Hospitals (Sussex)

Stephen Lloyd Excerpts

Wednesday 20th June 2012 Westminster Hall

[Stephen Lloyd (Eastbourne) (LD)]

It is an honour to serve under your chairmanship, Mrs Brooke.

I am grateful that Mr Speaker has given me an opportunity to address an important local issue—the proposed reconfiguration of my local Sussex NHS trust, the East Sussex Hospitals NHS Trust. A number of reconfigurations have already taken place in Sussex, such as the transfer in March of in-patient elderly care and orthopaedics in the Western Sussex Hospitals NHS Trust from Southlands hospital to Worthing hospital. It appears that the latest direction of travel for Southlands is to become a day surgery and out-patients-only hospital, with which I expect few local residents would agree.

Let me give the Minister the details of the proposed changes to my local trust and hospital, Eastbourne district general hospital. Four or five years ago, the trust board wished to downgrade maternity at the DGH while maintaining consultant-led maternity at our sister hospital in the trust, Conquest hospital in Hastings. There was a substantial campaign against the proposals in which all parties were involved, and eventually the matter was referred to the Independent Reconfiguration Panel for consideration. It found against the proposals, and the trust-proposed strategy was sent to the then Secretary of State for a decision. I am glad to say that he backed the IRP and our campaign to retain consultant-led maternity on both sites.

As I am sure the Minister is aware, there was a number of reasons why the IRP found against the trust, but essentially the main reason was the poor road link between Hastings and Eastbourne, which would have meant a blue-light ambulance potentially taking upwards of 50 minutes to travel from hospital to hospital. From a patient safety perspective—for example, for a mother facing a complicated birth—that was considered far too long. Hon. Members can imagine my surprise to find out a few weeks ago that the new trust board is recommending a similar change—to be precise, that there should be a consultant-led maternity unit on one site and a midwifery-led unit on the other site. For the record, the road links between the DGH and the Conquest are even worse than they were five years ago, when the IRP found in our favour.

[Henry Smith (Crawley) (Con)]

I congratulate the hon. Gentleman on securing this debate. The story elsewhere in Sussex has been similar. A decade ago, we lost maternity services from Crawley hospital, which was a very retrograde step. Mothers now have to travel long distances and a difficult journey to East Surrey hospital for maternity services. The proximity argument is important.

[Stephen Lloyd]

I thank the hon. Gentleman for that important intervention, not least because he demonstrates that if the proposed downgrades go through, the backlog will be even worse. Patients coming from his constituency would have an even longer wait, which an expectant mum with a complicated birth cannot afford.

Along with maternity, the proposed clinical changes recommend significant further reductions to trauma and orthopaedics, general surgery, stroke, emergency care, acute medicine, cardiology, paediatrics and child health provision. I am no medical expert, but even I can see that if some of the proposals are carried through, they will lead to a substantial downgrade of core services at Eastbourne district general hospital. We are talking about a possible downgrading of a much loved hospital in one of the fastest growing towns in the south-east, where the fastest growing age group is the 25 to 45s. I am simply not prepared to stand idly by and allow that to happen. The people of Eastbourne and the surrounding area are not prepared to do so, and none of the local political parties is prepared to accept the proposals.

On that note, I am grateful to the Under-Secretary of State for Transport, my hon. Friend the Member for Lewes (Norman Baker), who is here supporting me in this debate, as he has done throughout the past few years. He was very heavily involved five years ago, when we won the last campaign. I also acknowledge the support I have received from the Minister of State, Department of Energy and Climate Change, the hon. Member for Wealden (Charles Hendry), the hon. Member for Hastings and Rye (Amber Rudd) and the Minister of State, Department of Energy and Climate Change, the hon. Member for Bexhill and Battle (Gregory Barker). They send their apologies for not being here, but they are very supportive of what we are trying to achieve. The local business community and the voluntary sector are also not prepared to stand by while our hospital’s core services face such a proposed downgrade. We will all fight the proposals vigorously and tenaciously. I cannot emphasise that strongly enough to the Minister.

Why are we so determined to fight? Let me flesh out just a little of what we believe the consequences will be if the proposed clinical strategy goes ahead. The first issue is travel distance. The travel time between Conquest and the DGH is 50 minutes. Even when the planned Bexhill-Hastings bypass is built, in however many years’ time, that journey time will be reduced by only five-and-a-half minutes. That is still way outside the guidance from the Royal College of Midwives on mothers giving birth safely. The IRP and the Secretary of State agreed with us on that five years or so ago.

