Mid Staffordshire NHS Foundation Trust
Stephen Lloyd Excerpts(11 years, 5 months ago)
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Mr Hunt
My hon. Friend makes an important point. It is absolutely essential that the new chief inspector’s team talks to patients and relatives to get that feedback. One of the biggest changes from what we have now to what we will have is the element of judgment in the assessments made. We will not just be looking at the data, the dials or the numbers; there will be someone going to a hospital, smelling the coffee, understanding the culture of the place and talking to patients and relatives.
Stephen Lloyd (Eastbourne) (LD)
I commend the Secretary of State for his statement and for what I think is an absolutely outstandingly powerful report. However, I have concerns about recently proposed changes to the consultant-led maternity services at Eastbourne district general hospital. Will he confirm for the record that any changes that I and others have concerns about will be considered by the new chief inspector of hospitals?
Mr Hunt
I congratulate my hon. Friend on his ingenious segue. All hospitals—all NHS trusts—will be inspected by the chief inspector, so everything that happens at Eastbourne will be covered by the new regime. It will be strong, rigorous and independent, so that any concerns that my hon. Friend has should be picked up by anything that the chief inspector reports on.
Accident and Emergency Departments
Stephen Lloyd Excerpts(11 years, 6 months ago)
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Stephen Lloyd (Eastbourne) (LD)
I thank the Backbench Business Committee for granting the debate and endorse my colleagues’ expressions of appreciation to the hon. Member for Ealing, Southall (Mr Sharma) for obtaining it. It was a pleasure to be one of his co-sponsors.
The debate is badly needed. Not a month seems to pass without another NHS trust announcing that it will close one or more hospital departments, and at least 15 NHS bodies in England are pursuing major reconfiguration plans. There is, however, increasing concern in the medical field that NHS care for emergency patients might be going wrong in too many instances. Essentially, this is a debate about specialism and generalism. Rare complex surgery, for example for brain tumours or severe multiple injuries, is clearly best done in large volumes in specialist centres. I do not dispute that—nor do the overwhelming majority of clinicians—but it is not true for the common types of emergency surgery that are best done within good time in a quality district general hospital.
Hip fractures, for instance, are very common and the results are better if surgery is done as soon as possible, preferably on the next day’s operating list, by a surgeon who has at least three years’ experience of fixing hip fractures, yet around the country hospitals are being reconfigured to provide a specialist service in a major centre, leaving, as many experienced clinicians assert, thousands of patients with delayed and worse care.
Sarah Teather (Brent Central) (LD)
As I listen to my hon. Friend, I am struck by an example from my constituency, where the likely closure of the A and E will mean that people living in Harlesden will find it almost impossible to get to Northwick Park hospital. It is important for patient experience that their relatives can visit them.
Stephen Lloyd
I thank my hon. Friend for her intervention. That is a very important point and I shall be covering it in more detail later in my speech.
Last October, a group of 140 senior doctors wrote to the Prime Minister expressing alarm over proposals to close and reconfigure A and E units around the country. In their open letter, they said that they had yet to see evidence that plans to centralise and downgrade A and E services were beneficial to patients. A 2010 report by the National Confidential Enquiry into Patient Outcome and Death showed that the reason people often die after surgery is not that the surgery was difficult but that there was a delay in getting them to an emergency operation. I fear that that will be worse if more A and Es are closed as there will be no surgeon on site, or the patient will face an over-long travel time to a fully functioning and adequately staffed emergency department. The report was clear, suggesting that applying one-size-fits-all medicine to a heterogeneous population with varying needs fell short in ways that were both predictable and preventable. Crucially, it stated:
“Delays in surgery for the elderly are associated with poor outcomes”.
The letter to the Prime Minister also backed this view:
“Not only do many people in some of the country’s most deprived areas face longer journeys to hospital, but those in rural areas face longer waiting times for ambulances and crowded A and E departments when they arrive.”
Let me point out the obvious: that will mean more delay for what should be routine emergency surgery.
That is in contrast to how I foresaw developments in May 2010 when the coalition Government came to power. Unlike Labour, the coalition ring-fenced NHS funding.
Jim Dowd (Lewisham West and Penge) (Lab)
How can sums be ring-fenced if at the same time the Department insists on a 1% surplus—that is, money that cannot be spent?
Stephen Lloyd
The key difference is that the coalition Government ring-fenced it whereas the Opposition were considering a 20% cut—that is quite substantial.
Four reconfiguration tests were designed to build confidence among patients and communities as well as within the NHS. The right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) has already listed them, so I do not need to repeat them. In Eastbourne, my local hospital is run by East Sussex Healthcare NHS Trust, which also manages the Conquest hospital in Hastings. Last year, it consulted on the provision of orthopaedics, general surgery and stroke care in East Sussex. In my view and that of the cross-party Save the DGH campaign group, led by our remarkable and hard-working chair Liz Walke, it was clear from early on that the trust’s aim was to remove core services from my local hospital, the Eastbourne district general hospital, irrespective of the consultation.
