Oral Answers to Questions

Tim Farron Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

We believe in the clinical networks, including the network for cardiovascular disease. We have increased the funding for those networks by 27%. However, we want them to include mental health and maternity services. We think that it would be wrong to do what the Labour party wants, which is to concentrate that funding on cardiovascular disease and cancer, and deprive of the clear benefits of such networks the 700,000 women who give birth on the NHS every year and the nearly 1 million people who will be diagnosed with dementia.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Given that the majority of vascular interventions are acute in nature, following trauma or cardiac episodes, is it not reckless for NHS Lancashire and NHS Cumbria to be talking about moving vascular services away from the Morecambe bay area, meaning that people from the south lakes and north Cumbria will have to travel as far as Preston, Blackburn or Carlisle to receive treatment? Will the Secretary of State meet me, other local MPs and local consultants to discuss how we can put the matter right for local people?

[Mr Hunt]

We are very keen to ensure that all reconfigurations of services have strong local, clinical support. We are making good progress in this area. There is always a trade-off between access, which I recognise is extremely important in a rural constituency such as the hon. Gentleman’s, and the centralisation of services, which sometimes leads to better clinical outcomes. I am happy to arrange for him to meet me or one of my colleagues to discuss his concerns in more detail.

Vascular Services (Wycombe Hospital)

Tim Farron Excerpts

Monday 14th January 2013 Commons Chamber

[Steve Baker]

My hon. Friend raises an important point about transport, which will be an issue for many of our constituents, not least because they will not have cars.

People in need of vascular care will include those with abdominal aortic aneurysms, a life-threatening weakness of the main artery that must be repaired, and those who have had strokes or mini-strokes—transient ischaemic attacks. After a stroke, drugs are administered immediately, but they need to be followed up with a procedure to clear the carotid artery, called a carotid endarterectomy or, mercifully, a CEA. Other people requiring care will include those with poor blood supply, including smokers and diabetics, who might endure serious complications that might even lead to amputation.

Wycombe hospital provides the full range of services. It is proposed to move them all to Oxford university hospitals on the basis that the present arrangements are “not sustainable”, but I have yet to see evidence that supports that assertion. Leaked documents suggest that Oxford provides worse outcomes and is struggling to be ready.

[Tim Farron (Westmorland and Lonsdale) (LD)]

I am extremely grateful to my hon. Friend for giving way and congratulate him on securing the debate. Further to the point raised by my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw), in the north-west the number of units will go down from four to three. Folks in Morecambe bay will no longer be able to go to Lancaster but will have to go to Carlisle, Blackburn or Preston. Does my hon. Friend the Member for Wycombe (Steve Baker) agree that the majority of vascular surgery these days is not elective but acute, following road traffic trauma and incidents such as coronary emergencies? We are talking not about elective surgery but about acute emergency provision, so it is vital that the services are close at hand.

[Steve Baker]

My hon. Friend is possibly inviting me to stray beyond my expertise, but perhaps the Minister can deal with that point. The concern in Wycombe is about elective treatment of aneurysms, and particularly the treatment that goes with stroke services. The key concern is that it is an excellent service that will be degraded if it is moved to Oxford, according to the clinical evidence.

I am grateful to Dr Annet Gamell, chief clinical officer of the Chiltern clinical commissioning group. She has given me a clear explanation of the position in Buckinghamshire, which is that things are waiting on the outcome of the review in 2014. Once a new theatre is open at Oxford, it is proposed that all complex elective vascular surgery will go there. It is planned that outpatient and diagnostic services will remain at Wycombe. CEA services would be subject to review in 2014, and I understand from Dr Gammell that the group would support moving CEAs to Oxford only if results indicated that patients would benefit from it. The Chiltern clinical commissioning group would take into account the impact of such moves on other services. Dr Gammell points out that if it is agreed to transfer CEAs to Oxford, there would be another local consultation, but on the basis of recent experience it is not clear to me what end that consultation would serve. The decision would have been made and it is clear that there is vast momentum to take services in that direction, despite the clinical evidence.

The key performance indicators for the south central cardio-vascular network show that in the first two quarters of the 2012-13 reporting year, Wycombe performed 17 aneurysm repairs and Oxford 16. Wycombe carried out 31 carotid endarterectomies to Oxford’s 47. Almost half of patient records at Oxford did not provide the dates of patients’ symptoms. Eighty per cent. of CEA patients at Wycombe received the procedure within two weeks of referral. At Oxford, the figure was just 23%, although patients seem to have received their treatment within 48 hours of symptoms. At Wycombe, 58% of patients were treated within 48 hours. Oxford achieved a ratio of total vascular interventions to amputations of 4.55:1, whereas at Wycombe the ratio in the period was 8:1, which shows a considerably greater degree of success in maintaining people’s limbs in very difficult circumstances.

The clear clinical evidence in that period is that Wycombe outperforms Oxford, and it does so with fewer clinical staff. All this is not mentioned in the “Oxford University Hospitals Review of Phase 1 of the Centralisation of Vascular services”, which has been sent to me under cover of a letter dated 12 August from the chief executive of NHS Berkshire. It was among a number of documents leaked to me. The report describes the resignation of a vascular consultant, Mr Peter Rutter, following significant difficulties associated with the move from Wexham Park to Oxford. Those difficulties including antiquated theatre instruments, poor quality theatre lighting and patient safety issues.

Mr Rutter observed:

“Vascular surgery is not very important in Oxford and would take 5 years to bring up to standard.”

