Healthier Together Programme (Greater Manchester)

Kate Green Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Kate Green (Stretford and Urmston) (Lab)]

It is a great pleasure to speak in this debate, and I am grateful to my hon. Friend the Member for Blackley and Broughton (Graham Stringer) for introducing it.

I am here to express the concerns of my constituents in relation to what my hon. Friend has rightly described as a consultation that people are either completely unaware of, or, if they are aware of it, unsure what they are being consulted about, what the next steps might be, where decisions will be taken and by whom. As he said, everyone understands the pressures that we face within the NHS in Greater Manchester and across the country.

[Andrew Bingham (High Peak) (Con)]

I know that the consultation is about Greater Manchester, but may I just put it on the record that the impact of this consultation will go far beyond Greater Manchester? My constituency is split between relying on Stepping Hill hospital and Tameside hospital, so this consultation affects us as well. I just wanted to put that on the record, so that people are aware of it.

[Kate Green]

The hon. Gentleman is absolutely right, and I am pleased to see that the hon. Member for Macclesfield (David Rutley) is also present this afternoon. The ripple effect of the consultation, on hospitals in neighbouring areas and indeed—as I will go on to talk about—on the wider north-west and northern region of the country is quite significant in one reading of what is going on.

It is true that the pressures of rising demand on the NHS are well recognised, as are the cost constraints on social care provision. However, my constituents in Trafford were told all that three or four years ago, and we went through our change programme. We feel that we have been here before and, for us, this is groundhog day and a bit worse than that. We underwent the consultation “A New Health Deal for Trafford”, which took place in 2012 and culminated in the downgrading of Trafford general hospital. Looking at how the current consultation has been launched, I am concerned that a number of lessons that were learned from that Trafford process are being totally ignored.

I say clearly that I am not against sensible reconfiguration of acute services. I am very much in favour of concentrating expertise and specialisms in a small number of expert sites. I am entirely in favour of as much provision as possible being pushed into the community to front-line, preventive, community-based care, and of keeping people at home to receive that care for as long as possible.

However, if this is a consultation about the provision of integrated community-based care, it is not possible to go down the road of consulting about that provision and withdrawing services in acute settings before we are clear what the landscape and the reality of that community provision is. Nor is it possible to go down the route of suggesting that some acute services might be rationalised or closed when existing acute services are under so much pressure already. In particular—I know that my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) will talk about this issue too—one consequence of the downgrade of Trafford general hospital’s accident and emergency provision is that during the past nine months the waiting times and queues at Wythenshawe hospital have been significant, with little sign yet that they will be reduced.

In addition, I point out that we have some real uncertainty. My hon. Friend the Member for Blackley and Broughton mentioned the uncertainty that exists around trauma services, maternity services and so on, but we also have uncertainties in Trafford in relation to some of the primary provision that will be in place. We know that the NHS local team and the clinical commissioning group envisage a two-hub model of primary care and community-based care for our borough. The provision in the south is largely established, but in the north—including in my constituency, where we have some of the worst health outcomes in the borough—we are still completely unsure what sort of hub will be put in place, as the NHS local team and NHS England are quite unable to tell us what the funding for that kind of hub model will be.

I know that the Secretary of State for Health is aware of that particular situation and I am grateful to him and his office for what they are doing to try to unscramble it, but from the point of view of my constituents the idea that they will be consulted on a major reconfiguration, either of primary care or of acute services, does not inspire their confidence, because currently they simply see deficiencies in those services and particularly because they believe that their voice counts for little when it comes to the decision that will ultimately be taken.

Not only is there pressure in the system, but the NHS seems to make some really perverse decisions as it goes along, because of its rather hand-to-mouth approach to planning this kind of reconfiguration and strategic change. When the decision was taken to downgrade the A and E services at Trafford general hospital, the hon. Member for Altrincham and Sale West (Mr Brady) and the late Paul Goggins, my good friend and former colleague, managed between them to secure around £11 million of new investment in Wythenshawe hospital to provide for the extra capacity that it would need. We are now unclear, of course, about what will happen with that £11 million of investment; it would be good if the Minister could put it on the record today that it will continue. Given that the hospital cannot envisage even its short to medium-term future, that is a worrying situation.

