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Health Care (Gloucestershire)

Volume 577: debated on Wednesday 19 March 2014

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

My hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) and I have been calling for this debate for some time, so we are grateful for the opportunity to discuss health care provision in south Gloucestershire.

In 70 days’ time, the accident and emergency department at Frenchay hospital in south Gloucestershire will close its doors. The decision on this is not recent, as it was taken in 2005 under the Labour Government, who then refused to allow it to be referred to the independent reconfiguration panel, despite a 50,000-signature petition from local people. The decision to close the A and E was also voted through locally by Labour councillors against Conservative opposition. When my hon. Friend and I were elected to this place in 2010, we called a debate on the future of Frenchay hospital in which it was confirmed that contracts had already been signed under the Labour Government to close Frenchay’s A and E, making the decision irreversible. The downgrading of Frenchay will forever be Labour’s legacy to the people of south Gloucestershire. My hon. Friend will speak later about the hospital and the continuing uncertainty over the health care provision that will be based there.

For the first time, this Government allowed South Gloucestershire council’s health scrutiny panel to refer recent decisions by health care managers temporarily to relocate beds to Southmead hospital while the final provision of beds at Frenchay was investigated by the independent reconfiguration panel—something that the previous Government resolutely refused to do. As local MPs, we submitted our own statements in support of Frenchay to the IRP along with local campaigners, and they are listed in the report’s appendix, yet we were surprised to see that no statements of support were made by the local Labour party or by its candidates.

The publication of the IRP report on Frenchay this week highlights—

Motion lapsed (Standing Order No. 9 (3)).

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

The publication of the IRP report on Frenchay this week highlights for the first time real concerns about the reconfiguration of health care provision in south Gloucestershire. These concerns are so damning that it is right that we as local MPs raise them now on the Floor of the House. The IRP rightly observed not only that health care provision had been subject to continual alteration since 2005, but that

“there is considerable public disquiet with the process to date”,


“residents of the area should feel exasperated by the years of delay”,


“the overall process to date has shown a marked lack of empathy for patients and the public who have a right to expect better”,

and that

“progress to date has suffered from a lack of trust from the public”.

The IRP goes on to recommend that

“a new approach to pubic engagement and involvement is required that demonstrates mutual co-operation and ensures that the public can have confidence in a quality service”.

Importantly, the IRP also notes that

“concerns remain about access to outpatients and diagnostics, capacity for rehabilitation services particularly in light of housing developments, and the absence of external clinical assurance”.

The IRP has finally put on record what local people and groups such as the Save Frenchay Hospital group have long been saying. North Bristol NHS Trust and health care bosses must now listen to them, and to the IRP in the light of its damning conclusions.

I am concerned, however, that history is about to repeat itself at nearby Cossham hospital. As a member of the league of friends at Cossham hospital, and someone who volunteers at the café there—I hope that that will suffice as a declaration of interest—I know at first hand how cherished Cossham hospital is within the Kingswood community. In 2004, the hospital was threatened with closure. Then—a story all too familiar—the health care bosses said that they knew best and that there were strong clinical reasons for shutting the hospital, yet they underestimated the determination and resolve of the Save Cossham Hospital campaign group, which mounted a remarkable cross-party campaign to save the hospital from closure.

In the end, the decision to close Cossham was reversed, and the hospital underwent a £19 million refurbishment. So far, this has included a new renal dialysis unit, an X-ray and scanning department, physiotherapy and out-patient appointments, and Bristol's first free-standing, midwife-led birth centre, which has already delivered hundreds of babies. But the minor injuries unit at Cossham hospital, which was promised as part of the Bristol health services plan, and reaffirmed by the 2009 business plan for the hospital—signed and sealed, as it were—has not been delivered. Instead, the commissioning group is now considering installing a rapid assessment centre for the elderly in its place. Obviously we must consider an ageing population, but in this particular case we should be considering the needs of the entire health care community in south Gloucestershire.