He also said that vascular had no champion at Oxford, which is confirmed in other documents. Other remarks in the review include, for example,

“Many outlying district general hospitals have better endovascular facilities”,

“Oxford is not a modern endovascular hospital”

and

“Oxford has no culture of multidisciplinary working”,

which is essential when vascular supports those other specialties. Furthermore,

“Little thought had been given to the effect on Interventional Radiology in DGHs”

and very worryingly, an

“Oxford senior surgeon threatened to make Bucks vascular surgeons redundant unless they toed the line.”

A comment in the review implies that Wycombe’s excellent interventional radiologists would join Oxford University Hospitals only if CEA and bypass surgery stayed at Wycombe, which has been rejected. Presumably, these valuable experts who make the excellent service possible will resign and go elsewhere.

In summarising, the review explains that the impression had been given that OUH had not properly thought through the implications of centralisation. In discussing theatre upgrades, it concludes that

“there remain concerns about the quality of lighting, ventilation, anaesthetic facilities and sterility.”

I am only a humble aerospace and software engineer, but it seems to me that these are fairly basic concerns. Despite all this, the review clearly states:

“It will not be possible for carotid surgery to remain in Wycombe as CE and CAS will not be commissioned from Wycombe beyond 2013.”

Surely this is a matter for the commissioners.

The reviewers are clear that it is not viable for Wycombe to keep carotid surgery and bypass, but they do not state the evidence for their assertion beyond the new status of vascular as its own specialty. Before making recommendations, the review says:

“OUH practices Vascular Surgery more like a DGH than an important Teaching Hospital. Several of the surrounding DGHs, currently being centralised into Oxford, probably provide a better endovascular service.

Vascular surgery at OUH seems to be safe but has not developed in the way that it has in other hospitals in the United Kingdom. It seems to be positioned about ten to fifteen years behind the best.”

Notwithstanding the evidence of superior performance at Wycombe and shortcomings at Oxford, the review insists that vascular services must transfer, ultimately on the basis that it is inevitable that vascular services will be co-located alongside Oxford’s major trauma unit. That is a blatant rejection of the principle that is constantly used to justify centralising services away: clear clinical evidence. All the time that Wycombe provides better care and the team can provide it sustainably, in its opinion, and while local commissioners are prepared to buy it, why surrender to Oxford’s desire to be the Thames valley super-hospital, whatever the cost to patients?

Any responsible Member would admit that the trend in health care is towards specialisation. When my hon. Friend the Member for Bracknell (Dr Lee) was describing his Thames valley super-hospital proposal in Marlow, he said that any politician who claimed that they could restore A and E to a district general hospital would be a liar. I am grateful that I have not fallen into that trap, but it illustrates a point. Politicians are accountable to their electorates and businesmen are accountable to their customers, but managers and clinicians in the NHS who follow rules and guidelines seem to account seriously only to one another and, significantly, to do so on the basis of who carries the greatest authority through prestige.

In the midst of all that, senior NHS executives keep circulating. Stewart George and Fred Hucker—irrespective of their individual merits—who chaired the Bucks and Oxfordshire PCTs, became joint chairmen of the cluster. Mr George is now moving to the CCG, and Mr Hucker to Buckinghamshire hospitals trust. A new era of openness, accountability and genuine public involvement seems unlikely, and continuity seems a dreary inevitability, but all that ought not to be.

Vascular services in the Thames valley appear to be not so much sleepwalking into disaster as positively driving towards it. Vascular services in Wycombe are not some ditch and gatepost operation to be salvaged by the great Oxford University hospitals, as Wycombe outperforms them with a smaller team. In this regard, it is the John Radcliffe that needs saving.

Let me ask the Minister some specific questions. Is the Chiltern CCG able to insist that it will purchase vascular surgery from the Bucks health care trust at Wycombe despite national guidelines? What are the roles and authority of the NHS Commissioning Board, the local health and wellbeing board and the south central vascular network? Crucially, has the elevation of vascular surgery out of general surgery and into a specialisation of its own led to such things as turf wars, demarcation disputes and office politics? What formal influence are locally elected representatives—councillors and MPs—supposed to have?

Wycombe has had its own hospital since 1875. The current hospital was not founded by the NHS; it was built in 1923 with donations from local people, which were mostly given in pennies, as a memorial to the men we lost in the great war. The public are therefore right to be incandescent with rage at changes that appear to be driven by remote sectional interests, not local patient care.

Recently, my right hon. Friend the Secretary of State said:

“I need to say this to all managers: you will be held responsible for the care in your establishments. You wouldn’t expect to keep your job if you lost control of your finances. Well don’t expect to keep it if you lose control of your care.”

What is needed is real accountability. Let us get health under the control of the people who pay for it and start by keeping vascular at Wycombe for all the time that that remains in patients’ best interests.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate my hon. Friend the Member for Wycombe (Steve Baker) on securing the debate and raising issues that are pertinent not only to his constituents but to those of my right hon. and learned Friend the Attorney-General, who has been sitting next to me on the Front Bench listening to the debate and who shares a number of my hon. Friend’s concerns.

Before I discuss the substantive points about Wycombe, I should address my hon. Friend’s point about failing management in the NHS. He is right that there is a tendency to recycle failing managers in the NHS, and I am sure that the House will return to that point when my right hon. Friend the Secretary of State responds to the concerns raised in the Mid Staffordshire inquiry, following the Department’s receipt of the report.

It is worth paying tribute to the dedicated health care workers in Wycombe and the surrounding areas of Buckinghamshire, because my hon. Friend has a number of excellent clinicians. He highlighted several local successes in delivering high-quality care through vascular surgery, and I know that there are good outcomes locally in specialties such as carotid endarterectomy. He has many excellent doctors and nurses and other front-line health care professionals, and also some very good managers, who have the best interests of their patients at heart and deliver high-quality health care outcomes for local patients on a daily basis, 365 days a year.

