Healthier Together Programme (Greater Manchester)

Julie Hilling Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Kate Green]

I agree.

Meanwhile, Healthwatch Trafford says that there is concern about whether the committee-in-common model in Manchester is sufficiently transparent, regarding its ability to engage with and represent the concerns of local people and to oversee, in the wider public interest, what is being proposed.

I am utterly unconvinced that local people are aware of or understand the steps that are being put forward now that could result in major changes to health care provision in our area.

[Julie Hilling (Bolton West) (Lab)]

Before my hon. Friend moves away from the consultation, does she agree that the questions asked in the consultation document are ridiculous? For example:

“Do you…disagree that children and young people should be cared for closer to home where appropriate?”

Nobody would ever disagree with such questions.

[Kate Green]

That is absolutely right. Again, that is exactly what we saw in the consultation on the new health deal for Trafford. We raised concerns about that at the time, but the NHS has learned nothing about how proper engagement and debate with the public can be managed and take place.

There is real concern that a lot of groundwork has gone into producing this consultation but that much of it has happened behind closed doors. If the significant changes that are being advocated, or significant changes in other forms, are needed— the document says that they are, which may well be the case—it is imperative that the public be brought on board through a process of careful, systematic, dedicated engagement. It is not good enough to land a document out there without that work being put in and without any clarity about how decision makers will be informed by the views and opinions of the public at large and of elected Members who represent them.

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[Mike Kane]

I agree. It would be odd not only for my constituency, but for constituencies to the south in the Cheshire belt and the Cheshire plain that those hospitals serve.

Wythenshawe hospital is very much looking to the future and its long-term sustainability. It is developing the Manchester MediPark in partnership with Manchester city council and private sector developers. MediPark will exploit the huge strengths of Greater Manchester and the north-west in health and life science services. Research and development forms a key part of the new Manchester airport city enterprise zone, which I had the opportunity of updating Members on only last week during my Adjournment debate on regional airports.

UHSM is recognised as a centre of excellence for research and development, and is a founding member of Manchester Academic Health Science Centre. The partners of the science centre share the common goal of providing patients and clinicians with rapid access to the latest discoveries and improving the quality and effectiveness of patient care. It is clear that the hospital is going from strength to strength, but I fear that the planned Greater Manchester Healthier Together proposals, to which my hon. Friend the Member for Blackley and Broughton referred, could fundamentally destabilise the trust and lead to a loss of its major emergency service, many of its specialised services, its trauma service and even its teaching status.

The additional reorganisation is set against the backdrop of the Government’s £3 billion reorganisation of the NHS, which has siphoned off money from the front line to pay for back-office restructuring. In the first three years of this Government, attendances at A and E have increased by 633,000, yet Trafford general, to which my hon. Friend the Member for Stretford and Urmston referred and which serves many of my constituents, has seen a downgrading of its A and E department. It has got harder to get a GP appointment since the Government scrapped the previous Government’s guarantee of an appointment within 48 hours, and cut funding for extended opening hours. That is a key cause of Wythenshawe’s A and E problems.

[Julie Hilling]

Does my hon. Friend agree that the major vision that seems to be emerging is simply one of pitching hospital against hospital—fighting about whether to have a hospital in Wigan or Bolton, or four or five specialist hospitals, when, as has been said, we all want a good local service? Should not the concentration be first and foremost on getting primary care services correctly in place? That should be sorted out, and afterwards we can look at what hospital care we need.

[Mike Kane]

I agree; the most important thing is to get primary care in place first. Starting a consultation nine months from a general election that will pit MP against MP is not a good idea.

A quarter of walk-in centres, including Wythenshawe, have closed, and NHS Direct has been dismantled. On top of all that, the new Healthier Together proposals mean there is potential for a downgrade at Wythenshawe hospital. That would, as has been pointed out, be a broken promise for people in Wythenshawe and south-west Manchester, who following the downgrading of the A and E at Trafford general were assured that University Hospital of South Manchester would not be affected.

The aim of Healthier Together, to give patients across the region the same excellent standard of service wherever they live, is the right one. The challenge is huge. Manchester has the highest premature death rate of any local authority in the country. There can be no doubt that health care services in Greater Manchester need to change. Almost £2 billion has been taken out of the budget for adult social care. We need to do things differently to meet the challenges of the time and better integrating local authority services with the NHS will be a key part of that change. However, the current process is flawed and is moving too fast. The proposals fail to recognise that Wythenshawe is already a major specialist site that provides many vital services to the people of Greater Manchester.

The public are not being provided with enough detail to enable them fully to understand the implications of the proposed changes. The consultation meetings have been criticised—as they have today—for being jargon-ridden and held at inaccessible times. No financial models have been provided in the information for the public and UHSM believes that the current proposals could destabilise the finances of the trust.

