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Hospital Services (Worcestershire)

Volume 524: debated on Wednesday 2 March 2011

It is a pleasure to speak under your chairmanship, Mr Hood. I am delighted to secure the debate on hospital care in Worcestershire. To put hospital care in Worcestershire in context, I should explain that we have two acute hospitals and a treatment centre. The acute hospitals are based in Worcester and my constituency of Redditch, and the treatment centre is in Kidderminster. In other parts of the county, we have community hospitals, which play a great role in delivering the highest level of care to our constituents.

The emphasis today is of course on the new cancer care facility, but all areas of the NHS trust are working hard and playing important roles. Worcestershire Acute Hospitals NHS Trust has recently appointed a new chairman, who is determined that the mission of the trust will be to make all care patient-orientated. To do that, the care offered, the facilities available and the attitude of all staff must put patients and their well-being first.

I shall begin by sharing with hon. Members some of the successes within the trust. The national target of ensuring that 80% of patients brought to accident and emergency by ambulance staff are seen within 30 minutes has been surpassed by our trust. The benefits of receiving treatment quickly are self-explanatory. Obviously, the more quickly a person is seen, the less likely they are to deteriorate, and the ambulance staff can get back to doing what they do best.

I spent some time in A and E at the Alexandra hospital and was incredibly impressed by what I saw. The staff do an amazing job, sometimes in very challenging circumstances. Guided by Mr Christopher Hetherington, a consultant in the department, I saw at first hand how staff dealt efficiently with arriving patients. I was struck by their professionalism and commitment to their patients.

Despite the added challenge of the snow and bad weather in December and January in Worcestershire, the trust’s ambulance staff achieved a performance rating of more than 90%—the result of focus and dedication. I look forward to seeing them later this month when I do a night shift with an ambulance crew in Redditch.

Successes have also been shown in the results of patient surveys. The national maternity survey from 2010 showed that mothers in Worcestershire were impressed by the maternity care that they received. Those who completed the survey were pleased with all aspects of care, including care at home after leaving hospital. The trust now ranks in the top fifth for offering mothers choice. Choice should be at the forefront of the reorganisation that our NHS trusts face. If we are to create an NHS that is centred on patient care, offering patients choice about and influence over their treatment is essential.

I echo my hon. Friend’s comments about Alexandra hospital. It is a hospital that people in her constituency and in my constituency share, and I know that constituents from far and wide respect the services that they receive, the quality of care and the dedication of the employees and the health care professionals. Does she agree that, along with Alexandra hospital and the other acute hospital that we have in our county, the community hospitals, such as the Princess of Wales community hospital in Bromsgrove, complement the health services on which our constituents rely in Worcestershire?

I thank my hon. Friend for his intervention. I totally agree with him. Many of my constituents in Redditch also use the Princess of Wales hospital. I have been there on many occasions and know what a fantastic job the staff do.

Effective hospitals rely on good facilities. Kidderminster hospital has recently acquired a state-of-the-art MRI scanner. It offers patients the best diagnostic procedures available. New services can now be offered, including breast scans and whole-body imaging. Some 9,400 scans a year can be performed with the machine. One-stop-shop access to out-patient clinics cuts waiting times and means that patients are in the clinics for as little time as possible. Developments such as those are lessening the postcode lottery effect in the NHS.

Worcestershire is awaiting a decision about whether a radiotherapy unit will be built at the Alexandra hospital in Redditch or the Worcestershire Royal hospital. I, of course, hope very much that it will be built at the Alexandra hospital in Redditch.

I thank my hon. Friend for securing this extremely important debate, because it allows me to place on the record the thanks of the Malvern community for the opening of the new Malvern hospital by the Princess Royal last week. Does my hon. Friend agree that a key thing with radiotherapy services is the distance that people have to travel every day and that Worcester might be considered a very central location in the county of Worcestershire?

As you can see, Mr Hood, we have a debate among ourselves about where the cancer centre should be sited. Obviously, we in Redditch and Bromsgrove have the advantage of lots of space to build the cancer unit, and we have already started a local campaign to bring the unit to the Alexandra hospital.

