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Health Fit Process (Isle Of Wight)

Volume 400: debated on Wednesday 26 February 2003

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4 pm

Thank you, Mr Deputy Speaker, for allowing me to raise this issue. I am glad to see the Minister in her place.

There are three key questions that I hope that the Minister will be able to answer. First, health fit, which I will explain in more detail later, mentions drivers for change, some of which are practical and some of which are artificial. Do the Government accept that they have responsibility for creating some of those drivers for change and therefore that they have responsibility for the consequences? Secondly, when the Government set so many targets, why are there no targets for access to accident and emergency services? Thirdly, will the Government guarantee the future of emergency surgery facilities to support a consultant-led accident and emergency service together with maternity and paediatric services in my constituency?

The Isle of Wight is situated some two to five miles off the south coast of England, depending on where one crosses. It is difficult to describe the impact of living on a small offshore island to someone who does not share that experience. I will explain it for the Minister's benefit. If, every time she wanted to move from the city of Salford to the city of Manchester, she were only allowed to travel every half an hour, she spent half an hour doing so and there was no transport after 11 o'clock at night or before six o'clock in the morning, she could understand the practicalities faced by my constituents. There are only six ferry connections between the island and the mainland, very few of which run all the time.

The population of the island is 125,000 but it rises to 300,000 during the peak holiday season. It is one of poorest areas in the UK not to receive objective 1 or objective 2 status.

The hospital, which is run by the Isle of Wight Healthcare NHS Trust, is a splendid, albeit small, district general hospital. It was constructed in the late 1980s. A total of £26 million is now being spent on reconstruction because it has been agreed that 125,000 inhabitants in the winter and 300,000 in the summer

"must have an accident and emergency service, and therefore must have the 24-hour cover that supports that accident and emergency service, which has been described by the joint consultants committee of the BMA as acute medicine, acute surgery, trauma and orthopaedics, obstetrics and gynaecology, paediatrics, a full anaesthetic service, ITU, CCU and HDU, pathology and radiology, 24 hours a day, seven days a week, 52 weeks a year. That is a basic minimum without which A and E cannot function effectively or, indeed, safely."—[Official Report, 14 January 2003; Vol. 378, c. 655.]
We fear the loss of those services and, of course, the ambulance service must use coastguard helicopters to transfer patients to the mainland from time to time. I will give more background. There is an enduring concern in my constituency about the loss of island services to the mainland. We have got used to having a joint police service with Hampshire, although we still hanker to have the island mentioned in the service's name. Since 1997. we have seen the creation of a cross-Solent learning and skills council, and a health authority that was first amalgamated with that in Portsmouth and then re-amalgamated with that covering the rest of Hampshire.

Those may only provide backroom services, but more recently we have seen the loss of the police control room to Netley and the loss of Customs cover based on the island. There is a natural suspicion among my constituents that such losses will continue. Sadly, the health fit process was launched against that background of suspicion.

The health fit project is run by the Hampshire and Isle of Wight strategic health authority and is part of a national process to reconfigure hospitals in what is called "a rapidly changing environment". The local health community is expected to agree a strategic framework for reconfiguring those services to achieve what the health authority calls

"sustainable, affordable and efficient health services that meet the health care needs of the population."
The principles adduced include the recognition of drivers for change, the involvement of the public, meeting the needs of the human population rather than bricks and mortar and making services effective and safe while sometimes taking calculated and agreed risks. I shall shortly ask whether the risk of not having an accident and emergency department on the island is worth taking.

Three elements are profoundly important. The first is public involvement. I welcome the fact that consultation is not taking place behind closed doors, but the language must be more accessible. Using phrases such as

"based on a series of patient pathway conferences"
is unhelpful. It means precious little to me, though perhaps more to the Minister. The second element is drivers for change. Some are technological and medical advances, National Institute for Clinical Excellence clinical statements and the demands of the royal colleges. Another identified in the health fit document is to

"manage the pressures on the medical workforce as a result of the European Working Time Directive".
Some drivers are inevitable, some artificial. The Government imposed some—so the Government can take them away. Where they damage services or impose a financial cost that the Government are not prepared to meet, they should be interpreted flexibly.

