I attended the meeting in September when local GPs unanimously agreed "that the changes to A&E, paediatrics, maternity, and neonatal and planned care services agreed under the BEH Clinical Strategy (in accordance with the decision of the then Secretary of State in 2008 and 2011) should happen as soon as possible from 15 November 2013". I raised questions about the expectation since 2008 that primary care improvements would be in place by the time of this decision; the risks of delay to both Chase Farm Hospital and North Middlesex Hospital, and the negative impact on Enfield residents, particularly in the North East of the Borough.
It is important to recognise the issue at stake. It is not whether the downgrade of Chase Farm's A&E and maternity services should take place. Sadly, despite our campaigning that decision was made back in 2008 by Labour's Health Secretary and following a moratorium and review was confirmed in 2011. The decision is one of timing. Are services ready to be transferred from November?
The reality is that well over £100 million has been invested in the last year in our local hospitals with improved and expanded women's, children's and emergency services at both North Mid and Barnet hospitals as well as the investment in new urgent care facilities, paediatric and older persons assessment units and an elective surgical centre at Chase Farm. We heard that there is a real danger that our hospitals will be put at risk by a delay in the reconfiguration of services. We heard that all the hospitals are ready for the changes.
To cope with the changes to Chase Farm, over £20m is being spent at Barnet Hospital to achieve the most modern, high quality provision of services for patients. The main clinical changes that will benefit patients include: A&E expansion, expansion of the intensive care unit/higher dependency unit capacity, an additional CT scanner, larger treatment areas for children, an improved medical day treatment unit, a midwifery led birthing unit and expanded delivery facilities.
Chase Farm Hospital is not closing and we should not give credibility to the shroud wavers who talk about its demise. The reality is that following the service changes there will still be access to 24 hr urgent care at Chase Farm. In fact the urgent care will be better for older people and children with dedicated assessment units. Outpatients, planned surgery, rehabilitation, women's diagnostics, paediatric outpatient services, gynaecology outpatient services, ante natal services and maternity day units will all continue to be available at Chase Farm. Much as we continue to regret previous decisions about A&E and maternity services we are where we are and need to make decisions for the best future for Enfield patients. I believe that the biggest risk for Chase Farm's future is the blight of continued delay and uncertainty. We now need to get the necessary investment in Chase Farm to make it fit for modern day purposes rather than fight old battles.
I, like many of my constituents, was very disappointed to hear the news that Chase Farm Hospital is likely to lose its A&E and consultant led maternity services, especially given that I have campaigned to save frontline services at Chase Farm for many years.
David Cameron did promise when he visited Chase Farm Hospital in October 2007 to stop the forced closure of A&E at Chase Farm. In the event an election was not called by Gordon Brown. He continued his pledge, backed up by Andrew Lansley to have a moratorium on “top down” closure to A&E services. Specifically, Andrew Lansley pledged to halt the Barnet, Enfield and Haringey (BEH) Strategy which the previous Government had endorsed without proper consultation or engagement with GPs and the public. The basis of the Government’s position has been to avoid politicians and Whitehall making decisions which should be locally led and determined.
Soon after the election last year, Andrew Lansley fulfilled the pledge to have a moratorium on the BEH Strategy. We have since held a full review of the plan and engagement has taken place with GPs and the Council and other stakeholders.
The Council were given the opportunity to come up with alternatives to the BEH Strategy but beyond the natural desire for the status quo were unable to present alternatives.
The Independent Reconfiguration Panel (IRP) made up of independent clinicians has come to the view that it would be clinically unsafe to keep the status quo. It was also mindful of the previous decision to rebuild and expand North Middlesex Hospital with a £143 million redevelopment. North Middlesex now already has an additional ward to cater for Chase Farm’s patients that would be diverted there.
Given the above the Secretary of State was left with little option but to follow the recommendations of the IRP. I was disappointed having long campaigned for Chase Farm’s A&E and maternity service. I have a personal interest having seen my father and son having their lives saved by Chase Farm Hospital.
