Accident and Emergency Departments

Stephen Lloyd Excerpts

Thursday 7th February 2013 Commons Chamber

[Stephen Lloyd (Eastbourne) (LD)]

I thank the Backbench Business Committee for granting the debate and endorse my colleagues’ expressions of appreciation to the hon. Member for Ealing, Southall (Mr Sharma) for obtaining it. It was a pleasure to be one of his co-sponsors.

The debate is badly needed. Not a month seems to pass without another NHS trust announcing that it will close one or more hospital departments, and at least 15 NHS bodies in England are pursuing major reconfiguration plans. There is, however, increasing concern in the medical field that NHS care for emergency patients might be going wrong in too many instances. Essentially, this is a debate about specialism and generalism. Rare complex surgery, for example for brain tumours or severe multiple injuries, is clearly best done in large volumes in specialist centres. I do not dispute that—nor do the overwhelming majority of clinicians—but it is not true for the common types of emergency surgery that are best done within good time in a quality district general hospital.

Hip fractures, for instance, are very common and the results are better if surgery is done as soon as possible, preferably on the next day’s operating list, by a surgeon who has at least three years’ experience of fixing hip fractures, yet around the country hospitals are being reconfigured to provide a specialist service in a major centre, leaving, as many experienced clinicians assert, thousands of patients with delayed and worse care.

[Sarah Teather (Brent Central) (LD)]

As I listen to my hon. Friend, I am struck by an example from my constituency, where the likely closure of the A and E will mean that people living in Harlesden will find it almost impossible to get to Northwick Park hospital. It is important for patient experience that their relatives can visit them.

[Stephen Lloyd]

I thank my hon. Friend for her intervention. That is a very important point and I shall be covering it in more detail later in my speech.

Last October, a group of 140 senior doctors wrote to the Prime Minister expressing alarm over proposals to close and reconfigure A and E units around the country. In their open letter, they said that they had yet to see evidence that plans to centralise and downgrade A and E services were beneficial to patients. A 2010 report by the National Confidential Enquiry into Patient Outcome and Death showed that the reason people often die after surgery is not that the surgery was difficult but that there was a delay in getting them to an emergency operation. I fear that that will be worse if more A and Es are closed as there will be no surgeon on site, or the patient will face an over-long travel time to a fully functioning and adequately staffed emergency department. The report was clear, suggesting that applying one-size-fits-all medicine to a heterogeneous population with varying needs fell short in ways that were both predictable and preventable. Crucially, it stated:

“Delays in surgery for the elderly are associated with poor outcomes”.

The letter to the Prime Minister also backed this view:

“Not only do many people in some of the country’s most deprived areas face longer journeys to hospital, but those in rural areas face longer waiting times for ambulances and crowded A and E departments when they arrive.”

Let me point out the obvious: that will mean more delay for what should be routine emergency surgery.

That is in contrast to how I foresaw developments in May 2010 when the coalition Government came to power. Unlike Labour, the coalition ring-fenced NHS funding.

[Jim Dowd (Lewisham West and Penge) (Lab)]

How can sums be ring-fenced if at the same time the Department insists on a 1% surplus—that is, money that cannot be spent?

[Stephen Lloyd]

The key difference is that the coalition Government ring-fenced it whereas the Opposition were considering a 20% cut—that is quite substantial.

Four reconfiguration tests were designed to build confidence among patients and communities as well as within the NHS. The right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) has already listed them, so I do not need to repeat them. In Eastbourne, my local hospital is run by East Sussex Healthcare NHS Trust, which also manages the Conquest hospital in Hastings. Last year, it consulted on the provision of orthopaedics, general surgery and stroke care in East Sussex. In my view and that of the cross-party Save the DGH campaign group, led by our remarkable and hard-working chair Liz Walke, it was clear from early on that the trust’s aim was to remove core services from my local hospital, the Eastbourne district general hospital, irrespective of the consultation.

This was not the first time the trust had tried to remove core services from Eastbourne. Only five years earlier it had tried, unsuccessfully, to downgrade our maternity services. At the time the trust claimed that that would provide safer and more sustainable services for the people of East Sussex. However, after much local opposition the independent reconfiguration panel found against the trust’s proposals, so when my local hospital trust again consulted on health services in East Sussex, my constituents and I were very worried. I was uneasy, as so many local clinicians started to share with me confidentially their deep concerns about the trust’s proposals.

