Healthier Together Programme (Greater Manchester)

Jonathan Reynolds Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I thank my hon. Friend the Member for Blackley and Broughton (Graham Stringer) for securing the debate. It is particularly useful that we can express our views before the summer recess. I do not want to speak for too long. I will echo my colleagues’ sentiments about the quality of the consultation process, but I want to give a view from the eastern part of the conurbation, Tameside, and make a couple of additional observations.

A lot is going on with the NHS and health care in Greater Manchester at the moment, so the timing is not very conducive to running such a consultation. The changes to Trafford A and E have already been mentioned. Passenger transport has been privatised from the NHS ambulance service to Arriva. Most of the walk-in centres that I am aware of have gone. I do not know about the situation in other constituencies, but in mine GP access is a huge issue—people regularly wait a fortnight for access to a GP in Stalybridge. Of course, in Tameside there are particular challenges because of the Keogh review in Tameside hospital. All the Tameside MPs warmly welcome that. It has been a positive process enabling a light to be shone on many of the things that we have been discussing for several years. However, when all the factors I have mentioned are added together, it is a difficult time to carry out a consultation on any part of the NHS and particularly on hospitals, because the public are most sensitive about them in many ways.

I understand the need for specialisation. I echo the remarks of my hon. Friend the Member for Stretford and Urmston (Kate Green). Even if we had substantially greater resources, it would be difficult to recruit the people we would need to meet the standards now required for hospitals in the conurbation. With the financial modelling that has been done in Tameside, we are perhaps a little more advanced in our forward projection work than some other boroughs, and I think that we are in a perfect storm. We have had to spend a lot of money at the hospital to try to meet the higher standards that people should expect by correcting some of the processes that the Keogh review highlighted as wrong. On top of that, the council was always one of the leanest in the country, let alone in Greater Manchester, so it suffered the worst from the severe reductions made by the coalition in northern local authorities. Our clinical commissioning group is in a relatively good position, but clearly it is not to anyone’s benefit simply to use that financial picture to prop up other parts of the system that are not working so well.

History will be hard on the coalition for prioritising such a big ideological reorganisation at a time when the figures show that the situation I have described is the challenge that incoming Health Ministers should have concentrated on. The promise that no A and E departments in our hospitals will close is welcome news, but I wonder whether the scale of the rhetoric around Healthier Together justifies or validates that promise. Either we shall not produce the results that have been promised, or that promise on the long-term future of hospitals and A and Es may not be honoured in the way we expect.

[Graham Stringer]

My hon. Friend is right to say that that commitment was given when we met the Healthier Together people and in some background documents. Does he agree that it is worrying that it is not in the consultation document, whatever credibility we give to the commitment itself?

[Jonathan Reynolds]

I do agree. That is a matter of extreme concern to me. My understanding is that we have been given a cast-iron pledge that there will be no hospital or A and E closures as part of Healthier Together. The problem with all hospital reconfigurations anywhere—it happened with the maternity services consultation—is that they always appear to people to be about cuts. It is hard to get across the argument that they are about improving services. There is some mixed messaging about the primary outcome of such a process.

My principal problem with specialisation is the one that arises with specialisation in any field. Greater Manchester’s geography makes it hard to get from one borough to another. Public transport and the railway system are not configured to operate in that way. I should love the opposite to be true—if we had the resources and local autonomy to make public transport work differently. That will come one day, I think, but it is not true at the minute. I did not by any measure expect to become an MP in the 2010 general election, and my daughter was booked in to be born at St. Mary’s, because I worked in the centre of the city and it was easier to have appointments there than to get back to Tameside for them. Frankly, we were concerned about the possibility of labour starting in Tameside at the wrong time, because of the journey to get to St Mary’s and what that might mean. I think that that would be the same for many people, whatever the health issue: the journey is not easy in a car, but by public transport it is almost untenable. That would be people’s primary concern when they thought about the outcome of such a consultation

[Lisa Nandy]

I am grateful to my hon. Friend for raising that matter, because I do not think that the Healthier Together team has given it enough thought. My constituency has not only chronic transport problems, including traffic and the fact that some areas of the borough are densely populated and quite far from the existing hospital, but also large, tightly knit families who often do not have a huge number of resources. When a loved one is suddenly taken ill, the whole family wants to visit, which is particularly problematic and something that the team has not thought about. Does my hon. Friend agree?

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[Jonathan Reynolds]

That is absolutely true. If someone lives near the station in Stockport, it is sometimes quicker to get to London than to another part of Greater Manchester.

I am pleased that the hon. Member for High Peak (Andrew Bingham) was here, because something that is forgotten across the conurbation is that the health economy and structures are not coterminous with the political structures of Greater Manchester. Glossop is part of Tameside’s health economy and getting from Glossop to Ashton-under-Lyne is not an easy journey, but trying to get to a different part of Greater Manchester in an ambulance or with a need to access a particular service would be extremely worrying.