This was not the first time the trust had tried to remove core services from Eastbourne. Only five years earlier it had tried, unsuccessfully, to downgrade our maternity services. At the time the trust claimed that that would provide safer and more sustainable services for the people of East Sussex. However, after much local opposition the independent reconfiguration panel found against the trust’s proposals, so when my local hospital trust again consulted on health services in East Sussex, my constituents and I were very worried. I was uneasy, as so many local clinicians started to share with me confidentially their deep concerns about the trust’s proposals.
I reassured constituents that we were in a stronger position than last time because the coalition Government had shown their commitment to the NHS by ring-fencing the NHS budget at a time of deep financial constraint. In addition, the Prime Minister and the then Health Secretary, the current Leader of the House, had continually stated that the NHS would be led by the public and clinicians, and to ensure this they had introduced the four reconfiguration tests that were mentioned earlier.
Imagine my horror when, just before Christmas, my NHS hospital trust had its proposals confirmed by the East Sussex health and overview scrutiny committee and was given the go-ahead for its plan to remove emergency orthopaedics and emergency and highest-risk elective general surgery from Eastbourne district general hospital and site them only at the Conquest hospital in Hastings, as much as 24 miles from some of my constituents.
The consultants advisory committee, the body which represents consultants at Eastbourne DGH, conducted a confidential survey of its members’ views on the trust proposals. More than 90% of DGH consultants responded to the survey, with 97% of those respondents opposed to the proposals. I remind colleagues in the House of the four tests. A confidential GP survey was also conducted and 42 GPs in the town also opposed the trust’s plans. In addition, 36,766 local people signed a petition against the proposals.
Stephen Lloyd
I thank the hon. Gentleman for that intervention, and I agree. My point is that the four tests look good on paper but my anxiety, which I am putting to the Minister, is that they may not be so good in practice.
Stephen Lloyd
I will continue, as I have only two and a half minutes left.
In short, either the Government’s reconfiguration tests are not being properly adhered to, or trusts and PCTs are merely using them as a smokescreen to hoodwink local communities. I do not believe for a moment that this is what the Government originally planned, so what is going wrong and why? It is clear that many very experienced and expert clinicians believe that most areas must retain emergency departments, with co-located essential core services to manage the bulk of common emergency conditions, which I spoke about earlier, or to stabilise patients prior to transfer to specialist units.
In conclusion, I am far from confident that the current process to determine whether or not reconfigurations of health services or A and E are being done in the best interests of local people is working, irrespective of the four tests that I talked about earlier. This must be addressed and that needs to be done quickly because if we get it wrong, lives could quite literally be lost unnecessarily. The NHS is our most cherished institution, often referred to as the glue which binds our society together. I pay tribute to the coalition Government for protecting NHS funding at a far higher level than was the case in any other Government Department but—and this is a “but” laden with real anxiety—I fear we may be getting the reconfiguration elements wrong. I hope the Minister will address my specific concerns about the reconfiguration element and about specialism v. generalism, to ensure that the right and the best service is provided for my and all our constituents.
Mr Slaughter
Absolutely not. As part of the consultation process that was undertaken, it is on the record in the documentation that I was consulted. I was not consulted on those matters.
Mr Slaughter
I am sorry; although I would love to give way, I have been asked not to.
That consultation was ignored. The body taking the decision has no stake in these matters whatever. The joint PCT council, NHS North West London, will not exist. The bodies that do have a stake, namely the clinical commissioning groups that are taking over—the puppet masters, as it were—have too much influence in my view and too much to gain personally. I wish I had time to go through the declarations of interest that members of the CCGs have made. They show that most hold shares in Harmoni, Care UK or other private interests that might benefit from the commissioning powers that the CCGs are about to get. I have not received proper answers from the health service about what those interests are or what they remain.
To conclude, the decision for north-west London will be taken on 19 February, so this debate is very apposite. I have no doubt that the decision will be taken to go ahead with most or all of the proposed closures, but the protests that have taken place—the demonstrations, marches and petitioning—will continue, because this now becomes a political decision for the Secretary of State. In the early-day motion that I tabled last June, I referred to the fact that the health service locally was saying it would run out of money if it did not make these cuts. Services are already being run down by sleight of hand. The buck stops with the Secretary of State and the Government. The ball is in their court. I hope the decision will be taken, first, by the independent panel and, secondly, by the Secretary of State. The Government cannot dodge this issue. This is about cuts, as it was in the 1990s, and the denigration of our local health service. The buck cannot be passed beyond this point. I call on the Minister in her reply to say how she intends to preserve the local health service in north-west London.
Hospitals (Sussex)
Stephen Lloyd Excerpts(12 years, 2 months ago)
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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.
Health and Social Care (Re-committed) Bill
Stephen Lloyd Excerpts(12 years, 11 months ago)
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Andrew George
Yes, and my new clause 16 proposes to address that issue through an opportunity for the Secretary of State to intervene as necessary.
