The Minister of State, Department of Health (Mr Simon Burns)
I congratulate the hon. Member for Warrington North (Helen Jones) on securing this debate, and I totally agree that it is important for patients to have access to high-quality vascular services. I know that she is an active campaigner locally on health issues and a strong supporter of local health services.
The hon. Lady has raised a number of issues about the current review of vascular services in Cheshire and Merseyside. I appreciate that her constituents may be concerned about proposed service changes and want to be assured that they will have access to these services. Due to the shortage of time available, I hope she will forgive me if I do not go into the detail of the background at national level of all that the Government and the NHS are doing on vascular services, health checks, screening and so forth. I would like to address the situation in her constituency that she has raised. If I do not have enough time to provide all the answers to her questions, I assure her that I will write to her.
Currently, the commissioning of complex vascular services varies. In some areas, they are commissioned by regional specialised commissioning groups, but in others they are commissioned by individual primary care trusts. Evidence shows that, in order to maintain the safety and quality of these services, it is better that they are commissioned for larger populations.
There is robust evidence, highlighted by the work of the Vascular Society of Great Britain and Ireland, which shows that patient outcomes are best when complex vascular care is delivered by units that treat higher volumes of patients. In response to that evidence and national screening for abdominal aortic aneurysms, vascular services are being reviewed locally across England.
Reflecting that approach, in June 2010, the NHS in Cheshire and Merseyside embarked on a review of the way in which vascular services are delivered. It deals with non-cardiac vascular services for conditions such as abdominal aortic aneurysms, strokes and mini-strokes. Cardiac services continue, and will continue, to be provided in local hospitals in Cheshire and Merseyside. Vascular services are provided by nine district hospitals across Cheshire and Merseyside, including Warrington hospital in the hon. Lady’s constituency.
The review proposes that local hospitals should work in partnership to deliver the range of vascular services, with arterial complex interventional radiology and emergency surgery being carried out in a small number of arterial centres. Out-patient clinics, initial investigations and follow-up treatment will continue to be provided in local hospitals, including hospitals in Warrington and Halton. Patients with a vascular emergency will be taken to their nearest local hospital—unless the referring GP suggests otherwise—where they will be stabilised. If they require further emergency or arterial surgery, they will be transferred to the arterial centre. I have been informed that vascular surgeons will be based at local hospitals as well as arterial centres, which will ensure that patients can have access to their expertise.
Helen Jones
How many vascular surgeons will be based at Warrington, and what kind of rota will there be? The Minister knows as well as I do that problems occur with rotas when those surgeons are not available.
Mr Burns
Given that I want to deal with some of the other points raised by the hon. Lady, may I write to her about that? Given the shortage of time, I suspect that I shall also have to write to her about a number of other issues.
The Cheshire and Merseyside vascular review project board led the review, and was advised by a clinical advisory group consisting of local clinicians, including some from Warrington. The group developed a set of standards that each vascular network would need to meet, along with locally agreed minimum activity thresholds. They were considered in the light of the size of the population served by Cheshire and Merseyside. On the basis of advice from the clinicians, the project board concluded that, given the clinical activity and population size, it would be best for two vascular networks to serve populations in north and south Mersey, and that each network should have its own arterial centre.
In January 2011, the project board undertook a pre-consultation of local people, which included public and NHS staff meetings. They presented the pre-consultation to the local overview and scrutiny committees in every local authority across Cheshire and Merseyside, and wrote to local MPs, including the hon. Lady and, I assume, the hon. Member for Halton (Derek Twigg) and my hon. Friend the Member for Warrington South (David Mowat). In October 2011, the board provided the commissioners in Cheshire and Merseyside with a report setting out its findings and recommendations. The report proposed that the arterial centre in the north Mersey network should be based at Royal Liverpool university hospital, while the arterial centre in the south Mersey network should be based at either Warrington hospital or Countess of Chester hospital. However, the final decision was left to commissioners.
The two joint bids for the south Mersey network from the Warrington and Chester trusts were presented to the clinical commissioning group chairs in Runcorn, Widnes, Warrington, Wirral and Western Cheshire. The commissioning groups, including Warrington, unanimously decided to recommend to the PCT cluster board that the arterial centre for the south Mersey network should be based at Countess of Chester hospital. I understand that they felt that the joint bid from Chester and Wirral contained the most credible plan for developing a networked vascular service for the populations of Warrington, Halton, Western Cheshire and Wirral, while facilitating a full range of local hospital services. I appreciate the hon. Lady’s concerns about the impact on Warrington hospital of the arterial centre being located at Chester. I understand the project board commissioned an impact assessment of the changes on Warrington, which highlighted a number of issues, but it concluded that these could be mitigated. The proposals have been considered by the Cheshire, Warrington and Wirral and Merseyside primary care trust cluster boards, which have supported the project board’s recommendations, subject to formal public consultation.
The proposals will also be subject to gateway review and national clinical advisory team assessment, as well as assurance from NHS North West that they meet my right hon. Friend the Secretary of State for Health’s four tests for service change: the proposals must demonstrate strengthened public and patient engagement; be based on sound clinical evidence; there must be support from GP commissioners; and there must be consideration of patient choice.
David Mowat (Warrington South) (Con)
The Minister is describing in some detail the process by which the nine centres that previously existed are to be reduced to two, and we can, perhaps, accept the logic of that. This is a piecemeal decision for one type of service, however. If every centralisation decision is taken in a piecemeal way, Warrington and Halton might well lose every single time. When decisions on centralisation are made, should there not be some kind of strategy for deciding what will end up where, so that every decision is not made on a piecemeal basis?
Mr Burns
If my hon. Friend means by “piecemeal” that the decision is dealing only with a certain part of the country, then that is indeed the case. However, the review was carried out in the context of a wider geographical area in and around Merseyside, and in that respect it is achieving its aim of finding the most relevant service for the local communities. That is why the recommendation was to have two arterial centres located there.
The hon. Member for Warrington North raised the issue of population, as she believes, I think, that there should be a third centre. The following point is based on advice from both the Vascular Society of Great Britain and Ireland and the local clinical advisory group. The population in the area under discussion in respect of this decision on services is 1.2 million, whereas the figures that would be required to have a third centre are 1.4 million for the vascular networks and 1.6 million for abdominal aortic aneurysm screening programmes. Therefore, the population currently under discussion is too small to warrant an extra centre. I hope she will accept that.
Mr Burns
No, as there is not sufficient time.
On the proposals for consultation, I have been assured by NHS North West and the PCT cluster boards that an implementation steering group will ensure that the recommendations made in the impact assessment are taken forward. The final proposals will be subject to formal public consultation in 2012.
I appreciate that the hon. Lady and her constituents have concerns about the proposals for vascular services. However, I should stress that these proposals have been developed by the NHS in Cheshire and Merseyside based on advice by clinicians made in the light of best practice recommendations by the Vascular Society of Great Britain and Ireland. I therefore encourage her to take the opportunity to discuss the proposals with the Cheshire and Warrington and Wirral PCT cluster boards while they are being prepared for formal consultation, which will take place next year, as I mentioned earlier.
Question put and agreed to.