We saw something similar in Trafford, when investment of around £300 million in the intensive care unit was pretty well written off two years later when the new health deal for Trafford was implemented and the ICU was closed down. That may have been the right decision, but it was certainly a waste of money if investment was being poured into a hospital just two or three years before the whole status of that hospital was changed.

[Lisa Nandy (Wigan) (Lab)]

I am grateful to my hon. Friend for giving way, and I apologise for being late for the start of this debate, Mrs Riordan.

Does my hon. Friend agree that part of the problem with the process is that it does not take into account the particular needs, circumstances and history of our individual communities? For example, in Wigan we have invested in a number of our specialist services. However, we are a big borough, we have our own particular health challenges and we have real transport issues as well, which are different from those affecting other areas of Greater Manchester. Quite simply, a centrally driven top-down process that lacks any kind of democracy whatever, as far as I can make out, is not capable of delivering the sort of services that we need in our areas.

[Kate Green]

I absolutely agree with my hon. Friend, and the issue about democracy that she raises is one that we are all particularly concerned about.

[David Rutley (Macclesfield) (Con)]

I would just like to put it on record that my hon. Friend the Member for Altrincham and Sale West (Mr Brady), who cannot be here because of a commitment, shares concerns about the process and the way in which things are moving forward, which I think he has also expressed to the hon. Member for Wythenshawe and Sale East (Mike Kane). I just want to put it on the record that other Members are also expressing their concerns.

[Kate Green]

I am grateful to the hon. Gentleman for that contribution.

I am sure that my hon. Friend the Member for Wythenshawe and Sale East will talk particularly about the situation at Wythenshawe hospital, which is in his constituency, and our particular concern for the status of that hospital as a fixed-site specialist centre of excellence for a number of specialisms that matter not only to the population of south Manchester, or even to the population of Greater Manchester, but to the whole population of the north-west region. Some of those specialisms matter to the whole population of the north of England, and parts of Scotland too. It is deeply concerning to us that the Healthier Together consultation appears not only to be unaware of the difficulty of protecting those specialisms in the proposed process of remodelling hospital configurations, but to be completely unaware of the interdependency of specialisms and general acute and medical provision. If one element is removed from a cocktail of clinical support that is available to support high-level specialisms, those specialisms are completely undermined and eventually will probably be unable to survive.

I have a particular example of that process that I will draw to the Minister’s attention; it arises from my visit last week to Wythenshawe hospital and its highly regarded cystic fibrosis unit. The doctors and clinical staff there told me that the unit benefited from being part of a much broader, fixed-site specialist team, and indeed survived on that basis. It draws on a range of other specialisms around the hospital, including interventional radiology, transplantation, urology, nutritional support teams, gastroenterology, diabetes, endocrinology, ear, nose and throat services, obstetrics, extracorporeal membrane oxygenation and so on. Picking out some specialisms and moving them cannot be done in isolation, but Healthier Together does not seem to be aware of that at all.

Finally, as my hon. Friend the Member for Blackley and Broughton said, there are concerns about process—about how the public are being engaged in this debate. He said that we have a consultation taking place over the summer holidays, exactly as happened with the new health deal for Trafford, although we told them not to do that again, and during the working day. I understand that few people attended the public meeting in Trafford; I am not surprised, because it was difficult to know that it was even taking place. I would not be able to tell when it happened, because I was not notified directly, let alone my constituents.

[Andrew Bingham]

I thank the hon. Lady for giving way again; she is being generous. I tend to agree. There is a consultation meeting in the High Peak as we speak, although it is a Tuesday afternoon. I, for one, should have liked to be there. I just wonder: next week during the recess would have been a lot easier for me.

[Kate Green]

I agree.

Meanwhile, Healthwatch Trafford says that there is concern about whether the committee-in-common model in Manchester is sufficiently transparent, regarding its ability to engage with and represent the concerns of local people and to oversee, in the wider public interest, what is being proposed.

I am utterly unconvinced that local people are aware of or understand the steps that are being put forward now that could result in major changes to health care provision in our area.

[Julie Hilling (Bolton West) (Lab)]

Before my hon. Friend moves away from the consultation, does she agree that the questions asked in the consultation document are ridiculous? For example:

“Do you…disagree that children and young people should be cared for closer to home where appropriate?”

Nobody would ever disagree with such questions.