My hon. Friend rightly highlighted some local concerns about the ongoing loss of services at Wycombe hospital, and it is worth reiterating some of his words. He said that the hospital had lost A and E, consultant-led maternity—retaining a midwifery-led unit as a concession —and paediatrics, and this year the emergency medical centre was downgraded to a minor injuries unit, resulting in a repeat of much of the local outcry at the loss of A and E, and now he has highlighted eloquently the concerns over the potential loss of some of the vascular services at the hospital.

It is worth pointing out that I was reassured today before coming to the debate by local health care commissioners in the Wycombe area that there is a strong future for Wycombe hospital. There is no threat of the hospital being downgraded to the point of closure. Commissioners today reassured me—and I hope that this reassures my hon. Friend—that in many areas Wycombe provides a very good site further to develop health care services the better to meet the needs of the local population. It is an excellent satellite site, combined with Stoke Mandeville, for providing high-quality, close-to-home health care. From discussions that I have had, I believe that there may be the possibility of improving further some of the cardiac care that is offered.

I come specifically to the issues that my hon. Friend raised about vascular services, which are particularly important in Wycombe, which has a large Asian population, among whom, as we all know, there is a higher rate of cardiovascular disease. It has a higher rate of diabetes and many cardiovascular illnesses. My hon. Friend highlighted eloquently the number of local vascular services provided, and particularly referred to amputation services. We know that one of the complications of vascular disease and diabetes is the higher rates of amputation among some patients. It is quite right that he wants to make sure that high-quality services are provided locally to meet the established need for patients who require vascular services, and that those patients have a holistic service that looks not just at their immediate medical needs but provides high-quality surgical care.

We know that 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 technology. When we do change and reconfigure services, it must be about modernising facilities and improving the delivery of high-quality patient care. In that context, it is also important that while we have to recognise that some services are better provided in larger centres of care— for example, the John Radcliffe centre, which can offer super-specialist services—where the clinical outcomes for patients are better, we must also provide high-quality local services, particularly for older people. We know that the majority of vascular patients often fall into an older age demographic, and it is important that when there is any service reconfiguration, those day-to-day outpatient clinics for vascular patients are maintained locally. I am reassured that in the potential reconfiguration, bread-and-butter outpatient clinics and continuity of care for vascular patients will be maintained.

The Government are also 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 the four tests laid down in 2010 by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), require that local reconfiguration plans demonstrate support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice. If my hon. Friend is worried that these tests have not been met in the local reconfiguration, he has the opportunity directly to challenge them or to ask the local health scrutiny committee to refer them to the Secretary of State for review.

[Tim Farron]

The Minister rightly says that the NHS reforms allow local councillors to vote to refer such matters to Ministers. In my area of Morecambe bay, that opportunity comes on 22 January. Will he assure councillors that Ministers will take such referrals very seriously and look into them with great rigour?

[Dr Poulter]

Yes. I assure my hon. Friend that when a referral is made by a local overview and scrutiny panel the Secretary of State will look at it and decide whether to refer it to the independent reconfiguration panel. That is often the decision that is made in these cases, but it lies initially with the Secretary of State, who will then have to consider whether to refer it. I am happy to write to my hon. Friend further to outline these steps if that would be helpful.

It is worth highlighting the national parameters that are being set for the delivery of good vascular surgery by the NHS Commissioning Board, which takes over full responsibility for commissioning from April this year. The board published a draft national service specification for vascular surgery for consultation. The consultation commenced in December 2012 and will conclude on 25 January 2013. It identifies the service model, work force and infrastructure required of a vascular centre. It says:

“There are two service models emerging which enable sustainable delivery of the required infrastructure, patient volumes, and improved clinical outcomes. Both models are based on the concept of a network of providers working together to deliver comprehensive patient care pathways centralising where necessary and continuing to provide some services in local settings…One provider network model has only two levels of care: all elective and emergency arterial vascular care centralised in a single centre with outpatient assessment, diagnostics and vascular consultations undertaken in the centre and local hospitals.

The alternative network model has three levels of care: all elective and emergency arterial care provided in a single centre linked to some neighbouring hospitals which would provide non arterial vascular care and with outpatient assessment, diagnostics and vascular consultations undertaken in these and other local hospitals. All Trusts that provide a vascular service must belong to a vascular provider network.”

In essence, this is about making sure that we deliver high-quality vascular care. There are two or three circumstances in which someone would require vascular care. First, there is emergency care—for example, when there is a road traffic accident, or when someone has a leaking aortic aneurysm, which is a very severe and potentially life-threatening emergency. We know from medical data that such service provided in an emergency is much better provided in a specialist centre—an acute setting such as the John Radcliffe, which would be the hub and the central focus. There is also good evidence that trauma care in any setting, including the requirement for neurological specialists potentially to be involved, is better served in a specialist trauma centre. A specialist centre provides better care in emergencies.

