could result in the closure of the West Cumberland hospital. That would be—as the cuts are—the direct consequence of centrally imposed, top-down Government policy in the NHS.

Will the Minister guarantee that she will not let that happen and that the current level of services will only be added to and not taken away from? Will she agree to arrange a meeting between the Secretary of State, concerned local clinicians and me to hear the case in detail? Will she also grant the trust extra time to meet the foundation trust qualifying deadline so that a merger can be avoided? A merger of trusts is not in the interests of the trust itself or any other trust being asked to take it on. If not, will she guarantee that no other trust or willing service provider will reduce the services provided by the West Cumberland hospital? In short, will she commit today to ensure the delivery of the closer to home programme, which my constituents and those of my hon. Friend the Member for Workington have been consulted on and reached agreement on?

What of our local community hospitals and planned health centre? Will the Minister guarantee that the money for those facilities will be provided by Government, or financially facilitated, very soon, so that these long promised and keenly anticipated investments can take place? What is the status of the programme to rebuild and replace our community hospitals in west Cumbria and provide a new health centre in Cleator Moor? Does the Minister agree that the closer to home initiative will collapse if these facilities are not forthcoming and that a deal will then have been reneged upon? Were that to happen, the sense of betrayal would be profound and the consequences significant.

The West Cumberland hospital was the first new hospital in this country to be built by the NHS after its creation. Right now, it risks becoming the first casualty of what many see as the stealth privatisation of the NHS by a right-wing Government implementing centrally driven health policies that command no democratic mandate or clinical support. As I speak, Bevan will be turning in his grave. I am asking for help, compromise and understanding of the problems facing the future of health service provision in west Cumbria. There is still time to put that right and I hope that the Minister and the Government will see sense.