The Secretary of State in his intervention on the hon. Member for Pontypridd made it clear that in any case Secretaries of State tend not to micro-manage by intervening or by providing on every whip and flip, and there is no suggestion of that, but as a backstop we require the guarantee that, if all else fails and the whole system does not provide what we believe needs to be put in place to provide for a comprehensive health service, the Secretary of State will be there. There would be no harm in putting that word back in the Bill in one form or another. I do not understand the obstinacy, and in my view there is no legal impediment to the Government doing so.
Stephen Lloyd (Eastbourne) (LD)
Does my hon. Friend agree that, because this is such a totemic issue, the key reason behind the proposed change in the wording is totally to reassure the public that, come what may, and even if delegated powers mean that the Secretary of State has not been involved for a number of years, the buck will stop with the Secretary of State?
Andrew George
I am grateful to my hon. Friend. He has referred to the issue as being totemic, and although I do not want to detain the House for too long because many others have referred to it, he is absolutely right. Now that it has been raised in such a manner, unless there are good legal reasons not to insert it in the Bill, it should be.
On the comments of the hon. Member for Pontypridd, I make a further point. We are talking about major changes, and the issue is not only totemic but contextual, because, in the context of a major—in fact, the most major—reorganisation of the health service, the reassurance of that backstop being in place would be all the more important.
I do not questions the intentions of the Secretary of State, for whom I have tremendous respect, but, having opposed the creation of the health service in the first place, the Conservatives have a problem, because the context is one of a major change, and whether we like it or not the assumption is that, if the Secretary of State is a Conservative, the hurdle will have to be set higher to reassure the nation that there is no untoward intention behind the legislation.
Care Services (Older People)
Stephen Lloyd Excerpts(13 years, 2 months ago)
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Mr Speaker
Order. Before the hon. Member for Eastbourne (Stephen Lloyd) begins his speech, may I appeal to Members who are leaving the Chamber to do so quickly and quietly?
Stephen Lloyd
Thank you, Mr Speaker.
As an officer in the all-party parliamentary group for ageing and older people and an active member of the all-party parliamentary group on dementia, and as the Member of Parliament representing Eastbourne and Willingdon, an area that contains nearly 25,000 people over the age of 65, I called for this debate because the current system of care for older people is in crisis. The recent awful and shocking exposé by the “Panorama” programme is a desperate indictment of the worst in care provision, but it would be a naive mistake to believe that there are no other examples of bad practice out there. The growing age profile means that any Government will face difficult challenges for many years to come, and despite the growing demand, care provision has faced years of austerity with almost no net spending increase.
There are currently 291,000 people in residential and nursing homes in the United Kingdom, along with 6 million carers who allow people to live in their own homes. That means that an extremely large proportion of the United Kingdom’s population is directly affected by care service provision. Those who work in social care, or who care for someone on a voluntary basis, are the backbone of our society. They are the unsung heroes whose voices often go unheard, not least because they are simply too preoccupied with the enormousness of the task in hand.
A number of my colleagues who are present this evening will probably focus on several areas of care that affect older people, but I will focus mainly on dementia and on care service provision for dementia sufferers. I look forward to hearing the Minister’s response.
Penny Mordaunt (Portsmouth North) (Con)
I congratulate my hon. Friend on securing the debate. He mentions the increased demand resulting from an older population, but does he agree that we are starting from a very low base? In Portsmouth there are 1,000 people with dementia who have no access to services. It is necessary not just to improve the quality of services that people are already receiving, but to give people access to services in the first place.
Stephen Lloyd
I agree. My hon. Friend’s important intervention is relevant to one of the key issues with which I shall deal in my speech. Not only have the dementia figures risen hugely over the past few years—and they will clearly continue to rise—but there are still many tens of thousands of people with dementia throughout the UK for whom there is no provision whatsoever.
Let me put some of the figures into perspective. There are currently 750,000 people with dementia in the UK, and the number is set to rise to over 1 million in the next 15 years. One in three people in the UK over the age of 65 will die with dementia. People with dementia are significant users of both health and social care services. For example, people over 65 with dementia are currently using up to one quarter of hospital beds at any one time. That is an enormous problem.
Tracey Crouch (Chatham and Aylesford) (Con)
I congratulate the hon. Gentleman on securing this important debate. We have served together for some time now on the all-party group on dementia, and we have spoken on many occasions about the impact of dementia patients on primary health care. Does he agree that one way of addressing the problems of dementia patients receiving care in hospitals is by making sure that the professionals on the wards have mandatory training?
Stephen Lloyd
That is an important point. My partner is a community matron, and a wee while ago I made a rather foolish comment by asking why, with all the skills she and her colleagues have, they do not cover dementia as well. She gave me very short shrift, and emphasised, in her splendid way, “Stephen, dementia care is a very specific need. We all need more and better training on it, and also, to be honest, we need more specialist dementia nurses.” I certainly agree that it is essential that there is training for all professionals dealing with dementia.
The exponential growth of this debilitating condition is a result of the growing age profile. Today, we are dying in our 80s. That is a good thing of course, as many older people lead full and productive lives, but it also brings its own set of challenges, one of which is that one in six people over the age of 80 suffer from dementia.