At the same time, it is clear from those models that there can also be a strong role for other hospitals as satellites of the central hub at the John Radcliffe. My hon. Friend clearly made the case for the high-quality outcomes at Wycombe hospital for carotid endarterectomies and other vascular services. I would suggest that there is a role for challenging local commissioners if they wished to remove some elective procedures from Wycombe when there is a case that they can still be delivered in a high-quality manner and to a good standard for patients.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 27th November 2012 Commons Chamber

[Dr Poulter]

We have already highlighted in earlier answers the fact that under the previous Government health care rationing was far worse on varicose veins, which one of the right hon. Gentleman’s own Back Benchers mentioned, and elsewhere. This Government are very proud of our record whereby 60,000 fewer patients are waiting more than 18 weeks than under the previous Government and 16,000 fewer patients than in May 2010 are waiting longer than a year. Waiting times are coming down, infection rates in hospitals are coming down, and people are getting better care. This Government ended the worst health care rationing scandal of all—the fact that people with cancer were not getting access to the drugs they needed. Now, 23,000 people are getting access to that care. If he could not do anything about rationing, he should at least recognise that this Government have done something and have made a real difference to people’s lives, particularly patients with cancer, by reducing rationing.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Those of us who live in rural areas such as south Cumbria have faced the rationing of acute services for years—not rationing by price, but rationing by distance. Will the Minister encourage Morecambe Bay, which will undertake its review of the allocation of services in the coming months, to allocate accident and emergency services back to Westmorland general hospital, where they would be closer to the people whose lives they could save?

[Dr Poulter]

As my hon. Friend is aware, from next year the NHS Commissioning Board will have responsibility for commissioning local services and for setting the funding formula. I would be happy to raise his issue with the board, because it is true that, historically, the capitation formula has not recognised the fact that there are a lot of older people in rural areas and further distances to travel. The previous Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), took steps towards reviewing the formula and I assure my hon. Friend that the Government will be looking into it further.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 18th October 2011 Commons Chamber

[Anne Milton]

We need to ensure that they are, which is one of the reasons we have asked the Centre for Workforce Intelligence to undertake a pretty in-depth study of the nursing maternity work force during 2011-12. I can reassure the right hon. Lady that the current number of midwifery students entering training is at a record level—more than 2,500—and I join her in paying tribute to our midwives.

[Tim Farron (Westmorland and Lonsdale) (LD)]

After the recent inquiry into the Furness General hospital maternity unit, will the Minister confirm that she will give full support to midwives across the Morecambe Bay trust area and that the excellent midwife-led unit at Westmorland General hospital in Kendal will be protected?

Ovarian Cancer

Tim Farron Excerpts

Wednesday 12th October 2011 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

I pay tribute to my hon. Friend the Member for Pudsey (Stuart Andrew) for securing the debate and to all other colleagues who have contributed. In my patch, in the southern end of Cumbria, we have run awareness campaigns locally with our general practitioners on the symptoms of ovarian cancer. Most people here have had a tale to tell about how ovarian cancer has touched them, and my motivation is very personal: my mother was diagnosed with ovarian cancer in October 2002 and passed away in July 2004. She was one of the 75% of women who are diagnosed at stage 3 or 4. It is depressing that things have not progressed even since then. I go back to the cancer strategy and the Government’s announcement in January, with clear awareness and honesty that we are behind in survival rates for all sorts of cancers and that lack of awareness and lack of early diagnosis is the common theme in the failure to reach targets and save lives.

With regard to lack of awareness and lack of early diagnosis, ovarian cancer comes top of a pretty grisly league. It is brilliant that breast, lung and bowel cancer were included in the awareness programme, but I was dismayed, as I am sure many others were, to see that ovarian cancer was not. My hon. Friend the Member for Winchester (Mr Brine) used the phrase, “low-hanging fruit”. If we look at the cold stats on how we can save lives in big numbers pretty quickly, ovarian cancer is potentially the low-hanging fruit.

I will repeat quickly some of the stats already used: 500 women die unnecessarily every year from the disease; a third of cases take longer than six months to be diagnosed; and 29% are diagnosed at A and E, which shows a complete failure of the pathway. It is the fourth biggest killer of women in terms of cancer. Although I am hugely grateful for the stuff from Target Ovarian Cancer and other ovarian cancer organisations, I repeat those stats because my mum found them on the web nearly 10 years ago—and they have not got any flaming better! It is utterly depressing that the statistics have not improved in that time.

As the hon. Member for Blaenau Gwent (Nick Smith) rightly pointed out, survival rates are very bad, given what they could be. If women are diagnosed early, ovarian cancer is relatively easy to cure, with a 70% survival rate. Things are so bad that, by investing now, a huge difference will be made, and we will see lives saved in big numbers in no time.

As is the case for all people in such circumstances, my mum’s ovarian cancer was an appalling family tragedy, which, in many ways, brought us together. She had 20 or 21 months of extremely high-quality life following her diagnosis, and I pay huge tribute to the Macmillan nurses and to Rosemere trust at Preston hospital, who made her life bearable—indeed, made all our lives bearable, and sometimes even a joy. My mum was aware that there was a genetic potential, and her concern was for my sister, my sister’s kids and my kids. I would put a plea in, with the other pleas that I will make in a moment on behalf of all of us, for effort to be put into looking at diagnosis and at the potential for genetically tracking the disease early, before it even arises.

Our collective plea—I do not see any dissent here—is for the Department of Health to act quickly to make the issue a priority and for the Minister to meet Target Ovarian Cancer, the other ovarian cancer charities and members of the all-party group to discuss a practical strategy and to invest now in a targeted awareness campaign, without waiting for the results of the diagnostic test and the trial, which I think will arrive in 2015. Two thousand more women will die unnecessarily if we sit around and wait for that. We need action now, and I would like the Minister to undertake to do just that.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 25th January 2011 Commons Chamber

[Mr Lansley]

I find it astonishing that the hon. Lady should attack the NHS because some elective operations have been cancelled. We have been through a flu outbreak and very severe weather, and that is what happens as a consequence. She should not try to make a political point out of it.