Secondly, although I wholly accept that very specialised procedures—for instance, children’s cardiac surgery or even specialist oncology and cancer—are better in the fewer, larger specialist expert centres, the vast majority of Sussex patients also need good-quality local care for simple conditions. Why would the Department of Health encourage care closer to home and then sanction the massive movement of patients, which would be an inevitable consequence of some of the proposed changes?

Thirdly, there will continue to be two hospitals admitting medical emergencies, as there are too many patients to move them all into one giant hospital. The reality is that it is often difficult to make a diagnosis for elderly people, but the proposals mean that one unit will have a surgeon on call and one will not. An elderly person admitted to a hospital with no surgeon who proves to have a burst appendix or to be bleeding internally will have to travel from the DGH to Conquest. That simply cannot be safe.

Fourthly, both hospitals fix fractured bones, but under the proposed strategy, if someone has a fracture, they will have to travel. The number of elderly and frail patients with hip fractures having to travel will increase exponentially. It will take longer for them to get an operation, and the inherent delay will lead to worse outcomes. In addition, there is likely to be a longer waiting period to sort out social services, and the individual patient will have to be sent home from a greater distance. Surely that cannot be better for the patient. In fact, pretty much anyone with a broken arm, leg or hip that needs fixing will have to travel further. The service will not be better quality, Minister; it will just be slower.

Let us take a look at the nearby trusts that will, apparently, take up the slack. This is patently absurd. Brighton more often than not has huge waits, and Pembury is full, so that is no answer. In stroke care, elderly patients will be moved, making it doubly hard for their similarly-aged husbands and wives to visit. Is that good practice for the patient? I do not think so. There is more, but I am that sure the Minister gets my drift. If he does not, let me draw his attention to the contents of a very important letter that was leaked to me a couple of weeks ago—I am happy to share the contents of the letter with him afterwards.

The letter was sent to the trust board from the consultant advisory committee that represents the most senior clinicians at Eastbourne district general hospital, following a meeting that 63 consultants attended. I quote:

“The main body of Consultant Opinion expressed little or no confidence in significant elements of the strategy… Concerns repeatedly expressed (by the Consultants) were that proposals would not advance the desire for improved access and quality of care for patients in East Sussex”.

These are direct quotes. The letter continues:

“There was frustration that clinical input from the majority of CAC members into the strategy has not been taken into account. Furthermore, concern was expressed that although Management has described the strategy as clinically led, this has been by a few invited individuals and the majority Consultant opinion expressing concerns regarding many aspects of the strategy has not been adequately expressed… the clinical strategy as explained and understood by the CAC does not deliver clear benefits to patients and therefore cannot be supported in its current form”.

The CAC letter further states:

“our local population rightly expects key services should be maintained at both sites and that these include stroke care, orthopaedics and trauma, general surgery and other core services. The strong recommendation of the CAC was that both sites should be developed to improve quality of care, training issues and access for local patients”.

I shall conclude my speech, because I am very keen to listen to the Minister’s response. Time precludes me from going into detail about the cross-party “Save the DGH” campaign group, which has been working together for years. It succeeded five years ago and has come back together stronger than ever. Time precludes me from talking about the fantastic work that has been done by our chair, Liz Waike, the strong determination in my constituency to protect core services at the DGH, and the important support provided by our local paper, the Eastbourne Herald.

I also do not have enough time to talk about the details of the utter financial shambles. The trust has been under successive managements since it was merged with the Conquest more than 10 years ago. I am well aware that, like me, the Minister has a business background. The financial inefficiency of the trust for many years has been mind-blowing. I would be happy to give the right hon. Gentleman more details at another time.

Time precludes me from giving details of the severe morale challenges felt by community nurses, who face reductions while at the same time being told ad nauseum that they must keep people in the community, so as not to take up expensive hospital beds. Time precludes me from telling the Minister of the sheer frustration that my constituents and I feel as we have to fight a similar battle around maternity all over again, despite the IRP’s clear conclusions five years or so ago.

Time precludes me from presenting details of how, if necessary, we should seriously consider de-merging the trust and setting Eastbourne DGH up as a separate foundation trust. We have been doing this work for many months now, as we suspected that proposals to downgrade DGH core services from the current trust board were in the pipeline. I have even had a number of key people in the DGH campaign visit an equivalent sized trust in Yeovil in the west country. We came back from that visit with some very useful data and plans for if we were to de-merge.

As time is an issue, I will finish with a direct quote from our mutual friend and colleague, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), who wrote in a letter that I received yesterday:

“The Government has said that, in future, all service changes must be led by clinicians and patients”.

