Obstetric and Paediatric Services (East Sussex)

Stephen Lloyd Excerpts

Thursday 18th April 2013 Commons Chamber

[Stephen Lloyd (Eastbourne) (LD)]

Let me begin by thanking Mr. Speaker for allowing the debate, and by welcoming the Minister.

Unfortunately, it is an extremely challenging situation for my constituency that brings me here today: the imminent downgrading of the obstetrics and maternity department and the ending of in-patient paediatric services at my local hospital, Eastbourne district general hospital, which is managed by East Sussex Healthcare NHS Trust.

ESHT, as I will now call it, attempted to downgrade maternity services once before, in 2007, but East Sussex county council’s health overview and scrutiny committee, or HOSC, had severe reservations and duly referred the plans to the then Secretary of State, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who referred the proposals to the independent reconfiguration panel, or IRP.

As the Minister will be all too aware, the IRP is the independent expert on NHS service change and advises the Secretary of State for Health on contested reconfiguration proposals in England. In 2008, it finally published its recommendations, which were that consultant-led maternity, special care baby, in-patient gynaecology and related services must be retained on both sites—at Eastbourne district general hospital and Conquest hospital at Hastings.

The IRP felt that the trust did not make a clear case for safer and more sustainable services for the people of East Sussex and specifically that the proposals reduced accessibility compared with current service provision and that the journey from the DGH to the Conquest hospital posed a risk of incidents for women, especially during unexpected transfers.

Despite clear guidance from the IRP on how the hospital trust must remedy the problem, four years later a report from the national clinical advisory team, or NCAT, has deemed maternity services in East Sussex unsafe. That has given ESHT the opportunity to downgrade Eastbourne’s maternity from a consultant-led department to a midwife-led department almost immediately and, because safety is involved, without consultation. The trust managers have achieved exactly what they failed to achieve all those years ago. Is that a coincidence? I think not.

Let me be clear that I do not contest the findings of that report. How can I? I am not a clinician. However, I am extremely angry that we have found ourselves back where we were, with my hospital losing its consultant-led maternity services. We are back to the point at which we fought and won all those years ago, only now it seems it was a pyrrhic victory and that in fact we have lost. Eastbourne is to forgo its consultant-led maternity after all. Frankly, I think that is outrageous—absolutely outrageous.

Eastbourne is the fastest growing town in East Sussex. Our fastest growing demographic is 25 to 45, the age at which most people have children. The road connections between Eastbourne DGH and the Conquest hospital in Hastings are appalling—that was highlighted by the IRP report five years ago and they are still dreadful.

Where does the responsibility for that grotesque shambles lie? In the opinion of the cross-party “Save the DGH” campaign team, of the Under-Secretary of State for Transport, my hon. Friend the Member for Lewes (Norman Baker)—I am delighted to welcome his support today and although I know he cannot speak in the debate, I appreciate his presence in the Chamber—and of many tens of thousands of people across Eastbourne and the surrounding area, as well as in my opinion, the responsibility lies squarely with the current leadership of the trust and, specifically, at the feet of the chief executive, Mr Grayson, and the chairman, Mr Welling.

It has been made clear to me by many employees of the trust over a number of years that the trust was determined to push through these downgrades, regardless of the recommendations of the IRP. That was obvious for all to see when the chief executive, Mr Grayson, who, when he was asked about the reconfiguration at a HOSC meeting only last month, stated:

“I think it is fair to say the health and social care system in East Sussex failed women and babies in East Sussex when it failed to deliver a change to services in 2008 which, I feel, would have made them safer…we could have done something safer in 2007/08...we need to keep that at the front of our minds as we move into the next period.”

These words do not sound like a senior manager dedicated to implementing a solution that the IRP said was not only sustainable, had the recommendations been properly followed, but in the best interests of the safety of local mums and babies. Or does the Minister disagree with my proposition?