I am grateful that the coalition Government have stated their commitment to the national dementia strategy. I have had meetings on this issue with the Minister, so I am also grateful that he is present this evening. I also congratulate the Government on revising the implementation plan. Under this revised plan, dementia will be a major priority for the coalition, which I welcome, but I also look forward to hearing some of the specific detail.
I remain very concerned about provision on the ground. In my constituency of Eastbourne, we are desperately short of specialised dementia day-respite provision, and even more so of overnight and longer term respite. The funding to my local county council has not kept up with demand. That has been the case over the last 10 to 15 years, so it is not a recent phenomenon, but as a result of funding restrictions East Sussex county council has had to close a couple of respite care centres over the past few years, and I know that there are similar situations across the country. To put it bluntly, we in Eastbourne need at least three to four times more specialist dementia respite care provision, and I suspect that, broadly, there is a similar shortage across England and Wales.
This is not a new problem, and I am glad the coalition is recognising it by pledging an additional £2 billion. It is very significant that that extra money is being made available, especially in the current difficult times, so I am grateful for that, but I also want the detail, because I still have concerns about the pledges at the top not filtering down to the grass roots. Early diagnosis and intervention are essential to ensure taxpayers get the best value out of the substantial amounts the Government are spending on health and social care, and that will guarantee the best quality of life for dementia sufferers. This step will also reduce crisis admissions to hospital and release significant cost savings.
My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) and I are members of the all-party group on dementia, and the Alzheimer’s Society has been tremendously helpful in providing support to our group. Recent evidence collated by the Alzheimer’s Society shows that only 40% of people with dementia have been given a formal diagnosis, and the figure varies considerably across the UK. Where people do receive a diagnosis, it often comes late on in their condition, limiting the choices that people with dementia and their carers can make.
In addition to being given a diagnosis of dementia, people with the illness need to be able to access support and care early on in their condition, as my hon. Friend the Member for Portsmouth North (Penny Mordaunt) was saying. Services for people with dementia are skewed towards those in crisis situations, and people in the acute and long-term care sectors. As I have indicated, there is a lack of provision of support and care for the people with dementia who live in their own homes.
Despite the projection that more than 1 million people will have dementia by 2025, dementia research is severely underfunded in comparison with research into other major diseases such as heart disease or cancer. For example, the Government spend eight times less on dementia research than they do on cancer research. Not in a million years would I want to reduce the amount of money spent on cancer research but, as we all know from our constituencies, dementia is a time bomb ready to explode. I know that the Government are investing more on research but I want to hear some of the detail. Clearly more money must be spent on research into this condition, as developing new treatments has the potential to reduce significantly the number of people with dementia. For example, delaying the onset of dementia by five years would halve the number of deaths from the condition, thus saving 30,000 lives a year. I therefore welcome the coalition’s commitment—this was also a pledge in the Liberal Democrat manifesto—to prioritise dementia research within the health research and development budget, and I look forward to reading the Department’s plan to improve the volume, quality and impact of dementia research.
The Dilnot commission, which is due to report next month, provides an opportunity to resolve the historic and unsolved question of whether, as a society, we are able and willing to support people to live well in later life. The Dilnot commission must propose a road map for the delivery of a long-term settlement on the question of who pays for care and one that delivers significant improvements in access and quality. The funding envelope for social care must be increased to meet the needs of our ageing population, including the increasing number of people with dementia.
So what would I like to see happen? First, I wish to see a long-term settlement for social care that offers good quality care for people with dementia at a fair price, along with a set of guarantees about what people can expect to receive. As a starting point, I challenge the Minister by saying that the state should provide a minimum level of care and support for free. Guarantees about the care to be provided should include access to early intervention services, regular short breaks for carers and a guarantee that the care will be of high quality. One of the things to come out of recent research is that the earlier dementia is identified, and the earlier interventions are made and people with dementia are supported in a respite care background, the more the worse rate of dementia appears to be delayed—already we know that it is delayed by a good two or three years. So this is one of those things that really would save money in the long term.
If we are to revisit the Health and Social Care Bill, as I believe we may well do very soon, I would also like to see something else that is important. I know that the Minister feels passionately about this, so I am glad to be pushing at an open door. I am talking about better joined-up working between health and social care. However many years ago it took place and for whatever reason, it was a catastrophe that we split social care from the NHS. That has been appalling because social care budgets have been trimmed repeatedly over the years. In Eastbourne, as in every constituency, the social care sector deals with the respite care provision and the money has been cut every year, whereas the NHS, where money has not been cut—a lot of investment has gone into the NHS in the past 15 to 17 years—is dealing with people with dementia right at the crisis stage. It is an incredibly inefficient way of dealing with a desperate illness and it does not make financial sense. Better joined-up working between health and social care is essential for people with dementia.
I believe that integration of care pathways across health and social care services should also be considered a duty, similar to effectiveness, safety and quality, and should be applicable to all health bodies from the Secretary of State downwards. I recognise the important role that health and wellbeing boards could play in encouraging greater integration between health and social care and I strongly endorse their inclusion in the Bill. Health and wellbeing boards can also provide a strategic oversight for the development of local health and social care services and the proposed boards in the Bill must have a strong focus on dementia.