It is also astonishing that the hon. Lady gets up and says that she does not agree with our policy. On 3 December, she is quoted in GP news as saying that

“it is ‘absolutely right’ that GPs are ‘better involved’ in commissioning services.”

She supported it. The truth is that before the election the Labour Government instituted practice-based commissioning, introduced foundation trusts, started payment by results and said that patient choice was right. The shadow Secretary of State said just last week that

“these plans”—

our plans—

“are consistent, coherent and comprehensive”,

and indeed they are.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Cumbria’s current health commissioners—the PCT—chose to scrap the heart unit at Westmorland general hospital, despite medical, clinical and public opposition. Will the Secretary of State confirm that new GP fundholding arrangements allows the possibility of returning services that are clinically supportable, such as a heart unit at Westmorland general?

[Mr Lansley]

I know, not least from visiting that hospital, how strongly people in my hon. Friend’s area feel about their access to services locally. I am pleased to say that he will see in the Bill that one of the duties of the NHS commissioning board is to reduce inequalities in access to health services, and GPs can do precisely that.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Mr Lansley]

The hon. Lady will forgive me, but I do not propose to make that available, as it would be a great deal more expensive. Each year, and on an international basis, the World Health Organisation advises on what the seasonal flu vaccine should consist of, and it almost always consists of the three most likely strains combined together into one vaccine.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Is the Secretary of State prepared to make a statement on the vital work of the co-ordination of organ donation at the hospital level, particularly given that under the current system there is no specified organ donation co-ordinator at the Westmorland general hospital in Kendal?

[Anne Milton]

Organ donation co-ordinators are a vital part of the team in increasing organ donation rates. The organ donation taskforce recommended 100 extra organ donation co-ordinators, but we must not forget that there are other things. For example, training for staff who are likely to come into contact with potential organ donors is vital. We have got to get those rates up.

Accident and Emergency (Westmorland General Hospital)

Tim Farron Excerpts

Wednesday 23rd June 2010 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your chairmanship for the second time in an hour, Mr Benton. I wish to express my gratitude for the opportunity to make the case for my local hospital.

The Westmorland general hospital in Kendal sits almost exactly at the geographical centre of the area covered by the University Hospitals of Morecambe Bay NHS Trust. It is one of three hospitals serving the area, along with the Royal Lancaster infirmary and the Furness general hospital at Barrow. Westmorland general hospital serves, in Cumbria: the Lake district, the western part of the Yorkshire dales, South Lakeland district and the southern part of the Eden district. In north Lancashire, it serves large swathes of the Lune valley.

For all those areas, Westmorland general is the closest and most accessible hospital. Indeed, it was built in 1992 expressly to serve those communities as a district general hospital. At that time, it provided full accident and emergency services and acute provision. Since 1992, the population of Westmorland general hospital’s catchment area has grown significantly in comparison to the populations of the other hospitals at Lancaster and Barrow. However, the past 18 years have seen the steady removal of key services from Westmorland general, culminating in the loss of medical emergency services in August 2008.

Since 2008, anyone suffering a suspected cardiovascular emergency, a heart attack or a stroke in the Westmorland general catchment area has been taken by ambulance to Lancaster or Barrow instead. The majority of local health professionals opposed that decision throughout the consultation process in 2006, as did the overwhelming majority of the local population. I presented a petition to this place, with 27,000 signatures opposing the proposals. There were 7,000 responses to the formal consultation, almost all of which opposed the proposal. Some 6,000 people joined a march in opposition to the cuts and 4,000 of us joined a human chain around the hospital to protest. I am proud to have been involved in all of those actions, as they were a key mark of the strength and vitality of our communities and of the clear awareness of the immense danger that the proposals pose to tens of thousands of residents and visitors. The campaign went on for almost three years, but in August 2008 the medical emergency provision closed.

Trust managers—I would say disingenuously—attempted to convince the previous Labour Administration that the opposition to the proposals was simply a case of an emotional and uninformed public and MP against an informed and clinically astute medical community. I can assure the Minister that that is absolutely not the case—it is, indeed, nonsense. As I have already said, the majority of local medical opinion was opposed to the closure. There were some doctors who supported the closure of emergency services, but there were barely any of those who were not also some sort of trust manager, and therefore sticking to the party line. I am seeking the Minister’s help to ensure that safe emergency provision is reinstated for residents and visitors to South Lakeland, the lakes, the dales, the northern part of the Lune valley and the southern part of the Eden district.

The resident catchment population for the Westmorland general hospital is 123,973 individuals, rising to 157,513 when one factors in resident visitors. For the Royal Lancaster infirmary, the resident catchment area is 143,500, rising to 161,886 when factoring in resident visitors. For the Furness general hospital catchment area at Barrow, there are 71,800 residents—78,093 when factoring in resident visitors. The catchment populations of Lancaster and Westmorland are roughly identical, with the catchment area of Barrow less than half their size. An additional factor, of course, is the vast number of non-resident visitors in the Westmorland general hospital catchment area visiting the lakes and the dales, who are as likely as anyone else to fall ill and need emergency treatment. That means that, for most of the year, there will be significantly greater numbers of people in the Westmorland catchment area than in that of either of the other hospitals in the trust area, yet Westmorland general is the only one without medical emergency facilities.

The area served by Westmorland general is much more rural and sparsely populated than the rest of the trust area. Barrow has 10.2 people per hectare, Lancaster 2.81, and Westmorland just 0.6. Many parts of my constituency already face vast distances and a significant trek to get to Westmorland general hospital, but to now force people to go all the way to Lancaster or Barrow is a significant threat to patient safety.

