Accident and Emergency Departments

Kate Green Excerpts

Thursday 7th February 2013 Commons Chamber

[Kate Green (Stretford and Urmston) (Lab)]

I want to speak about changes to the A and E department at Trafford General hospital in my constituency.

Over the years, Trafford General has experienced financial and management problems, and last year it was absorbed into Central Manchester University Hospitals NHS Foundation Trust. We all expected that there would be a reconfiguration of services following that acquisition, and that is what happened. Last month, following public consultation on the so-called new health deal for Trafford, NHS Greater Manchester announced its intention to proceed with a downgrade of the A and E at Trafford General, first to an urgent care centre open from 8 am until midnight, and in due course to a nurse-led minor injuries unit, alongside other changes to services. I expect those changes now to be referred to the Secretary of State for decision.

Nobody in Trafford is opposed to change that can improve clinical care. Already, major trauma cases are diverted away from Trafford General, while serious stroke and cardiac cases go not to Trafford but to centres of excellence at Salford Royal, University Hospital of South Manchester and Manchester Royal Infirmary. That approach is widely understood and accepted by the public. Equally, plans to develop a model of integrated care locally are popular, and it is recognised that they could help to keep people out of hospital for longer.

However, there are consequences to the reconfigurations that have already taken place and to what is now proposed. More than half of Trafford residents now attend an A and E other than Trafford General, partly because more specialist and complex cases are rightly diverted to other centres, partly because local people are choosing to attend other nearby hospitals that offer them greater convenience or the kind of care they want, partly because it is widely believed that ambulances will not take people to Trafford General unless they specifically instruct them to do so, and partly because the whole downward spiral in activity is reinforcing public behaviour so that they are increasingly even less likely to decide to go to Trafford General. In other words, reducing activity levels are, to a degree, a self-fulfilling prophecy.

There are concerns about the capacity at neighbouring hospitals. My right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) has been raising concerns about capacity at the University hospital of South Manchester in Wythenshawe since we first knew about the proposals last summer. Its A and E is already coping with tens of thousands more admissions than the 70,000 for which it was designed. It simply cannot absorb more patients from Trafford without additional investment.

Commissioners assure me that there is progress in the development of integrated care, but that is pretty well invisible to local people. Recovering patients report long waits and great difficulty in getting rehabilitative care and support at home. In the meantime, many of the admissions to our A and E are elderly and frail patients, which is undoubtedly in part the result of the gulf between the ambition for integrated preventive services in the community and the reality.

There are concerns about the capacity of the North West ambulance service. If there is a reduction in hours and capacity at Trafford general, there will clearly be more patient journeys to other hospitals. There are also worries about what will happen if mental health patients present at Trafford general’s urgent care centre and it does not have the capacity to care for them.

All of that is taking place against the backdrop of a wider planned reconfiguration across Greater Manchester. Last year, in the middle of the consultation on the changes at Trafford, we learned about Healthier Together, a major redrawing of health care provision across Greater Manchester, including A and E provision. If, as is likely, that leads to further closures and reductions in A and E services across Manchester, there will be further capacity questions that will have a significant effect on Trafford. We are in an invidious position. It has been said that the new health deal for Trafford offers the best hope of a secure future for Trafford general, but we are planning in a vacuum. We know for sure that change is coming, but we have no idea what it will look like.

Late last year, my right hon. Friend the Member for Leigh (Andy Burnham) wrote to the Secretary of State asking him to halt the reconfiguration at Trafford and to consider it within the wider Healthier Together review. The Secretary of State refused to do that, but he has offered no guarantees or reassurances regarding the impact of Healthier Together on Trafford general.

There is now a broader context still with Sir Bruce Keogh’s review of emergency services. I hope that the Minister will reassure me that decisions about the future of services at Trafford will not pre-empt Sir Bruce’s review. Sir Bruce has made it clear that it is vital that new services are in place before existing services are closed. In The Guardian on 24 January, he was quoted as saying:

“I don’t think we can change the system until we know we have a solution that is OK.”

He specifically highlighted concerns about

“the idea of some poor mum having to travel to A&E on two buses because we closed an A&E down and she doesn’t have confidence that what is left is good enough”.

That is precisely our fear in Trafford.

I have no doubt about the good intentions and efforts of local NHS managers and commissioners, but they are being constrained by financial pressures and limited, as has become clear this afternoon, by a lack of overall vision and strategy from the Government. Local people cannot be expected to sign up to changes that they do not know have been future-proofed against changes that we know are imminent.

Last month, my right hon. Friend the Member for Leigh set out a vision for the future of district general hospitals such as Trafford general, which offered a different kind of future and a secure one. I agree with the hon. Member for Croydon Central (Gavin Barwell) that it is important to strike the right balance between quality and convenience, but process and trust are also important. Today, I have to inform the Minister that people do not feel that trust in relation to the plans for Trafford.