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Westmorland General Hospital

Volume 465: debated on Tuesday 23 October 2007

I am extremely grateful for the opportunity to engage the Minister on the matter of the acute service review at Westmorland general hospital. In spring 2006, the local Morecambe Bay hospitals NHS trust began a process of consultation on proposed changes to acute services provision at the hospital in Kendal. The consultation process formally began in the summer and concluded at the beginning of September last year.

The trust presented the public with four options, all of which constituted closure of or a severe cut to the coronary care unit and other acute services at the hospital. The public outcry against the proposals was enormous: more than 27,000 people signed the petition against the planned closures, a record-breaking 7,000 formal responses to the trust’s consultation were received, and 6,000 people marched through Kendal in abysmal weather last September to protest against the proposals.

The outcome was that on 13 September 2006 the hospitals trust chose option three, which entailed the closure of the heart and stroke unit and other acute services at Westmorland general. It seemed clear to thousands of us that although we had been consulted, we had not been listened to.

The acute service review has been marked not only by a staggeringly dangerous final decision that will, undoubtedly, cost lives, but by a catalogue of maladministration, procedural flaws, management failures and broken promises, which, frankly, have brought the management of the NHS in south Cumbria into disrepute. The Minister will have done her research, no doubt. My great concern, if I can be entirely honest with her, is that the principal source of that research will have been the trusts themselves. I suggest that she take information from such sources with a pinch of salt, given that at the centre of my concern and that of just about every one of my constituents is a range of faulty decisions taken chiefly by the hospitals trust after a faulty process.

As I speak, preparations are being made for a judicial review of the consultation process. In addition, the Healthcare Commission is undertaking an unprecedented independent review of the process that led to the decision to cut acute services at Westmorland general hospital. However, it should not fall to private citizens—NHS patients and their relatives—to have to undertake the risks associated with legal and other actions when we have a democratically elected Government, and, in particular, the Department of Health, which has the power to be their champion, to exact justice and to ensure that fair decisions are made.

The hospitals trust, alongside the now defunct Morecambe Bay primary care trust, presented four options, all of which constituted a reduction in service. At the time, I made a formal request for the inclusion of further options including the status quo and an option to enhance services. My request was refused by the then hospitals trust chief executive, who stated that status quo was not possible and could not therefore be an option.

The trusts used a formula to assess the four options, but, incidentally, had no financial costings. Option 3 came out on top and triggered the movement towards closure of the heart and stroke units and all other acute medical services at the hospital. At a meeting of the joint health service overview and scrutiny committee in October 2006, however, the then acting chief executive of the hospitals trust demonstrated that the status quo option, which the trusts had refused to offer in the consultation, would have scored more highly across all the trusts’ criteria than three of the four options that were presented in the review.

That graphic admission, if it were the only evidence, would be evidence that would render the consultation process flawed and unsafe. We were presented with incomplete options. Indeed, it appears that the selection of options was fixed and based on internal prejudices rather than fact. The evidence suggests that a decision had, in effect, already been taken.

There was no justifiable reason to exclude the status quo as an option in the consultation. Indeed, there was no justifiable reason to exclude an enhancement of acute services at Westmorland general. An enhancement such as the provision of a CT scanner would have been completely in line with the Government’s stated policy of delivering NHS services closer to home. There was no justifiable reason for those options to be excluded. However, there was a strong unjustifiable reason—the decision to downgrade had already been taken. Before a single consultation response had been received, before the options were even presented, the trusts knew what they would conclude.

Only last month, thanks to a medical consultant, whom I will not name at this point, we secured further evidence that the decision to close acute services had been taken before the consultation had even begun. I paraphrase only slightly what the consultant told witnesses at a public meeting at Kendal town hall: “The consultants had argued for 10 years with our administration that acute medical services should be transferred from Westmorland general to Lancaster. The administration had resisted, but we saw our opportunity when the financial crisis occurred. 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.”

Of course, the Minister may think that the consultants must be right, even though there is clear evidence of prejudice and maladministration. After all, they are the experts, are they not? However, the consultant in question was not a cardiologist, and a huge body of local clinicians fully object to the trust’s conclusions. The consultant did, however, confirm the suspicions of many of us, when he clarified that the matter had been a done deal all along.

Let me explain that the trust presented its case for closure chiefly on two grounds. First, the financial imperative: the hospitals trust had a projected deficit of more than £12 million and had to make savings. Although that was the case at the time of the board’s decision in September 2006, it is not the case now. Since that time, the trust has improved its financial standing, in part thanks to the Government’s correct decision to overturn the old accounting rules so that trusts were not forced, in effect, to pay back their deficits twice over. That accounting change alone improved the trust’s financial position by £6.3 million, and it completely destroyed its financial case for the closure of acute medical services at Kendal.

