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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Thank you, Mr Hollobone, for calling me to respond to the debate. It is a great pleasure to serve again under your chairmanship.
I pay tribute to my hon. Friend the Member for Redditch (Karen Lumley) for her advocacy on behalf of her constituents and local patients, and indeed for paying tribute herself to the hard-working staff at her local hospital. As she rightly points out, the future of the Redditch hospital has been discussed for far too long and I hope that, during the next few months, we can come to a conclusion that will not only be of benefit to local patients but bring higher-quality care to people in Redditch and the whole of Worcestershire. Any redesign of services must be led by local commissioners and—crucially—must also consider the best interests of local patients; those redesigning services must listen to the voices of local patients.
My hon. Friend rightly outlined in her speech the fact that no hospital or trust operates within a vacuum in the NHS, and she is also right to say that private finance initiative deals in the local area have been problematic and have left a very damaging legacy; that has happened not only in her part of the world but throughout the NHS. We must learn lessons from that in the future. It is distressing and regrettable that bad PFI deals sometimes have an impact on neighbouring hospitals, and it is a position that we, as a Government, have inherited. We will continue to do what we can, by working with trusts with difficult PFI deals, to try to mitigate those difficulties.
My hon. Friend rightly highlighted the fact that decisions about her local trust have an impact on the wider health economy in Worcestershire, and that that broader impact needs to be taken into account by those making decisions about the Alex hospital. When my hon. Friend and I met my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi)—my hon. Friend the Member for Bromsgrove (Sajid Javid) was unable to attend that meeting—the point was made clearly that many hospitals in the wider health economy of Worcestershire have natural links with Birmingham. That must be taken into account when services are redesigned for the benefit of patients.
Increasingly, clinical evidence is stacking up that some specialist clinical services need to be run from specialist centres, because those centres produce much better outcomes for patients, so the link to the major population centre for the surrounding counties should be taken into account. As I say, we need specialist centres of excellence for the benefit of patients.
My hon. Friend the Member for Redditch made the point that the Alex hospital has a historical legacy of difficulties, with big, intermittent deficits at the local trust. There have been commendable attempts to deal with those difficulties, but there has been a difficult situation for a number of years. Clearly, we want to see long-term stability for Redditch, for the local trust more broadly and for the local health care economy. Key to achieving those things is having high-quality medical personnel working in the hospital, and the ability to retain and recruit high-quality consultants.
Peter Luff
To be clear, for the majority of Worcestershire residents Birmingham and its services are a very long way away and very inaccessible.
Dr Poulter
With regard to “bread and butter” day-to-day medical services, my hon. Friend is absolutely right to say that. My point was that for some services—for example, trauma or stroke—having specialist centres brings better results for patients, and there is good clinical evidence to back that up. However, day-to-day, higher-quality “bread and butter” services for patients—such as heart care or children’s services—are often best provided locally, and he is absolutely right to make that point.
Mr Robin Walker (Worcester) (Con)
I congratulate my hon. Friend the Member for Redditch (Karen Lumley) on securing this very important debate.
The Minister mentioned the issue of recruitment of clinical staff. One thing that the NHS in Worcestershire has worked very hard on is a cancer strategy to keep cancer care within the county and to make the Worcestershire Royal hospital a centre of excellence for cancer care. We are looking to secure a radiotherapy unit in the near future. I urge the Minister, in taking whatever decisions are necessary to ensure that the county has the strongest, most sustainable NHS, to pay attention to that work and to the importance of having a cancer service for the county.
Dr Poulter
My hon. Friend is absolutely right to praise the high-quality work done in Worcester to look after cancer patients. It is exactly the point that I was making in response to the intervention from my hon. Friend the Member for Mid Worcestershire (Peter Luff): the high-quality day-to-day services that patients need must be delivered locally, but more specialist operations—such as for head and neck cancer—might be carried out at a specialist site that is geared up for such operations. Day-to-day oncology care, however, is often best carried out locally, particularly when people are unwell with cancer and receiving sometimes very intensive treatment. In those situations, they need to be looked after locally.
It does not benefit patients, for medical and many other reasons, to have very long distances to travel. However, when surgical outcomes might benefit from operations being carried out at specialist centres, we must differentiate day-to-day treatment from the more specialist care that may be required as a one-off surgical intervention. We should do that when the evidence stacks up that specialist centres for such surgical interventions often deliver better results and better care for patients. Nevertheless, my hon. Friend is absolutely right to pay tribute to his local trust for the work that it does on cancer care in Worcester, which I know is very important to him personally.
I will now respond specifically to some of the points that have been made in the debate, and consider how we go forward from where we are now. Hon. Members, particularly my hon. Friend the Member for Redditch, have made us well aware, through their articulate contributions, of the challenges that are faced by the local health care economy. Such ongoing uncertainty about the future of local health care services is wrong and completely undesirable. When local commissioners bring forward proposals for the two options that are likely to be considered later in the month, I urge them to move forward as promptly as possible to bring certainty to the situation. That will allow consideration of important issues, such as the need to have high-quality professionals working in hospitals. When there is uncertainty about the future of a trust or a particular site within a trust, it can be difficult, as my hon. Friend rightly outlined, to recruit high-quality staff to work in that trust. That is not in patients’ best interests, so the sooner we can have certainty, the better. I know my hon. Friend will join me in urging local commissioners to bring things forward as expediently and quickly as possible.