I am grateful to my hon. Friend for giving way and grateful to my hon. Friend the Member for West Worcestershire (Harriett Baldwin) for the point that she made. I am sure that my hon. Friend the Member for Redditch (Karen Lumley) would acknowledge that the Worcestershire Royal hospital already has considerable expertise in cancer treatment. Will she join me in urging our right hon. Friend the Minister to ensure that, wherever such services end up being placed, they are supported, as they are a vital component of a strong and much needed cancer strategy for our county?

As you can see, Mr Hood, the feeling among us is quite strong. We have all campaigned together to try to secure a unit in Worcestershire and we are all very grateful that we are to get that unit—we just need to know where it will be. But wherever it is built, I am very pleased that, by the end of 2013, 95% of the radiotherapy and chemotherapy patients will be treated in Worcestershire. That is the message that we all want to get across. The ability of my constituents battling cancer to receive their treatment close to home and to know that the treatment is the best available will, I hope, make a real difference. The new facility will match the already excellent care that the trust offers—care that means that it was ranked in the top 20% of trusts in the national cancer patient experience survey.

The news of the radiotherapy unit and other successes is encouraging. However, like many other MPs, I am very concerned about the money that is spent providing locum doctors to cover staff shortages. I hope that the Minister will deal with that today. The number of locum doctors employed has increased dramatically in the past 10 years. Trusts face acute shortages of middle grade doctors. Locum doctors are expensive. They should be used only to fill unforeseen gaps in staffing or when there is a dramatic increase in work load. They should not form part of the regular staffing arrangements as they do now.

We all know that we must make cuts in the public sector. However, I cannot see why my constituents should face reduced public services because money is being spent inefficiently. A cost-effective NHS will offer greater scope in how we care for people in our communities, both in Redditch and nationally.

The problem has been exacerbated by the European working time directive. Reducing—unnecessarily, I believe—the number of hours that doctors can work leads, of course, to a reduction in the number of hours covered by doctors available to hospital management. That is combined with the new strict immigration rules, which have resulted in far fewer doctors being able to emigrate from India and Pakistan and increased the pressure on hospitals as they try to fill an increasing number of vacancies.

The result in Worcestershire Acute Hospitals NHS Trust, which has 24 vacancies at the moment, is that money that could otherwise be directed to caring for patients is spent on locum doctors, the agencies that they come from and the bureaucracy involved in short-term employment. If we are to succeed in reducing public spending, we can no longer rely on short-term solutions. I understand that the trust has been actively recruiting doctors from Poland and the Czech Republic. Initiatives such as that must continue. However, the idea being explored whereby non-medical roles are created to support rotas and treatment concerns me. The trust considers that option “undesirable”.

It is not only doctors in hospitals who are anxious about the impending changes. I have met GPs recently—I do so regularly—who have shared with me their concerns about the establishment of the NHS commissioning board. When each GP must be a member of a consortium, their job will have to include commissioning services. The doctors in Redditch whom I meet regularly are equally concerned about the unequal funding for shire counties. I hope that that will be addressed sooner rather than later. There are also concerns about the reorganisation taking away local knowledge of the complexities of our county and its problems. Bromsgrove and Redditch GPs will do their best for their patients—I hope that, when the changes are introduced, they will be fully skilled to do the best job that they can.

In summary, I am delighted that we are finally getting a cancer care unit for Worcestershire—I hope that it will be in Redditch. However, I hope that the Minister will address my concerns about the expensive use of locum doctors and the concerns raised by local GPs. I welcome the coalition Government’s commitment to local health care being delivered by local clinicians in our own localities.