Finally, we come to multi-disciplinary commissioning. Let me use my partner as an example again: she is a community matron and her job is to go out into the community and to help people, mostly older people, to retain their independence by living at home. A lot of her work involves liaising with social services, the primary care trusts and the acute trust and doing all the multi-disciplinary co-ordination that is so necessary. We need to bring it into commissioning. I am concerned that most GPs might not necessarily know enough about dementia to commission effective services, so it would be beneficial in my view if a range of health and social care professionals could also be involved. I am not against GP consortia in principle, but I merely want more professionals from the different areas of health and social care to be involved in the commissioning process, such as nurses, occupational therapists and old age psychiatrists.
I suspect that we have all been touched personally by the impact of dementia on someone we love. In my family, two of my aunts had dementia and one still lives with it every day. It is a desperate illness that affects hundreds of thousands of people and it has an impact on millions. My aunt is an example: she is a lady who rode a scooter from Nairobi to Johannesburg and climbed Mount Kilimanjaro in the ’50s. She is an amazing, great woman who was a teacher for 50 years in east Africa. The dementia she has now is desperately sad—thankfully not so much for her, but for all the family around her. It is a desperate illness that affects many people and it is not going away any time soon. As a nation, we need to move up a gear. We need to get better at providing care for dementia sufferers and their families and we need to do it now.
Maternity Services (Hastings)
Stephen Lloyd Excerpts(13 years, 5 months ago)
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Stephen Lloyd (Eastbourne) (LD)
I thank my hon. Friend the Member for Hastings and Rye (Amber Rudd) for giving me an opportunity to speak in her Adjournment debate. I concur with everything that she said. I will take a limited time, because we want to listen to the Minister, but I wish to focus on a couple of separate matters. I add that my hon. Friend the Member for Lewes (Norman Baker) expressed specific concerns to me this morning, because many of his constituents in Polegate and Seaford use the district general hospital in Eastbourne.
I feel as though I have walked about 150 miles over the past few years for the “Save the DGH” campaign. It was an enormous, cross-party campaign with cross-community support, led in Eastbourne by a splendid lady, Liz Walke, and in Hastings by Margaret Williams. They are two fantastic, community-focused individuals who did a superb job in rallying their towns and all the political parties.
I shall quickly make a couple of points. I have never been a conspiracy theorist, but there is an exception to every rule. Just because I do not believe that there are conspiracies everywhere does not mean that they cannot sometimes exist. I have some good contacts in the district general hospital and I spent eight and a half years working in Eastbourne before gratifyingly winning the seat in the general election last year. I have developed some good contacts in the trust and, sadly, I must tell the Minister that I believe that the single-siters who originally wanted to move to one consultant-led maternity service have not gone away, despite being turned down by the Independent Reconfiguration Panel. I am afraid that they have used the pretext of the Care Quality Commission report to begin the process of moving to a single site.
As soon as we heard that, we were very active and we blitzed the media for 10 days solid. I believe that that led the trust’s chief executive to say that there were currently no plans to close one of the maternity wards even temporarily. The blunt reality is that there were such plans.
My hon. Friend the Member for Hastings and Rye mentioned middle grade doctors. Around the country, more than 30 different trusts with maternity wards deliver an outstanding quality of service without eight middle grade doctors. The issue is a smokescreen, I think that it has been seen as such and I will not tolerate it. I ask the Minister to speak to the trust board, expressly remind its members of the content of the IRP report and tell them to consider seriously options other than middle grade doctors. I think that this last option suits some of the consultants rather than the patients.
I am terribly keen to hear the Minister’s comments, so I will finish with a quote. I wrote to the IRP within 24 hours of the issue blowing up again two weeks ago. The other day, I got a response. For Hansard, I shall quote from it. It states:
“Dear Mr Lloyd…
As you note, in July 2008, the IRP completed a full review of the proposals to close the Eastbourne obstetrics service and advised that the case to do so had not been made. The IRP also made recommendations about what further action should be taken, all of which were accepted by the then Secretary of State for Health in making his decision.”
I urge the Minister to assist my hon. Friend the Member for Hastings and Rye and me to keep an eye on the trust over the next few months and years because we, my hon. Friend the Member for Lewes, and thousands of residents in Eastbourne and Hastings are not prepared to countenance in any way, shape or form the closure of either of the consultant-led maternity wards in Eastbourne.
Health and Social Care Bill
Stephen Lloyd Excerpts(13 years, 6 months ago)
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Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
I, too, rise to speak in favour of the Bill. There is a clear divide in the House between the Labour party, which stands by and defends NHS bureaucracy, box-ticking and putting bureaucracy in front of patients, and the Secretary of State and the coalition Government who genuinely want to deliver reforms that will benefit patients. As the Bill says, the people who are best placed to be the advocates of patients are doctors and other health care professionals. Such people are much better placed to be the advocates for their patients than the faceless bureaucrats who have made so many bad decisions, and who have put tick-boxes and targets in front of patient care.