The first that most islanders knew about the health fit process was on 10 January when the story hit theIsle of Wight County Press. I pay tribute to Suzanne Pert, its health correspondent and a mature and sensible journalist who does not scaremonger. She wrote:

"An explosive report on future health services suggests Islanders would have to go to the mainland for all emergency surgery and trauma services, for some planned operations and even to have babies for a caesarian or forceps delivery."
A document had been produced—ambiguous and full of health jargon—for the community health council meeting on 13 January. I shall summarise its key points. First, it states:

"For in-patient paediatrics at Levels 2 and 3, the working assumption might be that these services should align with the 'comprehensive' acute hospital sites in Southampton, Portsmouth and Basingstoke."
There are presently five, but that is only three. Secondly, it states:

"Whilst the role of the acute hospital will change, there is still a need to define sites where acute trauma (accidents) and acute surgical emergencies will be treated. The likely strategic sites for these services, in terms of population distribution and access, are Southampton, Portsmouth and Basingstoke."
A third extract states:

"However, the emerging view of the HealthFit event"—
typical of the language used—

"was that greater thought needs to be given to emergency access to the mainland, rather than treating the Solent as a barrier which completely defines the nature of services on the Island."
I understand what the document was getting at and I see the Minister nodding in her place, but it was open to profound misinterpretation—that if emergency services are wanted, one may have to cross the Solent to get them. That was a serious error on the part of those who wrote the document.

Fortuitously, on 14 January I held an Adjournment debate on public services, to which the Under-Secretary of State for Health, the hon. Member for Tottenham (Mr. Lammy), replied. I shall not quote all the relevant columns, but I had read the health fit document by then and pointed out that, if implemented, it would undermine the argument for minimum must-have provision for the population. I told the Under-Secretary that the proposals in the health fit document to remove accident and emergency to the mainland were unacceptable. I hoped that they were to him, too.

I provided the Under-Secretary with an opportunity to deal with that concern, by then widespread on the island. Sadly, he failed to do so. He merely read out a prepared script in columns 660 and 661, which described a process that would continue for a year or more, offering no comfort to residents on the future of accident and emergency, or, indeed, any other services on the island.

It was not surprising that the primary care trust and the health trust under the leadership of David Crawley and Graham Elderfield respectively should meet with their staff to put together the technical, financial and medical case for and against moving the services as described in the document. It is not surprising that the public became increasingly worried, that Councillor Roger Mazillius, the portfolio holder for health, social services and housing on the Isle of Wight council, called a public meeting, or that people wrote to me and telephoned me to ask what they could do. My assiduous local paper and other media including Isle of Wight Radio and the SouthamptonDaily Echo took a close interest.

On 22 January, the leaders of the three political groups on the Isle of Wight council, the Island First Group, the Conservatives, and Debbie Gardiner for Labour, launched a petition against what health fit called the proposals, but what I was careful subsequently to call the suggestions and ideas. I pay tribute to them, to the townswomen's guild for helping to launch the petition, and to people all over the island who helped to collect signatures for the petition in bars, pubs, shops, cafés, garages and fire stations. To date, I am pleased to say that 53,209 people have signed the petition: more than half the total adult population of my constituency. I have also received a huge number of letters, some of which I have with me.

Before the public meeting on 3 February, Peter Bingham, the chairman of the Hampshire and Isle of Wight strategic health authority, wrote:

"I cannot envisage the closure of accident and emergency services at St. Mary's. The bulk of accident and emergency services will always need to be provided from local facilities."
It is no reflection on Peter Bingham that islanders subjected that letter to the same kind of textual analysis with which they might examine a snip offered by a used car salesman. They were becoming suspicious because they had already lost their services. Some may have recalled, as I did when I read it, the words of my noble Friend Lord Heseltine, who notoriously "could not envisage" doing something rather damaging to my party. However, that is the kind of analysis to which the letter was subjected.

The statement was examined in detail at the public meeting. Richard Samuel, for the strategic health authority, gave three key assurances: a mini health fit for the island would be held in April; no decisions had been taken; and he repeated the "cannot envisage" statement.

