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West Sussex Primary Care Trust (Review)

Volume 489: debated on Friday 13 March 2009

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

I am delighted to have secured the debate.

It strikes terror in the hearts of most of our constituents, and certainly in the hearts of Members of Parliament, when they hear that there are to be health service reviews in their areas. In Crawley, we have been in the unfortunate position of being subjected to our fifth review since the early 1990s. It is without doubt a difficult experience, but the purpose of this debate is to demonstrate that we can do things decently, and ensure that reviews truly represent the views of not only local people, but local commissions and health experts. I firmly believe that the recommendations of the West Sussex primary care trust review of health services in the north-east of the county, which produced a report in January, will be implemented over the next year or so.

I mentioned that Crawley’s health services had been reviewed several times. In 1998, they were reviewed by a citizens’ panel. There was a consultation involving Mid Downs community health council in 1999, and West Sussex health authority organised a further consultation in the same year. The independent Bagnell review, which began in 2000, continued for two years. In the years leading up to 2005, we underwent a further review in the form of the fit for the future consultation conducted by West Sussex primary care trust.

I want to make clear that I am not opposed to the reviewing of health services. They are unrecognisable in comparison with their condition at the time when I was nursing. Until three weeks before the general election, I was still giving people bedpans. The health service has transformed itself since then, with the help of fantastic, dedicated staff—a third more staff, along with three times as much money. That has helped to ensure that our health service is something of which we can be justly proud. Last year we celebrated its 60th anniversary with fantastic events around the country.

Many Members of Parliament may find it easier to say “Please leave things as they are.” People become fearful and anxious about reviews, and many things may flow from that, including quite a difficult life for Members of Parliament. However, I became convinced that our health services needed to be reviewed. I suspect that most Members took a very different view.

I was convinced of the need for such reviews not only because I was a nurse in the service for 25 years, but because I understood that my constituents deserved better. Many of the decisions went against the views we in Crawley held, and were difficult to take. The way to overcome that is to have a new process, and that is what I want to concentrate on this afternoon. The way in which a review is undertaken can utterly change how recommendations are received at the end of the process.

All the people who took part in all the reviews undertaken in the last decade or so—the clinicians and the residents of Crawley—made a fantastic contribution. They were committed in their views, and they understood what was being asked of them, but I believe the process let them down in the end. They became confrontational; it looked like a “them and us” process. It is very sad to see constituents who just want improved services for their area in conflict with their local health services. I believe the north-east review by West Sussex PCT has avoided that this time, and we should congratulate it on that. If further reconfigurations and reviews of service have to be undertaken, I hope that the best practice of the north-east review will be used as an example of how to conduct business within the service—how to include our communities and give people a voice within the service, and allow clinicians the opportunity to put their point of view, and sit down around the table and discuss any proposals in detail.

One reason why the process was so different was that we were quickly told that there would be an independent review by the panel chairman, who was Sir Graeme Catto, the president of the General Medical Council and an eminent clinician in his own right. He was appointed to the post, and quickly grasped the subject of the health services under review—those in the north-east of the county of West Sussex—in order to understand how they were working. Therefore, he quickly got up to speed with how things were. He started to talk to all sorts of people—including Members of Parliament, clinicians and local people. He then set up a panel of very good people to listen to the views of local people. Importantly, at that point a stakeholder group—comprising many people—was set up and invited to many meetings, to hear and share evidence with the panel, and to look very closely at particular services. I cite the example of the children’s services in and around my constituency, which are vital, especially for those families with children with long-term conditions who need constant care and attention. Improving the pathway of care for those children, and their ability to access services more quickly, was vital. We did not just spend a couple of hours trying to decide how best to do that. One of our local GPs, and a leading expert on children’s services—someone who has taken a lead in making sure we have good well-being programmes in Crawley—undertook to examine those services, which included lots of people contributing their views. What we have now is a proper programme for improvement, which I believe will transform children’s services. That was just one strand of the work undertaken in the review.

I remember that in previous reviews there was talk of closing the paediatric unit, and we were all out on the streets marching in protest. We were incredibly cross that the proposal had been put to us with little or no care by the local health chiefs. This time, we spent a lot of time sitting down together—some 50 or 60 people were involved, including some parents of children with long-term conditions. We were all given an opportunity to contribute to a discussion about how best to improve children’s services. That is now firmly part of the north-east review recommendation and something to which we can sign up.