Let me move to the current proposals. The main incidents that led to the safety issues, according to the NCAT report, were problems related to staffing. For instance, emergency measures were required in September 2012 owing to the vacancies for middle-grade doctors and the absence of two consultants, as well as midwifery absences running at about 13%. However, on drilling down into the data, I discovered that the absence of one of the two consultants was due to retirement, and approximately half the midwifery absences were due to maternity leave, all of which, obviously, would have been known in advance. Importantly, other than that, the turnover of midwives was reported as low. This clearly shows an acute lack of planning and poor senior leadership. Staff pregnancy is not a secret, and retirement tends, in my experience, to have a pretty clear lead-in period.

I have brought up these very concerns and others with the Care Quality Commission, having met one of its directors only this week in Westminster. I can safely say that the CQC will in future pay even closer attention to the trust and in particular to the district general hospital.

It is with regret that I also have to tell the House that I have not been hugely impressed with the Department of Health over the issue of my local hospital. The Department has been slow to reply to my letters on what are, naturally, incredibly important concerns to my constituents. For instance, I wrote to the Secretary of State twice on 15 March when the shock news about consultant-led maternity services being switched to Conquest was announced. That will be five weeks ago tomorrow, and I have yet to receive a reply.

This is not the first time I have taken issue with the Department. Immediately before the maternity and paediatric downgrade, the hospital trust also removed emergency orthopaedics and emergency and highest risk elective general surgery from Eastbourne district general hospital. I and colleagues from the Save the DGH team were eventually able to meet the Secretary of State. We made it clear to him that the proposals to remove orthopaedics and general surgery from Eastbourne DGH did not meet all the Government’s four reconfiguration tests. I showed him the meeting papers which clearly state that our local GP commissioners did not support the move. The Minister then agreed to write to NHS South of England to investigate this further, and I received a reply from the Secretary of State a month later, in which he states:

“NHS South of England . . . is satisfied the proposals to reconfigure health services in East Sussex meet the requirements under the four tests.”

In the view of Eastbourne, Hailsham and Seaford clinical commissioning group, emergency general surgery and emergency orthopaedics should be sited at Eastbourne DGH, so clearly those two views contradict each other. I find that extraordinary.

Added to this, we conducted surveys of local GPs and consultants which showed that more than 90% of DGH consultants and 42 local GPs were opposed to the plans, and more than 36,000 people signed a petition against the proposals in only 18 days, which gives a strong indication of the strength of local feeling.

Alarmingly, the Secretary of State also informed me at our meeting that the issue had not even come on to his radar, despite his office confirming some weeks previously that it had received 5,506 letters in three months from people in Eastbourne and the surrounding area. These were individually enveloped letters, yet the Secretary of State was not made aware of them or of the issue. I find that extraordinary.

That brings me to my next key point. I would like to know who in the management structure of the health service or at the Department, both now and prior to the recent changes, is responsible for ensuring that trusts properly implement IRP recommendations, as it is clear in my view and that of others that the trust never sincerely implemented the series of recommendations made by the IRP, which were to maintain two sustainable and consultant-led maternity units. This obvious lack of commitment properly to implement the IRP recommendations was made crystal clear, as I said earlier in my speech, by the trust’s chief executive, Mr Grayson, when he gave evidence to HOSC only last month.

Consequently, I would like the Minister to arrange for me and the cross-party Save the DGH campaign team, which is ably led by the tenacious campaigner for our local hospital, Liz Walke, to meet his officials because we need to establish clear lines of communication with the Department. The people of Eastbourne are being failed, and to address that we need to ensure co-operation at the highest level.

Let me explain how the people of Eastbourne are being failed and what those failings will mean for local mums and babies. First, the proposed changes mean Eastbourne will be the largest discrete town in the UK without essential core services. Secondly, Eastbourne will have the worst population access factor in the UK. The PAF has been validated as a measure of the access to nearest facilities according to the size of population—as I am sure the Minister knows, it is the distance in miles multiplied by the population in thousands.

