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Children's Services (Manchester)

Volume 405: debated on Tuesday 20 May 2003

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Motion made, and Question proposed, That this House do now adjourn.— [Mr. Caplin.]

8.13 pm

I am grateful for the opportunity to discuss the unfortunate and unwelcome closure of Booth Hall children's hospital, and the consequential impacts that that will have on secondary and specialist children's services in Manchester. I am particularly interested to get reassurances from the Minister that the commitments given during the consultation process on the closure of Booth Hall children's hospital, and the commitments given about the future configuration of children's services, are honoured in principle and in detail. Some of those commitments cannot be honoured in detail because things have changed or moved on, but I am interested in ensuring that they are honoured in detail where they can be and in principle where they cannot.

It will be useful to give a brief history of the process that led to the decision to close Booth Hall children's hospital and what has happened since. I shall be brief, as there is not sufficient time to go through the full history in one half-hour Adjournment debate, but the issues can he summarised very simply. Over the past quarter of a century and more, it has been the steady and firm view of a number of health professionals that Booth Hall hospital should close. Just as firmly and with the same passion, virtually every person in north Manchester has opposed their view.

This is not simply a situation in which a hospital closes and people oppose that closure out of sheer conservatism. My constituents are more intelligent than that. In recent memory, three hospitals have closed—the northern hospital, the Jewish hospital and Ancoats hospital—which were either in Manchester, Blackley or on the constituency boundary. Some closures occurred with very little opposition and some with slightly more, but none of them received the same opposition as that of Booth Hall hospital. Indeed, I have yet to meet anybody outside the health service who agrees with the closure. This has been a difficult 25 years in which I do not think that a single mind has been changed among the people who live in north Manchester.

Interestingly—I ask my hon. Friend the Minister to reflect on this—given that level of opposition and the failure of the medics to persuade people that children's services would be better if the hospital closed, under the new proposals for foundation hospitals I suspect that any election to a body that controlled Booth Hall hospital would put in place people opposed to the closure. In those circumstances, it would be extremely difficult for anybody to proceed with the closure of the hospital.

There have been at least five consultations on this matter. Most of them were rejected, and in 1995 one consultation was conducted so badly that it ended up in the High Court in London. Manchester city council and, uniquely, the community health council brought an action, and leave was given to hold out an injunction against the consultation process. The process has not been a happy one.

Finally, on 15 March 1997, in the dying hours rather than days of the last Conservative Administration, the then Secretary of State for Health, the right hon. Member for Charnwood (Mr. Dorrell), decided that Booth Hall hospital and Pendlebury children's hospital would close and that there would be a new specialist hospital in the centre of Manchester. At this point, I wish to come to the commitments given by the then Secretary of State, which have been repeated by officials and by different Ministers in the Labour Administration and the Department of Health.

On 15 March 1997, in the letter giving closure, the former Secretary of State said:
"It is important, however, that these children's services retain their particular identity as a separate children's trust".
That was the first commitment—the assurance that there would be a children's trust to look after the interests of children's services as the new specialist hospital was developed, as the two current children's hospitals continued to be run and as future commitments to children's services were given. Furthermore—this is the second commitment—he said:
"Secondary children services would continue at the North Manchester General hospital".
The detail of what that meant was based on a letter from Mr. Neil Goodwin, who was then chief executive of the area health authority and is now chief executive of the strategic health authority.

In a letter on 21 January 1997, he said that there would be fully effective secondary services for children at North Manchester general hospital, consisting of general medical and surgical in-patient services, day care, out-patient and accident and emergency services. In effect, that was a commitment to move the secondary services that had existed at Booth Hall for 60 years or more to North Manchester general hospital while the specialist services moved to the brand new hospital on the Manchester Royal infirmary site in the centre of Manchester.

Does my hon. Friend recall that, similarly, in south Manchester, following the consultation and the commitments that were given, it was agreed that as the Duchess of York hospital in Withington was to close, secondary services for south Manchester should be centred at Wythenshawe hospital, while primary and community services should be developed at the new Withington community hospital? That commitment should also be honoured in any future consultation on services in Manchester.

