Hospital Services (South Manchester)

Mike Kane Excerpts

Tuesday 8th September 2015 Westminster Hall

[Mike Kane (Wythenshawe and Sale East) (Lab)]

I beg to move,

That this House has considered hospital services in south Manchester.

It is a pleasure, as ever, to serve under your chairmanship, Mr Hollobone.

I secured this debate to highlight to Parliament some serious and genuine concerns about the Healthier Together process, which is under way in Greater Manchester. Healthier Together Greater Manchester has been a three-year consultation that, according to its own website,

“was created to help make an NHS for the 21st Century, helping to save more lives.”

The Healthier Together proposals relating to hospitals seek to drive up quality and safety by forming a single service with networks of linked hospitals working in partnership. That means that care will be provided by a team of medical staff who will work together across a number of hospital sites within the single service.

The Healthier Together committees in common, made up of GPs from each clinical commissioning group in Greater Manchester, were responsible for making decisions about the proposals based on a wide range of evidence gathered during the past three years. That included evidence from a public consultation and data on travel and access, quality and safety, transition, affordability and value for money.

Before the public consultation, commissioners decided that there should be at least three single services in Greater Manchester, based in Salford Royal hospital, the central Manchester university hospitals and the Royal Oldham hospital, which will each specialise in emergency abdominal general surgery. That decision was made because of the clinical services already provided by those hospitals and to ensure that all areas in Greater Manchester had equitable access to specialist services. Each hospital will work in a single service model with other, neighbouring hospitals in Greater Manchester.

On Wednesday 17 June, commissioners took the decision to implement four rather than five single services to deliver hospital services in Greater Manchester. Commissioners believed that the evidence showed that four single services would offer exactly the same quality and benefits as five, and that it would be quicker and easier to recruit the additional doctors needed to run four single services. The commissioners also pointed out that, in the long term, four single services would cost less to run. At a meeting on 15 July, commissioners unanimously decided that Stepping Hill hospital in Stockport would be the fourth hospital in Greater Manchester to provide emergency abdominal surgery, as part of one of the four single services.

[Andrew Bingham (High Peak) (Con)]

I congratulate the hon. Gentleman on securing the debate. I apologise, but I cannot stay; I have a Select Committee to go to. I am concerned, as he is, about the initial consultation, which we debated in this Chamber in the previous Parliament. For the record, however, I should say that I am delighted that Stepping Hill was chosen; in High Peak, we are outside Greater Manchester and I was concerned that we had been forgotten. Choosing Stepping Hill means an awful lot to my constituents.

[Mike Kane]

The Healthier Together commissioners left us in a binary situation, so it became a competition between two hospitals. That should never have been the case.

The aim of Healthier Together—to give patients throughout the region the same standard of excellent 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 healthcare services in Greater Manchester need to change.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

Will my hon. Friend join me in congratulating a hospital in my constituency on its news? Today, Tameside general hospital has come out of special measures. Although we are concerned about Healthier Together and some of its proposals, that is fantastic news for the overall package for my constituents.

[Mike Kane]

May I say a couple of things? On a personal level, I am delighted that my hon. Friend won her seat of Ashton-under-Lyne. She worked at the coalface of integrated care services in east Manchester and she brings all that experience to the House. I, too, was involved in public life in Tameside, for six years, so I am delighted that the hospital has been taken out of special measures today. I pay tribute to everyone who has helped that to happen, from those in the Ministry to local leaders and the consultants at Wythenshawe hospital who over the past few years have advised on bringing Tameside general hospital out of special measures.

Almost £2 billion has been taken out of the budget for adult social care, with more cuts to come. We need to do things differently to meet the challenges of the time. Better integration of local authority services and the NHS will be a key part of that change and will be realised under the new powers being devolved to Greater Manchester. My hon. Friend the Member for Stretford and Urmston (Kate Green), the hon. Member for Altrincham and Sale West (Mr Brady) and I have serious concerns about the outcome of Healthier Together and believe that the decision-making process is flawed.

Reorganising our tertiary services before resolving the huge challenges that we face to integrate our health and social care in the region feels like putting the cart before the horse. The benefits to be gained from our devolved powers in this area are yet to be realised, so we are redesigning our tertiary services in the dark. My constituency is home to the University Hospital of South Manchester Trust, which delivers services costing £450 million, employs 6,500 people and has 530 volunteers who give up their free time to help patients and visitors. The UHSM hospital has several fields of specialist expertise, including cardiology and cardiothoracic surgery, heart and lung transplantation, respiratory conditions, burns and plastics, and cancer and breast care services. Indeed, the trust is home to Europe’s first purpose-built breast cancer prevention centre. Its hospital not only serves the people of south Manchester and Trafford, but helps patients from across the north-west and beyond.