Thirdly, the NCAT report confirmed that 36% of first-time mothers and 20% of mothers having a second or subsequent baby are referred to a doctor during their pregnancy. Although I accept that expectant mothers will be screened and those found to be at increased risk will be directed to have their babies at a consultant-led unit in Hastings or Brighton, the original IRP report concluded that the risk to mothers was unquantifiable, and the very nature of birth means that there will be examples of mothers who have been screened with no problems detected going on to experience complications. With around 2,000 births in Eastbourne last year, that is an awful lot of pregnant mothers having to be shipped, by blue-light services, across to Conquest hospital.

The South East Coast ambulance service, which gives an outstanding service, gave a range of travel times between 23 and 52 minutes. However, the total transfer time from Eastbourne’s freestanding midwifery-led unit to Hastings consultant obstetric unit is over 60 minutes, and one study showed averages of 90 minutes. The Minister will know that the total transfer time is the important one, rather than the blue-light travel time. It is the total time from the decision to transfer from the FMU to arrival in the receiving bed at the obstetrics unit, incorporating the time for the ambulance to arrive, park, load, travel and unload. Most importantly, it is the total “down time” during which a patient with an obstetric problem will not have access to skilled medical obstetric assistance.

Fourthly, even the NHS pregnancy book advises:

“You should also be aware that if something goes seriously wrong during your labour… it could be worse for you and your baby than if you were in hospital with access to specialised care.”

Let me give the Minister a scenario. A mother in her third pregnancy, which has been uncomplicated, arrives at the midwifery-led unit in Eastbourne, where she had planned to deliver. On arrival, she is found to be in early labour, her blood pressure is low and the baby’s heart rate is slow. The patient is transferred urgently by ambulance 20 miles east to the consultant-led unit at Hastings for delivery. We should remember that the average total transfer time from when that decision is taken to arrival is upwards of 90 minutes.

The baby is born in a frail condition and needs to be resuscitated by neonatal paediatric staff and helped to breathe on a ventilator. The baby will then need to be retrieved by the neonatal transfer team to the neonatal intensive care unit in Brighton, which is more than 30 miles to the west, bypassing the DGH. The mother will also require transfer to the post-natal unit in Brighton in order to be with her baby, and what about her family, husband or partner and the other children and grandparents? I look forward to the Minister telling me how that can possibly offer the mother or the baby a better or safer service.

I find this situation absolutely foolhardy and almost beyond belief. Eastbourne is a growing town that pulls together. We have rolled up our sleeves in the teeth of the financial economic downturn and we are bucking the economic trend: unemployment is down from this time last year, our town centre has secured a £70 million private regeneration investment and we have some of the best performing schools in Sussex. Simply put, Eastbourne is a wonderful place to live and bring up a family, yet—this beggars belief—it seems that our hospital is being salami-sliced, with downgrade after downgrade. It is just plain wrong. I urge the Minister to intervene before it is too late.

It is not only the downgrade of our maternity services that angers me; there is also the decision to close in-patient paediatrics at the DGH. By bundling everything under the “safety” umbrella, the trust has been able to bypass due process on the basis that NCAT recommends that maternity and paediatric services be co-located. In fact, horrifyingly, the NCAT report also states that all core services should be co-located on one site. Will the trust be able to bypass everything in future and downgrade the entire DGH to a cottage hospital at NCAT’s say so? It is absolutely absurd.

Lastly, I have issues about whether staff really can go public with their concerns; frankly, under the current regime they fear for their jobs. I have been contacted by staff from all the different levels in the hospital. All are courageously keeping me informed but, equally, they are profoundly fearful about going public. That puts me, their elected representative, in a very difficult position. I will not breach their confidentiality without permission and they do not give their identities for fear of the consequences, but the trust management is then able to pooh-pooh my concerns and public statements as not being based on fact. In fact, the contract of one of my NHS constituents states:

“If he or she discusses items under consideration by the Trust that he or she becomes aware of with ‘unauthorised persons’, this will result in disciplinary action which may involve dismissal”.

Minister, that not only prevents staff members from bringing their concerns to their democratically elected Member of Parliament, whom the trust determines to be an “unauthorised person”, but they are not even supposed to discuss concerns with their colleagues. Surely to God the Minister agrees that the position is completely unacceptable!

