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Health Service (West Dorset)

Volume 461: debated on Tuesday 19 June 2007

I note that the Chamber is not amazingly full. Nevertheless I am grateful to the Minister for turning up for a debate on a very specific set of issues. I could, of course, have sought a debate on the widest possible group of questions affecting the health service in West Dorset. Like any hon. Member, I get many letters from constituents and many people visiting my surgery about problems such as not being able to get an operation, having operations delayed, or difficulties over treatment that has been received. I also inevitably receive a good many complaints and queries from members of the general public and health service professionals who are worried about one thing or another. For example, GPs in West Dorset are at the moment concerned about the extent to which they feel unable to co-operate with the structures of authority, finding themselves instead too much imposed on by them.

However, I want to raise none of those concerns today. My topic is specific and narrow, but very important. The Dorset county hospital is in Dorchester in my constituency. Unlike many of the smaller outposts of the national health service in my constituency, it may be known to the Minister. He will have a pretty good idea of what it is like. It is a new set of buildings—a county hospital like many others. It has a high reputation, certainly locally. It manages to attract very highly qualified and competent professionals to work in it. Although there are complaints from time to time, it would be fair to say that if one were to conduct a survey among my constituents, which I admit I have not done, a high degree of confidence in Dorset county hospital would be found.

As the hospital is in Dorchester it is also convenient for many of my constituents. I am sure that the Minister has some idea of the characteristics of places such as West Dorset. It is a highly rural area, where people live at considerable distances from facilities, and where many people—particularly those most likely to need treatment of various kinds, because of their age, for example—do not find it easy to travel far outside the district. The result is that the availability of treatment at Dorchester is an immensely prized asset locally. There is, of course, a hospital just over the border, in Yeovil, Somerset. For many of my constituents that is not a suitable alternative. They are far nearer to Dorchester than they are to Yeovil, and for many of them it is a considerable distance away.

The prospect, therefore, that Dorset county hospital might at any time in the future not be available to my constituents on much the same basis as it is at present would cause considerable discomfort. I am glad to say that, in general, over the past 20 or 30 years, things have been on an upward trajectory for Dorset county hospital. It is no part of my case that it is coming apart. On the contrary, the hospital has been doing well—flourishing—and serving the community. Our concern is to ensure that it continues to do that.

From talking to those who are responsible for managing Dorset county hospital, it is clear that one of their greatest concerns is to ensure that they can continue to attract professional staff and clinicians of the same quality as those they currently attract. West Dorset has many advantages in that respect. It is, as I imagine the Minister may understand, a very pleasant place to live. The quality of life is high, the schools are good, and crime and unemployment are low.

As a matter of fact, those things have been true for many years, under many Administrations. No Administration have yet managed to make West Dorset an unpleasant place to live, and I hope that no Administration ever will. However, it also has a huge natural advantage, which is recognised globally, in that it is on the edge of the world heritage coastline. I share with my near neighbour and the Minister’s colleague, the Minister for Schools, the hon. Member for South Dorset (Jim Knight), and with my other neighbour, my hon. Friend the Member for East Devon (Mr. Swire), what must be one of the most beautiful coastlines in Britain.

To set the scene, there is a flourishing hospital in a beautiful place with a high quality of life. Unsurprisingly, it attracts high-quality clinicians who are willing to forsake the bright lights of the medical metropolises for what is undeniably, from many points of view, a higher quality of life. However, those clinicians are also professionals with a vocation. From talking to the clinicians at DCH, one receives the strong impression, as I am sure one would—and as indeed I have—in talking to similar clinicians around the country, that despite all the real pulls of the area and a nice life, the overriding pull for them is the job, professional satisfaction and the feeling that they do good things in a good place, surrounded and supported by other people of equivalent calibre. That in the end is what gives Dorset county hospital, as one goes around it, the feel of a place with high morale. That is what keeps the clinicians coming.

