Accident and Emergency Departments

Iain Wright Excerpts

Thursday 7th February 2013 Commons Chamber

[Mr Iain Wright (Hartlepool) (Lab)]

The A and E department at the University hospital of Hartlepool closed in August 2011. I want to raise five points relating to the experience of the 18 months since.

First, clinical safety is paramount in all health reconfigurations. There was clear consensus among senior medical staff that there were significant safety issues with the A and E at Hartlepool. The number of medical staff was insufficient to cover two rotas at Stockton and Hartlepool, and the supervision of junior medical staff was inadequate and did not meet modern guidance criteria. When senior clinical staff say that lives will be saved if changes are made, it is irresponsible for anybody, whether elected representatives or others, not to listen to those expert voices.

Despite the paramount importance of clinical safety, however, it is clear that the people of Hartlepool did not and do not want the closure of their A and E department—no community does. More provision can be made outside the hospital setting and in the local community to make services closer and more convenient to where people live. A One Life centre—a minor injury unit—has been built in the heart of the town centre and should be more easily accessible to a greater number of the town’s population. That is a welcome step. During a debate on A and E in September 2010, I said:

“Moving more serious cases to North Tees is very unwelcome as it is detrimental to my constituents”.—[Official Report, 14 September 2010; Vol. 515, c. 202WH.]

I stand by that.

My area has seen bitter disputes about the reconfiguration of acute services for the best part of 20 years. There is real tension between the views of professionals, who are best placed to consider the safest and most clinically effective means of providing a service, including in specialist concentrated centres, and the general public who will be the recipients and beneficiaries of that service, and who will pay for it through general taxation, even though they may often disagree with the means and location of that service. Successive Governments over two or three decades have failed to reconcile that basic tension. The concept of “No decision about me, without me” and the four tests of reconfiguration that are often bandied about are a fallacy. It is an understatement to say that Hartlepool would have preferred to maintain a full A and E service. People do not feel as if they have had a proper say in the matter.

Safety, changing medical practices and, increasingly, financial considerations, will play the decisive role in where A and E and other health services are located, and invariably it will be against the general wishes of the local population. I would be interested in the Minister’s views about how that tension between clinicians and the public can best be resolved.

That was my second point. My third point concerns communication about where a patient should go. If a child bangs his or head in Hartlepool tonight, where should their parent take them? Previously, it was a relatively simple choice—they went to A and E. Now, a parent is confronted with going perhaps to the A and E at North Tees hospital, perhaps the One Life minor injuries unit and urgent care centre, or even the university hospital of Hartlepool. The new arrangement seems more complex and fragmented, and surely if the system contains greater complexity and fragmentation, there is greater risk.

Some 18 months after the A and E closure, the system is bedding down; it was not perfect from day one, although that is another matter. However, I am not convinced that the risk is being adequately managed. There is inadequate communication and subsequent misdiagnosis, leading to obvious and understandable alarm among my constituents. What will the Minister do about that?

My fourth point concerns the pressing and persistent need to link reconfiguration of health services with transport policy. Such a link is just not there at the moment. How on earth will my constituents be able to travel to North Tees hospital 13 miles away? The hospital is a long way from many of them and difficult to get to. Hartlepool has low rates of car ownership and poor public transport links, and bus services are virtually non-existent, certainly at weekends and evenings. I would not have thought that the Government or local NHS trust wanted the public to rely solely on ambulance services. The point I wish to stress, and which I hope the Minister will address, is that any reconfiguration of services requires transport and accessibility at its heart. At the moment, transport policy is merely being paid lip service. What will the Minister do about that?

My final point is about the wider reconfiguration of health services north of the Tees. Although, as I said earlier, much of the decision to close Hartlepool A and E was based on immediate clinical safety grounds, it is fair to see that decision in the context of the Momentum programme, which is designed to move health services out of the hospital setting and into the community. The Momentum programme culminates in the building and opening of a new hospital in Wynyard, which is designed to incorporate the most advanced equipment and medical and surgical practices and serve the acute health needs of the populations of Hartlepool, Stockton, Sedgefield and Easington. The original plan was for construction to start last year and for the first patients to be admitted by 2014-15. Soon after taking office, however, the Government withdrew public funding for that hospital, and despite warm words and a series of announcements from the Foundation Trust Network, no alternative source of private funding has been approved. We do not appear to be any further forward.

Two procedures are running dangerously out of parallel. We have the Momentum programme, with the reconfiguration of services, and the funding programme for the new hospital. That is now three years out of date and there is no concrete indication that private funding is on the table. Services have been moved without any clarification about the endgame. My big fear is that my constituents will have the worst of all possible worlds with services moving to North Tees and no new hospital. Something must be done.