My right hon. Friend's recollection is exactly the same as mine.

In autumn 2000, the health authorities issued a new consultation document suggesting a merger between the children's trust and the central Manchester trust. It is important to note that that broke the commitment given in the original closure letter, which said that there should be a separate children's trust. The rather anodyne euphemisms used in the consultation document explained that that was happening to secure significant investment. My noble Friend Lord Hunt made it absolutely clear that the funding for the private finance initiative would not be available if the private sector had to deal with two separate trusts. That was the real driver behind the decision. I wrote in objection to that consultation document.

In the decision letter, Lord Hunt, who was then a Minister at the Department of Health, said that as a condition of approval—not as an add-on or a good idea—an NHS supervisory board to oversee the development of primary, secondary and tertiary paediatric services across Greater Manchester with the power of veto over decisions that could undermine the integrity of children's services should be set up. I think that the date of that decision letter was November 2000, but it was certainly well before the new combined trust was set up on 1 April 2001. So far, that supervisory board has not been established.

I wrote to my hon. Friend the Minister, who asked, in effect, what would have happened if the umbrella body—the supervisory body for children's services—had been set up. Uncharacteristically, she is being slightly unfair; I know that she is a very fair-minded person. The purpose of the supervisory body was to consider what could and should be done for the benefit of children's services to ensure that they were not swamped in the development not only of a new children's hospital, but of a new specialist hospital. I simply do not know the answer to my hon. Friend's question, although I am worried that things may not have happened, or that things may have happened that we do not know about, because the body was not set up. I ask her this: if a Minister of Her Majesty's Government says that something has to happen as a condition, but it does not happen, what then is the legal basis of the new trust? I do not particularly want to go down that route, but it is worth speculating on.

I do not know whether the decision temporarily to close the special care baby unit in North Manchester general—I believe the Pennine trust when it says that it will re-establish it in September—would have been made earlier, or later, if the body had been set up, but I know that it would have been watching developments. I do not know whether the consultation on cleft lips and palates, which is going to take place, would have happened. I do not know whether the speed with which the core clinical pathways have been rendered similar in the two operating hospitals where they were previously different would have been quicker.

I make no criticism of the chief executive or the members of the new trust. However, one has to ask whether there would have been swifter action and greater speed to reconfigure children's services if the supervisory board had been established, and without some of the blue-skies thinking of the Mann report. It suggested that we should forget everything that already existed, start afresh and consider where secondary paediatric services should go. That was an indulgent waste of time and a way to undermine the Government's commitments to providing good secondary services at North Manchester general hospital when it was decided to close the hospitals.

I ask the Government to honour their commitments to North Manchester general hospital on the transfer of services. The people and children of north Manchester were promised that those services would remain in the community, as they have done for 60 or 70 years. Keeping the promise is a matter of integrity, honour and credibility for the Government. When Ministers make commitments, they should be fulfilled. They should not simply say that because they were made two or three years ago, they can be forgotten. If the commitments are not fulfilled, the people of north Manchester will not forget. I ask my hon. Friend the Minister to reassure my hon. Friends and me, as well as the people of north Manchester, that they will be honoured.

If the previous argument—that Ministers made commitments—is not strong enough, I emphasise that if they are not fulfilled, the new investment in the super children's hospital, which will provide specialist services in the centre of Manchester, is less likely to be successful. Although I wish that it had been built on the Booth Hall site, the decision has been made, and I want the new hospital to be a great success. That is less likely if the commitments are not honoured, for a simple reason. If people who live in north and, I suspect, east Manchester, and have been used to going to Booth Hall children's hospital, cannot take children who have broken limbs, bee stings or need tonsillectomies or other minor surgery to North Manchester general hospital, they will not travel to hospitals further afield on the periphery of Greater Manchester. They will go to the new specialist hospital in the centre. In the words of several health officials, "This will swamp the specialist services." Clearly, the new hospital will not turn away a child with a broken arm or leg. However, such treatment will take up space and distract highly qualified consultants from the job that is best done in the tertiary hospital.