Wythenshawe is a level 1 major trauma centre, and is currently the only site capable of developing a single level 1 trauma site for adults for the whole of Greater Manchester. As my hon. Friend the Member for Blackley and Broughton pointed out, it covers Manchester airport, and if an accident were to happen such a nearby centre would be vital. The current proposals could leave the southern sector of Greater Manchester and north Cheshire with no specialist major emergency hospital. The proposal does not reflect the view of providers and local commissioners in the southern sector that Wythenshawe should remain and be developed further as the sole specialist site in the southern sector.

The failure of the proposals to acknowledge Wythenshawe as one of the fixed sites threatens the future clinical, operational and financial sustainability of the trust. For changes at such a level to have the desired impact on services across Greater Manchester, all the partners must be firmly on board. I urge Healthier Together to look again and ensure that the baby is not being thrown out with the bath water, because of a rushed consultation and flawed proposals.

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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 take that concern on board, and the hon. Lady should respond to the consultation. It is really important for hon. Members to do that.

Incidentally, I should say something on behalf of my hon. Friend the Member for Cheadle (Mark Hunter), because he is a Whip and so is unable to speak in the debate, although he has attended it all. He has expressed particular concerns about the potential implications for the University Hospital of South Manchester and Stepping Hill, and about options 4.1 and 4.2. It is important that I place that on the record.

[Julie Hilling]

Will the Minister give way?

[Norman Lamb]

Will the hon. Lady let me make another point that is on the tip of my tongue? I will then be happy to give way.

The hon. Member for Stalybridge and Hyde expressed the concern that, in his assertion, we are moving away from integrated care. Precisely the opposite is the case. Indeed, the hon. Member for Copeland (Jonathan Reynolds), the shadow Minister, expressed clearly some of the fantastic potential gains that could be achieved in the Greater Manchester area if the objectives were achieved. When I announced the pioneer programme to demonstrate the exemplars of integrated care, Greater Manchester was one of the applicants to get on to the shortlist and was close to securing pioneer status, so my every impression is that exciting work is going on in Manchester to change local health and care services in a way that all of us could probably sign up to.

[Julie Hilling]

rose—

[Kate Green]

rose—

[Norman Lamb]

I give way first to the hon. Member for Bolton West.

[Julie Hilling]

I thank the Minister for giving way. The bit that I do not understand is that local authorities, leaders such as Lord Smith and others, have been saying, “Yes, we need to sort out the integrated care”, but the consultation has been putting front and centre the need to change the status of hospitals. What everyone in the conurbation is saying is, “Let’s look at the integrated care and then see what comes out of that”, rather than putting changing hospitals up front, which is what exercises the whole community.

[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.

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[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.

[Julie Hilling]

Will the Minister give way?

[Norman Lamb]

I really cannot. I have been pretty generous in giving way many times, so I will make a bit more progress.

It is therefore for NHS commissioners and providers to work together with local authorities, patients and the public in bringing forward proposals that will improve the quality and sustainability of local health care services. Government policy has been to emphasise local autonomy and flexibility in how NHS organisations plan and deliver service changes, subject to meeting legal requirements, staying within the spirit of Department of Health guidance and ensuring schemes can demonstrate robust evidence against four tests. Those are that there is support from GP commissioners; there is a focus on improving patient outcomes; that schemes consider patient choice; and that they are based on sound clinical evidence.

I recognise that change is often difficult to achieve because the consequences of not getting it right could be so profound—hon. Members have been absolutely right to raise their concerns. It is therefore right that the NHS does not rush into change without fully understanding all the potential consequences, sometimes including unintended consequences. Change can be difficult to explain to patients who have had quite reasonable anxieties exacerbated by speculation—in many cases, in the media—about whether this or that service might close. Services are sometimes described as closing when in fact they are simply being provided in a neighbouring facility or changing for the better in response to advances in treatment.

For example, my hon. Friend the Member for Macclesfield (David Rutley) referred to the possibility of hospitals closing, but I am not aware of any proposal to close hospitals. When we communicate to patients and the public, it is important that we are clear on what this issue is and is not about, so as not to raise anxieties. From my perspective, we have to be careful to avoid ramping up anxieties inappropriately by playing on fears. We see that too often; unfortunately, it stifles genuine debate and discussion about what health services will need to change in order to do better in future. But I applaud all hon. Members for speaking in this debate very reasonably and about legitimate concerns.

The right hon. Member for Leigh (Andy Burnham) has agreed that the NHS needs to have the freedom to change the way services are provided. He said:

“If local hospitals are to grow into integrated providers of whole-person care, then it will make sense to continue to separate general care from specialist care”—

the point made by the hon. Member for Wigan a moment ago—

“and continue to centralise the latter. So hospitals will need to change and we shouldn’t fear that.”

Perhaps the hon. Lady will take the point better from her party’s health spokesperson than from a Minister, but the right hon. Member for Leigh was making the case for the specialisation of services.