It is pretty easy to imagine how, if a certain pattern of events were to set in, that very favourable circle—in which people want to come to Dorset county hospital because it is a good one with other good people and a high quality of life—could begin to give way to a less favourable circle, in which people might not feel that they could get the professional satisfaction that they required. If those people could not do in Dorset county hospital what their vocation led them to want to do, they would go elsewhere. If that were to start to happen, the future of Dorset county hospital could easily be put at risk. Just as magistrates courts and post offices have been disappearing from many parts of West Dorset, and just as many other local facilities can easily disappear as soon as someone starts to ask whether it would be more rational, effective, efficient or cost-effective to do things on a grander scale in fewer locations—typically centred in conurbations such as Bournemouth and Poole—it is perfectly possible to imagine that if we entered into the wrong, vicious, circle, Dorset county hospital’s future could eventually be under threat.

I am not trying to be alarmist or saying that someone has a plan to close Dorset county hospital tomorrow. Manifestly, no one does. However, it is important to exercise vigilance at the beginning of such processes, and not to wait until there is a real problem. It is in that context that I raise the issue of prostate cancer surgery, which, unless the Minister and the Secretary of State take action in the next very few days, is scheduled to be moved from Dorset county hospital to the conurbation, just as I mentioned.

In itself, the move of prostate cancer surgery to another centre will not trigger a disaster. I fully accept that. However, it has become clear from discussions with clinicians and managers—we have had discussions and public meetings about this matter in West Dorset—that the renal unit in Dorset county hospital, which is highly regarded among professionals, will be increasingly difficult to sustain if it cannot offer prostate cancer surgery. That is a problem because if the unit comes under any threat, an important element of the hospital’s expertise and specialisation will also be under threat. One can easily see how that might begin a sequence of events leading to a result that none of us wants: the hospital’s future being in question. I am extremely anxious to stop that process from beginning and so are many people in Dorset, not only in the rural parts, but in the conurbations too.

When the move was first suggested, various people in the cancer network who are responsible for cancer services got together and proposed a two-site solution, which was rejected by the Department of Health. They were sent back to do their homework again, and we now face the immediate prospect of services at the hospital being closed and removed to the conurbation. The basis on which that judgment is being made is an interesting reflection on the lack of serious outcome data in our health service. I know that the Minister is aware of that problem, and my party is greatly concerned by it, as the recent report from our policy review highlighted.

As far as I am aware, from the information that people have been able to provide to me, there is no solidly based, long-term analysis of prostate cancer surgery outcomes in Dorset county hospital, the conurbation or other comparable centres nearby. In the absence of a long time series, we have just two things, one of which is the short time series of outcome data that suggest that the hospital is doing rather well. In all the discussions so far, it has been pointed out that there is no suggestion that prostate surgery at Dorset county hospital has been inferior to that in the conurbation or in other places in Britain in the past few years. On the contrary, it seems to rank quite high in the short time series.

The second piece of information that we have is not a set of statistical outcomes, but the theory that unless surgeons do that kind of treatment a lot, they will not do it as well as they could. That theory is backed by a significant array of reputable evidence from the rest of the world. I do not have the technical competence to judge the research, but I have read it and that seems to be the general pattern. Of course, there is no way of telling whether the general pattern would apply in this particular case. If someone does something well, they might do it better if they did it more, but they might not. If large centres that perform a particular task a lot generally do it well, it does not follow that that will be true in every case. It is probably true that very large garages are better at mending some cars than smaller garages, but some small garages might be better at mending one’s car than other large garages.

The move is being made not because there is compelling evidence about the particular instance, but because there is a theory, the application of which to the particular instance is entirely unproven. That is the basis on which the Department of Health is overriding the settled view of all the people involved in cancer surgery in Dorset. I hope that the Minister will now, at the very 11th hour, pause, reconsider and ask that the move is not made. There is no solid evidential base for it, and there is the beginning of something that in time might threaten the renal unit and thereafter the fate of the whole hospital. All of us in West Dorset want to prevent that, and it is within the Minister’s gift at least to cause a pause in which to reflect on this issue. I hope that he will do just that.

