Newark Hospital

Patrick Mercer Excerpts

Tuesday 6th July 2010 Westminster Hall

[Patrick Mercer (Newark) (Con)]

I am most grateful that you are chairing this important debate, Mr Amess. Nottinghamshire is getting a good outing this morning. I hope that the local press appreciate it; it is not at all laid on for their benefit. I thank the Minister for being here. It shows a degree of commitment from his Department as well as from him personally. Not only did he give up his time to make his first ministerial visit to Newark hospital when I asked him, he is also here today. I thank him personally for the great interest and acumen that he is showing. I also thank the hon. Members who are here in support. My local paper, the Newark Advertiser, is interested in the issue and has been supportive, and the “Save Newark Hospital” campaign has been immensely helpful.

This subject is extremely important in my constituency. I will not say that it divides public opinion, because it does not. It is quite simple: I cannot find a single person in Newark who does not support the development and further expansion of the services of a vibrant and successful hospital in a town due to grow by many thousands over the next five to 10 years. The issue does not divide the town; everybody agrees that we need a proper, developing and expanding hospital.

A health care review began 18 months ago, entitled “Help to shape the future of Newark’s NHS”. As a sitting Member, I realised that the three elements involved—Nottinghamshire County primary care trust, Sherwood Forest Hospitals NHS Foundation Trust and the East Midlands ambulance service—needed my responsible and sensible support if we were to improve health service in a town that is growing exponentially.

The process made good progress, but recently we have run into trouble. The subject, quite rightly, became extremely contentious and difficult during the election campaign, and is now attracting more and more energy as people become more concerned about what is going on. One or two mendacious suggestions that the hospital would close were made during the campaign. I do not believe that the hospital will close under this Administration or any other, nor should it, so we can put that suggestion to one side. Those in the town of Newark who hope to frighten individuals with it are both irresponsible and mendacious, but things become difficult when one sees the health care review document—it also says that Newark hospital will not close, which is fine—which says:

“Some services will change, some will be added.”

If we pitch against that the changes that have occurred, we can understand the perception in my constituency. First, we are going to lose our accident and emergency ward. I know that and accept it, but it is alarming to the people of Newark. I will return to that issue in a moment. We have already lost the Friary ward; I will return to that in a moment as well. The blood classification service has been alienated. Pharmacy services have been closed. All sorts of dilemmas exist about the protocols under which ambulances work: for instance, if a child is knocked over within sight of Newark hospital, the ambulance that picks up that child will not take the child to Newark hospital. Nor should it—Newark hospital cannot cope with injured children—but it is hard for a parent who can see the hospital not to wonder why his or her child is being taken to Lincoln, King’s Mill or Mansfield hospitals or to Sutton in Ashfield, for instance. It is a difficult matter of perception. Furthermore, we were recently told that another ward would be closed. I think that my constituents feel that they have been misled rather than informed by the process.

We have had a healthy debate among the three different factions and various town campaigns, but if the Minister will bear with me for a few moments, I would like to apply to what is happening in Newark the four crucial tests laid down by the Health Secretary for the improvement of health services throughout the country. I repeat that a lot of it is a matter of perception. Ambulances were never going to take children to Newark hospital. However, why that has not been properly explained to my constituents, who continue to think that ambulances could do so, is a wholly different matter. I have no doubt that the Minister, who is nodding in agreement, understands that as well as I.

The first of the four crucial tests is that changes should have the support of GP commissioners. Let us test the closure of the accident and emergency ward at Newark hospital. Anybody who bothers to lift the stone and look underneath will understand that Newark has not had an A and E ward for as long as I can remember. There is no debate about whether it should; it meets none of the criteria. Therefore, the sign is clearly misleading and unhelpful, and it must go. However, Newark sits at an extremely important point on the A1, near the dualling of the A46 and the east coast railway line, where there is massive potential for large-scale injuries. If the Potters Bar crash happened in Newark, as it might, Newark hospital could not cope with that many accident and emergency cases.

However, we need something better than what is proposed. I am told—although I treat this with a certain amount of scepticism—that GPs are strongly behind the idea of having a minor injuries unit-plus rather than an A and E ward. I cannot describe how irritating that is, not only to me but to the people of Newark. Most will accept that A and E has no place at Newark hospital, but most believe, and indicated during the consultation process, that we need an urgent care centre, ward or similar at Newark hospital where people can go to receive the care that they need. I believe that that will be provided, so it does not matter much; we are really arguing about what the notice should say. However, I say to the Minister that if we do not get an urgent care ward, centre or whatever, it will spread unnecessary alarm and despondency in Newark. The title “minor injuries unit” suggests cuts and bruises or coughs and sneezes, which is unacceptable and similarly misleading to the public.