However, I recognise that in view of previous decisions, particularly the expansion of North Middlesex Hospital and the lack of credible alternatives, the decision of the Secretary of State is understandable. I am pleased that North Middlesex Hospital will be receiving £80 million from HM Treasury in agreement with the Department of Health to refurbish the majority of the Tower Block (built in the 1970s) up to modern day standards and to create a brand new state-of-the-art women and children’s centre. Nearly £35 million has also been agreed by NHS London to expand A&E services and maternity services at Barnet Hospital and create an Urgent Care Centre and brand new assessment units for children and for older people at Chase Farm Hospital.
We now need to make sure that the conditions of the IRP are met, such as investment in primary care services and improved transportation before implementation of the changes.
David Burrowes urges Minister to think again about decision to cut A & E and maternity services and to listen to widespread opposition in Enfield.
Mr. David Burrowes (Enfield, Southgate) (Con): I am pleased to have secured this important debate on Chase Farm hospital. It is a matter of great concern to my constituency and neighbouring constituencies, and I welcome the hon. Member for Edmonton (Mr. Love) and my hon. Friend the Member for Broxbourne (Mr. Walker). This issue is of concern to the community of Enfield, which is made up of 300,000 people, as well the surrounding area. Some 1 million people have been affected by recent decisions on Chase Farm hospital.
Issues affecting the hospital have been debated in the community for a number of years. We often say that a debate is timely, but this debate is particularly timely. Discussion has been going on since 1999, when the trusts were merged. We were given promises that a full range of front-line services would continue on both sites, followed by the “Healthy Hospitals” consultation in 2003, and recently, the “Your Health, Your Future: Safer, Closer, Better” consultation.
The primary concern is about the future of a fully functioning accident and emergency service and consultant-led maternity services. Those services have been in doubt, and over the years, successive Ministers have come to Chase Farm hospital—particularly at election time—to provide assurances that the A and E service would not be downgraded. Come the next election, however, we will not have that privilege. The future of A and E and consultant-led maternity services is no longer in doubt, because on 4 September 2008, the Secretary of State confirmed the local primary care trust’s decision to cut those services.
Joan Ryan (Enfield, North) (Lab): I congratulate the hon. Gentleman on securing this debate, and I agree that it is timely. Before he moves on from the history of the situation at Chase Farm hospital, may I point out that it has been a subject for debate for the past 20 years? Would he agree that the consultation processes that we have experienced personally have been wholly unsatisfactory, and that efforts to engage the public in such consultations have not facilitated their access to the process nor their ability adequately to express their views?
Mr. Burrowes: The consultation was inadequate and flawed, which is why this debate is particularly timely. Enfield council challenged the decision through judicial review, and the flawed consultation is at the heart of that challenge. If the Minister has any concerns about commenting on the details of the challenge or the decision, he may be pleased to know that the rule of sub judice does not apply in this case, because when a ministerial decision has been challenged, full debate is allowed. No jury would be affected by our debate today, so we can have a full and frank discussion, and I look forward to the Minister’s response to concern about the wholly flawed and inadequate consultation process.
The legal challenge should not surprise us. It did not surprise me when I received the Secretary of State’s letter on 4 September, which referred to “Your Health, Your Future”, with the sub-heading, “Safer, Closer, Better, Barnet”—no reference to Enfield. The letter went on to say that the independent reconfiguration panel
It then talked about
There was no mention of Enfield. That was plainly a mistake, but it gives rise to concerns at the very outset that this was a copy-and-paste decision, using national guidance and models, in relation to centralising A and E and maternity services.