Graham Elderfield, of the health trust, said that we needed to have accident and emergency services on the island, and pointed out that the clinicians had decided two years ago that it was too high a risk to move maternity services from the island. David Crawley, of the primary care trust, said that

"the document doesn't say close A&E, it will be provided on the island."
He also said that

"accident and emergency is an integral part of delivering services on an island."
However, later the same evening he said that

"accident and emergency will remain as it is; the question is the emergency services around it."
Paul Barber, the secretary of the community health council, said that the consensus was entirely the opposite of that indicated in the health fit document, which suggested that there was consensus on the ideas put forward in the document.

Given the promise that I have just quoted from Peter Bingham—a promise that people took seriously—people then began to focus on what was meant by accident and emergency services. Did it mean the accident and emergency service as presently provided, or did it mean an accident and emergency service at St. Mary's, but perhaps without emergency surgery and trauma support—in other words, a minor injuries unit?

My noble Friend the Earl Howe asked that question in another place last Wednesday, but even before he did so people were beginning to suspect that it meant a minor injuries unit. Lord Hunt of Kings Heath declined to give my noble Friend the confirmation that he sought—that emergency surgery would remain on the island.

Not surprisingly, my constituents have smelt a rat. What would be the consequences of the loss of accident and emergency services? It would mean the loss of other services. Without consultant-led accident and emergency services, as the British Medical Association has shown, there is no need for other acute hospital services. It would be impossible to provide maternity services in case an emergency caesarean was needed, as happened in the case of Elaine and Keith Ashdown of Cowes. Mrs. Ashdown had a textbook pregnancy, but needed an emergency caesarean when Daniel was born on 1 July 2002. Minutes later, he was whisked off to the neonatal intensive care unit. Mrs. Ashdown said:

"The one thing that helped my husband and I through what should have been the best day of our lives was the fact that we had family there with us."
Without consultant-led accident and emergency services, as accident and emergency consultant Peter Beal said, we would turn into a minor injuries unit. We must have complete accident and emergency coverage, and to have that we need all the necessary back-up. Mr. Jules Gwynn, who is a nurse in the unit, said:

"If people are trapped and need assessment, a whole specialised team would go out including a consultant and an anaesthetist. We are all on stand-by 365 days a year … It's part of the job, we don't get paid for that. We do it for the Island, we don't do it for ourselves."
The time and cost of travelling to the mainland is a problem. It costs the parents of a sick child £49.70 to visit him in Basingstoke. It is a return journey of more than five hours from Newport. A lady in East Cowes said she had just time to go to Southampton general hospital between leaving her children at school in the morning and picking them up in the afternoon.

There is pressure on mainland hospitals, with which they are ill equipped to cope. Caroline Dinenage of Portsmouth wrote to me to say:

"I am extremely worried about the impact that changes to the Isle of Wight hospital will have upon Portsmouth hospitals which are already under enormous pressure.
My personal experience was in September of last year when I was under St Mary's hospital Portsmouth for maternity care. I was booked to go in on the morning of Sept. 5th to be induced … The nurses on my ward told me that they were so overwhelmed with women in labour that some midwives were having to attend to two women simultaneously … Unfortunately the maternity/labour wards were so busy all of that day and the next that I had to wait until 9 pm on the following evening before I could be induced (36 hours later) … one of the midwives on my ward took pity on me and stayed late at work to carry out the procedure.

I have to say that the care I received from the staff during my stay was absolutely marvellous—they were all just so kind and good natured despite the pressure they work under. I really can't see how they will be able to cope without some substantial investment and dramatic increase in staff numbers."
That is what will happen if these changes go through.

I wrote to the Minister to say that islanders' concerns and, in some cases, fears will increase unless we get some assurances. Health staff morale will be sharply reduced and recruitment and retention, always difficult, would be imperilled. People would choose not to relocate to the island, and our holiday trade, on which a substantial proportion of our wealth depends, would be hit. Most important of all, however, lives would be put at risk, as was the case with a Dorset mother-to-be who was brought from Weymouth a fortnight ago today because no hospital in the south of England other than St. Mary's had the intensive care cot that her baby needed. Fortunately for her, the ferries were running, but 1,500 times a year ferry services are cancelled and often helicopters cannot fly. Mainlanders, as I am sure the Minister appreciates, can go elsewhere; islanders cannot. That is why a fully equipped hospital is a matter of life and death to the people of the Isle of Wight.