As we know, the trust is committed to providing the best-quality care for patients. That is essentially about finding the best solution for the people of Worcestershire so that they receive the best care in the future. As my hon. Friend outlined, Worcestershire Acute Hospitals NHS Trust and the West Mercia cluster have jointly commissioned a strategic review of services in the area. The review is essential to secure the clinical and financial sustainability of high-quality services for local people. That is about looking not just at getting through the next couple of years, but at what will be right for the local health economy in five or 10 years’ time.
I understand my hon. Friend’s concern that there have been delays with the review, and I once again urge local commissioners to take things forward as expediently and quickly as possible. The Worcestershire joint services review started in January 2012, and it was expected to be completed by November 2012. I hope my hon. Friend is somewhat reassured that we will move forward more quickly, notwithstanding a patchy history on resolving local health care issues. There is a need for certainty locally, and we must make sure that the time line is met and that we have a firm conclusion.
Importantly, the review involves clinicians and commissioners across the area and the NHS. It engaged with local people last summer to inform the development of proposals. As we know, developing proposals for the future of local services is about clinical leadership and about clinicians saying what is important and in patients’ best interests, but it is also about local involvement and engagement. When I met my hon. Friend before Christmas, we discussed that. The local newspaper has played a tremendous role in promoting local patients’ needs. My hon. Friend and the local population should be proud of the cross-party consensus on the importance of Redditch’s future.
Through the review, local people will have made, and will continue to make, their voices and views clear. That is important for the Government and for our four tests for reconfiguration. It is also important that local health care providers, the local trust and the trust’s board listen to local people and local health commissioners to make sure that their views are informed by what local patients want and need and by what local clinicians say is in patients’ best interests.
The joint services review steering group met on 12 September 2012 and, unfortunately, decided to delay the process again until it could explore all options to allow it to maximise service provision at the Alexandra hospital, including investigating the potential to work with other NHS providers—Birmingham being a case in point.
My hon. Friend will be aware that the Redditch and Bromsgrove clinical commissioning group has started initial discussions with three NHS providers in Birmingham to explore the feasibility of providing services from the Alexandra hospital: the University Hospitals of Birmingham NHS Foundation Trust, Birmingham Women’s NHS Foundation Trust and Birmingham Children’s Hospital NHS Foundation Trust. Those discussions are still in their early stages. However, my hon. Friend is right that when proposals are brought forward—hopefully, by the end of this month—we should move things forward quickly for the benefit of local patients.
No decisions have been made, and the discussions are only about the Alexandra hospital—that needs to be clearly set on the record. The Worcestershire Acute Hospitals NHS Trust would continue to provide all other services. Given the concerns my hon. Friends have raised, it is important to note that, although the services the trust provides need to be seen holistically, the ongoing discussions are about the specific future of Alex’s site in Redditch. That is an important distinction, and I hope it gives my hon. Friends some reassurance that any proposals are unlikely to disrupt local services to the patients they care about.
Ultimately, the decision is for local determination, and it would not be appropriate for me to comment on the discussions in further detail until we have firm proposals. We will continue to meet regularly. I am visiting Redditch in the near future, and will take a keen interest to make sure I can do all I can to support the right result for local patients.
Mark Garnier
The Minister will no doubt know what is coming: will he visit Kidderminster when he is next in Redditch?
Dr Poulter
I would be delighted to visit Kidderminster hospital. It might not be on the same day I visit Redditch, but I will make sure I put it on my list of priorities to visit. I would be delighted to see the excellent work done at Kidderminster hospital and, indeed, at Worcester, at some point in the near future. In addition to the bit of clinical work I still do, I prioritise going out on a Thursday as regularly as I can to see the NHS on the ground and to see what is going on. I would be delighted to visit other local trusts, when I can fit them into the diary, later in the year.
What are the next steps? If agreement is reached on a clinically and financially sustainable solution in the interests of local people, a robust process needs to follow. The Worcestershire joint services review steering committee will meet on 26 February to set out options for consultation. We are then likely to have two options regarding the way forward. One is likely to involve Worcestershire Acute Hospitals NHS Trust continuing to operate services from the Alexandra hospital. The other is likely to involve exploring the feasibility of the Birmingham foundation trust operating services at Alexandra hospital, if that is in local people’s best interests.
The final proposals will require the support of the NHS in Worcestershire. However, the local NHS has assured me that it will continue to engage with people while proposals are finalised. Of course, I would expect any proposals to meet the four tests for service change that we have clearly outlined—principally, that any changes are clinically led and have strong patient and public engagement. The local NHS expects final proposals to be ready for public consultation later in the summer. However, it is vital, as we have stressed throughout the debate, that we hold those involved firmly to their task and reach a conclusion for the sake of staff and patient certainty and for the benefit of the local NHS.
Karen Lumley
One of my questions was: who actually owns the Alexandra hospital?
Dr Poulter
As my hon. Friend will know, the local hospital is designated as part of a trust. It is a non-foundation trust, so there is direct regard to the Secretary of State in some matters relating to the trust. I hope that gives her some reassurance. Of course, the NHS is owned by all of us, which is why it was so important when we set out our four tests for reconfiguration that we made sure they were about strong clinical leadership in the best interests of patients, as well as strong patient and public engagement, so that patients and the public can clearly see that any changes to local services are in their best interests and so that they can properly engage in the process. There has been strong local feeling and opinion on this issue, and I am sure it will be listened to carefully when decisions are taken about the future.
In conclusion, I encourage my hon. Friends and local people to participate in the consultation process to ensure their views are fully taken into account. I will maintain a keen interest. I am looking forward to visiting each site in the trust in due course. I am always available to talk through matters if Members have concerns.