The Secretary of State said recently, and very publicly, that a culture of “openness and transparency” will be at the heart of trying to drive up NHS standards, by encouraging NHS staff to speak up when they have concerns. Well, we do not have a culture of openness and transparency within ESHT and the DGH. That is worrying.

Due to the failings of the local trust and the mismanagement of the situation that has led us to where we are, I, along with my hon. Friend the Member for Lewes (Norman Baker), whose constituents are also served by the hospital, have called for the resignation of the chief executive, Mr Grayson, and the chair, Mr Welling. Again, and in Parliament, I reiterate that call and ask that they step down in the interests of the people of Eastbourne and the surrounding area, so that they can be replaced with a more capable leadership team. The issue does not affect only Eastbourne, but the surrounding area. Last Saturday there was a march in Seaford, which is in my hon. Friend’s constituency. It was supported, across parties, by many local residents.

I also take this opportunity to thank my hon. Friend the Member for Wealden (Charles Hendry), who cannot be here today as he is elsewhere representing the Prime Minister as his trade envoy. His constituents are equally served by the DGH. He contacted me to give his express permission to relay to the House that he, too, wants to know how we reached a situation where these services were deemed to be unsafe. He is also keen for the full range of maternity services to be restored to the DGH as soon as possible.

In wrapping up, I take the opportunity to thank two local mums in particular. Selene Edwards and Amelia West, alongside the Save the DGH campaign group, are working hard to protect local services and in a matter of weeks have both set up Facebook groups with over 8,500 members between them. Such community involvement is bringing the town together to fight the changes.

I shall now conclude. The Minister is, of course, free to address any of the points I have raised, but I am particularly keen for her to address four key points. First, how have maternity services at the DGH been allowed to get to the current “unsafe” position despite the 2008 IRP recommendations being utterly emphatic that consultant-led maternity must remain on both sites? Secondly, were the 2008 IRP recommendations ever properly implemented by ESHT? My constituents and I have lost so much trust as a result of this sorry episode that we would insist, reasonably, that the whole process should be independently audited by medical experts. Was the 2008 IRP-recommended report ever properly implemented?

Thirdly, how do the chief executive and chair of the trust still remain in post when they have presided over this debacle? Finally, I would like to request a meeting with the relevant senior Department of Health officials, so that clear lines of communication can be established with the Department to fix the problem for my local hospital before it is too late.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing this debate. Given that no doubt many people in his constituency will, I hope, read all my speech and all the comments I make, it is very important that I make a number of matters very clear. As I am confident that he knows extremely well, this decision does not lie with the Department of Health. When he asks me a series of questions, which of course I am more than happy to answer, he must know, and those reading or listening to this speech must know, that these decisions are local decisions.

The coalition Government have taken the view that it is only right and proper that decisions of this nature regarding the provision of NHS services are made locally. My hon. Friend, quite properly, comes to this place to raise these matters on behalf of his constituents. I make no complaint at all about any Member of this place doing that, because, in many ways, it is our primary job. However, it is also absolutely imperative that when hon. Members, like my hon. Friend, come here and put forward a complaint on their constituents’ behalf, it is made clear where the decision-making process lies and where the responsibility lies—and it lies at a local level. That is why, in replying to his speech, I rely on information provided to me not by my officials in the Department, because they are not party to this decision, but by the various trusts, knowing the processes and understanding that this, as he must know, is a local matter.

I am told that the trust has been experiencing challenges in recruiting doctors for the specialties associated with obstetric and paediatric services. This has been followed by advice the trust has recently received from local clinicians and the national clinical advisory team. That advice, I am told, indicates that the trust’s current maternity and paediatric services cannot continue as they are. I am told that the current arrangements are unsustainable in terms of delivering a safe service to patients. I am sure that my hon. Friend has at heart a desire to ensure that all his constituents receive safe treatments and the safe delivery of their babies. That must be his, and indeed everybody’s, priority.