I reassured constituents that we were in a stronger position than last time because the coalition Government had shown their commitment to the NHS by ring-fencing the NHS budget at a time of deep financial constraint. In addition, the Prime Minister and the then Health Secretary, the current Leader of the House, had continually stated that the NHS would be led by the public and clinicians, and to ensure this they had introduced the four reconfiguration tests that were mentioned earlier.

Imagine my horror when, just before Christmas, my NHS hospital trust had its proposals confirmed by the East Sussex health and overview scrutiny committee and was given the go-ahead for its plan to remove emergency orthopaedics and emergency and highest-risk elective general surgery from Eastbourne district general hospital and site them only at the Conquest hospital in Hastings, as much as 24 miles from some of my constituents.

The consultants advisory committee, the body which represents consultants at Eastbourne DGH, conducted a confidential survey of its members’ views on the trust proposals. More than 90% of DGH consultants responded to the survey, with 97% of those respondents opposed to the proposals. I remind colleagues in the House of the four tests. A confidential GP survey was also conducted and 42 GPs in the town also opposed the trust’s plans. In addition, 36,766 local people signed a petition against the proposals.

[Mr Sharma]

Is this not the story of every trust, including Ealing and other west London hospitals, where the local consultants and GPs have totally opposed such proposals but the threat of closure still exists?

[Stephen Lloyd]

I thank the hon. Gentleman for that intervention, and I agree. My point is that the four tests look good on paper but my anxiety, which I am putting to the Minister, is that they may not be so good in practice.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

Will the hon. Gentleman give way?

[Stephen Lloyd]

I will continue, as I have only two and a half minutes left.

In short, either the Government’s reconfiguration tests are not being properly adhered to, or trusts and PCTs are merely using them as a smokescreen to hoodwink local communities. I do not believe for a moment that this is what the Government originally planned, so what is going wrong and why? It is clear that many very experienced and expert clinicians believe that most areas must retain emergency departments, with co-located essential core services to manage the bulk of common emergency conditions, which I spoke about earlier, or to stabilise patients prior to transfer to specialist units.

In conclusion, I am far from confident that the current process to determine whether or not reconfigurations of health services or A and E are being done in the best interests of local people is working, irrespective of the four tests that I talked about earlier. This must be addressed and that needs to be done quickly because if we get it wrong, lives could quite literally be lost unnecessarily. The NHS is our most cherished institution, often referred to as the glue which binds our society together. I pay tribute to the coalition Government for protecting NHS funding at a far higher level than was the case in any other Government Department but—and this is a “but” laden with real anxiety—I fear we may be getting the reconfiguration elements wrong. I hope the Minister will address my specific concerns about the reconfiguration element and about specialism v. generalism, to ensure that the right and the best service is provided for my and all our constituents.

--- Later in debate ---

[Mr Slaughter]

Absolutely not. As part of the consultation process that was undertaken, it is on the record in the documentation that I was consulted. I was not consulted on those matters.

[Stephen Lloyd]

Will the hon. Gentleman give way?

[Mr Slaughter]

I am sorry; although I would love to give way, I have been asked not to.

That consultation was ignored. The body taking the decision has no stake in these matters whatever. The joint PCT council, NHS North West London, will not exist. The bodies that do have a stake, namely the clinical commissioning groups that are taking over—the puppet masters, as it were—have too much influence in my view and too much to gain personally. I wish I had time to go through the declarations of interest that members of the CCGs have made. They show that most hold shares in Harmoni, Care UK or other private interests that might benefit from the commissioning powers that the CCGs are about to get. I have not received proper answers from the health service about what those interests are or what they remain.

To conclude, the decision for north-west London will be taken on 19 February, so this debate is very apposite. I have no doubt that the decision will be taken to go ahead with most or all of the proposed closures, but the protests that have taken place—the demonstrations, marches and petitioning—will continue, because this now becomes a political decision for the Secretary of State. In the early-day motion that I tabled last June, I referred to the fact that the health service locally was saying it would run out of money if it did not make these cuts. Services are already being run down by sleight of hand. The buck stops with the Secretary of State and the Government. The ball is in their court. I hope the decision will be taken, first, by the independent panel and, secondly, by the Secretary of State. The Government cannot dodge this issue. This is about cuts, as it was in the 1990s, and the denigration of our local health service. The buck cannot be passed beyond this point. I call on the Minister in her reply to say how she intends to preserve the local health service in north-west London.