A key issue in this debate was articulated by my right hon. Friend the Member for Charnwood (Mr Dorrell), who said that the NHS, whoever were in government, would face unprecedented strains and problems. One such problem is the ageing population. It is great that people live many years longer, but people consume the majority of their health care in the later years of their lives. Unless we reform the NHS, make it more patient-centred, and cut out the bureaucracy and put the money to better use on the front line, we will not be able to properly look after those older patients.
Stephen Lloyd (Eastbourne) (LD)
I agree that the issue of ageing patients is a fundamental challenge. Does my hon. Friend agree that domiciliary care, which is currently delivered through local authorities and primary care trusts, is a vital service that maintains many people’s health for the longer term and often prevents unnecessary stays in hospital? Does he agree that appropriate steps should be taken by the Government in the Bill to ensure access to high-quality domiciliary care for all?
Sarah Newton (Truro and Falmouth) (Con)
Thank you, Madam Deputy Speaker, for calling me to speak in this most important debate. The scope of the Bill is far reaching and other Members have covered many aspects in their contributions, so I want to focus on one area—that of the future governance of the NHS.
The Secretary of State has identified a powerful and simple concept that resonates with people across the country—that “No decisions taken about me should be taken without me.” While this concept is usually applied to the individual relationship between the patient and clinician, I believe it is just as applicable to the communities that the NHS serves in any particular area.
As we have seen from campaigns across the country, people do not want decisions about the health and care services available to them in their community to be taken without the opportunity to get involved in the decision: “No decisions about us without us.” Over the last few years, I have seen the lack of openness, the lack of transparency, the lack of consultation and the consequent fear and suspicion that that brings.
I realise that not everyone will want to become involved in local decision-making and that many are happy to leave it to others, but I believe that we are right to enable more resilient and empowered communities to shape their own futures. Giving more power to the people is as important in the context of decisions about health and well-being as it is in the context of decisions about planning, homes and the environment.
The Bill is nothing short of a revolution in terms of the devolution of decision-making power to people in their communities, accountability, and the governance of health and care services. First, it links two crucial services. For too long the separation of those services, and the silo mentality governing the care delivered by local authorities and health services commissioned by primary care trusts, have prevented care pathways from being developed effectively in a way that works for the patient, which has often closed off the vital role played by families, carers and volunteers in supporting people. There cannot be a Member in the House who has not had personal experience of that, or shared the experiences of elderly constituents who have been bundled around the system, described as bed-blockers and made to feel a burden.
Of course, in some parts of the country health and care services have been integrated, but they are in the minority. The Bill, and the money that the Government are making available to help fund the integration, will enable all parts of the country to develop the high-quality, joined-up services that are currently available only to a few.
Stephen Lloyd
I agree with much that my hon. Friend is saying about integration and the need to work with the community, and I applaud many of the changes made by the Bill. For years we have all talked of using pharmacists in a smarter way. Does not the Bill provide an opportunity for much more integration of community pharmacy with the consortia, and for the Government to support the consortia in that endeavour?
Sarah Newton
As someone who represents a rural area of Cornwall where GPs’ delivery of pharmaceutical services is vital, I think that that is an extremely good idea.
Secondly, the new responsibilities of Monitor and the Care Quality Commission will make possible independent regulation of both quality and safety of care and value for money. I have observed the problems that have occurred in recent years when managers have evaluated their own compliance with standards. Good decisions can be made only with sound evidence. The powers of the National Institute for Health and Clinical Excellence and the Information Centre will be enshrined in legislation for the first time, and their independence from Government will thus be guaranteed.
Thirdly, the Bill creates a new role for local authorities in public health. Directors of public health, jointly appointed by Public Health England and local authorities, will play a leading role in the discharging of authorities’ public health functions. Arguably, it was the initiatives of local authorities in past centuries—such as the introduction of fresh water, drains, sewage management and the controlling of vermin—that led to some of the most significant improvements in life expectancy.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
As we have already heard today, the public love the NHS. and they are right to do so. Of course it is not universally perfect; of course there are times when it does need reform; but it is still something of which we are right to be proud, and we should not be proud of it just from a moral standpoint.
As economists of many different political persuasions have shown, a centrally funded NHS is a far more efficient way of providing a system of health care than the imperfect market of a system of health insurance. We need only look to America, where, until the recent reforms, more than half all personal bankruptcies were caused by people who were unable to meet their medical bills, to recognise how decent and effective our system of health care really is.
That brings me to the main point that I want to make. In my view, these proposals do not represent an evolution in the NHS reforms of the last Government. The principal goal of the Bill—to transfer commissioning from PCTs to GPs—is, in fact, a dangerous gamble with one of the country’s most-prized institutions. Bringing GPs closer to decision-making did not require the wholesale dissolution of PCTs and the transfer of their responsibility to GPs. When the Government promised no further top-down reorganisation, they should have meant it, because this reorganisation is ill judged and ill advised, as is spending the £3 billion that it will cost. However, now that they have embarked on this revolution, they should be aware of what has come about as a result of it.
