Motion made, and Question proposed, That this House do now adjourn.—(Amber Rudd.)
I am delighted to have secured this Adjournment debate on such an important issue for my constituents and for the Halifax and Calderdale area. This goes to the very heart—the very essence—of what people should be able to expect from their national health service, what services they should get from their local hospital, and how they should have confidence that well-run, popular and accessible services like Calderdale Royal hospital accident and emergency department will not be cut back or closed. However, for some time now Calderdale Royal hospital’s accident and emergency department has been under threat. It is an issue that has been simmering away in my constituency and recently the rumours have turned to reality as the Government and local health bosses, much to the anger of local people, have refused to guarantee that Calderdale’s A and E department is safe.
I shall briefly set out some of the background to this issue. In 2001 Halifax’s general and royal infirmaries merged with Northowram hospital to become Calderdale Royal. Over the last decade it has served the area extremely well. It has excellent, dedicated and well-qualified staff who provide a first-class health service to people across the district. It serves many diverse communities in Halifax and Calderdale, and its reach extends to the Lancashire border and to communities bordering Bradford. Therefore, a wide geographical area needs, and relies on, Calderdale Royal, and in particular its A and E department.
In recent months, as speculation has risen that the axe could fall on the town’s A and E, so has the sense of public outrage that such a short-sighted, unnecessary and unwanted decision is even under consideration, let alone that there is the possibility of it being implemented. United against that are hospital users, health campaigners, trade unions and Calderdale council. I have yet to find anyone who would be in favour of such a decision.
I know the Minister will say that nothing has yet been proposed, but nothing has been denied either. Indeed, I have asked in this House whether Calderdale’s A and E is safe and no one has confirmed that it is.
I dare say that the hon. Lady, coming from the Calderdale area, has, like myself, had briefings both from the chief executive officer of the NHS trust and the chairman of the Calderdale clinical commissioning group, and I must say that at no time have either of those two people mentioned to me that Calderdale Royal is under threat of closure. I just wonder whether she could elaborate on where this information has come from.
I have met the Calderdale and Huddersfield NHS Trust CEO and doctors and other clinicians. They say—and they gave out a document for me to read—that changes are afoot. That is coming from inside the hospital and the council, and from the general public. So, again, I ask the Minister to rule out the possible closure or even any cuts.
All I have been told is that a strategic document is available on the future of local services. Frankly, my constituents do not need to read jargon-filled paragraphs about clinical decisions. They know when something is right or wrong, and they know that what matters in Halifax is the continuation of our good local health service, with an accident and emergency department free at the point of need. They do not want that service to be in Huddersfield, Dewsbury or Bradford. They want it where it is, in Halifax, serving the communities that I represent and those of Calderdale.
I have read and heard a lot in recent weeks about how A and E departments need reforming. I have heard that too many of the people using them could be seen elsewhere. I am afraid that that is a weak argument. The whole point of the service is to deal with accidents as well as emergencies. People cannot be told to use alternative services if their walk-in centres are closing, or if their doctor’s surgery has closed for the night or, when it is open, they cannot get an urgent appointment.
The hon. Lady will know that we recently had a campaign to keep the walk-in centre in Todmorden open. The reality is, however, that the walk-in centres in Halifax and Todmorden are both under-utilised. Would it not be far better if those carrying out the review came up with a proposal for a low-level accident and emergency-type service in Halifax and in Todmorden? Surely that would be better than the current arrangements.
We need the full A and E. Walk-in centres were designed to take the pressure off A and E departments and if they are used correctly, in conjunction with educating people on how they should be used, that is exactly what they will do.
My constituents certainly do not want to make a 25-minute journey across town to access health services that they rightly want to see in their own community. Let me be clear: the Government could and should have an important role to play in this decision. The buck should not be passed solely to local clinicians so that the Government can wash their hands of the matter. I was hoping that the hon. Member for Calder Valley (Craig Whittaker) would make it clear that he intended to put pressure on his Government to protect local health services.
I am in total agreement with the hon. Lady: I would not accept the closure of A and E at Calderdale Royal. I am very much hoping that, following the review that is due in January, we will see an enhanced service not only in Calder Valley but in Halifax and the whole of Calderdale. I am looking forward to seeing those proposals.
I am very much hoping that the Minister is going to tell us that Calderdale Royal hospital’s accident and emergency department is guaranteed to stay open.
The Government set the policies, and they must also take responsibility for any decisions that will affect the A and E in Calderdale. Also, there should be no hiding behind a public consultation. The question is quite simple: do the Government support the retention of the accident and emergency department in Calderdale? If they do, there is no need for any consultation. If they do not, they should come clean and set out their position. This lack of clarity is causing a lot of worry, anguish and anger in my constituency and across Calderdale.
Last week I organised a round-table meeting with interested parties at a local level to discuss a way forward. The town is united in the need to ensure that Calderdale’s A and E stays put. Let us imagine what would happen if the department were cut back or closed. I presume that the services would transfer to Huddersfield. For many of my constituents that would mean at best a 20-minute journey, but probably journeys of 25, 30, 35 or even 40 minutes along busy roads, past a motorway interchange, and into Huddersfield. At the risk of using emotive language, such a move really could be a matter of life and death. Do health bosses think that people would stop using the other A and Es if they closed the one in Calderdale? I do not think they would. I also want to place on the record that this is not about Halifax versus Huddersfield; it is not about pitting one A and E against the other. This is about ensuring that people across west Yorkshire have access to good quality health care that is rooted in their local communities.