As the local MP for Kingswood, I feel that not to have a minor injuries unit for Cossham is unacceptable. With Frenchay A & E closing in just 70 days, if local people are in need of treatment for an injury, they will have to travel 11 miles to Yate, or have to travel across Bristol to Southmead hospital or to the Bristol royal infirmary. As many local people know, public transport to Yate and Southmead is woeful, with the bus often taking several hours. Without a minor injuries unit at Cossham, I remain concerned about health care provision for the east side of the Bristol region. I set out the case for a minor injuries unit in my letter to the Health Secretary on 26 February, and I would welcome the opportunity for the reformed Save Cossham Hospital group to meet the Minister to present the case in detail. There is a clear and present need for a minor injuries unit at Cossham, and a clear and present danger to our local community if it is not delivered.

I cannot impress enough on the Minister that I believe that, just as in the case of Frenchay hospital, and in the light of the highly critical IRP report on its changing services, the ability of health care bosses continually to chop and change health care services at Cossham and in the south Gloucestershire area without regard to public opinion and confidence is extremely damaging. Above all, it raises questions about why local people, who pay for their health service through their own taxes, should feel, as the IRP report states, “exasperated” by the uncertainty surrounding the health care for which they have paid.

The people of Kingswood and south Gloucestershire, as the IRP has firmly stated, “deserve better”. We also deserve better when it comes to the provision of a minor injuries unit at Cossham. We were promised a minor injuries unit, we want a minor injuries unit, and for the sake of the health and safety of local people in my community, we need a minor injuries unit at Cossham hospital.

First, I pay tribute to my hon. Friend the Member for Kingswood (Chris Skidmore) and congratulate him on securing this debate, and thank him for working closely with me on this matter, which is extremely important to our constituents. My remarks will focus on my local hospital, Frenchay.

Before I begin, I would like to declare a personal interest of sorts. I have had a lot of serious health issues over the past year and have spent a lot of time in and out of Frenchay hospital. I want to place on the record my huge thanks and appreciation to all the doctors, nurses and staff who looked after me and made me better while I was there. [Hon. Members: “Hear, hear.”] Thank you. I am pleased to say that I have now been given the all-clear and can get on with the rest my life. I do not think it is an exaggeration to say that I probably would not be here without all the care and treatment I have had over the past year, for which I will always be grateful.

Sadly, health care provision at Frenchay hospital is to be fundamentally reduced in May, when the main part of the hospital will close until 2016. Its out-patient and diagnostic services, and probably beds, will be relocated. The Independent Reconfiguration Panel has given advice to the Secretary of State and I fully understand that it would be unprecedented for him not to accept it. I am of course disappointed with the IRP’s decision, but it has made some extremely important points.

I am particularly concerned about which health services will be provided when and if Frenchay hospital fully reopens in 2016. The future health care provision in south Gloucestershire and the future of Frenchay hospital have gone through a terribly long, drawn-out process. There have been about 10 years of discussion and it is still not clear what will happen in the future.

The previous Labour Government made the changes in 2005, when a vision was set out for health services in the Greater Bristol area, which included plans for a community hospital at Frenchay. Five years later, in 2010, the “emerging themes” proposals for health care in the area again promised a community hospital at Frenchay and we were told that the acute care services would move to the new acute hospital at Southmead.

We were told that the community hospital at Frenchay would have step-down and step-up services. The step-down service would be for patients who received surgery at the new Southmead hospital and were moved to their local community hospital prior to going home. That was in order to reduce the number of beds required at Southmead and to enable family and friends to visit patients more easily during their convalescence. Step-up patients are those who require hospitalisation for more minor matters but who do not require the full services of an acute hospital. The bed numbers for the new Southmead hospital were planned on the basis of community hospitals such as Frenchay being available for more minor matters.

In total, it was recommended that there would be 68 beds at Frenchay. There was also going to be a range of out-patient services and diagnostics and an enhanced community health service in order for care to be provided at home. On top of that, there was going to be space left on the site for a doctors’ surgery, extra care housing and possibly even a nursing home.

That was fine: it was not what local people wanted, but at least it was a clear plan with clear objectives. However, in July 2012 the primary care trust and the clinical commissioning group began to change their minds, but they did not fully update the South Gloucestershire council public health and health scrutiny committee until April 2013. At this point, they also confirmed that a stocktake was being taken of out-patient and diagnostic capacity at Frenchay. In September 2013, the council’s health committee received confirmation that it proposed no longer to have out-patients and diagnostics on the Frenchay site, while the CCG met and decided in August that, for the interim, rehabilitation beds at Frenchay would be moved to Southmead for two years.