I hope that my hon. Friend the Minister can reassure my constituents and me that the commitments will be honoured in detail when possible and in principle when the detail can no longer be fulfilled.

8.29 pm

I congratulate my hon. Friend the Member for Manchester, Blackley (Mr. Stringer) on securing the debate. I think the fact that he is accompanied by not just my right hon. Friend the Member for Manchester, Withington (Mr. Bradley) but my hon. Friend the Member for Rochdale (Mrs. Fitzsimons) demonstrates the importance of the issue to the people of Greater Manchester—but I already appreciated that.

Before I respond to the points raised by the my hon. Friend the Member for Manchester, Blackley I want to set out the context of any developments in children's services in the NHS in Manchester. I believe that that framework should reassure him and others there.

Services for children are never far from the headlines. How we treat our children is an important test for our health and care services, and how we modernise services to respond to their needs is a challenge for the NHS in Manchester and more widely. That is why we have been developing a national service framework specifically to set national standards intended to improve the quality of care for children and young people, and to reduce the number of variations in the provision of that care.

On 10 April we published the standard for hospital services as the first standard of that framework. At its core is the NHS plan principle that services must be designed and delivered in the context of service users' needs. That can be achieved only by better partnership working among all the agencies that deliver services to children, and by the empowerment of children and their families through full involvement in choices relating to their care. Clinical systems must focus on the particular needs of children and young people; staff caring for them should have the appropriate training and skills to provide high-quality care; and hospital environments must be safe, healthy, friendly places for children and young people.

This is the beginning of an unprecedented period of financial investment in the NHS in Manchester. We have an opportunity to transform NHS services for children, we can plan for expansion rather than contraction, and we can build up capacity and increase not just the volume of the local NHS's work but its quality and responsiveness.

I fully understand the history of concern about changes in children's NHS services in Manchester. My hon. Friend described some of the background. The concern is not surprising, given that too often in the past change meant cuts. We have just published "Keeping the NHS Local—A New Direction of Travel". It gives local NHS organisations new opportunities to design better ways of developing services that are more responsive to patients' needs.

Our objectives are clear. They are to improve the accessibility of our services, to end the automatic assumption that has prevailed for decades that reconfiguration means an inevitable concentration on fewer and fewer sites, taking services further and further from local communities—it should not mean that at all—and to challenge the view that the era of small local hospitals is over: it is not.

The new approach set out in our guidance rests on the assumption that patients and the wider public must and always should be treated as partners rather than protagonists in the process of managing change in the NHS. It is clear that local people and Manchester Members have not always felt that in the past. There is now a new opportunity for wider engagement in developments that I will describe shortly.

There may be strong arguments in favour of concentrating the delivery of very specialised services on fewer dedicated sites. We know, too, that many of our existing buildings need to be replaced. Those matters need to be addressed: no one disputes that for a second—least of all the public, who above all else expect the services we provide to conform to the highest possible standards of quality and safety. We must, however, move away from a viewpoint that automatically equates relocation with centralisation, and presents that as the public's only option. The development of services in Manchester will be based on those principles. It must also be based on clear evidence of what is effective, safe and likely to deliver the best services to Manchester's children. That point has been made strongly by Members locally: they have made their feelings clear to me and, I believe, to local health commissioners.

What does all this mean for the future of children's services in the NHS in Greater Manchester? They have been in place for decades without much change. They were designed to respond to the needs of earlier generations of children. For example, serious infections and illnesses are much less common than they used to be, but technological advances mean that we can now treat more complex conditions that were fatal only a few years ago, and give sufferers from those conditions a better quality of life. More children are attending accident and emergency departments, but the time that they need to spend in them can now often be measured in hours rather than days. Such changes mean that the health service needs to consider how best to provide good quality integrated services to the children of Greater Manchester.