The clinicians, as I have already reported, have profound concerns. I can assure the Minister of State that patients—former and future, from Eastbourne, Willingdon, Lewes and beyond—also have profound concerns about the proposed clinical strategy currently presented by East Sussex Hospitals NHS Trust managers.

I ask the Minister to take on board our concerns, to do what is necessary to address them, and to ensure that our hospital, Eastbourne DGH, is continues to perform as a fully functioning district general hospital for many years to come. Eastbourne is a growing town—in many ways, we are bucking the economic trend—and I am working closely with business and the council. We are rolling up our sleeves up in this difficult economic climate. I have already mentioned that the fastest-growing demographic in my constituency is the 25-to-45 age group. I need a proper hospital for Eastbourne. I need a district general hospital for the long term. I would welcome any comments that the Minister has to make.

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

It is a pleasure to serve under your chairmanship, Mrs Brooke. I congratulate the hon. Member for Eastbourne (Stephen Lloyd) on securing the debate on an issue that I know is of considerable concern to him and his constituents, and to other hon. Members attending today.

Before I address the issues raised, I would first like to pay tribute to all those who work in the national health service in Eastbourne, whose dedication, determination and commitment provide first class care to the hon. Gentleman’s constituents and those of other hon. Members. I know the hon. Gentleman is committed to ensuring that his constituents have access to high quality health care whenever and wherever they need it. I also appreciate that when any changes to local services are mooted, people can become anxious and feelings can run high.

As lifestyles, society and medicine change, the NHS must continually adapt. The NHS has always had to respond to patients’ changing expectations and to advances in medical technology. Reconfiguration is about modernising the facilities and the delivery of care to improve patient outcomes, to develop services closer to home, and, most importantly, to save lives. The Government are very clear that the reconfiguration of front-line health services is a matter for the local NHS. Services should be tailored to meet the needs of local people and to provide them with the best possible outcomes. That is why we are putting patients, carers and local communities at the heart of the NHS, placing decision making as close as possible to individual patients by devolving power to professionals and providers, and liberating them from top-down control.

Those principles are further enshrined in the four tests introduced in 2010 by my right hon. Friend the Secretary of State. Local reconfiguration plans must demonstrate: support from GP commissioners; strengthened public and patient engagement; clarity on the clinical evidence base; and support for patient choice. Our reforms allow strategic decisions to be taken at the most appropriate level. We are enabling clinical commissioners to make the changes that will deliver real improvements in health outcomes, and we will provide incentives to providers to deliver higher quality and more efficient services.

We are also aware that the reconfiguration of services works best when there is a partnership approach between the NHS, local government and the public. That is why we are strengthening local partnership arrangements, under the Health and Social Care Act 2012, through health and wellbeing boards. They will provide a forum where commissioners, local authorities and the local HealthWatch can discuss and plan the future shape of services to meet the health requirements of the local health economy.

NHS Sussex and local clinical commissioning groups, such as the commissioners of East Sussex Healthcare NHS Trust, have been working with NHS South of England, with support from the National Clinical Advisory Team, to ensure that there is full and proper scrutiny of the proposals to reconfigure some services. That has included assessing the readiness of the local NHS to go out to formal consultation, including reviewing the case for change and understanding whether the four tests, as laid down by my right hon. Friend the Secretary of State, for service change have been met.

The services under consideration for reconfiguration at the trust’s two acute sites at Eastbourne District General hospital and the Conquest hospital, Hastings are: orthopaedics, higher risk and emergency surgery only; general surgery, higher risk and emergency surgery only; and stroke, hyper-acute and acute only. Those are the only services being consulted on under the proposals. The local NHS agrees that hyper-acute and acute stroke services, all emergency and higher risk elective general surgical procedures, and all emergency and higher risk elective orthopaedic procedures can no longer be provided at both of the trust’s acute hospital sites. I understand that the proposed changes were approved on 30 May by the two local clinical commissioning groups—Hastings and Rother; and Eastbourne, Hailsham and Seaford. NHS South of England strategic health authority formally reviewed those proposals and assured itself that the Secretary of State’s four tests have been met and will continue to be met. The trust will now look to launch a 14-week public consultation exercise, which it anticipates will commence on 25 June, or shortly thereafter.

The hon. Gentleman raised concerns about maternity services, and I will seek to reassure him. For the sake of clarity, the current proposed consultation will not include maternity services. I understand that maternity services will be included in a separate programme known as Sussex Together, which is still being developed. That will look at maternity services across the county as a whole. The proposals are focused on enabling the local NHS to deliver directly clinically safe and sustainable services for patients, now and into the future. I am sure the hon. Gentleman agrees that this is something we all want and expect from the NHS.