[Julie Hilling]

It must be recognised that people living within Greater Manchester will also travel to hospitals outside. Some of my constituents might travel to Chorley for treatment, for example, because it is much closer than Bolton or Wigan. My hon. Friend is absolutely right that there is no wall around Greater Manchester in terms of people travelling in or out.

[Jonathan Reynolds]

That is absolutely true and has been mentioned by several colleagues today. My specific point about Glossop is that it shares an NHS trust hospital and clinical commissioning group with Tameside and that must be considered in a manner that people do not fully appreciate at the moment.

Looking at the financial picture for the NHS in Tameside and Glossop, we see many challenges to meet in future. I cannot see the utility in a big hospital reorganisation such as this unless there is much wider reform of out-of-hospital care, because we will still face the problem of too many medically healthy people being in hospital because they have nowhere else to go. Such reform would require much stronger integration of social services, public health, the CCG and the hospital, but the Government’s entire direction of travel is towards a more fractured and competitive system. I understand the motivation, but I cannot see how it tallies with something such as the Healthier Together programme.

The Minister has several points to address in his speech, but I hope that he can respond to that one in particular, because I am unsure about why we are going through this process if it will not deliver the improvements in health care that should be the ultimate goal of any kind of reorganisation.

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[Norman Lamb]

I note the hon. Lady’s point, but I come back to Lord Smith’s statement:

“We accept the case for change made in this consultation document”.

It cannot be clearer than that.

[Jonathan Reynolds]

Will the Minister give way?

[Norman Lamb]

Let me finish the point. I am acutely aware that it is critical to develop those out-of-hospital services to which the hon. Member for Wigan referred. That is the whole essence of integrated care, of which Manchester is seeking to be an exemplar. I applaud Manchester for doing that, because that is a big shift towards the greater focus on preventing ill health, rather than on repairing the damage once it is done.

[Jonathan Reynolds]

rose—

[Norman Lamb]

I am conscious that I need to make progress in my response to the debate, but I will give way to the hon. Gentleman.

[Jonathan Reynolds]

I am extremely grateful to the Minister for addressing my point directly. It is pleasing to see that he is well briefed. He is right about some of the exciting conversations about integration going on in Greater Manchester. I anticipate that he knows something about the proposals. If they develop into specific plans, is it his desire and belief that the Government would not seek to apply the competition law to which the NHS is now subject and allow them to proceed?

[Norman Lamb]

I have made the case very clearly that the whole purpose of the pioneer programme is to use the pioneers—although we are not simply focused on them—to identify the barriers to integration and to remove them. That is the whole point. There are concerns about all sorts of things that could block integrated care, such as information sharing across different providers and competition.

I should stress, incidentally, that in the section 75 regulations is a specific recognition that integrated care is an ambition that should be achieved, so commissioning can be for the whole integrated care pathway. There should be no problem in securing our ambition. Where barriers are found, they need to be addressed and removed.

I am conscious that the hon. Member for Stretford and Urmston asked to intervene—

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[Norman Lamb]

I understand that the health and wellbeing boards are keeping a watching brief throughout. They will have a decisive voice at the end of the consultation process in declaring whether they support the outcome. They bring together the local authority and the NHS, so they are pretty central to the whole process—and rightly so. The local NHS is constantly seeking to modernise delivery of care and facilities to improve patient outcomes, to develop services closer to home and, most importantly, to save lives.

The hon. Member for Stalybridge and Hyde focused on specialisation, and expressed scepticism about the case for it. Let me give him a case. It is from during the Labour Government and should be applauded—the lessons from it should be learned here. Stroke care in London, centralised into eight hyper-acute stroke units, now provides 24/7 acute stroke care to patients, regardless of where they live across the city.

Transport links are not that great across much of London—[Interruption.] Hon. Members should listen to Members from London complaining about transport links. Stroke mortality is now 20% lower in London than in the rest of the UK and survivors with lower levels of long-term disability are experiencing better quality of life. Hundreds of lives have been saved as a result of the specialisation undertaken predominantly under the previous Government.

[Jonathan Reynolds]

I was very fair in my speech and said that I absolutely accept the case for specialisation. I actually made the most positive case of any made by an Opposition Member today as to why that might be important for my borough, so the Minister has perhaps misunderstood that. But I have to say that comparing the transport situation in Greater London with that of Greater Manchester or any other northern city will, I am afraid, have our constituents in uproar: it is simply not the same picture by any means.

[Norman Lamb]

I acknowledge that, just as in London, there are real bottlenecks in Manchester. I have a son who was at university in Manchester—and found it to be a very fine city—so I understand the transport challenges there completely. The point remains that specialisations can save lives. We all have to recognise that.

All service changes should be led by clinicians and be based on a clear, robust clinical case for change that delivers better outcomes for patients.