I congratulate my hon. Friend the Member for Redditch (Karen Lumley) on securing what she rightly describes as an important debate. May I say how pleased I am to see my hon. Friends the Members for Bromsgrove (Sajid Javid), for Worcester (Mr Walker) and for West Worcestershire (Harriett Baldwin) here today? Together with my hon. Friend the Member for Redditch, their commitment and interest in the NHS in Worcestershire is second to none. They make a fine team, fighting on behalf of their constituents for the finest health care, which, as my hon. Friend the Member for Redditch said in her closing remarks, is at the forefront of the modernisation of the NHS outlined by my right hon. Friend the Secretary of State. I am delighted to hear of my hon. Friend’s commitment not only to increasing choice for her constituents but to our modernisation programme; local decision-making will give far greater flexibility in effecting local health economies.

I take the opportunity to pay tribute to the many who work so hard to deliver high-quality NHS services in Redditch but, equally important, across Worcestershire, for the benefit of my hon. Friend’s constituents and those of the other hon. Members who represent that fine county. They do a tremendous job, and the Government will support and empower front-line staff to continue improving services like none before them.

I join my hon. Friend in welcoming the creation of the Worcestershire Health and Care NHS Trust. The new trust will manage all mental health services in Worcestershire, and all community services currently managed by the PCT’s provider arm. That can only be of benefit to the people of Worcestershire. Sarah Dugan, formerly chief executive of NHS Dudley, has been appointed as chief executive of the new trust, and the full board should be in place by the end of March. It will officially come into being on 1 July, giving it sufficient time to complete its registration with the Care Quality Commission.

The people of Worcestershire are also benefiting from the new Malvern community hospital, which, as my hon. Friend the Member for West Worcestershire said, was recently opened by the Princess Royal. The hospital brings together the expertise of nurses, physiotherapists, occupational therapists, speech and language therapists, dieticians and a Macmillan team to provide integrated, patient-centred care for patients in the community and in their homes. Providing more NHS care in that way is essential if we are to improve health outcomes while making significant efficiency savings across the health service. Frankly, outcomes are of the utmost importance to our constituents, as part of their care pathway.

My hon. Friend the Member for Redditch is concerned also about the current shortage of full-time health care professionals, which is due in part to restrictions on recruitment from outside the European Union. I appreciate that she is concerned because of the impact that the problem is having on her constituency. The Government’s policy on immigration seeks to balance the obvious benefits that people can bring to the UK while limiting additional pressures on local services such as housing and schools.

We still want the UK to benefit from the brightest and the best individuals who can contribute positively to the UK economy and to the NHS. The Department of Health is working closely with the UK Border Agency to ensure that the NHS has continued access to the best candidates, in order to provide the best quality care for NHS patients. I hope that that goes some way to reassuring my hon. Friend that we are aware of the situation and are working to find a practical solution that stays within the general philosophy and the wider scope of our immigration policy.

My hon. Friend raised a related issue—the ongoing impact of the working time directive. The Government committed themselves in the coalition agreement to limiting the application of the directive in the UK. The Department of Health and the Department for Business, Innovation and Skills are working closely together to achieve greater flexibility in the application of the directive in the NHS.

I understand that Worcestershire Acute Hospitals NHS Trust currently has 24 vacancies for middle-grade doctors in specific specialities, including emergency medicine, paediatrics and anaesthetics. That has caused the trust to rely on expensive short-term locum doctors. I agree with my hon. Friend that that is a far from ideal situation. She rightly said that if one is paying more for locum doctors it means that there is less to be reinvested in front-line services. In the current economic climate, it is crucial that we save as much money as we can from inefficiencies, or working practices that need to be improved, and that every penny of those savings is reinvested in front-line services for the benefit all of our constituents.

It is the responsibility of NHS trusts to plan and manage their demand for temporary staff in the context of local business and work force planning. Worcestershire Acute Hospitals Trust is actively looking to recruit doctors from the Europe Union; as my hon. Friend said, the trust had success recently in recruiting doctors from Poland and the Czech Republic. Eight of the 24 vacancies have thus been filled, and I assure my hon. Friend that every effort is being made to fill the rest. I totally agree that it is crucial that the trust is able to fill those placements as quickly as possible.