Healthier Together has decided that UHSM will partner the Central Manchester University Hospitals NHS Foundation Trust, or CMFT, in a single service for Trafford and Manchester. UHSM and CMFT have agreed to work together to improve collaboration between the trusts. There is clearly a great opportunity for two of Greater Manchester’s leading university teaching hospitals to work together to improve services, to increase integration at all levels, including with social care, and to improve research and education.

The Wythenshawe hospital, however, provides an extensive portfolio of secondary and tertiary services that rely on support from general surgery to maintain their quality and safety. In fact, UHSM provides all 18 of the services identified by Healthier Together as needing support from general surgery, including secondary services such as maternity, gynaecology, gastroenterology, urology and acute medicine, as well as tertiary services such as heart and lung transplant, burns care, cystic fibrosis and extracorporeal membrane oxygenation, which are provided only by UHSM for patients from across Greater Manchester and the north-west.

UHSM regularly accepts elective and emergency surgical patients from Greater Manchester and beyond who require the specialist support of its tertiary services —for example, patients requiring emergency or complex elective general surgery with complex cardiac disease. There is genuine concern that those secondary and tertiary services, which are outside the scope of Healthier Together, could be destabilised or downgraded through the implementation of the proposals.

UHSM also provides all the services, as identified by Healthier Together, on which emergency, high-risk general surgery is absolutely dependent, such as interventional gastrointestinal radiology and interventional vascular radiology. The latter is only provided at three hospitals in Greater Manchester that also provide vascular surgery, one of which is UHSM’s Wythenshawe hospital. Wythenshawe hospital must continue to deliver high-risk, emergency general surgery procedures for in-patients and for surgical emergencies in its secondary and tertiary services. UHSM will need to retain its existing level of general surgery support at Wythenshawe hospital in order to undertake surgical assessment, perform emergency surgery and manage the elective workload from a highly complex group of patients.

We were pleased that, in order to support UHSM’s tertiary services, Healthier Together recognised at a public meeting on 15 July that Wythenshawe hospital would need a higher level of general surgery service than that described in the Healthier Together service model for a local hospital. Much greater clarity, however, is required on how secondary care services, such as maternity, gynaecology, gastroenterology, urology and acute medicine, will continue to be supported, as the service model for general surgery could have significant implications for many services outside the scope of Healthier Together.

UHSM believes that the key features of a service that would maintain the quality and safety of its secondary and tertiary services are that Wythenshawe hospital should meet the Healthier Together quality and safety standards; should remain a receiving site for emergency general patients, including those with co-morbidities in its tertiary specialties and those who self-present; should have 24/7 senior general surgical assessment and opinion rapidly available to A&E; should remain able to admit and manage general surgery patients of all types; and should continue to deliver all emergency general surgery procedures, both major and minor, for in-house emergencies—for example, in-patients in urology—as well as for emergency general surgery patients with co-morbidities in its tertiary specialties. I am thinking, for example, of a patient with a bowel obstruction who is also being treated by the hospital for cystic fibrosis. As a minimum, the existing level of general surgery capacity must be retained in order to deliver and maintain that level of service in support of UHSM’s secondary and tertiary services.

Wythenshawe currently has a high-capability team of 10 consultant general surgeons with experience in all specialities of managing high-risk surgical emergencies in-patients, supported by a team of trainee surgeons. Although Healthier Together analysed implications for the consultant workforce, it is not clear what analysis there has been of the implications for other staff, including the effects on medical training posts and the support those posts provide to consultants.

Healthier Together has recognised that the service model required at UHSM must be more than that described by the programme for a local general hospital, and UHSM’s surgeons have been invited to discuss potential service models with the Healthier Together team. However, serious questions have been raised with both me and Members whose constituencies border mine about patient safety and quality in what can only be described as a fudged model for UHSM, which would be neither a specialist hospital nor a local one.

Throughout the Healthier Together process, we have been told that the dominant driving force of the proposed changes is to save more lives, yet in the end the final part of the decision to allocate the fourth specialist site was taken based on one factor only: travel and access. It is clear that for the Greater Manchester-wide—indeed, north-west-wide—specialist services provided at UHSM to continue safely, a robust and high-quality general surgery service must be maintained at Wythenshawe hospital. That is essential to ensure the quality and safety of the secondary and tertiary services that our constituents and patients from across Greater Manchester, and beyond, rely on.

[Graham Stringer (Blackley and Broughton) (Lab)]

I congratulate my hon. Friend on securing this debate. He is making an excellent and detailed technical case on behalf of Wythenshawe hospital. Does he agree that the downgrading of the status of Wythenshawe—that is what this is—will make it much more difficult to recruit the necessary specialist staff and is another example of how flawed the whole process has been?

[Mike Kane]

My hon. Friend knows more than anyone in this place about the principle of subsidiarity. He was fighting for devolved services for Manchester in the ’80s. We are beginning to catch up with his vision for devolved services across Greater Manchester that he argued for when he was ably leading Manchester through the depression of the ’80s and its economic regeneration in the ’90s. I agree that this fudged proposal could lead to a death by 1,000 cuts. It will undermine confidence, and we are passionate about avoiding that.