Throughout the country, there is a pressure cooker of discontent in the primary care sector as PCTs struggle to balance their budgets and hand over what, on paper, will appear to be their stable financial footing. In order to do that, many have already implemented restrictions on procedures, described in the jargon as “procedures of limited clinical value”. I assure Ministers that they are not of limited value to people who are suffering and in need of care. In a number of areas, PCTs have asked GPs to suspend all but urgent referrals to secondary care. This prompts us to ask what kind of health service GPs will be inheriting. Patients are suffering now as a result of the actions of this Secretary of State.
I also fear that the commissioning of specialised services will create a real gap. For all the faults that some may ascribe to them, PCTs ensured equity for those who, if commissioning had been done on a smaller scale, would have struggled to have had their voices heard. There is a real question of scope here. Many GPs simply do not have sufficient sight of some types of work to commission effectively. The provision of mental health services is a particular concern. As ever with this Government, it seems that the most vulnerable will be most at risk.
If GPs really are better placed to commission services on behalf of patients, why were there shortages of flu vaccines this winter? GPs were responsible for ordering those vital supplies. They had the medical records of the people in their areas; they had the information that they needed in order to make effective provision. In my area it was the local PCT that remedied the situation, but who will be there to do that in future? GPs already have to balance financial and medical considerations. Have they really proved that they can do so effectively?
Finally, we must look at what exactly GPs will be expected to do and how they will go about doing it. In all the contracts they award, someone will have to monitor financial and clinical governance. That requires expertise, which GPs will have to buy in. Who will evaluate the tenders for services and deal with contractual issues? That will require yet more expertise to be brought in. Once we consider all that PCTs do across a wide geographical area, we see that GP consortia doing the same thing over a smaller area will result in an army of consultants, private companies and ex-PCT staff being contracted in by the consortia. We will, in effect, have the expense of PCTs as they work on the same things as now, but without the accountability and economies of scale currently enjoyed. Alternatively, GP consortia might achieve these economies of scale, but they will do so by ceasing to be the community-based practices with which we are all familiar. They will become faceless corporate entities, where doctors will be salaried members of staff with no connection to a specific practice or locality. That might be the Government’s intention, but it is not an evolutionary change to the NHS.
I do not wish to be entirely negative, because there are parts of the Bill—these do not deal with changes to commissioning—that I have to be more positive about. I welcome the ongoing commitment to patient choice, as I have never believed those who say that the public do not want to choose which NHS facilities they wish to use. As with other public services, the NHS must reflect the autonomy people now expect to be able to exercise over their own lives. I also welcome a stronger role for local government in scrutinising health outcomes in their area, provided that that is a real power, not a symbolic one, entailing the ability to force changes when outcomes are not good enough.
However, those are small consolations when we consider a Bill that risks the very future of the NHS as we know it. This is a poor Bill, which has been rushed out without scrutiny and which lacks a democratic mandate. It is not so much a hand grenade thrown into the national health service, as a commercial demolition designed to break the NHS as we know it in order to serve a set of interests which are—
Jonathan Reynolds
I am not going to give way. Other hon. Members wish to get involved in this debate and it is a disgrace that we have only one day to discuss this.
This Bill will break the NHS to serve a set of interests that are not those of NHS patients, not those of NHS staff and not those of my constituents. It is for those reasons that I shall vote against it today.
Maternity Services
Stephen Lloyd Excerpts(13 years, 10 months ago)
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The Parliamentary Under-Secretary of State for Health (Anne Milton)
I will come to the speeches by other hon. Members when I have dealt with—that sounds awful, —my hon. Friend the Member for Southend West (Mr Amess).
I am aware that my hon. Friend has maintained an active interest in this issue for many years, and I congratulate him on securing the debate. I should like to start by agreeing with him that there is nothing in the world more wonderful than a baby being born. I have given birth to four children, at four different hospitals. As is the case for many parents, having a baby was the most amazing thing that has ever happened to me. Getting elected to this House was a close second, but nothing compares to giving birth.
Maternity care is so much more than a new arrival in the family. Pregnancy is a vital time for health promotion, and a time when parents are receptive to information and advice, and motivated to do the best for their children. For some of the more hard-to-reach people in our communities, pregnancy is one of the first opportunities that health service professionals have to talk to them about bringing up children, as well as about their own health and well-being. The impact that midwives can have is significant. Midwives and our maternity services can help us to tackle issues such as nutrition, physical activity and health inequalities, which are some of the biggest public health issues that we face. Later this year, the Government will publish a public health White Paper setting out more detail, but there is no doubt that pregnancy and childbirth are golden opportunities.
The Government set out their long-term vision for the future of the NHS in the “Equity and excellence: Liberating the NHS” White Paper. We are committed to extending choice in maternity, to enable women and their families to make safe, informed choices throughout pregnancy and about childbirth. Maternity networks will help to make this a reality. They will extend choice by encouraging providers to work together to offer expectant mothers and their families a broader choice of maternity services and to facilitate a woman’s movement between the different maternity services that she might want or need. Networks will also need to work closely with health visitors to ensure the very best support for families at this vital early stage in their child’s life. The extra 4,200 new health visitors that we plan over the lifetime of this Parliament will complement the work of maternity services to improve support for all new families and help to ensure extra support for those who need it most. The White Paper consultation period closed earlier this month and we are now considering the responses from the various royal colleges, stakeholders and the public.