The second part of the trust’s case for closure was ostensibly clinical. In a nutshell, the Royal College of Physicians produced guidance notes in 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 medical services at either Lancaster or Kendal. However, the guidance is just that—guidance. It is not an edict. Indeed, in answer to my written question last year, the then Secretary of State for Health, the right hon. Member for Leicester, West (Ms Hewitt), confirmed that it was only one of a range of considerations to be weighed up when trusts were deciding how best to allocate acute medical resources.

The principal alternative consideration to the guidance is the sheer distances involved in south Cumbria, which includes massive tracts of the Yorkshire dales and the Lake district. The Minister will know all about the golden hour in which patients must get to hospital to be stabilised in the event of a heart attack, for example. As things stand, more than half of my constituency is already an hour or more from hospital, yet the trust seeks to close Kendal and make dangerously ill patients travel a further 30 or 40 minutes to Lancaster or Barrow.

All acute medical crises have better outcomes the sooner they are treated by a full medical team of a doctor and specialist nurses situated in a fully equipped resuscitation room. Kendal has an excellent record of managing the initial stages of heart attacks and other life-threatening acute cardiac emergencies. I invite the Minister to review the statistics, which show clearly that timings at Kendal for patients getting vital treatment after the patient reaches the hospital door are significantly and consistently better than those for either Lancaster or Barrow. Outcomes are also excellent.

To counter the compelling clinical evidence against the preferred option of closure, the trust management presented the board at the crucial meeting on 13 September last year with new evidence secured at the last minute. It stated that no patient in the trust area would be more than 42 minutes away from the coronary care unit at Lancaster. The board accepted the figure, and the decision was taken to close acute medical services.

I can inform the Minister that she might make it from the north of my constituency to Lancaster in 42 minutes, if the Department were to provide her with her own jet pack. However, if she had access to an ambulance only, like the rest of us, the average journey time from, for example, Chapel Stile near Ambleside to Lancaster would be in the region of 75 minutes or more. On top of that, ambulance response times in south Lakeland are often in excess of 30 minutes. Having decided to close acute medical services, partly on the basis of that laughably faulty evidence, the trust sheepishly admitted a week later that it had been wrong and that the evidence presented to the board consisted of draft figures. The severely embarrassed board hurriedly agreed to change the figures, but carried on regardless with the plans to close acute medical services. I am no lawyer, but I know that any verdict based on faulty evidence is unsafe. At that point, the trust should have gone back to the drawing board, but it seems that it had already made up its mind, so why let a few faulty facts get in the way?

Sadly, the Morecambe Bay primary care trust voted to support the hospital trust and to back the closures, but providence prevailed. Owing to NHS reorganisation a fortnight later, the Morecambe Bay PCT was wound up at the end of September 2006. At the beginning of October, the new Cumbria PCT reacted with horror to the position that it had inherited and refused to endorse its predecessor’s decision. Eventually, the PCT organised a group of GPs who used the strength of public opinion to win some concessions, including the retention of 50 GP-managed beds, but the trust continued to press on with the proposed closure of 70 per cent. of acute medical services at Westmorland general and, particularly, the loss of the coronary care and stroke units.

The Cumbria PCT caved in on the other 70 per cent., having been promised by the hospital trust that the closures would not begin until April 2008, and on the understanding that no movement towards enacting the acute service review would take place until Lancaster and Barrow hospitals had been upgraded to take on the additional capacity and until the ambulance service had been significantly enhanced.

The upgrade to the ambulance service to cope with the significant increase in journey distances would constitute a guarantee of at least one and normally two paramedics per ambulance, a 12-lead electrocardiogram on each vehicle, full telemetry and telephone contact on each vehicle—incidentally, something that just will not work in south Cumbria because of the terrain—and one additional ambulance serving the south lakeland area. At the moment, there has been no enhancement at Lancaster or Barrow hospitals and no upgrade of the ambulance service. Indeed, senior ambulance service managers stated candidly and publicly that they cannot, for example, guarantee even one paramedic on every ambulance.

The hospital trust’s promise to wait not only until April 2008, but until all those measures are in place before moving towards closure was broken earlier this month. A report was leaked to me on 2 October showing that the hospital trust was beginning implementation of the acute service review that very week, with the closure of ward 11. I protested against that, and the PCT, to its credit, refused to support the document. Ward 11 was then re-opened, but not fully. It took a further week of pressure to ensure that the trust did more than just re-open it in name and re-opened it fully in practice. That latest demonstration of bad faith rightly led to a humiliating climbdown by the trust.