Conservative councillors on the health committee came up with a plan, and identified funds in the council’s budget to keep the in-patient rehabilitation beds at Frenchay for two years until the new Frenchay health and social care centre opens in 2016. They proposed the plans to the health committee in September last year, but to my utter amazement, Liberal and Labour councillors on the committee joined together to vote against the plan to keep Frenchay fully open. I felt that that was purely and cynically party political, and not at all in the interests of the people of South Gloucestershire.

In the end, all the council’s health committee as a whole could agree was to ask the Secretary of State for Health to refer the decision to the IRP. My right hon. Friend made the referral which, I must say, is more than the previous Government did; had they done so, we might not be in quite this situation now. My constituent Barbara Harris wrote to me this morning that the IRP has made “scathing comments” on the way in which local health care providers have handled the issue of Frenchay hospital. As my hon. Friend the Member for Kingswood has said, the IRP has said that it is understandable that residents

“should feel exasperated by the years of delay”

and by the “amendments to plans”. The IRP has concluded that the whole process shows a “marked lack of empathy” by local health care providers

“for patients and public who have the right to expect better”.

The North Bristol NHS Trust should now publish in full its findings on population growth and its stocktake of the diagnostic and out-patient capacity in south Gloucestershire, as the IRP suggested. That should be the local health care provider’s first step in fulfilling the IRP’s other recommendation on how hard it must work to regain the public’s trust. I fully agree with the IRP’s point that patient and public engagement must now be a core element in the design and delivery of how diagnostic and out-patient services are delivered in south Gloucestershire. I have said for a long time that health care providers should not feel that they can go back on their word as and when they wish.

South Gloucestershire council, our local residents and I need clarity about the plans for health care services in our area. Ten years down the line, my constituents deserve more than the ongoing confusion, broken promises and moved goalposts. I can understand why many of my constituents are not convinced that any health care provision, except perhaps a care home, will be left at Frenchay. I want a guarantee that health services are going to be provided at the Frenchay site in future. My constituents and I also want to know and to be reassured about the basis on which services will be provided.

I congratulate my hon. Friend the Member for Kingswood (Chris Skidmore) on securing this debate, as well as my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), on his speech. It is good that all three of south Gloucestershire’s MPs are in the Chamber, including the hon. Member for Thornbury and Yate (Steve Webb), who I know is listening to the debate with great interest, because it also affects his constituents.

Before I respond to some of the points that have been made, may I, as I always like to do, take the opportunity to highlight the wonderful work carried out every day by those who work in the NHS, particularly those in my hon. Friends’ constituencies? Carrying on great work and serving the public against a backdrop of uncertainty, as we have heard about this evening, is sometimes quite difficult, but I pay tribute to the staff there and right across the country.

As my hon. Friend the Member for Kingswood will be aware, the South Gloucestershire CCG is leading proposals for the future provision of health care services provided in the area, under the auspices of the Bristol health services plan. I hope that he will forgive me if, for the benefit of the House, I put on the record some of the twists and turns of the past 10 years. I recognise the frustration that has been expressed today. I felt some sense of it just on being briefed about the situation, so I can understand how it must feel from a local MP’s point of view.

The 10-year strategic plan, which began in September 2004 with an extensive public consultation, aims to improve the quality of care provided in the region; to move services closer to people’s homes and reduce travelling time for patients and carers; to bring together specialist hospital services; and to improve the quality of old hospital buildings. Under the plans, Southmead was selected as the location for a new acute hospital to replace acute services at the existing hospital in Southmead and the Frenchay hospital in south Gloucestershire. The new acute hospital at Southmead is due to open this spring. The West Gate centre in Yate and Cossham hospital will continue to play a role by providing medical and surgical out-patient services, hosting therapy out-patient services and providing X-ray, ultrasound and echocardiogram services.

I will turn first to the proposals for Frenchay. As my hon. Friends are aware, the 2010 proposals called for a new community hospital at the Frenchay site to provide up to 68 in-patient rehabilitation beds, out-patient therapy and diagnostic services. However, a 2012 review by the primary care trust concluded that the proposals for out-patient and diagnostic services were unaffordable and inflexible, and duplicated other services.

I understand that that was disappointing, but CCGs are charged with using their resources in the most effective way for the benefit of all residents. I am assured that the local NHS is committed to finding a long-term solution for the provision of in-patient beds at Frenchay. Although the CCG is commissioning 68 beds at Southmead for May 2014, that is a temporary measure while the Frenchay site is being improved to accommodate them after April 2016.

