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House of Commons Hansard
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A&E Provision: Shropshire and Mid-Wales
11 January 2017
Volume 619

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

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In the previous Parliament, we took action to empower local doctors, surgeons and clinicians to think about the optimum way of providing hospital services under ever-changing circumstances, namely the demographic and other changes that are taking place in our society. That was the right step to take. Rather than remote civil servants in Whitehall making those decisions, we wanted to ensure that the people at the coalface provided those services—people who already provide services to our constituents; people with medical expertise; people who have dedicated their lives to improving the care and safety of others. We wanted to empower them to make those decisions.

I stand by the decision that we took, but I want to tell the Minister this evening about some of the practical problems that have ensued in Shropshire as a result of that devolution of power. I do so because I believe in the process and want to ensure that it is retained and protected for future programmes.

We have two hospitals in Shropshire: one in Shrewsbury and one in Telford. They do not just look after the people in those two towns; they look after all the people throughout the whole of Shropshire and mid-Wales. I am not going to go into all the specifics of the Future Fit programme with the Minister, as I and the other Shropshire MPs have briefed him repeatedly about the process over the past few days, weeks and months. However, I would like to thank, in a genuine and heartfelt way, the 300 surgeons, doctors, GPs and medical consultants in our community in Shropshire, who, despite the extraordinary pressures they face already in their day-to-day work in the NHS, have been able to dedicate themselves to and persevere with, despite the many problems and obstacles in their way, coming up with the Future Fit proposals for a reconfiguration of accident and emergency services in Shropshire and mid-Wales. A decision has been achieved after three years and £3 million of taxpayers’ money.

There was going to be a public consultation on that decision. Unfortunately, it has been blocked by Telford clinical commissioning group and Telford Council. Telford CCG has been a part of the process from its inception and it was consulted throughout. At the eleventh hour, however, when the decision did not go the way it thought it would or the way it wanted it to go, it decided, to a man, to vote against the proposals—even though it was party to the whole methodology and process.

In addition to Telford CCG voting against the changes, Telford Council—an esteemed body no doubt, but one, I would argue, with somewhat limited medical experience—has decided to threaten the Future Fit programme with a judicial review if the public are allowed to have the final public consultation. Of course, in a democracy Telford Council has the right to challenge things. Of course, in a democracy Telford Council may even have the right to use taxpayers’ money to instigate a judicial review. What the Minister must remember and retain from our experience, however, is that these two parties were a part and parcel of the whole process from its inception. I have a real and genuine concern about the integrity of the process if we do not back the local clinicians and doctors.

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Will my hon. Friend give way?

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I will of course give way to my hard-working neighbour from Telford.

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I thank my hon. Friend for securing this debate. I tried to secure a debate with a very similar title. Does he agree that the Telford clinicians have an absolute right to express their views, just as the Shropshire clinicians do? The fact that they did not come to the same view is no indication that the Shropshire clinicians came to the wrong view.

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As I said earlier, of course they have the right to do so. Let me take this opportunity to acknowledge the work my hon. Friend has done since she became a Member of Parliament to campaign for Telford, and to campaign very strongly and effectively on this issue without being overtly political or personal, unlike some other people. I will come on to talk about the CCG a little later.

I reiterate that my concern is for us all to put our cards on the table. We all went along with the Future Fit process. The decision could have gone against Shrewsbury. Ultimately, the decision has been made to have the urgent care centre in Telford and that the main A&E service should be provided by Shrewsbury. That decision could have gone the other way. It could have gone to Telford, and we would have lost out. At the end of the day, it should not be about winning or losing—that is the biggest problem.

My right hon. Friend the Member for North Shropshire (Mr Paterson) has talked about the pillow fight that has gone on between Shrewsbury and Telford ever since he became an MP. Over the past 11 years, I have lost more sleepless nights over the constant fighting between Shrewsbury and Telford about hospital services than over anything else. At the end of the day, we are one county and we must fight collectively as one county for all the people of Shropshire, and of course for our friends across the border in Wales.