Greater Manchester is benefiting from our extra investment. We now have the opportunity to relocate the current out-of-date specialist children's hospitals to a new purpose-built hospital offering state-of-the-art facilities to the children of Greater Manchester and the surrounding areas. Notwithstanding my hon. Friend's concerns, particularly in respect of Booth Hall in his constituency, the outline business case of £250 million for both the new children's hospital and the redevelopment of some adult services has been approved. The fact that the intention is to have contracts signed by September this year provides a very big opportunity for Manchester to ensure that there are better facilities and technology for seriously ill children and also to enable us to look at how the expertise in that tertiary centre can benefit the development of secondary and community services across the city and beyond.

We cannot use the additional investment to reinforce outmoded ways of delivering services. Nor can I dictate from Whitehall how children's services should be delivered in Manchester. That is a matter for the local NHS, working in partnership with the communities that it serves. But I can expect service developments to take place within the context of both the national service framework and our NHS plan vision of better quality services being provided closer to where people live. As my hon. Friend mentioned, we must ensure that an overview is taken of those developments.

I recognise my hon. Friend's concerns about the time that it has taken to set up the supervisory board, but I am pleased that the strategic health authority has established a children's network for Greater Manchester. It has a network supervisory board which has now met twice and which will meet every month from now on to ensure that its prime objective of overseeing the development of primary, secondary and tertiary services for children is met. It includes representation from health, social care, education and the voluntary sector. It will link service delivery into a co-ordinated patient-centred approach in a way that is not constricted by traditional, professional or organisational boundaries.

The network will work at local level, particularly in involving children, young people and their families in deciding how their services should be modernised. I believe that it should fulfil the commitment made at the time of the merger to ensure that those decisions are made in a co-ordinated way. I can assure my hon. Friend that nothing will be able to happen without the consideration and approval of the network. That will be an important way of ensuring that the system works effectively for children across tertiary, secondary and community services.

The strategic health authority has started to engage local communities, and I welcome my hon. Friend's continued close scrutiny and contribution to that debate—one that I think has been important up to this point. I hope that this will have reassured my hon. Friend and others that we have learned from the history of dissatisfaction about the way in which the process was being undertaken. The establishment of the network and the supervisory board, their very broad membership, and the commitment to ensure that they involve local people will ensure that some of the past difficulties are overcome and that we are able to move forward to provide the sort of services that will be beneficial to my hon. Friend's constituents.

I also recognise my hon. Friend's concerns about particular commitments given in the past. I can tell him that, in his constituency, the North Manchester general hospital will develop a children's service, and I have been assured that the strategic health authority and primary care trust are at an advanced stage of approving the children's service investment plan for North Manchester general. So, what was once a far-off dream for his constituents will become a reality.

I hope that I can also assure my hon. Friend that those of his constituents with broken limbs will be able to make use of those services in North Manchester general hospital. I recognise his concern that we ensure that the specialist services in the specialist hospital are used for those particular functions. That is in no small part due to the focus of attention that he has brought to the issue, and I am sure that his constituents recognise his important contribution to the delivery of significant increased investment in health services across his constituency and the surrounding areas.

May I also reassure my right hon. Friend the Member for Manchester, Withington on the particular circumstances in his part of the city? As I understand it, the development of the children's resource centre at Withington is widely welcomed in the area, and I can assure him that there is a continuing place for secondary services for children at the Wythenshawe hospital. It is important that we recognise that although we need to modernise, we must do so in the context of ensuring that we achieve continuity of services, that commitments made to people can be delivered and that we are doing that in the context of growth, not of cutting.

I know that concerns remain about NHS services for children in Greater Manchester. Let me be clear: any changes planned will be delivered, as I have suggested, in that context of growth, not of cuts. Should that process lead to recommendations for service changes, such recommendations could be made only in the context that I set out earlier—that is, patient-centred services, better use of local hospitals, and full and active participation of service users in the development of those recommendations. Furthermore, those changes could take place only following full and open public consultation, subject to the rigorous public scrutiny system that we have in place.

With those assurances, the extra investment and the renewed focus on the needs of the children of Greater Manchester, I hope that my right hon. and hon. Friends are reassured that we are indeed going forward in terms of children's services in the NHS in Greater Manchester in a way that will serve their constituents and the families of their constituents for many years to come.

Question put and agreed to.

Adjourned accordingly at eighteen minutes to Nine o'clock.