Sherwood Forest Hospitals NHS Foundation Trust says that it supports

“the provision of an ‘urgent care, minor illnesses and minor injuries service’ at Newark Hospital, as agreed by local clinicians and supported by the majority of local people during the formal consultation process”

and wishes

“to ensure that the name of the new unit clearly describes the breadth of services provided and ensures that patients access services in the right place, at the right time, first time.”

The next test, however, is that proposed changes must strengthen public and patient engagement. I seek an assurance from the Minister about patients, members of the public, all local GPs and particularly the staff of Newark hospital, who have been enormously supportive, helpful and loyal to their organisation. A horrible rumour circulated in town that staff had been gagged from talking to the press or the Minister. I am sure that the Minister would agree that during his visit last Thursday, not only did we hear some extremely articulate individuals but members of staff were not restricted at all. They and their opinions are terribly important. Will staff at Newark hospital be included in all decisions on the future of the hospital? I ask the Minister how we can achieve that, because clearly we are anxious to help with the process.

The next question I ask the Minister comes under the same heading of strengthening public and patient engagement. I absolutely accept his point that the process has to be led from the bottom up—it must be led from the grass roots and must not be top down and dictated from the top. I know that the Government are committed to maintaining front-line services, but will the Minister assure me that services at my local hospital will not be reduced or diminished for acute and sub-acute patients? I understand that change has to occur—I am not being a stick-in-the-mud about this; I am trying to be as helpful as I can—but that question is crucial. As I have said, not only has the Friary ward been closed, but there is word that another 30 beds will be taken away. That is the equivalent of another ward. If we lose that number of beds, my worry is that very shortly Newark hospital will become nothing more than a cottage hospital. That is the last thing I want, so I ask the Minister to deal with that question.

[Mr Mark Spencer (Sherwood) (Con)]

Does my hon. Friend recognise that Newark hospital is important to not only his constituents, but the constituents of Sherwood and Bassetlaw? It is particularly important to people who live in villages to the east of the A614, many of whom prefer to use the services at Newark rather than travel to the Queen’s medical centre or to King’s Mill hospital.

[Patrick Mercer]

I am grateful to my hon. Friend for that intervention and I congratulate him on his tremendous success at the election, although I regret the departure of his predecessor, who was a close friend of mine. I completely agree: the hospital’s influence extends far beyond Newark. Once the A46 is dualled—heaven help us if that is cancelled—it becomes even more important that the hospital can provide a quick and urgent service to people in the Sherwood constituency. I absolutely accept his point.

The third crucial test is that of greater local clarity and the need to have a clinical evidence base for any proposals that will be made. In the light of that, it is proposed that patients are treated at Lincoln hospital’s accident and emergency department instead of Newark’s. The patient safety record at Lincoln hospital is worse than at Sherwood Forest Hospitals NHS Foundation Trust. Can the Minister shed some light on the matter of patient safety, because I want my constituents, or anyone who is injured, to go to the best possible place? If such a situation exists, can we have some explanation for that proposal?

The last test is that proposals should take account of patient choice. Many in the town of Newark would say that the consultation process was faulty and was not properly delivered. A number of proposals were clearly supported by everybody who responded to the process and therefore my fourth, and almost my last, question to the Minister—I am sorry if I am burdening him with tedious matters—is whether he will investigate the closure of the Friary ward, which is our local psycho-geriatric ward, and consider whether it might be reopened in the future. We have been told that the Friary ward has only been closed temporarily and that we will get psycho-geriatric services back in the near future. It is crucial that that happens.

I respect and understand those four points. The difficulty is that Newark lies right on the edge of Nottinghamshire and Lincolnshire. In theory, we have excellent communications in all four directions, but if we have a national health service based on centres of excellence in places such as Lincoln, Sutton-in-Ashfield and Nottingham, we obviously need communication from Newark to those centres of excellence. I understand that we cannot have one of the several hospitals in Nottingham inside Newark, but we must have an ambulance service that is capable of getting our injured or routinely sick to centres of excellence quickly, efficiently and calmly. I have received a number of reassurances from the ambulance service that those improvements are in hand, but I would be grateful to the Minister if he could dilate upon that a little more. Can he reassure me that we will have an ambulance service that is fit for the 21st century, which can deal with the increasing number of people who live inside the town?