While all that was going on, nurses, doctors and other staff continued to provide outstanding service. Despite being undermined and working under a cloud of job insecurity in the knowledge that trust bosses have dealt with them and their patients unjustly, local NHS workers have not let us down. They deserve our praise and enduring gratitude, and I want to take the opportunity to register my thanks to them in this place. However, hospital staff deserve more than gratitude, and I am asking the Minister to give Westmorland general hospital staff and the whole south lakeland community what they deserve. I am simply asking the Minister to undertake a full review of the facts, with a view to instructing the local NHS trusts to go back to the drawing board, and to instruct the Cumbria PCT to lead new consultation in which all options are fully considered and due process is observed.

A decision to close life-saving services that was clearly prejudged and chosen from a deliberately inadequate list of options, based on laughably inaccurate information about ambulance journey times, that failed to gain the confidence of the PCT and that has been pushed by a trust that has lost the confidence of the community that it serves stands to bring the NHS into disrepute. Only last month, 4,000 of us formed a human shield around the hospital to demonstrate our support for medical emergency services there and our opposition to the closure of those services. Eighteen months from the start of the consultation process, the acute wards at Westmorland are still open. We, the community, take some credit for that. We will not accept a decision that is both wrong and wrongly arrived at, and which is unsafe in both the legal and medical senses of the word.

I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing this debate. I am aware of his keen interest in the future of health services at Morecambe Bay, particularly in the future of Westmorland general hospital. I also pay tribute to all the NHS staff in Cumbria and Lancashire who have made such an enormous contribution to improve the local NHS.

As is the case throughout England, Cumbria PCT has received major increases in resources to improve the health service for its local population. During the two years 2006-07 and 2007-08, Cumbria PCT will receive an increased allocation of £108.4 million. In the hon. Gentleman’s area of the North West strategic health authority, the extra funding received since 1997 has provided 1,153 more consultants, 544 more GPs and more than 11,000 more nurses. All those professionals make a huge contribution to health care in the hon. Gentleman’s constituency.

Waiting times have greatly reduced as a result. In the north-west, the number of people waiting more than 26 weeks for in-patient treatment has fallen to 10, and only 16 are waiting more than 13 weeks for an out-patient appointment, compared with more than 61,000 in 1998. All staff should be congratulated on that major achievement, which is real progress. However, we recognise that, alongside record investment, reform is needed to deliver a national health service that provides health care fit for the 21st century.

As part of those reforms, many NHS organisations are considering with their local stakeholders changes to the way in which they organise their services. I am sure that the hon. Gentleman will agree that hospital and community services must adapt if we are to continue to meet patients’ needs and to improve access. I am also sure that he will agree that it is right that those changes should be driven locally and in conjunction with patients, clinicians and other stakeholders.

In 2006, the university hospital of Morecambe Bay trust and the then Morecambe Bay primary care trust identified strong clinical and financial reasons why the pattern of acute medical services needed to be reviewed and undertook a review and consultation. The review’s aim was to improve the management of patient flows—the patient journey—operational management and bed usage. On the clinical front, the overriding consideration is, and always has been, patient safety. Consultant physicians at Westmorland general hospital had raised concerns about the admission of acute medical patients to the hospital and their management on several occasions. In addition, the Royal College of Physicians issued guidance on the minimum resources, both human and capital, required.

The review’s report was considered by the overview and scrutiny committee of elected local councillors, who recognised the need to move forward, but raised concerns and recommended some modifications. To accommodate those concerns, the Morecambe Bay NHS Trust and the newly formed Cumbria PCT initiated a planning process that focused on clinicians and clinical issues from primary and secondary care perspectives. The aim was to establish a new consensus across the clinical spectrum and to reflect the perspectives that had been articulated during both the consultation and the subsequent engagement with public and patient groups, which was not easy.

As a result of that work, a new clinical model for acute medical services emerged, which was more responsive to the needs of local residents and significantly supported a more integrated general approach by the PCT to the health systems throughout the county. Proposals relating to the Westmorland general hospital were consulted on between June and September 2006, and the preferred option has since been subject to further work. Westmorland hospital has since fallen under the remit of Cumbria PCT. The proposals relating to the hospital will now be taken forward as part of the Cumbria-wide whole system review. The consultation on the review commenced on 27 September and will run for three months. It does not cover the services provided at Westmorland general hospital, and the proposals that were previously considered will not be revisited. Proposals for the reconfiguration of services are a matter for the NHS locally, working in conjunction with clinicians, patients and other stakeholders, and they are built on a sound clinical case for change.

Until such time as the Cumbria-wide review is completed, it would be inappropriate for me to comment further on the details of the consultation, as I am sure that the hon. Gentleman realises. However, under the current proposals, I understand that Westmorland general hospital will become a diagnostic, treatment, care and rehabilitation centre, designed to offer quality services to meet the needs of the local community. The proposed redesign and development of the unscheduled care facilities at the hospital will therefore be in line with the developing Cumbria-wide strategic plan for delivering urgent care services.