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I congratulate my hon. Friend on landing this debate. He is absolutely right. This bickering between Shrewsbury and Telford has dogged my nearly 20 years in Parliament. I thoroughly back Future Fit because it provides a solution that benefits everybody. I like the idea that the two existing A&Es carry on doing 80% of their current work, albeit—possibly—having been renamed as urgent care centres, while we get a £300 million emergency care centre. Some of my rural areas look to Shrewsbury, some look to Telford, but we will also gain from urgent care centres being built in the rural areas. What is utterly exasperating for my constituents is this indecision. We have had three years and £3 million spent, and still no decision. I am delighted that the Minister is listening so carefully and I very much hope that at the end of the debate we will have a clear recommendation for a decisive mechanism to deliver the will of the local commissions.

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I could not agree with my right hon. Friend more, and I pay tribute to him for the work he has done on this over the last few years.

I would like the Minister to intervene to ensure that the process allows for a decision. In our case, all six members of the Shropshire CCG voted for the proposals and all six members in Telford voted against. I am very concerned—I want him to take this away—about this. What sort of a process is it when we can get a tie? There needs to be a casting vote or perhaps some independent third party who can arbitrate in such a hotly contested issue where the two local CCGs cannot come to an agreement. So I would like to hear from him on that.

I appeal to constituents from the whole of Shropshire and mid Wales to lobby Telford Council, to get behind the concept of us all working together, as my right hon. Friend said, and to lobby the Government more effectively for more resources, rather than fighting one another in a rather parochial way over where these services are going to be. Let us not forget how close these two hospitals are to one another. We are not talking about 50 miles, 30 miles or 20 miles. Somebody might correct me if I am wrong, but I think they are only 13 miles apart. We ought to be thinking about how to improve and modernise the provision of healthcare for all the people of Shropshire and mid-Wales and listening to the proposals of the medical experts, who have done so much work to put these proposals together.

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I thank my hon. Friend for bringing this debate forward. Both my hon. Friend the Member for Montgomeryshire (Glyn Davies) and I represent seats in Powys, in mid-Wales, which, as he said, does not have a general hospital. It is one of the few councils not to have one. We rely heavily on both Telford and Shrewsbury, certainly in the top end of my constituency. I appeal to the Minister: our constituents are very concerned. Even though health is devolved in Wales, many of our constituents travel across the border, and for them this is a vital issue.

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I thank my hon. Friend for his intervention. He is absolutely right. In fact, my colleague from just across the border, my hon. Friend the Member for Montgomeryshire (Glyn Davies), always joins us at our meetings with our hospital trust. We almost think of him as a Salopian. [Hon. Members: “Steady!”] Not quite, but he does so much to represent his constituents in Wales, who already have to travel long distances to get to the Royal Shrewsbury hospital. He might correct me if I am wrong, but I think that some of them, from the extreme west of his constituency, already have to travel for over an hour to access A&E services in Shrewsbury. So any movement even further away from Shrewsbury would be completely unacceptable to his constituents.

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I come from a peripheral position, further to the west of Montgomeryshire. I congratulate the hon. Gentleman on securing this debate and stress the importance of getting this right, because it has an impact further to the west. If this issue is not resolved, it will impact on the capacity of my district general hospital in Aberystwyth to serve the people of mid-Wales as well. It is crucial to address this issue.

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I concur with the hon. Gentleman, and I am grateful for his intervention.

I shall start to end because I want to give the Minister as much time as possible to answer these questions. Let us not forget that if we get this right, it could result in an investment of £300 million into the NHS in Shropshire. I do not know about all my colleagues—I know that my right hon. Friend the Member for North Shropshire has been an MP for longer than me—but I certainly do not remember a time during my 11 years as an MP when we have had such an investment in the local NHS. As I say, if we get this right, we could see an investment of £300 million in Shropshire to implement these changes.

I know that there is more work to be done to secure this money. I know that more work will have to be done in innovative ways, both locally and nationally, to secure all the funding. If we do not sort ourselves out, however, we are going to get further and further behind, while other areas in the United Kingdom—this is not an issue peculiar to Shropshire—that are going through this process in a more cordial and mutually effective way are going to jump the queue, and Shropshire will be left right at the end. I am not prepared to see that happen.