My hon. Friend mentioned the success of cancer care in Worcestershire, as did my hon. Friends the Members for Worcester and for West Worcestershire. Worcestershire Acute Hospitals NHS Trust has been held up by the national cancer survivorship initiative team as an example of how to run a successful prostate cancer service. It reflects extremely well on the staff of the trust that they have been able to deliver that quality of care—and received justified recognition for what they have achieved. The trust has just celebrated the first anniversary of its being declared a level 1 paediatric oncology shared-care unit, for providing better and more local care to children and families in Worcestershire. There is now a Macmillan cancer information and support centre at each of the three hospital sites. I join my hon. Friend in welcoming these developments, as it means better quality cancer services for her constituents and those of other Members.

I am glad to see that Worcestershire Acute Hospitals NHS Trust, University Hospitals Coventry and Worcestershire NHS Trust, and Warwickshire NHS Trust are working together to build a new specialist radiotherapy centre in Worcestershire. That is a subject and an interest that is close to the hearts of all Worcestershire Members, but particularly to those here today. As my hon. Friends will know, patients in Worcestershire travel in excess of a million miles every year for treatment, but by the end of 2013 the centre will mean that 95% of radiotherapy and almost all chemotherapy will be delivered within the county.

I am sure that my hon. Friends as well as the people of Worcestershire will accept that that is the right way to go, because when it is justified—it certainly is in these circumstances—care should be provided as locally as possible so as to reduce or eliminate the need for people to travel too far, especially if it is not necessary. My hon. Friends will agree, particularly for cancer care and radiotherapy, that it can be extremely upsetting, distressing and uncomfortable to people to have to travel long distances rather than being treated in the local hospital. For Worcestershire patients to have to travel in excess of a million miles every year for treatment is excessive, and I congratulate the Worcestershire trusts on coming up with such a proposal.

The trusts will work with existing cancer service providers to ensure that there is no disruption for patients who are currently receiving treatment. As my hon. Friend has said, they need to decide whether to locate the new centre at Worcestershire Royal hospital in Worcester or at the Alexandra hospital in Redditch. The local NHS will work with patient and clinical groups to make a decision as soon as possible based on the clinical and operational benefits of each site.

I understand that my hon. Friend has been encouraging the trust to locate the centre in Redditch. I suspect that my hon. Friend the Member for Worcester is doing exactly the same with regard to his constituency. I can assure my hon. Friend the Member for Redditch that her views will be taken fully into consideration when the decision is made. I hope that she is satisfied with that. She realises that it would be totally inappropriate for me to seek to interfere with the process because it must be decided locally—by local clinicians and local trusts. I am confident that a decision will be reached at the appropriate time, and I urge all my hon. Friends to have some patience because an announcement will be made in due course.

Oncology patients and diagnostics will continue at Alexandra hospital, Worcestershire Royal hospital and at Kidderminster hospital. I hope my hon. Friends will be reassured and pleased by that.

My hon. Friend also raised concerns over the impact of GP-led commissioning on local NHS services, following her recent meeting with health care professionals in Redditch. While the new commissioning arrangements will be led by GPs, they will work not in isolation, but in partnership with their clinical colleagues. When one starts to bring together clinicians from primary, secondary and community care to discuss how best to design local services, organisational distinctions quickly fall away. The conversation instead becomes one about the most appropriate pathway of care for a particular group of patients. I am pleased to say that that is already starting to happen in Worcestershire. Again, that must be the right way forward.

There are currently two pathfinder consortia in Worcestershire: South Worcestershire GP Commissioning Consortium and Wyre Forest GP Commissioning Consortium, with a third group, covering Redditch and Bromsgrove, in the pipeline.

Worcestershire Acute Hospitals NHS Trust is starting to build good relationships with these new consortia and has already had some very positive discussions with its GP colleagues. Indeed, each hospital, including the Alexandra hospital, has set up a commissioning board and is already meeting regularly with GPs. The trust’s recent restructuring has enabled its senior clinicians and management team to develop further the relationships, and individual boards are now in place at each hospital site. That will allow the hospitals to work with consortia on a regular basis and jointly to agree the most appropriate way in which to provide safe, effective, patient-centred care for the people of Worcestershire.