Let us just examine for a moment why this position might have come about. Since 2010, the Government have been systematically dismantling alternatives to A and E: a quarter of walk-in centres have been closed since the election; NHS Direct has been scrapped; the guarantee of a GP appointment within 48 hours has been scrapped; and fewer and fewer GP practices are open at evenings and weekends. People in Halifax and Calderdale will have fewer alternatives, not more, if the A and E closes. If patients are waiting more than four hours for treatment, is the answer to close A and Es? I do not think it is. This crisis is not due to a lack of education or people going to A and E with minor problems; it is more to do with cuts to social care budgets, meaning that more older people are ending up in hospital because there is no one else to take care of them.
If the Government’s answer to an A and E crisis is to close A and E departments, we really are in trouble in Halifax. Cutting back on services does not solve the problem; it just transfers it elsewhere. I am determined to fight for better services at Calderdale Royal, not to see them cut. I want to see our A and E department saved, not sacrificed. I want to see the excellent staff supported, not under-resourced, and to ensure we have the best possible NHS serving Halifax and its wider communities.
The reaction of the public in my constituency has been an overwhelming “Hands off our A and E department.” We need it to stay open, to continue the excellent service it provides and to ensure it serves the people of Halifax today and for years to come. Anything else would be a tragic mistake of short-term thinking, and a failure to provide my constituents with a local hospital and a national health service fit for the 21st century.
I congratulate the hon. Member for Halifax (Mrs Riordan) on securing this debate and my hon. Friend the Member for Calder Valley (Craig Whittaker) on staying on to attend and intervening in the telling way he did. There is obviously a keen interest in all these local health matters among Members on both sides of the House. I am aware that all parties are interested in these matters; I have received representations from other Members, and not just the hon. Lady who has raised this matter in the House previously during Health questions.
The reconfiguration of health services is an important issue for all of us and our constituents, and the future of A and E departments is particularly topical at present. I understand that people have anxieties about change and, in particular, about change in the NHS, because it is such a greatly loved and respected institution, but I hope I am in keeping with the spirit of this debate when I say that it is vital that we do not play on those anxieties, especially for purely political purposes. It is important that these difficult but necessary debates take place in an atmosphere of calm consideration.
I ask the hon. Lady to let me develop my points, because I have not even begun to respond to her speech. I shall give way, if time allows, a little later.
Before I address the particulars of this debate, may I touch on the Government’s policy on changes to services in general? I realise that the hon. Lady may say that this is what I was going to say, but it is important to understand the principles behind reconfiguration policy. This Government are clear that the design of front-line health services, including A and E, is a matter for the local NHS. That is for good reason, because those local leaders, working closely with local democratic representatives, local government and the public they serve, can come to better conclusions about the services for their area than a Minister sitting in Whitehall trying to decide policy for the whole country, which is a very old-fashioned model of how to do these things.
The NHS has a responsibility to ensure that people have access to the best and safest health care possible. That means planning ahead and looking at sustainability as well as safety in NHS health care provision. No party can escape the challenge of providing sustainable services, and I do not think that challenge is any different for the Labour Front-Bench team from how it is for the Government. The Labour party made these points often when it was in government.
Reconfiguration is about modernising delivery of care and ensuring that we have the facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives. I listened carefully to the hon. Lady’s arguments about her own local area, but if we look at an area in London, as I represent a London seat, we will see that exactly the same arguments were made against centralising stroke care, which was centralised in eight hyper-acute stroke units. They are now providing 24/7 acute stroke care. Stroke mortality is now 20% lower in London than the rest of UK, and survivors are experiencing a better quality of life.
I gave that example to illustrate the fact that we must be wary of some of the arguments against reconfiguration. I am quite clear that in London something that was opposed for some of the reasons the hon. Lady has touched on in her speech is now saving lives for my constituents and others. I want to ensure that that point is at least underlined.
We must allow the local NHS continually to challenge the status quo. I do not accept the hon. Lady’s argument, which, as I understand it, is that nothing should ever change. How, in a modern and ever-changing world, can she advance the argument that nothing should ever change and that it would be wrong of her clinicians even to look at the case for change?
I am sure that the Minister listened to my speech. I did say at the beginning, just to give her some brief history, that in 2001, under a Labour Government, we finally got that brand-new hospital for which we had waited nearly 20 years. It had been promised by a Tory Government. We went from three hospitals to one. She is quite right: things do change, and I was part of that change in 2001.
I thank the hon. Lady for her intervention, and I am glad that we have established some consensus on that point She is probably aware that I know her area quite well, having lived there for quite a few years before I moved to London.
All service changes should be led by clinicians, and be based on a clear, robust clinical case for change that delivers better outcomes for all our constituents. We have put patients, carers and local communities at the heart of the NHS, by shifting decision making as close as possible to individual patients, devolving power to professionals and providers, who also have patient care, safety and sustainable service at the core of their public service commitment, and liberating them from top-down control.