If one had a heart attack in Hawkshead, it might take an ambulance half an hour to arrive. The fastest time it would then take to get to Lancaster hospital would be an hour, but it would be more likely to take 90 minutes. The average patient suffering a heart attack would therefore arrive at Lancaster’s coronary care unit some two hours after they had dialled 999—if they survived. It would take 37 minutes to get to Kendal, rising to 45 if the traffic was sticky. The same, give or take a minute or two, is true for people who fall ill in Chapel Stile, Elterwater, Grasmere or Coniston. It takes 46 minutes at best—it is more likely to take an hour and a quarter—to get from Ambleside to Lancaster, but less than 20 minutes to get to Kendal.

We all know about the golden hour following a heart attack, during which a patient must be stabilised. After the hour is up, the chances of a patient dying or suffering permanent damage rocket. Anecdotally, I know of a great number of deaths that occurred as a consequence of the decision to close down emergency medical services at Westmorland general hospital. I know, from talking to ambulance service staff, that patients have died in the back of ambulances en route to Barrow or Lancaster, but that they would have survived had they been allowed to be taken to Kendal. Such deaths do not show up in statistics, because no one officially dies in an ambulance—they are only designated dead on arrival. I encourage the Minister to dig as deep as she is able to uncover hard evidence of that through coroners’ reports and other similar material.

All acute medical crises have better outcomes the sooner they are treated by a full medical team, a doctor and specialist nurses situated in a fully equipped resuscitation room. It is criminal to reconfigure acute services to lengthen the time that dangerously ill people have to wait before receiving life-saving treatment, especially given that Westmorland general hospital had an excellent record of managing the initial stages of heart attacks and other life-threatening acute cardiac emergencies. I invite the Minister to look at the official statistics, which show clearly that timings at Westmorland general for patients receiving vital treatment were significantly and consistently better than at Lancaster or Barrow. Outcomes were also excellent.

It is not the case that Kendal operated at a lower level or standard than the other two hospitals. Cutting-edge coronary care units are equipped to provide angioplasty services, but the nearest such unit to Morecambe bay is in Blackpool, which is well outside the trust area. It is important to spell out that neither Lancaster nor Barrow provide that function. Indeed, although the expertise and the level and standard of service provided by the coronary care units at Lancaster and Barrow are excellent, they are no more advanced and no better in terms of outcomes, patient experience, safety or survival rates than those that were available at Westmorland general hospital in Kendal just 22 months ago.

Expert opinion suggests that, where it is appropriate, a patient should be thrombolysed by a trained paramedic at the scene before being transported to the nearest specialist centre. In order to allay my fears and those of my constituents, the hospitals trust negotiated with the North West Ambulance Service to provide an additional ambulance service for South Lakeland and a number of additional paramedics to compensate for the closure of acute services at Westmorland general. Those promises were kept, but the figures clearly show that the administration of thrombolysis at the scene almost never happens in South Lakeland. Indeed, in the first six months of operation, only four instances of thrombolysis took place outside a hospital in the south lakes. In the other 95% to 99% of cases, the patient is left waiting at least 30 minutes longer for their treatment than they would have when the Westmorland general’s coronary care unit was open. I can only speculate why that is so—it may be due to a lack of training or a lack of confidence. A paramedic is now being asked to perform the same function alone in an immensely stressful situation, possibly in the presence of distressed relatives, that only 22 months ago would have been performed by a team of experts and experienced coronary care nurses in a specialist unit. I do not blame the paramedics for not thrombolysing, but I blame the trust management for pretending that this practice could ever have been a safe alternative to a coronary care unit at Westmorland General hospital.

There are additional dangers to patients as a result of this decision. Because more than 90% of ambulances from the south lakes now have to make the journey to Lancaster or Barrow to deliver a patient to hospital, the south lakes ambulances tend to be at least 30 minutes further away from their next emergency call than they used to be. That had to have a dramatic effect on response times, and indeed it has. However, some of this lengthening of response times has been covered by the presence of our outstanding volunteer first responder teams, who will usually get to the scene of an emergency before an ambulance and in some cases more than an hour before an ambulance, thus making it appear that the ambulance service has met its response time target when in reality it has not.

To illustrate the situation, I will use one example. In December I went on shift with one of Kendal’s ambulance crews. We responded to a 999 call from a man in his late 80s who had presented with chest pains. He lived roughly a mile from the Westmorland general hospital in Kendal, which 16 months previously would have been able to receive him and treat him. Instead, we had to drive this patient past the Westmorland general hospital on the A65 and take him down the M6 to Lancaster. The patient was clearly afraid and the paramedics were clearly appalled at having to take a potentially dangerously ill person so much further to receive treatment. His frail wife was left behind in Kendal, with no prospect of being able to visit her husband in the coming days, as she would have been able to do at the nearby Westmorland general hospital. Even with blue lights flashing and sirens blaring, it still took us 45 minutes to reach Lancaster’s A and E department. The nature of Lancaster’s traffic system means that, even when other road users pull over in unison to allow an ambulance to pass, it is barely possible to go above more than 15 or 20 mph as a driver attempts to negotiate the traffic.

We stayed with the patient for more than an hour until he was safely admitted and then we left to return to the ambulance station in Kendal. From getting the 999 call to returning to the base and being once again available for the next emergency call, it had taken almost three hours. If we had been allowed to take the patient to Kendal, we could have been back at the base, out and ready to help the next patient in just half an hour.

