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Health Care (West Cumbria)

Volume 525: debated on Wednesday 16 March 2011

I am pleased to have secured this debate because few things, if anything, are more important to my constituents and the wider population of west Cumbria than the future of the NHS and local health care services.

Sitting suspended for Divisions in the House.

On resuming

Before continuing, I ought to declare some interests. I shall be talking about the West Cumberland hospital today. Not only was I born there, but so was my wife and our four children; my nieces and nephews were all born there; and about a year ago it saved my life.

At best, the future provision of health care services in west Cumbria—indeed, in Cumbria in its entirety—is confused. Given the majority of representations that I have received, from ordinary people and medical professionals, at worst it is in crisis. Before the election, and immediately after it, the development of health care services in Cumbria was praised by the Secretary of State for Health and those sympathetic to his views as a model for the rest of the country. I shall return to this aspect in due course, but suffice it to say that the Secretary of State has stopped using Cumbria as an example of best practice; surely even he realises the chaos that is being caused there by the top-down, unwanted and unwarranted reorganisation of the NHS that he is inflicting on us.

First I shall give a brief history. In 2007-08, NHS Cumbria, the primary care trust for the area, undertook a huge public consultation under the closer to home initiative. It was an enormous task; 140,000 people contributed to the consultation, a huge proportion for any consultation, let alone for a county with a total population of just under half a million. It identified the need to redevelop the West Cumberland hospital and to integrate and improve primary care services as part of the closer to home deal.

During a period of record and sustained funding for the NHS, the public reluctantly agreed to a reduction in the number of beds at the West Cumberland hospital. I have no doubt that the Minister will say that beds do not equal services, and I accept that from the outset. Negotiations with the public were incredibly difficult, but the change was accepted with two provisos. First, the reduction in the number of beds would result in more complex surgery and tertiary-level care coming back to Cumbria from the north-east, taking place at the Cumberland infirmary in Carlisle; that would reduce travelling times for people in my constituency and west Cumbria and help with family concerns for those requiring tertiary-level services.

Secondly, the reduction would effectively result in the building of a new hospital on the site of the West Cumberland hospital. The hospital would retain its acute status, its consultant-led maternity, paediatric and anaesthesiology services, develop specialisms not available at Carlisle, and develop its teaching function. Crucially, it would be surrounded by a network of refurbished or even entirely rebuilt community hospitals in Millom, Keswick, Cockermouth and Maryport, with a brand-new health centre in Cleator Moor; together, they would be able to deal with an increased level of primary-care needs, to allocate resources better, to sign-post acute care when necessary and, importantly, to provide care closer to home.

After real difficulties, hospital consultants from both hospitals in north Cumbria—the West Cumberland hospital in Whitehaven and the Cumberland infirmary in Carlisle—began to forge an effective working relationship with local GPs. I brokered many of their meetings, chaired them and tried to help navigate a route towards an integrated provision of local health services in west Cumbria—one that was outcomes driven in the best interests of patients and that would underpin the future professional and economic stability, viability and sustainability of the local NHS. I believe that it was achieved, albeit imperfectly.

Collectively, the local community and primary and acute medical practitioners were developing a model that would best fit Cumbria. I am delighted to see my hon. Friend the Member for Workington (Tony Cunningham); he had a huge part to play in those developments. So advanced was the relationship, and so strong was the plan, that we were able to insist that a publicly funded, privately operated clinical assessment and treatment centre was not introduced in the area. We knew that it would destabilise the local NHS. My right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), then Secretary of State for Health, listened and did as we asked. It seems that times have changed—and significantly for the worse.

A funding package was developed for west Cumbria, through the west Cumbria strategic forum, and the principle of “west Cumbria proofing” was consistently implemented by the previous Government. That funding was meant to provide £100 million for the West Cumberland hospital and up to £80 million for the community health facilities that I mentioned earlier. Do the Government and the Department of Health remain committed to “west Cumbria proofing”, and the memorandum of agreement that underpinned it?

After the election, these moneys were arbitrarily withdrawn, despite the fact that demolition had already begun on the site of the West Cumberland hospital. The events in my constituency on 2 June 2010 caused me to ask the Prime Minister to visit the hospital and to see for himself the extraordinary clinical work being undertaken by the accident and emergency team in the face of quite unprecedented events. I also used the opportunity to lobby for the money that had been taken from us. Eventually, the Department of Health returned £70 million to the project.

Finance is obviously an important part of health care in north Cumbria. Does the hon. Gentleman agree that the PFI scheme has been a burden to the area?

I would like to examine our PFI scheme forensically and try to discover why other PFI schemes around the country work so well. What is it about the Carlisle scheme that causes such difficulties for the health economy of our area? However, the burdens that it imposes pale in comparison with the GP fundholding system that we face.

