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Health Services (Telford)

Volume 485: debated on Wednesday 3 December 2008

Motion made, and Question proposed, That this House do now adjourn.—(Barbara Keeley.)

I am pleased to have secured this Adjournment debate Session on health services in Telford on the first day of the Shift. If hon. Members listen to the tone of my voice, they will know that I could do with some health services, but I have loitered here for seven hours to make this speech, not knowing when the previous debate would conclude, because this issue is incredibly important to local people. Health services in my constituency are important, and the issue is exercising the minds of local health professionals and those who represent our community locally.

I want to cover two points this evening. First, I want briefly to discuss improving primary care services. Secondly, I want to discuss in some detail the impact on my constituents of the new health and health care strategy for Shropshire, Telford and Wrekin, which is being developed by the clinical leaders forum in the area and which is being discussed by the NHS trusts and local stakeholders at the moment.

We have an excellent range of primary health care providers in our town. Telford and Wrekin PCT will spend some £230 million of public money in 2008-09 on the NHS serving local people. Primary care services are important, and PCTs act as local leaders in determining what services communities need and how those services are commissioned. Our PCT has a good reputation locally for working in partnership with other agencies and delivering more through partnership than it could achieve alone.

For many people, the GP is their first point of contact with the NHS, and we have seen significant investment in GP services in Telford in recent years. New practices have been built in Oakengates, Dawley and Lawley, and more than £3 million is being invested in 2008 to improve the 20 existing GP practices—there has been significant investment at Stirchley and Sutton Hill, for example. That money is rightly being targeted at some of the most deprived communities in my constituency.

In passing, I pay tribute to those who work in the Shropdoc out-of-hours service. I am pleased that the PCT is looking to provide more services for local people with a new GP practice and health centre in Telford town centre, extended hours GP drop-in and pre-booked appointments, sexual clinics and screening, an onsite pharmacy, counselling services and a minor injuries and minor surgery unit. That is a positive step forward in primary care, but it needs to be developed in partnership with other GP practices. Facilities such as the Dawley practice should be expanded to meet local needs alongside that town centre development.

We have seen the provision of more NHS dental services in the town in recent years. I particularly mention the facility at Stafford Park and the service at the Park Lane centre in Woodside, which is part of a major estate regeneration process. That shows us putting together the jigsaw pieces of estate-based regeneration.

Secondly, I want to discuss the development of the overarching health and health care strategy for Shropshire, Telford and Wrekin, which provides a framework for improving health and providing health services over the next five years until 2012-13 and sets out the vision for 2020 and beyond. That approach is part of the work by Lord Darzi to shape the vision of the NHS. The latest proposals have been developed by the clinical leaders forum, which was commissioned to look at the development of services in the county. Its strategic focus is on developing world-class services for maternity, new-born care and children’s health, planned care, mental health, getting healthy and staying healthy, long-term conditions, acute care and end-of-life care. That body of health professionals is bound by two guiding principles in the development of the strategy—in fact, those principles have been established as part of the strategic process. The first is that any proposals that the body comes forward with for our area must make sense clinically, and the second is that they must make sense to the communities served. I shall return to those two points in a few moments.

The clinical leaders forum has now produced a next-stage report that is being discussed by the primary care trusts and the local health scrutiny boards. The strategy does not focus only on hospital services, of course; a key focus in the report is the need to prevent disease and promote healthy lifestyles, and I welcome that. The report also looks at how we could provide services at home, or as close to home as possible. Again, that is welcome; the creation of hospital-at-home services makes sense, and I am pleased to note that the ambulance service, for example, is working hard right now to treat patients at first point of contact, therefore avoiding the need to admit so many people to A and E. However, we need to recognise that the A and E service in our county is often stretched to capacity and that many people still have to wait a long time to be seen.

I also welcome the proposal in the strategy that minor surgery, out-patient appointments and many types of scans will take place increasingly in community settings rather than in acute hospitals. Having said all that, I recognise that the most controversial element of the report relates to a series of options for acute hospital services. In simple terms, the health bosses want to do two things. First, they want to keep children’s assessment units at both the Princess Royal hospital in Telford and Wrekin and the Royal Shrewsbury hospital, but they want to put the in-patient children’s service on one site. That, they say, is the safest option. They also want to develop a service to care for children in their own homes. As I have said, that would reduce admissions generally.

Secondly, the bosses want to retain the A and E service on both sites, but with one dealing with the most seriously injured and ill—those involved in multiple-trauma road traffic accidents, for example. Level 1 A and E would be provided at regional centres, as it is now, and the two acute hospitals would have level 2 and level 3 A and E services respectively. At present, no decision has been made about which site should have which services. The clinical leaders forum has produced a long list of four clinical options for sustainable acute services. More work is to be done on those prior to public consultation on the recommended options in spring next year. The Minister will say that she cannot comment on the configuration until further work has been done, and in many senses I accept that. However, she will understand that I am using this debate to lay down a marker on my thoughts. I hope that the clinical leaders forum will think hard about what I have to say.