Again, I can only speculate as to the motives of the trust management who were behind the closure. At the time, financial motives were cited, although those financial pressures have actually alleviated significantly. Mostly, clinical reasons were put forward for the closure, but those clinical reasons were seriously flawed. The solitary piece of clinical evidence used by the hospital trust and the PCT to justify their decision was the Royal College of Physicians’ guidance notes from 2002, which included a recommendation that consultants in acute medical care should not straddle more than one hospital. To follow that guidance to the letter would mean closing acute hospital medical services at either Lancaster or Kendal, so the trust chose to close services at Kendal.

However, the guidance is just that—it is guidance. It is not an edict. Indeed, in an answer to a written question from myself to the former Secretary of State, Patricia Hewitt, it was confirmed that that guidance was only one of a range of considerations that had to be weighed up when trusts were deciding how best to deploy acute medical resources and, crucially, that many trusts, especially in rural areas, had chosen to acknowledge the guidelines but had also chosen to continue to operate the relevant coronary care unit, because of the greater importance of ensuring adequate treatment for patients within the golden hour.

We can look at the example of Fort William hospital, where GPs are recruited to fulfil a cardiac role within the hospital. They are well trained to manage cardiac emergencies, independently if necessary. At Westmorland general hospital, the answer could be to recruit a medical registrar—a grade doctor—and to ensure the presence of such a registrar around the clock with sufficient supporting cardiac-trained nursing staff. The reality is that, before the loss of coronary care services at Westmorland general, a consultant would very rarely be present during the acute stages—as is the case with most other coronary care units—and that the senior house officer or registrar would manage just as well as a consultant. One only needs to look at the outstanding performance indicators from the coronary care unit in Kendal until 22 months ago to see that.

As the Minister will be aware, local geographical and territorial politics can often be just as significant as party politics. In our case, the rural catchment area for Westmorland general seems to have been squeezed out by the more urban interests of the two districts either side of us. That is despite our large and often larger population.

I quote what a senior trust representative told Kendal town councillors when the closure proposal was made. He said:

“We had argued for 10 years with our administration that acute medical services should be transferred from WGH to Lancaster. They had resisted it but when the financial crisis occurred, we saw our opportunity. We recognise that the Consultation process was defective and we argued for accurate costs to be included but the final decision was the one we wanted. That is all that matters.”

I do not have time to give full details of the flaws in the process that led to the closure of Westmorland’s emergency service. Instead, I have chosen to make an outline case for such provision to be returned. In answer to my question about cancer services on 9 June, the Prime Minister made it clear that the present Government do not follow the “one size fits all” mantra of the previous Government that big is always beautiful. I know from his visits and those of the Deputy Prime Minister to Westmorland that they are particularly supportive of our cause.

As someone who lives in the south lakes area and whose family and friends rely on local services, I simply want the safest and most appropriate emergency care for our communities and the hundreds of thousands who visit our communities each year. I ask the Minister to do all that she can to ensure that emergency services are restored to Westmorland general as a matter of urgency.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Thank you for calling me to speak, Mr Benton; we seem to have spent a fair bit of time here today.

I congratulate my colleague the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing this debate. I know that the future of Westmorland general hospital is a matter of long-standing interest and concern to him. He spoke with passion—and some frustration, because he has clearly been fighting a long and hard campaign. As a constituency MP, I have engaged in not dissimilar exercises in connection with a community hospital and a large acute trust hospital. I possibly lost one, but won the other. I know how passionate he must feel—and how passionate his constituents feel, which is demonstrated by the size of the petition that he presented.

I know how important hospital services are to local communities, and how worrying it can be to local people when services are moved. The fact is that change has not always been well managed in the NHS. I assure my honourable colleague that the Government are determined to do these things differently, and to get local populations behind changes in the NHS. We believe that the best decisions are local and that change should be driven by local clinicians and not imposed, top-down, by politicians or decided behind closed doors by managers. That is why we introduced an immediate moratorium on new or pending service reconfigurations.

The Secretary of State for Health has made it clear that all proposed service changes must now pass four crucial tests. First, they must have the support of GP commissioners. Secondly, public and patient engagement must be strengthened; that was at the hub of my colleague’s words. Thirdly, there must be greater clarity about the clinical evidence base for any proposals—a matter also mentioned by my honourable colleague. Fourthly, proposals must take account of patient choice. As a result, the local NHS will have to make its proposals more transparent to the public, more responsive to the views of the clinical community and more firmly grounded in robust clinical evidence.

In the case brought to the House by my honourable colleague, it means that there may be new opportunities for local debate, with new clinical judgments on how services should operate. However—my colleague will be disappointed to hear me say it—this is not an opportunity to revisit reconfigurations that have already been completed. That simply is not possible. That means that the 2006 review will not be reopened, and that the decision will stand. However, I note my honourable colleague’s concerns about valuation and patient safety; the Department of Health has raised them with the primary care trust and the local NHS trust. In case I forget to say so in my concluding remarks, I know that a Health Minister will be happy to meet my honourable colleague.

I understand that following a full public consultation, Cumbria county council’s health and well-being overview and scrutiny committee approved the changes; they were not referred to the Secretary of State for review by the independent reconfiguration panel.

[Tim Farron]

The overview and scrutiny committee did indeed rubber-stamp the proposals, but its process was deemed flawed by an investigation by the independent health commissioner because it did not take any evidence from the non-trust side. It was a completely loaded investigation.

[Anne Milton]

I thank my honourable colleague for that clarification, and it highlights so well what happens when things cease to have public trust and confidence.