Whatever concerns have been voiced by local clinicians in my hon. Friend’s constituency, I hope that the practical experience of working with consortia—as opposed to working separately from them via primary care trusts—will soon change minds. Once the pathfinders have established themselves and their working practices and become more familiar with their enhanced role within the modernised NHS as laid out in our White Paper, I am confident that they will come to appreciate the system. GPs have the best knowledge of their patients’ requirements. For the vast majority of patients, their first contact with the NHS is through their GP, and GPs are best qualified to identify their needs and requirements. I am sure that as the system beds down, GPs will come to appreciate their greater independence and their proactive role. In effect, there will be a bottom-up provision of commissioning for the health care requirements of patients rather than the existing top-down procedures through the PCTs. It will be a boon not only for GP consortia in Worcestershire but throughout England as the system becomes more established.

My hon. Friend is concerned about the possible impact on the Alexandra hospital of the financial challenges that lie ahead. Last year, the Alexandra hospital made a surplus of approximately 1.3%, which was roughly in line with the trust’s surplus. Figures for this year are not yet available. However, as part of the need for the NHS to make up to £20 billion of efficiency savings in the coming years, Worcestershire Acute Hospitals NHS Trust faces a significant efficiency target in 2011-12. The Alexandra will have to find its share of those efficiency savings. Budgets are in the process of being set and hospital teams are currently identifying where savings and efficiencies can be made. I hasten to reassure my hon. Friends about the savings. Every single penny of those savings will be reinvested in front-line services, providing care for the constituents of my hon. Friends and people elsewhere in the county, and, indeed, the country. It is crucial that we make savings to cut out inefficiency and ensure that the provision of care is of the highest quality and delivered in the most effective and efficient way. Let me repeat again, all of the £20 billion that is saved over the time period will be reinvested in front-line services. That is what providing health care is all about. That is what we will do and what must happen so that we can maximise the money available for front-line care for patients.

The trust assures me that it has no plans to reduce the status of A and E services at Alexandra hospital, which I hope reassures my hon. Friend. Indeed, the terms of reference for the ongoing surgical review at the site state that there must be a viable A and E service in Redditch. I trust that my hon. Friend and her constituents will be reassured by that commitment.

My hon. Friend was also concerned that rural constituencies such as her own may be losing out under the NHS allocation formula. Rural communities generally have a higher proportion of elderly people and, because of the increased difficulty in reaching providers, rural populations may make less use of health services. Some argue that the previous formula may have disadvantaged such areas.

The Advisory Committee on Resource Allocation examined the issue but found no evidence that an adjustment was needed for rural areas other than the continued need for an emergency ambulances cost adjustment to account for geographical variations in the cost of ambulance services. However, my right hon. Friend the Secretary of State has asked ACRA to look again at the unavoidable cost differences in rural areas in the light of the move to GP consortia. ACRA is due to report its findings to the Secretary of State in June 2011. I cannot anticipate what those findings will be, but it is important to get an independent body to examine an issue that is of great concern not only to my hon. Friend but to other hon. Members who represent rural constituencies in England.

In conclusion, there is a great deal to be positive about in Worcestershire, and I am sure that my hon. Friends will agree with me on that. The addition of a new radiotherapy centre is a particularly exciting new development. Indeed, all my hon. Friends showed great enthusiasm for the centre, calling it a positive enhancement of local health care. They also expressed their wishes as to where it should be located. Even more exciting is the changing nature of the clinical relationships that our modernisation of the health service will bring and the potential for significant improvements in NHS services for my hon. Friend’s constituents.

I am delighted to have had this opportunity to discuss the local health service in Worcestershire. There is a lot of positive news. My hon. Friends still have to express some of their views to the relevant authorities, and in due course, decisions will be taken.

Sitting adjourned without Question put (Standing Order No.10(11)).