You will be relieved to hear that I have almost finished, Mr Amess. I understand that we must have demonstrably better outcomes for patients and that we must ensure they receive the highest-quality specialist care in specialist centres. I understand that, in many cases, it is better to treat people at home rather than in hospitals. I am not being narrow minded or reactionary about this, but so much of the process has been badly presented to the public, to health care professionals and to patients. If only we could have some clarity on the matter and I could see clearly that the four tests set by the Secretary of State were being met, I would be a lot happier. The matter is crucial to Newark, which sits on the edge of two different local authority areas, and I am extremely grateful to the Minister for the time he has taken to visit the town. However, a strong and vibrant outcome from this process would assure Newark that it does not just sit on the edge of everything; it lies in the heart of the east midlands, which is exactly where it ought to lie.

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate my hon. Friend the Member for Newark (Patrick Mercer) on securing this important debate on the future of Newark hospital. As he said, I was fortunate enough to visit the hospital last week. I was extremely grateful to have the opportunity to do so and I was particularly struck by the enthusiasm and dedication of all the staff and management I had the privilege of meeting during that visit. I fully understand my hon. Friend’s desire to ensure his constituents have the best possible health services. My visit last week proved extremely useful in understanding the issues there.

I would like to take this opportunity to outline briefly the Government’s approach to service reconfiguration. We believe that the best decisions are local decisions, and that change should be driven by local clinicians, not imposed by politicians or decided by managers behind closed doors. The Secretary of State has identified four crucial tests that all reconfigurations must now pass. First, they should have the support of GP commissioners; secondly, arrangements for public and patient engagement, including local authorities, should be strengthened; thirdly, there should be greater clarity about the clinical evidence base underpinning any proposals; and fourthly, any proposals should take into account the need to develop and support patient choice.

To ensure the long-term future and sustainability of health service provision in Newark, a range of NHS services in the area have been reviewed. Those include unplanned and emergency care as well as in-patient dementia care. I understand that clinicians from primary and secondary care are in unanimous agreement that Newark hospital cannot provide a full accident and emergency service—I am grateful to see my hon. Friend nodding in agreement to that. They have concluded that, for the sake of patient safety, the hospital should no longer care for patients with acute medical conditions. The hospital should also be named more accurately to avoid public confusion, ensuring that patients go to the right place first time and are not put at additional and unnecessary risk by going as a first destination to a unit that is not able to look after their degree of injury.

The main reasons for that are as follows. First, every tier 1 accident and emergency department needs an intensive care unit, emergency operating theatres and 24/7 anaesthetics to provide back up for the A&E and acute medical conditions. Unfortunately, Newark does not have those and has not had them. Secondly, acute emergencies require specialist skills, which are not and have not been available in Newark. Thirdly, doctors agree that avoidable transfers are associated with poorer health outcomes and worse patient experiences. In 2009/10, the PCT reports, a significant number of patients had to be transferred, many due to a deterioration in their condition.

The local NHS ran a consultation exercise earlier this year to garner the views of local people. The majority were in favour of changes to urgent and emergency services at Newark hospital. I know that there is a view, expressed by some campaigners, that the consultation was rushed, too small to be properly representative of the local community’s views and that the full implications of the review have not been sufficiently drawn out. The NHS must not take local support for granted and must continue to engage fully with clinicians, the public and the council’s overview and scrutiny committee. If a consultation is inadequate, it must be improved and should provide as much relevant information as possible. The overview and scrutiny committee continues to review the implementation of planned changes, which is essential to help to ensure democratic scrutiny.

The strategic health authority has told me that Nottinghamshire County PCT engaged with the overview and scrutiny committee throughout the Newark review and that evidence of that engagement was presented at the PCT board meeting on 17 June. Yesterday, the PCT met with the overview and scrutiny committee to decide the next steps. I understand that it does not intend to refer the proposals to the Secretary of State.

I will turn now to one of the problems with the reconfiguration: the naming of the unit that will deal with injuries, which my hon. Friend mentioned. It is of course important that the facility at Newark hospital is appropriately named. I know that some people would prefer it to be known as a minor injuries-plus unit, while others would prefer to call it an urgent care centre. As he will appreciate, it is not for me to intervene in that issue in a top-down manner. The choice of a name must be agreed locally and should clearly reflect the nature of the facility, so I hope that the matter can be resolved locally through ongoing discussions.