I should like to join my hon. Friend the Member for Southend West in commending the work of the Royal College of Midwives, of Cathy Warwick and of all those who have gone before us. He mentioned the noble Baroness Cumberlege’s work on the “Changing Childbirth” report. That document has stood the test of time, with its insight into what is needed during this special time for families. I should also like to join the praise for the National Childbirth Trust. I am proud to say that I was chairman of its Hackney and Islington branch many years ago, when my first child was born. I certainly know only too well the contribution that it makes to many families.
Women and families who are well informed about the maternity care options available to them are more likely to receive the care that meets their particular needs, to feel more satisfied with their care and to feel confident about the transition to parenthood. In recent years, maternity services have faced increased challenges, including a rising birth rate and an increase in complexity in pregnancies. Demographic changes in childbearing, such as more women giving birth at a later age, increased rates of heart disease and obesity, and more births to mothers born outside the UK have resulted in a greater number of higher-risk births. We welcomed the recent guidelines produced by the National Institute for Health and Clinical Excellence on pregnancy and complex social factors.
Stephen Lloyd (Eastbourne) (LD)
Will the Minister confirm that the organisations that she has mentioned, including the National Childbirth Trust, all emphasise, as my hon. Friends have done this evening, that a key part of pregnancy and maternity services is that they should be close to the mothers-to-be? I believe that that is a clear objective of the White Paper, as well as of many of the organisations and groups that have been mentioned. Will she confirm that that will be a thread running through the findings of the White Paper when they finally come before the House in the form of a Bill?
Anne Milton
Absolutely. Proximity to the people for whom we are trying to design services to meet their needs is vital.
I should like to mention the Marmott review, “Fair Society, Healthy Lives”, which highlighted the strong associations between the health of mothers and the health of their babies. It also pointed to equally strong associations between the health of mothers and their socio-economic circumstances. This means that pre-conception care and early intervention before birth are as important as support during and after the birth. We need women to access maternity care early and for that to continue, exactly along the lines that the hon. Member for Eastbourne (Stephen Lloyd) suggests.
Family nurse partnerships will be extended so that we can provide the highly targeted, highly specialised support through pregnancy and the first years of life that the most vulnerable young families need. Our vision is for all women to have choice and equity of service standards and quality of care, wherever in England they are receiving care. However, we know that, in practice, not all women are offered a choice. “No decision about me without me” is what this is all about. It is about giving people the opportunity and support to make the choices that will make a difference to them, their babies and their families. It is also about giving them the information they need to exercise control, and of course the confidence to use it. Not all families find that easy.
The new outcomes framework proposes five national outcome domains covering all treatment activity across effectiveness, patient experience and safety. A number of indicators for maternity and children were proposed, including maternal death, infant mortality and the unexpected or unplanned admission of term babies to neonatal care. The consultation period has now closed and we are considering the responses. I hope that that will deal with many of the issues that have been raised this evening.
Midwives and the maternity team use their skill and compassion to help parents-to-be along their journey—a vital journey—to parenthood. We will make sure that any changes in services are led by local clinicians, patients and service users. The NHS White Paper is all about giving control of health services to the clinical staff who deliver them. My hon. Friend the Member for Maidstone and The Weald (Mrs Grant) spoke passionately about that this evening.
Effective skill mix in the maternity work force will be important. The NHS is focusing increasingly on utilising the whole maternity team and helping to use innovation and new technology to drive up the quality of care and deliver value for money.
In the next few months, we will receive information about women’s experience of maternity services from surveys conducted by the National Perinatal Epidemiology Unit and the Care Quality Commission. These survey results will give us a clear and up-to-date picture of what women think about the maternity services they receive and what more needs to be done.
My hon. Friend the Member for Gosport (Caroline Dinenage) raised local concerns about the closure of the Blake. Although I am assured that it is due to open again in January next year, I know how very unsettling it is to have local services closed. It causes a loss of confidence among local people.
My hon. Friend the Member for Colne Valley (Jason McCartney) raised the closure of services in his area. I am sorry, but sadly we cannot always turn back the clock. I am delighted to hear that a new midwife-led unit has opened and I hope it will be possible to provide people with the services they need.
As I have already said, my hon. Friend the Member for Maidstone and The Weald also raised some constituency issues. Nobody but nobody could have done more or have campaigned harder on those issues. I know that the Secretary of State asked the strategic health authority to report to him at the end of September, and he now has that report. I am sure that my hon. Friend will agree that the Secretary of State must be allowed some time to consider the report’s content.
I thank my hon. Friend the Member for Southend West for calling this debate. He has raised a number of important points about maternity care and the provision of maternity services. Our White Paper gives us the chance to refocus the NHS on what is important to its users and staff, providing those services so that we achieve the results that are important to them—ensuring that all women and their families have access to the best possible care at this crucial time in their and their family’s lives.
Question put and agreed to.