I am told that it is because of those factors—the shortage in recruitment and the safety of patients—that the trust has had to take urgent action, primarily on the grounds of patient safety. As my hon. Friend knows, the trust met in March and made a temporary decision—this is not a permanent decision.

[Stephen Lloyd]

Will the Minister give way?

[Anna Soubry]

In one moment, if I may, because the clock is against me and it is really important that I place on the record a proper and full response to my hon. Friend’s speech.

I am told that this is a temporary measure whereby the consultant-led obstetric service, neonatal services, including a special care baby unit, and in-patient paediatric and emergency gynaecology services will, in order to make sure that they are safe, be provided by Conquest hospital alone.

[Stephen Lloyd]

Will the Minister give way on that particular issue?

[Anna Soubry]

Briefly, yes.

[Stephen Lloyd]

I appreciate that. The Minister will be interested to know that I went to an extraordinary general meeting where the chair said that the measure would be temporary. I got a commitment that it would last for 18 months. I then publicised that and three days later I got a clarifying letter saying, “No, Mr Lloyd, we are saying that in 18 months we will consult on whether it is temporary.” I do not believe that it is temporary, and having the Minister support the idea that it will be temporary means that it is more likely to stay as such.

[Anna Soubry]

I get the point, but it is not a question of me supporting or believing in anything. I have been given information and am placing it before the House to ensure that the good people whom my hon. Friend represents have the full picture. It would be a serious allegation to suggest that the information with which I have been provided is false. I can say only what I have been told, which is that it is a temporary decision.

That is combined with the establishment of a stand-alone, midwifery-led maternity unit, alongside a short-stay paediatric assessment unit at Eastbourne district general hospital. This means that if a paediatric patient requires in-patient admission, they will be transferred to Hastings under the interim change.

As yet, no woman or child has been transferred to Conquest hospital. I understand that the project plans are in place for the delivery of the interim configuration of maternity and paediatric services, providing a single-site service at the Conquest hospital from 7 May.

My hon. Friend is fully aware that the trust has confirmed, as I have said, that this is a temporary change and, indeed, that a strategic and long-term solution will need to be agreed within 18 months. It is also important to remind hon. Members that I am told that the process will be led by local general practitioners and what we now call local clinical commissioning groups.

I am conscious that the clock is against me, but there is much I wish to say. I press on my hon. Friend that, as I have said, there are no specific proposals at the moment. I am informed that in order to develop a solution, the future of maternity and paediatric services is being considered as part of a separate, countywide programme called Sussex Together, which will bring together doctors, nurses and health professionals, in conjunction with local authority colleagues from across the county, so there is a real opportunity to improve health services and outcomes across organisational boundaries.

I will, of course, write to my hon. Friend to try to answer all his questions. I wish I had been given notice of them, because I could have answered them today, but I am precluded from doing so. At the moment there is no point in my meeting any of his good constituents who are leading the campaign, because there is nothing that we in the Department can do. As I have said, this is a local decision and it is temporary.

[Stephen Lloyd]

Will the Minister give way on that point?

[Anna Soubry]

No, I am afraid that I cannot take any more interventions, because I am keen to place the following on the record. The trust’s latest decision has been taken on urgent safety grounds as a temporary solution, and CCGs—clinicians, doctors and nurses—hope to and will find the long-term solution to the problem. In arriving at that solution, CCGs will want to assess proposals against the four tests that have already been outlined. Adhering to those tests and continuing to focus on the needs of the local population will ensure that proposed changes to services are locally led, not Government-driven or directed by Whitehall.

We hope that everyone will work together, including the local authority’s health and wellbeing board. Moreover, the health overview and scrutiny committee is a very important organisation that can refer proposals to the Secretary of State. It comprises democratically elected members and professionals, all of whom can ensure that the right thing is done.

[Stephen Lloyd]

Will the Minister give way?

[Anna Soubry]

No, I only have 10 seconds left. The committee has the power to refer proposals for changes to services to the Secretary of State—