The principles are enshrined in the four reconfiguration tests. I am sure the hon. Lady knows them well, but for the record they are support from GP commissioners; strengthened public and patient engagements; clarity on the clinical evidence base; and support for patient choice. Those are the tests against which any reconfiguration needs to be judged.
A and E is obviously very topical at the moment. The NHS is seeing increasing pressure on A and E services, but is generally coping well. I am sure that that is the case with the hon. Lady’s local hospital as well. We are meeting our four-hour A and E standard at the moment. It is the 32nd consecutive week the standard has been met. We are determined to do everything we can for the NHS to continue providing high-quality care. She will know of some of the extra moneys that we have allocated—I think it is £2.3 million for Calderdale and Huddersfield—for winter pressures. That does not allow us to escape the fact that there are longer-term challenges, and these have been acknowledged across the House. One million more patients have gone to A and E in the past three years, and there are the pressures of an ageing population. We, across the House, have to address those long-term challenges, and the Government are trying to focus on some of the underlying causes, whether by having named GPs for the over-75s or changes to GP contracts; or, in public health, helping people to manage long-term conditions and to live well for longer; or the £3.8 billion allocated to help to integrate health and social care, because we recognise how vital that process is. All those measures are about addressing the underlying drivers of pressure on A and E and pressure on our health service and looking at how we can make it sustainable in the longer term.
We have recently had an excellent review from Sir Bruce Keogh that looked at urgent and emergency care. It also looked at demands on services and how the NHS should respond. We asked for that review because of the determination not to sidestep the problem of growing pressure on A and E but to deal long term with a problem that has been building for decades. Too many sticking plasters have been applied in the past to get through a year or two. That is why we need to clarify to the public how we are planning to shape those services for the longer term and where they will be delivered.
Most of the current reconfiguration projects are in line with the Keogh report’s principles as an overall direction of travel. We have been clear about that for some time. All local health economies that are undergoing reconfiguration have to pay close heed to the direction of travel set out in the Keogh report, the essence of which was that this is about services, people and co-ordination. It is not just about the bricks and mortar; it is about getting the right care to people at the right time, and flexibility and the co-ordination of services are just as important as how they are geographically configured, and that was the message from the Keogh review.
Let me turn to the hon. Lady’s local area. She said that people want good quality health care rooted in the local area. That is exactly what is at the heart of the review that is being undertaken. As I have outlined, the configuration of local health services is a matter for the local NHS, for the very good reasons I have given. It cannot be dictated from Whitehall. Locally, I understand that the review is considering health and social care services with the point about ensuring that patients continue to receive high-quality and sustainable services at its heart. The work includes considering how best emergency care services and other acute services can be delivered, and in an intervention my hon. Friend the Member for Calder Valley touched on some of the ways that can be done differently and in a more imaginative and responsive way.
No decisions have been made at the moment, and of course any plans for major service change that emerge from the review would be subject to formal public consultation. Public consultation has to be real and robust. Commissioners know that, and at all stages of the process I would expect Members to be involved, as well as local government. At this stage, the commissioners have not brought forward plans for consultation, but they will need to be assured that any proposals they make for reconfiguration and change will meet the strengthened tests I mentioned earlier.
At the heart of all this is the need to serve local people better. I understand from some of the early engagement work, in which thousands of local people were involved, that the message was that people want quality and access. Those are the two key messages that came through and that are the forefront of people’s minds. They want quality services and they want access to them at the right time. The trust has, I believe, identified a need to co-locate acute services to maximise the potential of its work force, to ensure that services are safe and to deliver the best outcomes for patients for a long time.
The trust is taking on board a range of views as part of the review. I know that the hon. Lady has met local NHS leaders, as have my hon. Friend and other interested local parties. That will include external independent clinical opinion on how best to deliver emergency care, such as that given by the Keogh review. I stress again that the process is locally driven, and I encourage interested hon. Members to continue to engage with the process and to work with the local NHS as it develops those plans. The NHS is one of the world’s greatest institutions, so ensuring that it is sustainable and serves the best interests of patients sometimes means taking tough decisions, including on the provision of urgent and emergency care. Those decisions are taken for a reason: good-quality care and access to it are at the heart of this.
As the hon. Lady has acknowledged, sometimes things change over time. The pressures change, as do the way we respond to them and what we know about how we respond to them. For example, we know that more than 30% of people who go to A and E—in some places, it is more in the order of 50%—do not even need to be there. That is not sustainable in the long term and we need to address it, but those decisions are best made when the NHS is working in collaboration with local people, with local democratic representatives and with local authorities and considering what is best for the people of their area.
May I take this opportunity before I close to place on record my thanks to the hard-working NHS staff of Calderdale for the service they give to the people of that area and to the hon. Lady’s constituents? I hope very much that they have a good Christmas in the sense that they have as few people as possible in A and E who do not need to be in A and E over Christmas, because I know it is a difficult and challenging time for NHS staff, but we are all grateful for what they do for all of us.
Question put and agreed to.