I will turn to the questions about the recent council referrals. My hon. Friend the Member for Filton and Bradley Stoke said that my right hon. Friend the Secretary of State had seized the challenge to refer the matter, and he mentioned some of the comments of the Independent Reconfiguration Panel. As he said, South Gloucestershire council’s public health and health scrutiny committee has the power to examine the proposals for service change and refer them to the Secretary of State if it considers that there are grounds to do so. The committee made two referrals to the Secretary of State. The first, which was made in October 2013, concerned the temporary provision of rehabilitation beds at Southmead hospital. The Secretary of State asked the IRP for initial advice on that referral on 2 November 2013.

Before that advice was completed, a second referral was received in December 2013 regarding the wider set of proposals under the plan, including the decision no longer to provide out-patient, therapy and diagnostic services at the Frenchay site. Specifically, the committee cited concerns that the new proposals for diagnostics and out-patient services would not be as convenient for patients as the option of maintaining three sites at Frenchay, Yate and Cossham. Additionally, the committee raised concerns about rehabilitation capacity in the light of population growth and financial sustainability.

In January 2014, the Secretary of State asked the IRP for further advice to take into account both referrals. That has now been received, as we have heard. After careful consideration, the panel does not believe that the referral warrants a full review. Acting on the advice of the IRP, the Secretary of State has decided that there should be no barrier to the local NHS continuing the implementation of the proposals in their current state. The Secretary of State wrote to South Gloucestershire council on Monday to confirm that he accepts the IRP’s advice and to agree that the implementation programme should be allowed to proceed. Both sets of initial advice are available on the IRP’s website.

The panel acknowledged, and I acknowledge from the Dispatch Box tonight, that the debate about the provision of health services in the area has been long and difficult. Delays, changes, pauses and amendments to the plans have all played a role, and the progress to date has suffered from a lack of trust and from poor communication. As I have said, I can only imagine the frustration that is felt by the local community at seeing that stop-start approach to commissioning and the reconfiguration of its local health services. My hon. Friends are right to raise these issues on the Floor of the House. Their constituents are fortunate that they have done so with such tenacity.

I will turn briefly to Cossham. As my hon. Friend the Member for Kingswood will be aware, the 2009 business case for Cossham hospital highlighted the fact that it serves a fast-growing population in the Kingswood catchment that has more older people and people suffering from long-term health conditions than other parts of south Gloucestershire. I understand that the growth in the number of older people has put increased pressure on local urgent and emergency care services, posing a significant challenge for commissioners.

My hon. Friends will be aware that in 2013, NHS England commissioned Sir Bruce Keogh to undertake a comprehensive review of how urgent and emergency care services are organised and provided in England. The report from the first phase of the review was published in November 2013. I think it is fair to say that it has transformed our national debate about the future of such services, and that all parts of the NHS in England are having to judge themselves against Sir Bruce’s recommendations and his road map for future excellence in urgent and emergency care. The subsequent phases of that review could have implications for how those services are organised for the benefit of local communities in future.

In parallel with that, the CCG decided to revisit the plans for a minor injuries unit at Cossham, in order to take account of local evidence and the themes emerging from the national review. It is clear that many local people want to see the MIU that was originally planned, which has been so ably argued for this evening, open as soon as possible and are frustrated about the decision to revisit previously agreed plans. For urgent care as for all services, the CCG’s priority has to be to ensure that the best possible combination of services is provided to meet the needs of the whole population, and that those services are sustainable and excellent for the long term. Achieving the right mix of services at Cossham will be an important part of the solution.

My hon. Friends the Members for Kingswood and for Filton and Bradley Stoke have made powerful cases. Although the task of getting the right mix of local health services is ultimately a decision for local clinicians, I would of course be happy to meet them to discuss the matter and hear their case, so that I can ensure that I have the clearest possible understanding of the issues that affect their area.

Once again, I pay tribute to my hon. Friends for their work on behalf of their constituents on the proposals. They have ensured that they have explored every possibility to ensure that they are part of an engaged process that will ultimately deliver what we all want for our constituents—excellent local health care. I congratulate them on that and look forward to continuing to engage with them on the issue.

Question put and agreed to.

House adjourned.