The process has involved the panel and the stakeholder group meeting regularly. I tried hard to attend most of the panel’s meetings, because I wanted to listen to other constituents and clinicians who have a particular view, even if it is an opposing one. Sometimes difficult issues were aired, but everybody dealt with each other with courtesy and kindness, and listened to the views of others in a manner that should be replicated in this House when we discuss crucial issues that make us feel incredibly anxious and worried that somebody might not share our view. The whole process took almost a year, as was necessary; it needed to be inclusive and to ensure that, each step of the way, those who were assisting with the process on the stakeholder group, and the public, were consulted. The people who took part were decent, good and honest, and they had to come to some difficult decisions.

We followed a programme, looking at particular parts of the service in detail. This was not just about saying, “Look you are going to have to change. We are going to keep changing our minds about how we are going to provide this service.” We started with a blank sheet. We started by asking what we wanted and what was the most important thing for us. We started by looking at the fantastic radiotherapy services that we receive St. Luke’s hospital in Guildford, but getting to that hospital involves a very difficult and long journey. People are very grateful for those services, but what if we were to have a linear accelerator in Crawley? Would that not be the most amazing thing to set up to supplement our cancer services? That was one of the recommendations of the review.

We wanted to examine how we can genuinely help carers in our homes and support them in a much more meaningful way. We wanted to consider how we ensure that we protect children. Even before our debates yesterday on the publication of the Laming progress report on children’s services within local authorities, our review had already decided that there should be more health visitors for the Crawley area to assist parents—the review was ahead of the game in saying that we know how to protect children and we know what will be needed for the future. Our experience was far from combative; it was collaborative and co-operative, and it allowed us all to contribute in a atmosphere in which we did not feel fearful about raising our voice or having a different point of view from other people in the room. This was a good way of reviewing our services.

Astonishing changes are contained in the review; because we started with a blank sheet, it did not have the flavour of clinicians just saying, “This is what we need to do, because we are going to save money this way. The service will then be better.” Often I am sure that that is true, but we addressed the issues that were really important to people. We examined the expensive 0844 numbers to which many GP services have signed up; we were committed to examining how to ensure that people do not have to pay too much to contact their valuable GP services. We wanted to find a way to re-establish good links between Crawley and East Surrey hospital—there used to be a shuttle bus, but sadly it was withdrawn by the acute trust at the time, and that made people extremely angry. The review accepted that that change made people angry, and brought everyone around the table, including the trust, the borough council and county council, to discuss how to re-establish a decent link between the towns in the area and the acute hospital that serves the most-ill patients.

Given that the principle that we needed a 24-hour accident and emergency department that would accept seriously ill patients—such as those with heart attacks, who can get an angioplasty done in next to no time—had been accepted, we also needed to accept that people need to be able to access the hospital. That is why I was delighted that the review recommended that Crawley hospital should have more beds. Because of its grass-roots nature, the review understood the pressure on beds in the acute trust and the need to provide valuable services. The hospital makes a valuable contribution to health care in the area, and it is probably the largest such hospital run by a PCT.

The review process now has a different feel to it, and we all feel that we can sign up to it. I hope that the Minister will feel able to use it as an example of how to approach continuing reconfigurations. Our fabulous NHS will continue to change. For example, we will have more care at home and we will begin to lose the reliance on the hospital as the front door of the NHS. I hope that the Minister will be able to tell me that she will use this review as a good example of how to change services locally.

I congratulate my hon. Friend the Member for Crawley (Laura Moffatt) on securing this debate on health services in the north-east area of West Sussex. If I may say so, this is a unique occasion, as two nurses are discussing business in the House today. I know that this matter is of great importance to my hon. Friend and her constituents, and I appreciate the comments that she has made. She is known for her commitment to her constituents and to health services. She is in a unique position in being able to assist in the review, and she has shown great leadership in doing so.

I congratulate NHS staff in West Sussex on the hard work that they have put into improving services and performance. Millions of people receive high quality and safe services every day. The best of the NHS is among the best health care in the world and we should all be proud of its achievements.

The review of health care and health services in the north-east of West Sussex was commissioned by West Sussex primary care trust in May 2008. That followed the “Creating an NHS fit for the future” programme and consultation, which took place during 2007-08.

In terms of acute health care, the fit for the future programme was concerned primarily with services in the south of West Sussex, along the coast at Chichester and Worthing, and at Haywards Heath in mid-Sussex. It was therefore felt that further work was needed to look at the future of services in the north-east of West Sussex.