The North Cumbria University Hospitals NHS Trust remains committed to its £20 million investment. However, the abolition of the north-west regional development agency and the instruction from Downing street that incomplete projects were to have RDA funding withdrawn has led to a £10 million shortfall in the new-build budget. Will the Minister please reinstate that missing £10 million? If not, will she and her Department help me to identify money to cover that shortfall from other sources—even, perhaps, not from the Department of Health? Can she help expedite the detailed business case approval for the West Cumberland hospital?

Already £10 million down, the trust and NHS Cumbria have also been instructed to make 4% annual recurring cuts. That would be an incredibly difficult situation for the west Cumbrian health economy at any time, but we have not yet approached the real horror that threatens to hole it below the waterline.

At Prime Minister’s Question Time today, the Prime Minister made a Freudian slip when referring to GP fundholding. The Department of Health prefers to call it GP commissioning, but GP fundholding is the practice that brought hospitals to their knees and that almost bankrupted the NHS in the 1980s and 1990s. That is precisely what GP commissioning is. There is all the difference between GPs commissioning and designing services in an integrated way with their hospital colleagues, and GPs being forced to hold the purse strings for the provision of each hospital service upon which their patients rely.

Will the Minister tell us what limit, if any, will be placed on GPs’ remuneration under the new system? Does she have any fears relating to soaring salaries and the fact that the bond of trust between patient and doctor could become severed as a result? Does she have any concerns with regard to the imbalance now between GPs and their acute colleagues and does she think that that will affect future recruitment and the provision of services within the NHS?

With GP fundholding effectively in place in Cumbria—in shadow form—we are witnessing a massive cut to the North Cumbria University Hospitals NHS Trust and to the West Cumberland hospital. Last year, the hospitals trust provided acute hospital services worth some £183 million across its sites. Under GP fundholding, that is being reduced, in the space of one year, to £153 million, which is bound to affect the provision of acute hospital services at the West Cumberland hospital. Does the Minister agree that such a financial hit cannot be absorbed without affecting front-line services?

The shortfall has plunged the trust into chaos. It is now unable, not unreasonably, to meet the foundation trust status qualifying criteria deadline of 2013-14 and that has caused it to seek a merger with another trust or any other willing provider. I hope that the Minister will be able to tell us categorically what the Department means by “any other willing provider”. Minutes from meetings of senior consultants across the North Cumbria University Hospitals NHS Trust, which have been leaked to me, show that those consultants fear that this could result in the closure of the West Cumberland hospital. That would be—as the cuts are—the direct consequence of centrally imposed, top-down Government policy in the NHS.

Will the Minister guarantee that she will not let that happen and that the current level of services will only be added to and not taken away from? Will she agree to arrange a meeting between the Secretary of State, concerned local clinicians and me to hear the case in detail? Will she also grant the trust extra time to meet the foundation trust qualifying deadline so that a merger can be avoided? A merger of trusts is not in the interests of the trust itself or any other trust being asked to take it on. If not, will she guarantee that no other trust or willing service provider will reduce the services provided by the West Cumberland hospital? In short, will she commit today to ensure the delivery of the closer to home programme, which my constituents and those of my hon. Friend the Member for Workington have been consulted on and reached agreement on?

What of our local community hospitals and planned health centre? Will the Minister guarantee that the money for those facilities will be provided by Government, or financially facilitated, very soon, so that these long promised and keenly anticipated investments can take place? What is the status of the programme to rebuild and replace our community hospitals in west Cumbria and provide a new health centre in Cleator Moor? Does the Minister agree that the closer to home initiative will collapse if these facilities are not forthcoming and that a deal will then have been reneged upon? Were that to happen, the sense of betrayal would be profound and the consequences significant.

The West Cumberland hospital was the first new hospital in this country to be built by the NHS after its creation. Right now, it risks becoming the first casualty of what many see as the stealth privatisation of the NHS by a right-wing Government implementing centrally driven health policies that command no democratic mandate or clinical support. As I speak, Bevan will be turning in his grave. I am asking for help, compromise and understanding of the problems facing the future of health service provision in west Cumbria. There is still time to put that right and I hope that the Minister and the Government will see sense.

It is a pleasure to serve under your chairmanship for the first time, Mr Weir. I congratulate the hon. Member for Copeland (Mr Reed) on securing this debate. My goodness, it is quite a thing that he, his wife and his four children were all born in the West Cumberland hospital. The hospital also saved his life. Despite our political differences, I am sure that he will join me in saying that whenever we debate the NHS, we always pay tribute to the staff who work in it at every level. We tend to talk about doctors and nurses, but there are many members of staff who ensure the safe delivery of children and who save lives. I am sure that the hon. Gentleman would like to associate himself with those comments.