A great deal of work is taking place to develop a local clinical strategy, one that will ensure the future sustainability of health services in the county and the best possible outcomes for local patients. The clinical strategy centres on eight areas of care, described by the trust as primary access points, covering 80% of service delivery. They are: acute medicine; cardiology; emergency care—A and E; general surgery; maternity; musculoskeletal, trauma and orthopaedics; paediatrics and child health; and stroke. For each one, a report on current challenges, the case for change and the proposed option has been produced.

With those plans, the local NHS in Sussex wants to achieve greater integration across health and social care services, to provide more care within communities, together with, where appropriate, shorter stays in hospital and better support when patients leave hospital, to provide care that continues to meet national clinical standards and best practice, to improve patient access to clinical experts at the earliest appropriate opportunity and to deliver the best outcomes for local patients.

[Stephen Lloyd]

I appreciate what the Minister says. I share his belief that the broader we go on the consultation, the better it will be. I support the health and wellbeing boards, introduced under the Health and Social Care Act 2012, because they are a good idea and will have some clout under the legislation. Does he agree that as the ESHT goes through the consultation, our new health and wellbeing board should be part of that consultation?

[Mr Burns]

Yes. Anyone and anybody should contribute to the consultation on any proposed reconfiguration. A key role of the health and wellbeing boards, particularly when fully established and operating in their own right, rather than in their shadow form at the moment, will be to ensure that the interests of the local health economy and patients are met. I would be surprised if the health and wellbeing boards did not show an interest in any reconfiguration, whether affecting the hon. Gentleman’s constituency or elsewhere. I am sure that they would form a view about any proposals.

The plans have been developed by local clinicians, including input from local clinical commissioning groups, with involvement from patient representatives, local people and other stakeholders, taking into consideration national best practice. Local clinical commissioning groups are also working alongside NHS Sussex to lead work on assuring the plans. The local NHS says that it believes that the majority of the changes required can be achieved by redesigning services and introducing greater integration and productivity within and between services. The proposed changes should enable the trust to deliver best practice, such as early access to senior clinicians, dedicated units, with specialist support staff and facilities, and improved multi-disciplinary teams.

Under the preferred options, surgery and orthopaedic services would be provided from the same site to support trauma unit designation. However, stroke services would not necessarily have to be on the same site as those services.

As I have said, reconfiguration is a matter for the NHS locally. I hope that the hon. Gentleman accepts that it would be inappropriate for Ministers to intervene in local due process, because the ethos of NHS reform is to put an end to the constant interference and micromanagement of the day-to-day running of the health service by Ministers like me or civil servants in the Department of Health in Whitehall. The nub of our reforms is that decisions on local issues—the local provision of health care—should and must be determined locally within the local health economy.

[Stephen Lloyd]

I appreciate where the Minister is coming from. Again, I genuinely and profoundly agree with him. That is why it is so significant that the majority of senior clinicians, as well as the public, are singing broadly from the same hymn sheet. The significance of the changes in the Health and Social Care Act 2012 is, as our colleague the Under-Secretary of State for Health says, that they must be led by clinicians and patients. That is why I made the point in my speech. I am gratified that the Minister has reiterated that.

[Mr Burns]

Let me mention something that will be of some comfort to the hon. Gentleman when the proposals get to the appropriate part of the process. The local authority health overview and scrutiny committee, which comprises democratically elected members of the council, has powers to refer a service reconfiguration to my right hon. Friend the Secretary of State if it is not satisfied that the proposals are in the interest of the health service in the area and in line with the content of the consultation or the time that has been allowed for it and that the consultation has been conducted appropriately.

As this consultation has not yet even begun, the HOSC has obviously not yet had the opportunity to make any such decision on whether it has been conducted appropriately. I therefore encourage the hon. Gentleman, his constituents and other interested parties who may be affected by the proposals to engage fully in the consultation when it commences to ensure that their views are fully taken into consideration.

If a decision flowing from the consultation does not find favour with the overview and scrutiny committee, it will be open to that committee to write to my right hon. Friend the Secretary of State to express its concern and dissatisfaction with the process, the decisions taken and the conclusions reached and to request that he refer it to the independent reconfiguration panel. That is a number of stages down the road, because we have not yet even commenced the consultation.

I urge the hon. Gentleman and every other interested party in East Sussex and even further afield if they might be affected by this reconfiguration to engage fully in the process, so that their views and concerns and their ideas of the best way to provide local health services are met.

Question put and agreed to.