[Kate Green]

That is absolutely right. Again, that is exactly what we saw in the consultation on the new health deal for Trafford. We raised concerns about that at the time, but the NHS has learned nothing about how proper engagement and debate with the public can be managed and take place.

There is real concern that a lot of groundwork has gone into producing this consultation but that much of it has happened behind closed doors. If the significant changes that are being advocated, or significant changes in other forms, are needed— the document says that they are, which may well be the case—it is imperative that the public be brought on board through a process of careful, systematic, dedicated engagement. It is not good enough to land a document out there without that work being put in and without any clarity about how decision makers will be informed by the views and opinions of the public at large and of elected Members who represent them.

--- Later in debate ---

[Julie Hilling]

rose—

[Kate Green]

rose—

[Norman Lamb]

I give way first to the hon. Member for Bolton West.

--- Later in debate ---

[Norman Lamb]

I have made the case very clearly that the whole purpose of the pioneer programme is to use the pioneers—although we are not simply focused on them—to identify the barriers to integration and to remove them. That is the whole point. There are concerns about all sorts of things that could block integrated care, such as information sharing across different providers and competition.

I should stress, incidentally, that in the section 75 regulations is a specific recognition that integrated care is an ambition that should be achieved, so commissioning can be for the whole integrated care pathway. There should be no problem in securing our ambition. Where barriers are found, they need to be addressed and removed.

I am conscious that the hon. Member for Stretford and Urmston asked to intervene—

[Kate Green]

indicated dissent.

[Norman Lamb]

The hon. Lady has moved on, so let me make some progress.

It is important to recognise that we are discussing proposals that originated with local clinicians. Dr Chris Brookes, who is not a politician or a bureaucrat, who too often get condemned, but an accident and emergency consultant and a medical director of Healthier Together, says—

[Norman Lamb]

May I make this point? I am sure that the hon. Lady will be interested to hear it. Dr Brookes said:

“Currently, there are too many variations in the quality of treatment, whether its emergency surgery or getting to see a GP when you need to. Not one of our hospitals in Greater Manchester meet all the national quality and safety standards.”

I am sure that all hon. Members present are concerned about that. He goes on to say something which, if we think about it, is shocking:

“At present your chance of being operated on by a consultant surgeon in an emergency at the weekend is much less than midweek. Your chance of recovering well from surgery carried out by a consultant is greatly improved.

But it’s not just about hospitals. It’s about access to a GP, and better community-based services—more services provided locally or at home and joining up the care provided by local authorities.”

That is a clinician making the case for integration.

Before I turn to the Healthier Together changes, it is probably best to make a few points about service changes in the NHS generally and Government policy towards them. The Government are clear that the design of health services, including front-line services and A and E, is a matter for the local NHS and, critically, the health and wellbeing boards, which have democratic accountability. Our reforms put doctors in charge of the care that people receive and how it is delivered to best serve their populations.

The NHS has a responsibility to ensure that people have access to the best and safest health care possible, which means that it must plan ahead and look at how best to secure safe and sustainable NHS health care provision—not only to meet today’s needs, but to plan ahead for next 10 or 20 years.

[Kate Green]

In Trafford, my understanding is that neither the local authority nor the CCG supports the proposals before us. Will the Minister explain the role of the health and wellbeing boards in the final decision on the plans?

[Norman Lamb]

I understand that the health and wellbeing boards are keeping a watching brief throughout. They will have a decisive voice at the end of the consultation process in declaring whether they support the outcome. They bring together the local authority and the NHS, so they are pretty central to the whole process—and rightly so. The local NHS is constantly seeking to modernise delivery of care and facilities to improve patient outcomes, to develop services closer to home and, most importantly, to save lives.

The hon. Member for Stalybridge and Hyde focused on specialisation, and expressed scepticism about the case for it. Let me give him a case. It is from during the Labour Government and should be applauded—the lessons from it should be learned here. Stroke care in London, centralised into eight hyper-acute stroke units, now provides 24/7 acute stroke care to patients, regardless of where they live across the city.

Transport links are not that great across much of London—[Interruption.] Hon. Members should listen to Members from London complaining about transport links. Stroke mortality is now 20% lower in London than in the rest of the UK and survivors with lower levels of long-term disability are experiencing better quality of life. Hundreds of lives have been saved as a result of the specialisation undertaken predominantly under the previous Government.