The hon. Gentleman has been actively involved in campaigning for the redevelopment of West Cumberland hospital, and he is also a strong supporter of community hospitals. He spoke with some passion about his role and his long history in that regard.

The Minister mentioned community hospitals. There is one in my constituency at Cockermouth, and for a considerable period the authorities have been promising to rebuild it. After the terrible flooding in 2009, parts of the hospital are in portakabins. We are desperate for the new hospital. The funding and the planning permission are in place, yet we are still waiting for a decision. Will the Minister please look into that situation—she does not have to do it now—because the people of Cockermouth are desperate to get their new hospital?

I thank the hon. Gentleman for his remarks. It is frustrating for local people when they are waiting for decisions to be made. General elections come along, disrupt things and, sadly, slow down the process even more. I can understand his constituents’ frustration. Later in my remarks, I will address how we can move forward.

The hon. Member for Copeland was right to make the point that local NHS organisations are precious not just for the services that they provide, but for the employment and economic support that they bring to the area. I note, in particular, his work with the west Cumbria strategic forum and the development of the energy coast master plan for west Cumbria. The development of local NHS services plays an important role in that.

The hon. Gentleman will also know that in west Cumbria, as in other parts of the country, the NHS is under tremendous financial pressure. Indeed, he alluded to that. We are where we are; we have inherited a substantial deficit. Both parties acknowledge the fact that we face some serious economic challenges, and we are determined to find £20 billion in efficiency savings so that we can then reinvest in quality care, and the need to do that is real and urgent. Such pressures would have existed whoever was in government. The fact that we have protected NHS budgets is an important step in ensuring that the challenges facing the NHS are slightly less than those facing other areas. None the less, the upshot is that every NHS trust in the country will have to make tough choices to put health care on a sustainable footing, and that is what is happening in west Cumbria.

I understand that the North Cumbria University Hospitals NHS Trust has struggled financially for a number of years. Clearly, there are some unresolved issues that people are now keen to sort out. Like the country as a whole, the trust is on a journey to restore balance to its finances, and we need to consider how we get better value for money. When I visit hospitals and trusts, it is interesting to see how substantial amounts of money have been taken out of costs by small changes in the way services are delivered. Although this is a challenge, it is also an opportunity, and I am impressed with the innovation that people are demonstrating.

As the hon. Gentleman is aware, the trust concluded in February 2011 that it would not be in a financially viable position for achieving independent foundation trust status by the 2014 deadline. It has made the difficult choice to pursue an arrangement with an existing foundation trust, through merger or acquisition, to ensure its ability to deliver high quality services in the future. The trust reached that decision for a number of reasons, including reduced contract income as more health care is provided outside acute settings, historical debts, costs associated with the private finance initiative scheme, to which the hon. Gentleman alluded, and ongoing requirements to meet cost saving targets.

Having trained as a nurse and worked in the NHS for 25 years, including as a district nurse, I am acutely aware that although our focus is always on acute care the majority of health care is delivered outside acute settings. It is the tension and the co-operation between those two elements of health care that we must now finally get right. The trust must address the issues that I have just mentioned. In particular, it must identify and agree an affordable clinical model that will deliver sustainable high-quality services. It is no good going for short-term gains. We need the process to be sustainable and lasting.

The hon. Gentleman will know that, back in 2007, the NHS in Cumbria set out its plan to reduce unnecessary hospital admissions by looking after people closer to their homes, which is where they want to be. The closer to home programme supported the development of community-based services and the redevelopment of acute facilities to meet local needs. In support of that programme in Cumbria, there is the redevelopment of West Cumberland hospital, which will deliver acute services with support from a wider range of community services.

Following recommendations by the national clinical advisory team last year, I understand that the north Cumbria health economy is now working to develop an affordable clinical strategy, covering primary, secondary and acute hospital services. I understand that the strategy will be published this summer. I suspect that it cannot come soon enough for the hon. Gentleman and many others in the area. In many ways, the strategy will build on the closer to home programme by considering how local health care services can be delivered more affordably, while keeping service quality at the very highest level, which is critical. As part of that process, it is true that the review group is looking at what will happen to acute services at West Cumberland hospital.

During his tour of hospitals in Cumbria last year, my right hon. Friend the Secretary of State for Health acknowledged the importance of West Cumberland hospital to the local people. That view is shared by all of us and it is being taken into account by the Department of Health, the North West strategic health authority and the NHS in Cumbria, which is working on the full business case for the redevelopment of the hospital. That business case will need to reflect the clinical strategy. It is very important that these decisions are driven by clinical need and that they meet the needs of local people.