The four options are for the medium term, and in my view we will ultimately have to examine the shape of services beyond 2020. I take the view that in the longer term we will have to look at the idea of developing a new emergency hospital situated between Telford and Shrewsbury and serving both. The Princess Royal and Royal Shrewsbury hospitals would be retained to deliver other services. I know that my proposal is controversial, but it would put to bed for ever the argument that rages in the county between the two towns.

I have already said that it is important that we move to develop more community-based services, but we all know that there will be occasions when people need to use major hospital services. The history of hospital services in Shropshire includes a long struggle to get the status of Telford new town recognised as it grew from the 1960s onwards. The Royal Shrewsbury hospital continues to be the larger of the two acute hospitals in the county, despite the increase in Telford’s population and its projected growth for the next couple of decades. The Princess Royal hospital was built in Telford after a long campaign and, ever since then, it seems that there has been a constant process of reviewing service delivery structures. To put it bluntly, I am pretty sick and tired of continual reviews of our local hospital services—a view that I am sure Telford residents endorse and that local health service workers share. We seem to have the same discourse and discussions year after year, and it must be costing a fortune.

I know from family experience how important Princess Royal hospital is to Telford people and to those from the east of the county. When I was a teenager, my grandfather spent nearly a year in hospital. He was a Shifnal man who spent most of his life as a chain maker. Princess Royal hospital had not been built in those days, and my mother travelled from Telford to Shifnal to pick up my grandmother every night so that they could go together to see my grandfather at the old Copthorne site at Shrewsbury. I used to go with them occasionally to visit him. If one factors in the return leg, that was a round trip of about 45 miles, night after night for a year. If there had been a hospital in Telford then, we would have benefited enormously as a family. We have come a long way since those days. The health service review does not threaten to take away the excellent hospital, Princess Royal, which serves my constituents, but I am going to fight to get the best deal that I can for local people, because I know how important that hospital is.

For me, the argument is fairly simple. It relates to the second guiding principle that I laid out earlier: proposals for the local health service must make sense to the communities they serve. Telford is the largest population centre in the county, with approximately 133,000 residents; Shrewsbury has approximately 67,000 residents. Moreover, Telford is a growing town, and it is about time that the consultants and health managers recognised that fact. By 2026, at least 26,500 new homes will have been built in the borough of Telford and Wrekin, and that figure could expand to over 30,000 in the current review. Telford could easily grow to become a town of 200,000 people in the next two decades, and we need hospital services to reflect that fact.

In Telford and Wrekin, 21.4 per cent. of the population live in areas classified within the most deprived areas of England, compared with 3 per cent. for the rest of Shropshire. In Telford and Wrekin, 24.5 per cent. of children aged nought to 15 live in deprivation, which is higher than the national average; in Shropshire, the figure is 13.2 per cent. Life expectancy is lower in Telford and Wrekin, and our public health indicators are worse than in the rest of the wider Shropshire area. Car ownership levels are also lower in Telford and Wrekin.

That brings me to the effective catchment population figures for the two main acute hospitals. That information is on page 39 of the clinical leaders forum report, and it has been produced using drive-time data adjusted to reflect market share. Even if we include patients from Montgomeryshire, there are 224,838 people in the Princess Royal hospital catchment and 191,267 in the Royal Shrewsbury hospital catchment. Those of us from Telford want the county’s main accident and emergency department to be located at Princess Royal, along with in-patient children’s services.

On all the social indicators, anyone can see the logic of structuring services around the Telford site. To put it bluntly, services should not be based on how the county looked 50 years ago or even 10 years ago—they should be based on how it looks now and how it is going to look. If that means moving services to focus on Telford, then so be it. This process is basically about what services are available for those of us who live in Telford and those of us in the east of the county. The issue is too important for us to get bogged down in political squabbling, because we all need to work together to get the best deal for Princess Royal hospital.

Princess Royal hospital is not doomed, and we need to campaign in a positive manner—the people of Telford deserve nothing less. That is why, in the new year, I will launch an “I’m backing Telford hospital” petition campaign to show local health chiefs the importance of our local services. That will give my constituents the chance to show their support for the Princess Royal hospital and the staff who work there. As I said, Telford people deserve nothing less.

I congratulate my hon. Friend the Member for Telford (David Wright) on securing the debate and on championing an important issue for Telford and the surrounding area. Yet again this evening, he has eloquently and clearly put his case on behalf of his constituents. I am especially pleased to join him in acknowledging the progress that has been made in the past decade to raise the national health service from the ashes of under-investment and neglect. I join him in paying tribute to the hard work and dedication of health service staff throughout Shropshire, which has experienced some fantastic advances in local health care.

Shrewsbury and Telford is ahead of the national target for 98 per cent. of patients to be seen within four hours in A and E. The trust is on course to deliver by the end of December the 18-week target for GP referrals for treatment. This year, the Healthcare Commission ranked the maternity services at Shrewsbury and Telford as best performing. It is right to applaud those achievements, but, as my hon. Friend acknowledges, we must also look forward, especially to the way in which we will build on the progress in the face of new challenges.