I hope the Minister will work with us to ensure that patient safety across Greater Manchester is the primary factor in the decision-making process. Very few Members of Parliament are fortunate enough to represent the hospital that they were born in. There is nothing I would not do for patients—not just in my constituency, but throughout Greater Manchester. We were told that Healthier Together was a clinician-led consultation; unfortunately, our clinicians are now telling us that they have serious concerns. Local MPs must listen and act. We have reached an unfortunate situation in which those clinicians have applied for judicial review, and we are at the stage of the letter before action in that process.

I urge all sides to negotiate to see whether an equitable solution can be found. If it cannot, the proposals are so flawed that any judicial review would probably be successful. That would not please me in any way whatever; I am the last person who wants to see a long and protracted legal process. I believe that, fundamentally, we should move towards a devolved set-up in Greater Manchester and that that process will be put back by this situation. However, I cannot stand by and be told that patient safety may be at risk without raising the issue in Parliament.

--- Later in debate ---

[Mike Kane]

Thank you for your excellent chairing of these proceedings, Mr Hollobone. I am grateful to the Minister for his reflective comments on the process and for bringing us up to date on the latest developments. I stress to him that the hon. Member for Altrincham and Sale West (Mr Brady), my hon. Friend the Member for Stretford and Urmston (Kate Green) and I are not behind the curve, as he can probably tell from the excellent contributions made by them.

I also thank the Minister for what he said about Paul Goggins, who worked with local elected members long before I did on the reconfiguration of Trafford services. In some ways, the assurances that he had about those reconfigurations and about working with NHS England are not being met through the process. It was also Paul Goggins, along with colleagues, who campaigned for the improvements in accident and emergency at Wythenshawe hospital. A £12 million scheme will begin there in November to create a new A and E village, a world-class facility. The Minister is right that this is a once-in-a-generation opportunity to integrate health and social care. It is also a once-in-a-generation opportunity to show that large conurbations such as Manchester, which is moving towards 3 million people, can take control of their powers to deliver their own health and social care.

I thank the Members who have turned up. What my hon. Friend the Member for Manchester, Withington (Jeff Smith) did not say about himself is that he was at the forefront of the campaign to build the new hospital in Withington all those years ago, when we reconfigured the services. We can make more of that hospital; we are already discussing 24/7 GP access there. If we can realise that vision to ease the pressures on A and E departments across the conurbation, it will be a major achievement, thanks in no small part to his campaigning activity long before he came to this place.

I am delighted that my hon. Friend the Member for Ashton-under-Lyne (Angela Rayner) is in her place. The hospital in her constituency has undoubtedly had a torrid time over the past six or seven years, but today NHS England lifted it out of special measures, which is cause for everyone to celebrate. My hon. Friend the Member for Blackley and Broughton (Graham Stringer) has been a constant defender of his local hospital, North Manchester General, and has been a visionary leader, in the sense that we are now getting to the point of being able to devolve powers on skills, housing, transport, business, investment and, eventually, healthcare to Greater Manchester. He has been at the forefront of that.

I thank the shadow Minister for his erudite contribution and for linking the issue to Manchester airport. We cannot consider health on its own. The decision on “The Northern Way”, or the northern powerhouse, can be pivotal in getting world-class inward investment in healthcare in Manchester. It will link to the airport next to the hospital, which had 23 million passengers this year, increasing to 40 million over the next couple of years. We have plans in our area to expand the Metrolink at some stage to connect Wythenshawe directly. Currently it connects to Manchester airport, but we want to send the loop around to connect with the High Speed 2 station and back to Wythenshawe hospital.

We in the north-west have had problems in the past, as hon. Members will know. I pay tribute to the hon. Member for Macclesfield (David Rutley), who has been considering life sciences across the region, including AstraZeneca and regenerating Alderley Park, and linking the issue to our vision of a life sciences institute medi-park on the Roundthorn industrial estate next to our hospital. That could be further linked to the Corridor project involving graphene and the life sciences, associated with Central Manchester hospital. We need more links with that in the future. That site also ties into Airport City, which is in development both south and north of the airport. We are expecting massive change in south Manchester and Trafford over the next 10 to 15 years. It will be generational change that will drive the northern powerhouse, with the addition of HS2 and possibly, given the discussions that the Department for Transport is having, of HS3.

We have a wider vision for the site, and we do not want it to be set back by process issues. Let us all—people watching today and everybody in this Chamber—commit to the vision of making south Manchester and Greater Manchester a world-class place for economic investment and healthcare.

[Mr Philip Hollobone (in the Chair)]

Would all those who are not staying for the next debate please be courteous enough to leave quickly and quietly?