The Minister talked about the trust’s unique responsibilities. Of course, one of the unique responsibilities that the trust must address is the unique service that west Cumbria provides to this country in the form of the nuclear industry, and the unique challenges that the industry poses for the trust. It is in the interests not only of my constituents but of the whole country that the issue is addressed, and it must be done on a cross-party basis. Would the hon. Lady care to say something about that?

Yes. I thank the hon. Gentleman for that intervention. He is absolutely right to tie up the facts. As politicians, we tend to use the word “sustainable” in a rather flippant way, but what he has just said is what “sustainability” should be about. It should take account of the changing needs of the area; we should be building services not for the next five years but for the next 10, 20 or 30 years.

Tension between acute services and community services has always existed, as has tension between acute services and specialist services. If I think back to my own time in the NHS 30 or 40 years ago—I am very old and it was a long time ago—I recall that regional centres for neurosurgery were being developed. Specialist services need to be provided in specialist centres. Local people want to know that they can go to their local hospital for the majority of things that are wrong with them. That is important. There needs to be a clinical driver in the process, to ensure that people get the quality of care that they need. However, one also needs to take account of people’s wants and desires, and they want care on their doorstep.

The hon. Gentleman raised a number of issues. I recommend that he attends the debate that is happening elsewhere in the House today if he wants a fuller discussion of NHS services. He wanted a number of guarantees from me, so he wanted a number of guarantees from the centre and yet in the same breath he talked about “top-down” and “centrally imposed” diktats. Again, that is one of the key issues, because the centre is never very good at making local decisions. What matters locally is that changes and discussions have the support of clinicians, and ideally are led by clinicians. Those changes and discussions must also have the confidence of local people. That confidence is possibly what has suffered in the past.

The hon. Gentleman talked a little about GP commissioning, GP fundholding and “any other willing provider”. He asked what “any other willing provider” means. I suggest that he goes back to his own party to ask that question, because using “any other willing provider” was at one point its policy. I feel very strongly that the reforms in the NHS will bring decisions about commissioning and getting care right for people absolutely where they should be: with the GPs who know and understand their local communities. It is extremely important that GPs’ inputs and commissioning skills are used to the fullest.

I am told that the national clinical advisory team is reviewing the draft strategy and that a final version will be put to the strategic health authority in the months ahead. In addition, the full business case for West Cumberland hospital, together with the business cases for development of community services, will need to be considered alongside the final clinical strategy. I know that the delay is frustrating, but it is absolutely vital if the decisions are to be made. I or my ministerial colleagues will be very happy to have a meeting with the hon. Member for Copeland. In fact, it might be useful if a meeting was set up with a number of MPs from the area, to thrash out some of the more difficult issues when we have slightly more time to do so.

The process must be clinically led and choices must be made on clinical grounds. The primary care trust must also be satisfied that proposals are properly costed and can deliver sustainable solutions and a sustainable model of care for Cumbria. However, I emphasise that no final decisions have yet been made.

This is an important period in the story of the NHS. An ageing population, rising demand and increasing costs are combining to make it a uniquely challenging time. It is always challenging to deliver health care, with rising expectations and rising demands. That means that all parts of the country must look critically at how they can make the best use of resources to deliver effective health care, in whatever setting it can be most effectively delivered. It also means more care being provided in the home and in the community. I think most people see that development as a positive step, and there must be support for it. The difficulty is that realising cost savings ultimately means changing hospital services as demand changes. However, the NHS actually has a good history and a good record on evolving and changing to meet changes in demand and patient choice.

I quite agree with the Minister, and we understand why there need to be more services in the community. However, the point that I was trying to make in my earlier intervention is that we are desperately in need of a new community hospital in Cockermouth. If we are to have acute services at the West Cumberland hospital, we need up-to-date modern community hospitals that can do the sort of work that she is talking about. Will she at least undertake to look personally into why there is such a delay in the development of the community hospital in Cockermouth?

Yes. I thank the hon. Gentleman for that intervention and I understand completely his passion on the subject. It is terribly frustrating to wait for something and I will ensure that we come back to him specifically on that point, because the hospital has been delayed for too long.

Our ministerial doors are open, so I urge Members to set up a meeting to thrash out some of the issues that we have discussed today. Obviously, no final decisions have been made yet and we are waiting for reviews to be completed, so that all the relevant information is on the table. However, it is terribly important that local politicians feel confidence in the process, which must always be led by clinical needs, and feel that they can bring the public with them.

It is not an easy time in west Cumbria. Change is not easy and we are in a difficult financial climate. However, change requires proper scrutiny and this debate has been an opportunity for some of that scrutiny. As I have said, change also requires public engagement. I hope—indeed, I am sure—that the hon. Member for Copeland and his colleagues in the area will play their part in making change happen and ensuring that there is public engagement with it.