4.17 pm

Once again, I find myself in the fortunate position of being able to begin by congratulating the hon. Member for the Isle of Wight on securing today's debate. I am sure that he will often raise issues of concern to his constituents in Westminster Hall. He is concerned to ensure that there is a high standard of health care on the island, and rightly so. For the record, I reassure him that the Government are absolutely committed to providing high-quality services for people in this country, wherever they may live, and that includes the hon. Gentleman's constituents on the Isle of Wight.

I do not intend to repeat the lengthy catalogue of improvements that my fellow Under-Secretary of State for Health, my hon. Friend the Member for Tottenham (Mr. Lammy) mentioned in the previous debate about changes that have taken place on the Isle of Wight. As the hon. Gentleman is aware, there has been a great deal of extra investment in and improvement to the infrastructure of the NHS and to direct service delivery in his area. However, it is worth repeating a statement that my hon. Friend the Under-Secretary made in the previous debate, as it sets the context for the health fit proposals. He said:

"Health services are never stagnant: they adapt to new opportunities and challenges as they appear. That applied especially when the Government introduced the NHS plan and the "Shifting the Balance of Power" initiative. In accordance with those policies, it is up to strategic health authorities and primary care trusts, with their specific local knowledge and expertise, to plan and develop health services in line with the needs of their local communities."—[Official Report, 14 January 2003; Vol. 397, c. 659.]
It is important that the hon. Member for Isle of Wight, his constituents, the health professionals and all those in his area look at any proposal in the context of that policy. The Government are determined that local people will be involved from the outset in shaping, designing and developing services to meet their needs and those of their families. I urge the hon. Gentleman to have a little faith and courage, and to have confidence in the ability of local people to come up with robust proposals that will meet the health care needs of his constituents.

Let me contrast the health fit process with what happened previously. The hon. Gentleman will know that I was chair of a community health council during the deep, dark Tory years, when consultation seemed to consist of the expiry of a period of time. A 12-week consultation process consisted of the NHS presenting its preferred option as a fait accompli to local people, the 12 weeks passing, and the initial option being adopted. That was entirely unsatisfactory and unworthy of the name public consultation.

The Government have tried to introduce an entirely new system, involving the public and patients from the outset in considering with health professionals the services in their communities—involving questions such as which services should be in the acute sector, how many should be in primary care and how many in intermediate care, and where specialties should be sited—as well as in debating difficult issues in a mature, realistic and reasonable way. If we have confidence in local people, we shall end up with robust, rigorous and sustainable solutions that will work in the longer term.

We are not merely preparing health policies that will suit us today, but trying to look into the future and to ask how the health service in the 21st century might provide high-quality services for people in the Isle of Wight. I urge the hon. Gentleman, the local press and the local community to involve themselves in the process. I have had a chance to look at the health fit document. It is excellent. The strategic health authority has grappled with a new way of designing proposals.

The hon. Gentleman should look at the back of that document and see the list of people who have already been involved at stage one of the process in trying to draw up some of the options that might be available. They include a range of people from local authorities, the primary care sector, the ambulance service, primary care trusts and the acute services who in the past would never have been engaged in the process. They would not have brought the views of community representatives, their knowledge of the local area, or their information about transport and about the way in which the community works into the health service planning process.

In the bad old days, the NHS would simply have decided in a closed environment what the local people should have. We are turning the system on its head and saying that it is for the local community to determine its priorities and for the health service to try to respond—within the bounds of quality and affordability.