As someone whose family lives in Shropshire, I have a direct interest in the matter and also in the confidentiality of the information that is available to my Member of Parliament, my hon. Friend the Member for Ludlow (Mr. Dunne), in the event that something occurs that requires my having to supply him with confidential information. I have seen the proposal for the Government’s motion regarding the Speaker’s Committee on the search of the parliamentary estate—

Order. The hon. Gentleman should not try to intervene in an Adjournment debate in the way in which he is choosing to do. The Adjournment debate is the personal possession of the hon. Member who is given the opportunity to raise the matter. The hon. Member for Stone (Mr. Cash) was not here to listen to the speech of the hon. Member for Telford (David Wright) and I therefore suggest that he is out of order in seeking to intervene.

On a point of order, Mr. Deputy Speaker. I was the only person in the House when the Minister got up to speak.

The hon. Gentleman should not quibble. He is taking valuable time out of an important Adjournment debate for the hon. Member for Telford.

Thank you, Mr. Deputy Speaker. As my hon. Friend knows, an ageing population, heightened public expectations, new technologies and treatment and the changing profile of the disease burden place new demands on health services throughout the country. As he said, health services in Telford face particular pressures as the local population changes and expands.

We expect the numbers living in Telford and Wrekin to rise by 17 per cent. by 2022, requiring more than 26,000 homes to be built and a decisive shift in local services to accommodate an ageing population. That is the debate currently happening in Telford. The county-wide strategy, developing health and health care, shows how the local NHS must evolve over the next five years to meet the new challenges.

As my hon. Friend acknowledged, the recommendations take in the views of health care professionals, local authorities, community and voluntary organisations and patients, reflecting the broadest range of expertise and opinion. As he said, it contains plans to provide an increasing range of services in community settings, ensuring that people receive treatment, whenever possible and appropriate, close to their homes.

The key themes in the strategy document, as in others being developed throughout the country, are sustainability, choice and quality. We are talking about taking a hard look at local services and exploring how we can future-proof them against changing local needs without compromising patient care, as my hon. Friend articulated so clearly.

My hon. Friend raised concerns about the future of two hospitals serving Telford and Shrewsbury. The report says that the vast majority of health care services at the Royal Shrewsbury hospital and Princess Royal hospital can and should remain there in the medium term. However, the report also expresses concerns that the current model is unsustainable. There is a particular issue concerning the availability of specialist clinicians and, as the population changes, the risk that patient safety could be jeopardised.

As my hon. Friend said, the report sets out four options, each of which examines how accident and emergency, maternity, neonatal, in-patient paediatrics and urology services could be provided to reduce patient risk and ensure the highest quality of service for local people. The focus of any future consultation will be about ensuring that care is provided as close to home as possible, with 24/7 access and appropriate support.

Similarly, as my hon. Friend will know, we would expect any settlement for maternity and neonatal services to be in line with the Department’s framework document “Maternity Matters”, which makes it clear that maternity and neonatal care must be well co-ordinated and focused once again on patient safety and the highest standards of care. The point to stress is that the proposals are about specialisation and providing a better quality of service to patients.

I know that my hon. Friend is particularly concerned about the A and E provision available to his constituents. I agree with him that it is paramount that there should be adequate coverage across Telford, Shrewsbury and Shropshire. I know that local health services are working closely with stakeholders, clinicians and the public to ensure that that is the case. I am sure that my hon. Friend would agree that although coverage is an important factor in A and E services, patient quality and safety are even more paramount. He and I want patients to get the right treatment as quickly as possible. Patient safety is always paramount.

I understand that such issues are sensitive. It is therefore important to stress that the strategy document to which we are referring is by no means the final verdict. Rather, it looks at options. I want to be clear with my hon. Friend and his constituents: no decision has been made about the future direction of health services in Telford, and there are no current plans to close local A and E services. If the NHS organisations in Shropshire and the strategic health authority consider it appropriate to pursue one or more of the four options, a full impact assessment would be drawn up with costings, followed by further public and stakeholder engagement and an NHS consultation next spring.

I know that my hon. Friend appreciates that we are a long way from any action being taken and that, in securing this debate, he recognises that there will be other opportunities for him and his constituents to influence the debate before any decisions are taken. Until we have a proposal in place for consideration, I hope that he will accept that none of us should jump to hasty conclusions. I entirely understand his frustration in wanting to see the issues finally settled for the benefit of his constituents, following what he has described as a long and frustrating series of considerations. We have made it clear, in the next-stage review, that patient quality must be the driving force in a modern NHS. In Telford, as in the rest of the country, I expect any changes to support that guiding principle. They must be clinically led and focused squarely on the best outcomes for patients. I do not expect any changes to be made that will compromise the safety of my hon. Friend’s constituents or the quality of care that they receive.

My hon. Friend has put his case clearly today, and I know that he will put it again and again. He is quite right to do that on behalf of his constituents. Telford’s health services will need to adapt to meet the region’s changing needs, but any changes that are considered should, as I have said, improve the quality of treatment, not reduce it, and should have the full support of those whom they seek to serve. I know that he, in advancing his case, will use every opportunity to make sure that his constituents’ voices are heard.

Question put and agreed to.

House adjourned.