Mr. Charles Walker (Broxbourne) (Con): Would my hon. Friend agree that the various consultations seem to have ignored the fact that approximately 150,000 people in Hertfordshire use Chase Farm A and E and other Chase Farm services? My constituents now face not only the prospect of a reduced service at Chase Farm, but also reduced services at the QE2, so their nearest A and E will be the Lister, which is approximately 30 miles away and can take an hour and a quarter to get to in the rush hour, if not longer.
Mr. Burrowes: My hon. Friend makes a good point. Yesterday I was talking to an ambulance man who raised a similar concern about the travel time to neighbouring hospitals, with the loss of accident and emergency services. My hon. Friend has been a doughty campaigner on behalf of his constituents and I pay tribute to him, as well as to his 16,423 constituents who signed the petition that was delivered to No. 10 and the House of Commons. That petition was ignored, along with the concerns of Enfield residents. That is summed up by one campaigner, who said that the recent comments made in the House by the Minister who will respond to the debate today have raised acute concerns that the interests of Enfield and neighbouring constituencies have not been properly considered and, indeed, that those concerns have been treated with contempt. In parliamentary terms, this debate comes soon after the business questions in the House on 16 December, when my hon. Friend the Member for Eddisbury (Mr. O'Brien) asked the Minister:
I am not aware that the Minister took up that invitation to come to Enfield before Christmas to explain the position, but we have an opportunity today to get a proper explanation and to recognise the timely report by the College of Emergency Medicine, which concluded:
and that the Government’s proposals are
We look forward to an explanation from the Minister that goes further than his response to the House, in which he sought to hide behind the legal challenge, which we now know is unnecessary, given the rules of sub judice. He concluded:
We have already heard today that that is not the case, and that it is untrue. The words of Kate Wilkinson, one of the staunch campaigners on this issue, are pertinent. She says on behalf of many people that the Minister’s comments
Those objections and that scrutiny have been made on a cross-party basis, in an investigation ably chaired by Councillor Ann Marie Pearce, of the joint scrutiny committees of Haringey, Barnet and Enfield, which are united in their opposition. Opposition has also been ably led by my colleague Nick de Bois, and by Irene Wilson and Ivy Beard, who has come to hear our debate today. Opposition has consisted of a large number of petitions—notably one that was organised by Irene Wilson and presented to No. 10 which was signed by 30,000 people—and marches. Some 5,000 people participated in one march. Hon. Members present in the Chamber today and I were united at the front of that march. We were concerned and were campaigning against the downgrade of A and E and consultant-led maternity services. Also notable was a petition organised by Nick de Bois during the consultation process. It was signed by 9,000 residents. More than 70,000 people have signed petitions or made representations, and all of them objected to the downgrade. That is why it is time that we heard a full explanation from the Minister.
This debate is timely because last night, something unexpected happened that made me aware of the need to retain services. Today, I could focus on the independent reconfiguration report, which expressed concern about the flawed consultation. I could focus on the 50,000 responses that were rejected in the consultation process. I could focus on the fact that option E, which would retain and improve existing major services at Chase Farm, was not included, and that the consultation document, as has been said, was fundamentally flawed and poorly communicated. I could emphasise the transport problems in east Enfield, in Cheshunt and in Winchmore Hill in my constituency, or I could focus on the capital plans, which the independent panel said do not have a clear source of funding.
I could speak about the concerns of chief executives and funding gaps. The chief executive of North Middlesex hospital is extremely concerned about how she will find the extra £60 million required—over and above existing plans for the private finance initiative expansion at North Middlesex hospital, which is welcome—to cater for the increased demand should Chase Farm hospital be downgraded. The chief executive of Chase Farm accepts that the planned £100 million will not be enough to cover the improvements necessary for the three sites.
Last night, I attended A and E with my daughter, Dorothy, who suffered a fall and an injury to her head. Perhaps that is taking preparation a little too far but, thankfully, my daughter’s injury was minor. The Minister would probably be quick to say that such an injury would be catered for under the proposals for a downgraded unit. Let us not call it a local A and E, as that is ambiguous. One could describe it as an urgent care unit, but we need further details about what that means. However, it would deal with a minor injury such as the one that Dorothy suffered.