The hon. Gentleman has raised serious questions about the drivers for change that are set out in the document. We must all address work force issues. We need more doctors, nurses, therapists, cleaners and porters—every kind of person working in the health service. This Government, with their massive investment, are enabling that to happen. We must also look at the skills mix. People will have to do different jobs from those that they have done in the past: nurses will have to do many of the things that only doctors have done, and doctors will do things that only consultants have done. Radiotherapy practitioners will have to do things that in the past only radiologists will have done. Getting the skills mix into the system is a key issue and a big driver.

There are pressures to centralise some services, some of which relate to quality, and there is recognition that in areas such as cancer, where surgeons have an opportunity to do a goodly number of operations, outcomes are better. It is now accepted in a number of specialist areas that bringing services together can result in better outcomes. Set against the pressure to centralise is an equal pressure to have services located in local communities wherever possible. If communities are engaged in that discussion, they can accept some of those contradictions and work through which services are better brought together and which are better done at local level. The traditional way of organising those services is not always the best way of meeting the needs.

We have to be imaginative. We have to use new technology. The introduction of telemedicine, teleconferencing and new IT means that we can work in different ways. Primary care services can often be connected through IT to the acute trust. A patient does not always have to go to the hospital to have an appointment: consultants can come out to primary care centres and run their out-patient clinics in the community. The health service is changing almost as we speak and faster than we have ever known before because of these drivers in the system.

Another driver is that we have to provide services within the money that is available. The hon. Gentleman must recognise that the investment in the past few years has been pretty significant. There was an increase in investment of 3.5 per cent in 1997–98, nearly 6 per cent. in 1999–00, and 8 per cent. in 2001–2002. There was a further cash increase last year of 9.6 per cent. and another increase of 9.7 per cent is coming.

Those are big numbers. This is the biggest investment that the NHS has ever known. The hon. Gentleman's constituents are seeing the benefits of having a Labour Government who have the courage to increase taxes and are prepared to invest in the NHS. The hon. Gentleman should be aware that this kind of change and transformation cannot take place unless there is an environment of increased investment that enables us to make those changes.

The hon. Gentleman asked about accident and emergency services. The chairman of the strategic health authority said very clearly on the record:

"I cannot envisage the closure of accident and emergency services at St Mary's. The bulk of accident and emergency services will always need to be provided from local facilities, because of the need for urgent access."
I challenge the hon. Gentleman to be more imaginative about what emergency services can look like in the future. They do not have to be designed as they have been for the past 30 or 40 years. With technology, new techniques and many more nurse practitioners, more people can be seen even closer to home than the original A and E services might have provided.

We are at an early stage. There are currently no proposals on the table and there is a long way to go in drawing up the health fit process. To rule out any possibilities at this stage would be undemocratic, not the best form of consultation and unnecessarily restrictive. It would not be fair to the local community. Whatever the hon. Gentleman says about the press not scaremongering, it is not fair to tell the community that they face the prospect of losing all their A and E services in their local hospital. That sort of statement will not encourage them to engage properly in the process or to play their full part in making their contribution to shaping the future health service for the Isle of Wight.

The hon. Gentleman talked about targets for access to A and E. He knows that we have targets about waiting times in A and E. Ninety per cent. of people are seen in A and E at his local hospital within four hours. That service is meeting the target. There is an excellent service on the Isle of Wight. He also talked about providing a consultant-led A and E and maternity service. Clearly those are important matters to local people and ought to be considered as part of that process. I am absolutely sure that they will be.

This strategic health authority has really tried. It has gone out of its way to do things in a different way and to actively engage with local people. It is determined to make that work. It recognises that the old style of operating—simply coming up with the option preferred by the professionals—is not the way to have a sustainable, responsive and accessible NHS in the future. The strategic health authority is doing its absolute best to ensure that it involves people.

Some important messages are already emerging from the initial health fit events. People say that there needs to be greater diversity of access, that primary care services should be extended and that more acute care should be taking place in the community. The role of the acute general hospital needs to change. Health services are changing for the future.

The hon. Gentleman should have some courage. He should have some ambition for his community. Things do not have to be as they are. In the future, they can be much better because of the investment that the Government are putting in and our determination to reform health services so that they operate in the best interests of the people. The hon. Gentleman should have some faith. He should get involved, play his part, and encourage his constituents to do the same.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Four o'clock.