On A and E services, I understand that Newark hospital has never had a full A and E department. Confusion has arisen in part because there is an A and E sign outside the building, but that does not reflect the nature of the services provided inside. Having a local A and E department on one’s doorstep can feel reassuring, but the reality is that receiving the best care does not always mean being taken to the nearest hospital. Some patients might be treated at the scene and others might be taken to Newark for treatment, but those who have suffered major trauma will be best served by being taken directly to specialist units, receiving care en route to the hospital that has the most suitable facilities.

The proposed changes aim to solidify the existing protocols on diverting acute patients to more appropriate hospitals, ensuring that patients go to the right place the first time and are not put at additional and unnecessary risk. I understand that the parents of a young child recently turned up at Newark hospital A and E, incorrectly assuming—understandably—that it was a full A and E department, and the child’s care was delayed as a result. I stress my earlier point about the importance of naming the unit correctly so that local people can understand easily what it does and does not do. I am pleased that during October and November there will be a public education process in Newark to explain exactly what the unit does and where patients should go in the first instance, either to Newark or to another hospital, for appropriate treatment when injured.

[Patrick Mercer]

Would the Minister be kind enough to inform the relevant authorities that I would very much like to be involved in that work? The whole process has been marred by poor communication and bad consultation, so I would be happy to help in any way I can.

[Mr Burns]

I am extremely grateful to my hon. Friend and am sure that there is a role for him to play in helping his constituents in the education process and explaining fully the role of the unit so that it receives appropriate admissions in future.

On the running down of services at Newark, we must be careful not to do the local NHS a disservice through idle talk about the future of the hospital. The proposals focus on giving patients access to safe care for urgent conditions. The people of Newark will continue to access Newark hospital if that is the most clinically appropriate place for their treatment. There will be an increased availability of same-day or next-day outpatient appointments for patients who GPs believe require urgent assessment. If a diagnostic test such as an X-ray is required, that will be done at the same time.

There is also scope for Newark hospital to undertake more planned surgery, such as hip and knee replacements. I know that that is being explored by the Sherwood Forest Hospitals NHS Foundation Trust and the PCT. It is also important to note the important role that Newark hospital plays in rehabilitating patients who are well enough to leave the facilities at Lincoln and Nottingham and can continue their care closer to home. Those proposals would also see an out-of-hours GP service available on site, which I hope my hon. Friend will welcome, as patients who wish to see a GP after midnight currently have to travel up to 20 miles to see one in Mansfield.

I am aware that the local press have reported that Newark hospital is being downgraded. The trust has made it clear that there are no plans whatever to downgrade the hospital. Rather, the plan is to make it fit for purpose and safe for patients. The trust also assures me that it is fully committed to Newark hospital and has no plans to close it. Rather, it sees the hospital as an integral part of local health services. I hope that that goes some way towards reassuring my hon. Friend and his constituents.

He also mentioned Friary ward, which was temporarily closed by Nottinghamshire Health Care Trust to assess how it can best be used in future. I gather that demand for the ward, which has 15 beds, had dwindled to two patients. More people need to be cared for in their own homes, as I suspect many patients would prefer, if that is medically and clinically feasible. I will certainly write to him with more details on what is happening at Friary ward and what will happen as a result of the trust’s assessment of the future of that part of the hospital’s activities.

On the concerns about the public consultation, the evidence I have been given indicates that there was a full engagement with the local community about the proposals that were put out to consultation prior to decisions being reached, although there will always be differences of opinion. I have no evidence to show that that was not a satisfactory and wholehearted consultation, even though I accept that some people remain unconvinced by the proposals before the trust.

In conclusion, local health services will need to evolve and become more efficient, in line with current Government policy. If we want to take people with us, we must ensure that they have full confidence in the decisions being taken and feel that their voices are properly heard. That is what the new arrangements are about. That will not always be easy, but if it is clear, transparent and led locally by clinicians, and if it listens and responds to the voices of local people, it will help to reduce the anxiety my hon. Friend has spoken about today and on which he has so eloquently campaigned over the past few months for the people of Newark. The commitment and tenacity he has shown in fighting for local health services is commendable, and I know that he will continue to engage constructively with the local NHS to ensure that his constituents’ concerns are properly heard.

I trust that something can be done through continued dialogue between all parties, including my hon. Friend, to resolve satisfactorily the differences of opinion on the name of the unit so that there is no confusion about where his constituents should go if they or their family members are involved in an accident and that they get the quickest and finest health care possible in the most appropriate setting.