My honourable colleague has made the case for acute services to be reinstated at the Westmorland. The NHS trust tells me that the coronary care unit had to be closed on the grounds that it was no longer sustainable or safe. There is an increasingly difficult balance to be drawn between services that are local and accessible and those that have a significant throughput to ensure that clinical safety is maintained. A service might have been safe in the past, but that does not necessarily mean that it will be safe in the future. I understand that, on average, the service treated only three or four patients a week, and that level of throughput is simply not enough and potentially puts patients at risk.

--- Later in debate ---

[Tim Farron]

I have two quick things to say. First, will the Minister investigate what evidence there was at the time of the closure for the Westmorland general unit to be deemed less safe than the other two units that we have mentioned at Barrow and Lancaster? Secondly, will she conduct an assessment of the position with regard to the safety of patients now? In other words, what impact has the closure had on the safety of patients or visitors within the South Lakeland area?

[Anne Milton]

There are two issues here: what happened in the past and what happens in the future. The concerns that my honourable colleague has about safety in the future will be examined, and I am sure that Department of Health officials will help with that. I understand that Professor Roger Boyle, the national director for heart disease and strokes, has said that he does not believe that reopening the cardiac unit will be best for the local people, so that should be borne in mind. He feels that it would not be feasible to provide primary angioplasty for severe heart attacks at the Westmorland. He also thinks that for less severe heart attacks, Westmorland cannot provide the most appropriate care, such as early referral for intervention. However, I do recognise my honourable colleague’s legitimate concern over the use of pre-hospital thrombolysis, and over the fact that it is low in Cumbria. Clearly, more work is needed to ensure that heart attack patients in Cumbria get the best possible treatment.

I understand that the trust is listening to my honourable colleague’s concerns and that it is looking to increase the number of cardiologists from three to five across the regions. Those clinicians will be based at the Royal Lancaster infirmary and the Furness general hospital, but they will help to build extra capacity in the treatment of outpatients. That might not be enough here and now, but it is something that my honourable colleague can take away.

I understand that there has never been an accident and emergency department—whatever that means in this day and age—but I am also told by the NHS trust that there would be insufficient volume of patients going through Westmorland to sustain a full A and E department. An A and E department has to have back-up services, such as intensive care and CT scanning, to support the unit, and the Westmorland is not in a position to provide those facilities. The trust’s argument, therefore, is that it is safer for patients to access those services at Barrow or Lancaster, and I appreciate that that is fundamental to this debate and will be fundamental to ongoing discussions, because my honourable colleague believes that the opposite is the case.

My honourable colleague also mentioned travel times, and I am told that the North West Ambulance Service advises that across Cumbria, the average time for it to get to the scene is 10 minutes. He might dispute that, but that is what I have been told. The average time on scene assessing and treating a patient is 20 minutes and the average time from Kendal to Lancaster under normal driving conditions—not with blue lights—is 20 to 30 minutes. I acknowledge that patients on the far reaches of his constituency have further to travel.

[Tim Farron]

I simply reiterate my earlier point: in rural areas, the bulk of those times record the time that the first responder arrives—the ambulance probably arrives another 20 minutes later.

[Anne Milton]

And let us pay tribute to first responders; I have them in my constituency and they do a fantastic job.

[Tim Farron]

Indeed.

[Anne Milton]

It is not always about the time spent getting to the hospital, but the treatment in the first crucial half hour or so.

Provided paramedics can reach the patient quickly, they can provide treatment and stabilise them en route, which is often preferable, and then go to a hospital or an A and E department further away. However, the expertise has to be provided by the ambulance staff. “Dead on arrival” incidents would be reported, and NHS Cumbria has advised me that no such cases have been reported in the past 18 months, but the hon. Gentleman may have data that goes back further.

Unfortunately, when it comes to serving rural populations, the NHS has to balance what is safe with what is desirable. This is very tricky and it is held in the balance. There is no doubt that across the country the NHS is facing considerable challenges, and the local NHS in Cumbria is no different from any other. We made an historic decision, as a coalition Government, to protect health spending during this Parliament and to secure the front-line services that our constituents value so highly, but it is clear that local health services need to change and to become more efficient to secure their long-term future. That will not always be a smooth process; there will be tough calls to make in the future, as there have been in the past, but a clearer and more open process, led by clinicians and putting the local people firmly in the picture, will, I hope, reduce the anxiety that my honourable colleague has spoken about today. I hope that it will also build the trust that we need around such decisions. That is how we can achieve higher standards and better outcomes.

I said to my honourable colleague that I am sure that the Minister will be happy to meet him. The question is: how does my honourable colleague move forward with his constituents and how do we ensure that, even if we cannot right what has happened in the past, we move forward constructively? This is just a suggestion, but if he and local GPs formed a small informed group to work with the trust, I would hope that the local NHS organisations could take into account some of his concerns about the future of health services. What matters now is what happens in the future. I hope that they can provide the service that he wants to see.

[Tim Farron]

I am grateful to the hon. Lady for giving way so often. Would that include the possibility of the local GP community, should they so wish, moving towards something akin to the Fort William situation that I mentioned earlier?

[Anne Milton]

I thank my honourable colleague, but I am always very nervous about stepping outside my pay grade. The crucial thing now is how we and local MPs who have fought closures and reconfigurations move forward constructively; and we cannot reopen what has gone in the past. Local GPs and clinicians forming a group to work with and alongside the local primary care trust could ensure that good and improving decisions are made about NHS services.

It is not always about how close someone lives to a hospital. Across his constituency, life expectancy will vary by 10 years or more, and that has nothing to do with proximity to the hospital, but with deprivation. The issue of health care is much wider than this debate. There is an open door for my honourable colleague, so he feels that he can get the access to Ministers; I hope that will restore his trust and the trust of his local community.

Question put and agreed to.