I congratulate the right hon. Member for West Dorset (Mr. Letwin) on securing the debate and on presenting his case in a balanced, responsible and reasonable way. From the way that he talks about his constituency, it sounds like a cross between utopia and paradise, largely, no doubt, as a consequence of the economic and social policies that this Government have pursued.

The right hon. Gentleman has every reason to be proud of the NHS in his area. Coming new to the debate, I am struck by the thought that most health services in the country would be incredibly proud of performing as well as the health service in West Dorset. The trust recently achieved foundation status and became the Dorset County Hospital NHS Foundation Trust in June. There has been major investment in its services, so any suggestion that the hospital is at risk is nonsense. I think that the right hon. Gentleman knows that and, to his credit, was not attempting to imply it.

There has been a remarkable level of investment, with investments of £8.1 million in renal services, £3.9 million in a new critical care unit and £1.4 million in county-wide spinal surgical services. There have also been investments of £1.694 million in specialist cardiology services and a supporting catheter laboratory, £300,000 in a new stroke unit and £10 million in reducing waiting times. A new dedicated laparoscopic theatre has been installed at the hospital, and the trust has recently introduced the electronic ordering and reporting of pathology and diagnostic imaging, which will cut down on duplicated tests and allow clinicians to make earlier diagnoses.

The trust’s performance is extraordinarily impressive. The number of people who wait more than 26 weeks for in-patient treatment has fallen from 2,428 to zero, and no patient waits more than 13 weeks for their first out-patient appointment. The next statistic is relevant to this debate—99.4 per cent. of cancer patients are seen within 62 days. In March 2007, 98.1 per cent. of patients in accident and emergency were seen within four hours, compared with 93.6 per cent in June 2003. There has also been a 100 per cent. achievement of the rapid access chest pain target. That is a very impressive track record.

The right hon. Gentleman rightly refers to the contributions of clinicians in making all that possible and to their commitment to their vocation. I am sure that he will agree that the whole range of professionals working on the front line of the NHS make a difference, including nurses, doctors, support staff and, dare I say it, managers. Good management and leadership are absolutely essential to successful performance in any public service, but especially the health service.

I turn to the right hon. Gentleman’s specific questions about cancer care. One achievement of the Government’s NHS strategy and policy is the national cancer plan. Very few people would dispute that there have been significant advances, given the additional resources that have gone in and, more importantly, the outcome. To give some statistics, cancer mortality in people aged under 75 fell by nearly 16 per cent. between 1996 and 2004, and 50,000 lives were saved in that period. We are on course to meet our target of reducing cancer deaths by at least 20 per cent. by 2010. In 2005, a National Audit Office report acknowledged significant improvements in the management and provision of cancer services.

The right hon. Gentleman referred specifically to national guidance affecting decisions being made within his local health community. The specific guidance sets out detailed recommendations on how services for urological cancers should be organised, and contains five key recommendations, which are based on the views of top professionals in the field.

The right hon. Gentleman conceded, as I do, that we are not practitioners or experts in this area, so we are, to some extent, dependent on the advice of the brightest and best in this specialty. They recommend the following: that all patients with urological cancers should be managed by multidisciplinary urological cancer teams; that members of urological cancer teams should have specialised skills appropriate for their roles at each level of the service; that radical surgery for prostate and bladder cancer should be provided by teams typically serving populations of 1 million or more, and carrying out a cumulative total of at least 50 such operations per annum, and that while the teams are being established, surgeons carrying out smaller numbers of either operation should make arrangements within their network to pass this work on to more specialised colleagues; that major improvements are required in information and support services for patients and carers, and nurse specialist members of urological cancer teams will have key roles in these services; and that high-quality research studies about the optimum form of treatment for patients with urological cancers should be supported, with encouragement of greater rates of participation in clinical trials.