Just behind us at reception was the family of a constituent—an old ex-council colleague whom neighbouring MPs will know well. Last week, Richard Course suffered an aneurysm and thankfully survived. His family came to the hospital last night to thank the staff for saving his life. I pay tribute to the staff who did that—they save lives day in, day out. The family wanted to make the point that Mr. Course would not have survived under the proposals, as there was no time because of his aneurism to transfer him to Royal College hospital. He would not have survived. Chase Farm—and the location of Chase Farm—saved his life. It also saved the life of my father when he suffered asthma attacks. Timing was crucial, so it was important he could get there quickly, and no doubt many others have similar experiences. I could also mention the complications during the birth of one of my children. A mid-labour transfer to another hospital would have jeopardised his life.
Mr. Mark Field (Cities of London and Westminster) (Con): I have some experience of the matter, having lived in Enfield in the run-up to the 1997 election when I was the candidate there. Chase Farm hospital was a big issue at that stage.
Does my hon. Friend agree that, given that there was a case at that juncture to keep the A and E open, that case is considerably stronger a decade or so on, not least because of the huge increase in population? The Enfield Island site was still in gestation in the late 1990s. It is now fully finished, and a huge number of people live in that part of eastern Enfield. The case is even stronger now, and it should be made by all the folk who have a local concern in Enfield.
Mr. Burrowes: I wholeheartedly agree. The Enfield area has a disproportionate number of nought to 14-year-olds and of over-74s, and the population is increasing dramatically. If one looks at maternity services, the latest statistics from the Office for National Statistics show that there has been a 17.5 per cent. increase in the birth rate, which is the second highest in London. The population of Enfield is the fifth largest and is increasing. The case was good when my hon. Friend was campaigning there, but it is even better now.
The situation became clear to me last night. I heard about it while speaking to various practitioners who were present. It was a very busy evening. There were three patients on trolleys who were waiting for beds. They were there with ambulance men, who said that usually people wait one or two hours for a bed. They explained that 164 patients had gone through A and E the day before yesterday. Patients were waiting to be offloaded from ambulances—they were stacking up—and four patients waited on trolleys for a bed. They said that overnight there had been 22 admissions for the 16 beds in the wards.
The observation unit is often full to the extent that there is 24-hour observation, which goes beyond the remit for observation. I was told that the Barnet and North Middlesex hospitals were full that evening, and that often it is obvious from the board that Barnet is full. Indeed, Enfield often takes more patients than the surrounding hospitals. The ambulance men and nurses told me that patients often require urgent surgical and medical attention, and that time is critical. Time-critical patients coming from the surrounding area are often elderly—every minute matters—and they need a local hospital to deliver the care they require.
North Middlesex hospital is the fifth busiest in London. It would have to take up capacity from Chase Farm hospital. The words of Sir George Alberti are particularly pertinent:
The Government hired him to provide advice, and they ought to listen to his words extremely carefully.
The concerns expressed by the ambulance men and nurses should be heard, as should the concerns of the consultants and doctors to whom I spoke last night. They said that the closure does not make sense, and that it is madness, given the demand coming through Chase Farm. They said that their concern and that of others was that if A and E were to close, it would lead to the end of the hospital. None of us would want that; it does not make sense. In legal terms, practitioners are concerned that the decision is irrational. No doubt that is why the council is challenging it, and it is why the Minister should give a full explanation today.
All of that is before we talk about maternity services and the grave concerns about a lack of true clinical benefits and the loss of consultant-led maternity services. Midwives have communicated their concerns. A group of 10 said that the closure will result in fatal outcomes if a shoulder dystocia occurs—that is when the baby’s head is delivered but the shoulders become trapped. They said that there are six minutes to deliver the shoulders before brain damage or even the death of the baby occurs. If a woman starts to haemorrhage during or after the delivery of the placenta, she could bleed to death in minutes. Those events and many others cannot be predicted during antenatal screening for suitability to deliver at the birth centre.