Finally, Telford Council would obviously have us believe that as part of this programme, women and children’s services have to be moved from Telford to Shrewsbury, because the main A&E will need to have women’s and children’s services next to the main A&E provider at the Royal Shrewsbury hospital. The council says—this is an important point that I want the Minister to note—that because these services were moved from Shrewsbury to Telford a few years ago, such a move would lead to the waste of £28 million. It repeatedly talks about this through the local media. No, no, no. It is not a waste. The building will be used for other purposes, and all the equipment in it, which is easily moved, will be moved to Royal Shrewsbury hospital. So I refute any proposal that there has been a waste of the £28 million invested in women’s and children’s services because of the changes that will take place.

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I thank my hon. Friend for giving way on that incredibly important point. Will he accept that the brand-new women and children’s unit in Telford has been there only since 2015 when it was opened and that the proposal to close it is of huge concern to all my constituents? I am sure he will understand why that is.

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I do understand that concern, and the previous chief executive of the trust responsible for those changes is, I believe, now working in Qatar. It caused a great deal of controversy at the time. Of course, the Government, Ministers and Future Fit will have to do more to alleviate those concerns, but at the end of the day, as my right hon. Friend the Member for North Shropshire has stated, a decision has to be made.

With that, I end my speech and thank you, Madam Deputy Speaker.

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Thank you, Madam Deputy Speaker, for allowing me to speak on what is the most important and concerning issue in my constituency over recent years—and it is certainly particularly acute at this moment. I would love to make several points and make a full speech at some stage, but on this occasion, I shall restrict myself to making just three points that I hope the Minister will address.

First, I emphasise the importance of the title chosen for the debate: A&E Provision: Shropshire and Mid-Wales. We so often assume that health is devolved, but the reality is that it is a devolved form of government, but it is not independence. The position is that in much of Wales, the system and the financial arrangements between the Governments allow for people to come to Shropshire. Nearly all Montgomeryshire’s patients who want secondary care, elective care and emergency care go to Shropshire. We depend absolutely on Shropshire, so I am hugely grateful that this debate is about Shropshire and mid-Wales.

My second point concerns the position of A&E units throughout Britain. We know perfectly well what the problem is: too many people are going to A&E without what we think of as reasons to need emergency treatment. We know that about 20% of the people who go to the A&E units in Shropshire should be going to the emergency centre because their conditions are life-threatening, with the remaining 80% going to the two centres in Telford and Shrewsbury. They will still effectively be A&E units, but they may well be referred to as urgent care centres. We know that that system will work.

This is my final point. Our two clinical commissioning groups set up a Future Fit programme board to make recommendations. It spent three years and £2 million—it could have been £3 million—producing a report which made it clear that the emergency centre should be based at Shrewsbury. It was a huge shock to my constituents when that recommendation was not accepted. Everyone is flabbergasted. I merely ask the Minister to give us some idea of how we can move forward from the shambles that is putting the interests and the care of my constituents—who are already having to travel for an hour to Shrewsbury for treatment—at the centre of the plans for Shropshire. That is vital to us. I hope the Minister will tell us how we can provide safe care for the people of Shropshire and the people of mid-Wales, which is our duty.

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In the few minutes available I shall give the House a recap, describing the process that we have undergone, the impasse that we have reached, and what it has been suggested we do to bring about a decision. I agree with my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) that it is important for us to make that decision and to get it right. The provision of better A&E services for the whole county in a way that works for everyone should not be the divisive issue that it has become.

First, however, I think it appropriate to reflect on the 2.7 million people who work in the NHS and the care system and to acknowledge and congratulate them on the work that they do. Today, as every day, some 2 million people have used A&E services across the country. Let me also say that my hon. Friend the Member for Shrewsbury and Atcham has worked diligently on this issue, as have other Members, including my hon. Friend the Member for Telford (Lucy Allan). I know that it is difficult for them to get this right for their constituents.

At the beginning of his speech, my hon. Friend the Member for Shrewsbury and Atcham made the important point that, ultimately, this must be a local decision. It is not a decision for Ministers, and it will not be imposed. It will be made by the local governance bodies that have been established, notwithstanding the present impasse.