An important point that I wish to stress at the outset is that the organisation of health care is decided not by Ministers or civil servants in Whitehall, but by local health care professionals on the ground. Organisational change conjures up a host of images, not all of them positive, and has become a euphemism for closures and downgrading of hospitals, as my hon. Friend outlined. It is not about closure or downgrading, but about the NHS adapting itself to new patterns of care, using leading edge technology and care pathways to treat people more quickly, more safely and in more convenient settings.

The north-east review was therefore set up, and it was led by a panel of nine professional and lay people chaired by Sir Graeme Catto, president of the General Medical Council. The review panel was asked to identify significant gaps in health care provision in the north-east sector of West Sussex. It was then asked to make recommendations to West Sussex PCT on a way forward to help improve the health and well-being of people living in the north-eastern area of West Sussex. Furthermore, the aim of the review was to ensure not only that people have quality services but that they have better access to these services.

Led so admirably by Sir Graeme Catto, the review undertook an extensive consultation process whereby it engaged with health care experts, local authorities, voluntary organisations and a 100-strong stakeholder forum that met on a number of occasions. The review also engaged with special interest groups including older people, people with long-term conditions and the black and minority ethnic communities. West Sussex PCT’s board received the review panel’s report on 29 January 2009. The panel made a total of 45 recommendations, which the PCT board has supported in principle while it develops a detailed response and action plan.

The north-east review panel reported a number of key findings, a few of which I shall now mention. Generally, the area had a healthy and relatively wealthy population, but a number of deprived wards were identified in the Crawley area. Although the PCT, in partnership with local authorities, had targeted initiatives to support those deprived communities, the take-up of some health services by black and minority ethnic communities was reported as low. Although the greatest proportion of the population lived in urban areas and towns, a number of people living in rural areas were adversely affected by poorer access to health care. It is estimated that the population of the area is likely to increase by a greater proportion than that of the county as a whole.

There had been less investment in a number of services in the north-east sector than in the rest of the county, especially as regards therapy services and some aspects of nursing. I am sure my hon. Friend is pleased that one of the review’s recommendations is that a shortfall in in-patient capacity should be met by patient improved pathways and improving productivity at Crawley and Horsham hospitals. I understand that West Sussex PCT has agreed to consider the opening of closed wards at those hospitals to supplement the overall secondary care system in the area.

West Sussex is planning to address the current shortage of health visitors in Crawley by this autumn to ensure equity of provision in the area and to support the arrangements for the safeguarding of children. The review also recommended more female GPs for black and minority ethnic communities by spring 2010 to encourage take-up of health care services by members of the minority communities.

I understand that the West Sussex health overview and scrutiny committee has been involved with the review process. It established a taskforce in June 2008 to scrutinise the north-east review. The taskforce met on a number of occasions and took part in panel and stakeholder forum meetings. The West Sussex health overview and scrutiny committee was presented with a review of the consultation process in December 2008. I understand that the committee was broadly satisfied with the consultation process. The content of the report was discussed at a committee meeting on 24 February and 18 recommendations were made. That will help the PCT board make a final determination on the original recommendations in due course.

I am advised that as well as the West Sussex overview and scrutiny committee a majority of the stakeholders engaged with during the review are supportive of the process and have welcomed the recommendations in the report. They include the mid-Sussex and Crawley practice-based commissioning groups, local district councils and the stakeholder forum. That support is encouraging and will enable the process to move ahead smoothly. It is obvious, as my hon. Friend said, that the consultation looked at good practice in the area.

I am sure that my hon. Friend agrees that the decisions being taken in her area about health are being led by the local NHS, with the support of local clinicians, the public and, indeed, their Member of Parliament. The local NHS is determined both to improve the quality of service that the public receive and to provide better access to services. I urge her and fellow MPs to continue to work constructively with local NHS organisations and NHS South East Coast to ensure that the residents of north-east West Sussex are provided with the very best health services now and in the future.

Those services are funded by taxation but they are also supported by many different organisations, and with your permission, Mr. Deputy Speaker, I should like to mention today’s fundraising event. It relates to health not only in the UK but around the world. On this special day—red nose day—I congratulate in particular the brave celebrities who climbed Kilimanjaro to raise more than £1 million: Gary Barlow, Chris Moyles, Cheryl Cole, Fearne Cotton, Alesha Dixon, Denise Van Outen, Ben Shephard, Kimberley Walsh and Ronan Keating. The British public are supporting red nose day and Comic Relief to raise money not only for health and children in the UK, but for much-needed help in the developing world.

I thank you, Mr. Deputy Speaker, for allowing me to make those remarks on this day, and I thank my hon. Friend for raising such an important debate.

Question put and agreed to.

House adjourned.