The shared clinical vision for the future is that acute medical care will build on the expertise of clinicians from primary and secondary care. The development of the vision for Westmorland general hospital sets the future of services in the broader context of care and rehabilitation for patients at home, in the community and in hospital—an important aspect of aftercare rehabilitation. That vision is very much in line with the White Paper “Our health, our care, our say”, which signalled a shift towards a greater concentration of specialist services for those who need them, while more care would be provided closer to people’s homes to deal with cases where treatments no longer required a hospital visit. All aspects of health care change regularly, as they should, and that important point is very significant to today’s chronic management of care.

In future, some patients may no longer be admitted directly to Westmorland general hospital. Such patients are those whose diagnosis is such that they would be deemed to be at risk if they were not admitted straight to a more specialist acute hospital, so it is absolutely right that they should be transferred to neighbouring sites. For example, someone who has a stroke needs to be in hospital, given a brain scan and seen by a specialist within three hours to determine whether they can be given the clot-busting drug that can make the difference between permanent disability and walking out of hospital again. Not everyone can have thrombylosis, but we need to act quickly to find those who can. The required scanning facilities are not available at Westmorland general hospital, but once the patient is medically stable, it would be possible to return them there for the remainder of their care and, most importantly, their rehabilitation. That is progress, and we should acknowledge and cheer it.

I am pleased to say that the delivery of a new emergency floor at the Royal Lancaster infirmary, comprising an acute assessment unit, an in-patient, short-stay medical/surgical ward and a coronary care unit, is well advanced, and it is planned to open those facilities in December. Providing care and rehabilitation at Westmorland general hospital for patients who currently receive their acute specialist care in Lancaster, or who will receive it there in the future, will have a positive impact on patients’ lengths of stay in the Royal Lancaster infirmary.

My fears have been realised, in that the trusts with a case to defend are the source of the Minister’s information. In no way do I demur from her earlier comment about the importance of the health service specialising and modernising, but does she agree that we need to take a balanced view of what is most relevant in every case? To put it bluntly, there is no point in having all bells and whistles at Lancaster if someone is dead on arrival. If someone has an hour-and-a-half journey from the point where they have their emergency to the point where they arrive at hospital, that will, to say the least, be counter-productive. Given that the planned closure of the heart unit will take place in April 2008, unless someone intervenes to prevent it, will the Minister at least agree to force the PCT to review the consultation, so that any decision that is made—whether to close or otherwise—can be deemed medically and legally safe?

The hon. Gentleman’s point would be valid if the facts that he gave earlier about the ambulance service were correct, but the upgrades have taken place. I will happily meet him to share the information that I have received about the upgrades to ambulances and the ambulance service itself.

Yes. It is important to put that on record.

The PCT and North West Ambulance Service NHS Trust are working together to produce better services for the south lakeland population. There will be investment in a range of service provision, including manpower, vehicles and equipment. It is accepted that additional training and a lead-in time will be needed to ensure that staff are trained. I hope that that meets the hon. Gentleman’s concerns.

When we talk about reorganisation and improvement, we are talking about providing better, safer services. The desire is to achieve better outcomes for patients, including increases in safety and quality of care, and that is ultimately what is driving the change. If change is clinically led through consultation, with all the experts working together, difficult as that may be, the desired outcome is better patient care. We have to go along with such discussions, and we have a duty to see them put into practice to ensure patient safety and patient care.

I am reassured to know that no services will change until clinicians are satisfied that it is safe to proceed and that no services at Westmorland general hospital will close until local NHS organisations are satisfied that ambulance service provision is the same as the current service or better. It has also been agreed that the overview and scrutiny committee will be kept informed by means of regular six-monthly reports and prior notification of specific service changes that will take place.

The trust believes that it has a robust and sustainable plan for the future of Westmorland general hospital and the community that it serves. It continues to work to deliver improved services to communities in Cumbria. It is the duty of all of us to ensure that we do not raise patients’ and families’ anxieties to a level that is not justified, when people are working to such safe clinical ends.

To sum up, reconfiguration is about modernising treatment and improving facilities to improve patient outcomes, to develop accessible services closer to home and, most importantly, to save lives. I remind the hon. Gentleman that proposals for the reconfiguration of services are a matter for the NHS locally, working at all times in conjunction with clinicians, patients and other stakeholders, and that such proposals are built on a sound clinical case for change. I therefore encourage him to continue to engage with his local NHS on the way forward for services in Westmorland. I feel confident that Nye Bevan today would say to us what he said almost 60 years ago:

“the service must always be changing, growing and improving—it must always appear inadequate.”

We must always do more to achieve that goal, and we will do so.

Question put and agreed to.

Adjourned accordingly at two minutes to Two o’clock.