Let me summarise what has been happening. This is a tale of two CCGs and a hospital trust providing services across Shropshire—in Ludlow, Bridgnorth, Oswestry and Shrewsbury—and, indeed, in mid-Wales, including Powys. I agree with my hon. Friend the Member for Montgomeryshire (Glyn Davies) that we need to get this right for the people of Wales as well. The process has been going on for a long time, but the driver for change is not financial. We are finding it increasingly difficult to staff the two A&E centres in Telford and Shrewsbury. Rotas are not being filled, and it is feared that unless we find a robust solution, there will be safety issues and it will not be possible to keep the centres open for as long as we want.

My hon. Friend the Member for Shrewsbury and Atcham observed that this was not a new issue, and that is certainly true. I understand that it is being discussed locally and that projects have been reviewing it since about 2005 without a solution being found. The Future Fit project was set up in 2013. As has been said, the process ended at the end of last year with a preferred option, which was, in broad terms, that emergency care should be centralised in Shrewsbury, with urgent care continuing to be in both locations. I heard it said in the debate earlier that that would mean most patients would continue to be served closer to where they are, either at Telford or Shrewsbury.

On the governance issue, the report of the Future Fit process was voted on by members of the two CCGs, who have broadly a 50% share in that decision, and the result was a tie. Indeed, Telford CCG raised concerns about the methodology of the process and the appraisal techniques used and whether it was robust and fair. As a consequence, there has been no agreement and we have reached our current impasse.

I understand that at the end of December an editorial in the Shrewsbury Star—

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Shropshire Star.

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Sorry, an editorial in the Shropshire Star—it is not a newspaper I read—made the point that we now need to get this right; we need to make a decision and to stick by it. I think everybody in the Chamber would agree with that, with the caveat that in the end it has to be a local decision. There are very real battle lines here; I think my hon. Friend the Member for Telford met the Secretary of State yesterday on this with other Members and council leaders.

What is the proposed way forward? My briefing from the CCGs is that a week today there will be a meeting at which the intention is that two things happen. The joint committee will be reconstituted and an independent chair appointed who will have a casting vote. In parallel with that, there will be an appraisal, or review of the appraisal process, that Future Fit takes, with the intent to address the concerns raised by Telford about whether it was robust. At the end of the review—depending on the outcome, I guess—there will be a new vote with a view to potentially having a majority on one side or the other and therefore there will be a local direction. That is my understanding of the way forward.

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It is tremendous news that there will be a mechanism that will give us the ability to come up with a clear answer. Does the Minister have any idea of the timescale for this new process?

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I have been advised that the timescale is in the order of eight to 12 weeks, but it remains a local decision. That is what we hope and expect to be the case.

In finalising my comments, I want to make a couple of observations.

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I am pleased with the Minister’s announcement; hopefully we will see a conclusion to this. May I appeal to him to take an active interest in the process in these eight to 12 weeks because the integrity of this devolution of power is at stake unless we empower the clinicians to take the decisions we have ultimately empowered them to take?

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I am happy to agree to that, although I should have said at the start of my remarks that in the normal course of events this debate would have been answered by my ministerial colleague, my hon. Friend the Member for Ludlow (Mr Dunne), as he is the Minister with this responsibility, although he is not independent on this, so it is appropriate that I answer for the Government.

Once the decision has been taken and a consultation occurs, a component of the proposal will require capital. Various numbers have been floated around, one of which is £300 million. I do not believe that NHS England has yet confirmed that that capital is available, so there is a hurdle to be overcome once a local decision has been taken. I do not want to raise expectations that the process will necessarily be straightforward. This is the way in which the process will occur, as I am sure colleagues would expect. If, as a result of that stage, capital is awarded, there is the potential for those on either side of this discussion to take the configuration proposal to the independent reconfiguration panel. That is always the case in such processes, and the panel can accept or not accept what has been suggested. That is the normal process in the NHS.

I want to make one final point to all my colleagues, who are so keen to get this right for their constituents in Telford and in Shrewsbury. I ask them to remember that the NHS is not just about bricks and mortar. We often have discussions about the bricks and mortar, but I want gently to point out to right hon. and hon. Members that there are other things that they should be holding their clinical commissioning groups to account for. They should be looking at cancer performance, cancer survival rates and maternity performance, for example. There are many aspects of the NHS that are not about bricks and mortar, and it is important that Members should recognise that when we debate these matters.

Question put and agreed to.

House adjourned.