That is the overall framework, and those are the principles that should underpin every local health economy when looking at the treatment offered to patients in this area. I understand that before any decision was made, significant debate and consultation took place about the implications of the guidance and the configuration of services in the right hon. Gentleman’s constituency and neighbouring areas. It is important that I state that the question is about where patients are to have their operations; it is not about where patients are to receive their ongoing medical support and attention.

On 24 May, the relevant cancer network made its final decision to centralise radical surgery at a single centre at the Royal Bournemouth and Christchurch Hospitals Trust with effect from 1 August—a matter of days, as the right hon. Gentleman said. That means that this specific surgical procedure will no longer be carried out by the Dorset County Hospital NHS Foundation Trust.

The right hon. Gentleman might wish to correct me on this—I would be happy to hear from him—but the estimate that I have been given is that about 35 patients a year will be affected by this decision. I am trying to contextualise our discussion. I want to make it clear that in terms of the provision of renal services or cancer services, the rest of the services at Dorset county hospital will not, in any circumstances, be affected by this decision.

Let us consider what tends to happen in sensitive reconfiguration decisions. The views of clinicians and the definition of best interest that the primary care trust comes up with sometimes do not coincide with strong community feeling. Groups of clinicians based in a particular health setting sometimes do not like the idea of change, sometimes for good reason, sometimes because change can be quite difficult. I understand that much discussion and consultation has taken place locally and that the process allows for the local authority’s overview and scrutiny committee to refer the matter to the Secretary of State for consideration if it believes that the decision is wrong or the consultation is flawed. The Secretary of State would then have the option to refer the issue to the independent review configuration panel.

I understand that the overview and scrutiny committee, which must have been under significant pressure to reach a different conclusion, has examined this matter objectively. It has heard from the cancer network and, doubtless, from clinicians and the right hon. Gentleman, and has formed a judgment that this decision probably is in the best interest of patients in terms of their having access to highly specialist care. Because the role of the committee in the process is clear, it would be entirely inappropriate for Ministers in the Department of Health to second-guess the views of those who are democratically elected locally and have the option to say that this decision is not right in terms of patient care in their locality.

I should stress the services that will be untouched and will continue to be provided at this excellent hospital, because I believe that this answers the question about job satisfaction and the future recruitment and retention of top cancer specialists and consultants in the right hon. Gentleman’s community. I am talking about services in the following areas: urology; haematology; skin; upper gastro-intestinal; palliative care; head and neck; gynaecology; chemotherapy; breast; colorectal; and lungs. All that care will continue to be provided to a very high standard at Dorset county hospital.

The hospital’s future is bright, as is the future for cancer care in this particular trust in the right hon. Gentleman’s constituency. I have reviewed all the evidence, considered the consultation and examined the determination made by the overview and scrutiny committee, and believe that, on balance, the decision to relocate the highly specialist surgery is in the best interests of patients in his constituency.

It is right that right hon. and hon. Members come to this place to advocate and champion the views and interests of their constituents. There will be strong feeling on this issue in the right hon. Gentleman’s constituency, because there are few more emotive issues than accessible services or the impact that cancer has on individuals and families. I hope that his constituents will accept, having studied the evidence, examined why the decision has been made and reviewed this debate, that, on balance, change is sometimes not only necessary but desirable for patient care and that it will do nothing to undermine the excellence of the clinical practice that is so evident in this particular trust.

Once again, I congratulate the right hon. Gentleman on bringing this issue to the attention of the House. I am sorry that I am unable to give him the answer that he desires, but I believe that the decision is probably right and, more importantly, that the people best placed locally to make that determination—those in the local health service and the democratically elected members of the local authority—have concluded that this is the best way forward.

Question put and agreed to.

Adjourned accordingly at one minute to Two o’clock.