The birth centre and the labour ward at Chase Farm hospital are an ideal configuration. The midwives at the birth centre say that seven out of 10 women would not choose to go to the birth centre if the labour ward were not downstairs. Who can blame them for not taking a risk? Sadly, Enfield mothers would not choose to have their baby at the birth centre if there were not the assurance of a labour ward there as well. I again pay tribute to the staff at Chase Farm and to those who have worked tirelessly for local health care. I congratulate Nadia Conway on being awarded an MBE for her services. I commend the progress made in a number of areas that we do not have time to debate today. I am thinking particularly of infection control: Chase Farm has been praised for its cleanliness, staff knowledge and commitment to ensuring that appropriate control mechanisms are in place.
We are all convinced—and there is almost unanimous support in the community for this—by the argument that the best opportunity to improve services is at Chase Farm. We need to ensure that we have a fully functioning A and E and consultant-led maternity services. That is what the council has said in motions and what the challenge is all about. Now the Minister has an opportunity to provide an explanation. I hope that he will use the opportunity to say, “No, we’re not just going to go to court. We’re going to retain a fully functioning A and E and maternity service.”
David has tabled an Early Day Motion at the House of Commons which highlights a report by the College of Emergency Medicine which concludes there is no evidence of the clinical or financial benefit of the urgent care model.
The EDM (No. 363) also supports the decision of Enfield Council to seek a judicial review of the Secretary of State for Health's decision to downgrade services at Chase Farm.
David's Early Day Motion reads:
Conservative MPs challenge Ministers to reverse the decision to replace accident and emergency services at Chase Farm with an urgent care centre.
Mr. Stephen O'Brien (Eddisbury) (Con): Will the Minister find time before Christmas to go to Enfield and tell the people there why they do not need an accident and emergency department at Chase Farm hospital and why it will be replaced by a non-blue light service at the urgent care centre? The most recently published report by the experts, the College of Emergency Medicine, concluded:
of the urgent care centre model, and that the Government’s proposals are
In the light of those statements, will the Minister and the Secretary of State reverse their decision to replace accident and emergency services at Chase Farm with an urgent care centre?
Mr. Bradshaw: The hon. Gentleman is aware—or at least he should be—that there is a potential legal challenge, if not an active legal challenge, to that case. I shall therefore not comment on his specific point. He will be aware that the proposals in north-east London have been through the democratic check of both the overview and scrutiny panel and the independent reconfiguration panel. Everybody—including the four primary care trusts, most of which cover boroughs with Conservative majorities—is agreed that the proposals are the best solution for the north-east London health economy.
David Burrowes MP responded with dismay at the decision of the Government to close Chase Farm Hospital's A&E and maternity labour ward.
He said "it is a travesty that the views of my constituents have not been listened to by the Government. The Health Secretary has just rubber stamped the PCTs' proposals to close A&E and downgrade maternity services. Alan Johnson has either ignored the concerns of Enfield or dismissed them without good reason.
Alan Johnson's letter to me informing me of his decision could not even get the name of our area right by making reference to the proposals for East Sussex rather than Enfield. It is a 'copy and paste' decision by this Labour Government who are intent on imposing their nationwide policy of centralising A&E and maternity services.
Not only are we losing A&E a Chase Farm but the Health Secretary cannot even provide a cast iron commitment to keep a midwife led birthing unit. The cruel message from the Government is if you have an emergency or are pregnant don't go to Chase Farm."
David Burrowes MP asked the first of the last questions to Prime Minister Blair today. He took the opportunity to raise the issue of the plans to downgrade Chase Farm's A&E and maternity services.
He asked, "In 1997 the PM said there were "24 hrs to save the NHS", why is it that more than 86,700 hrs later his successor is indicating that the NHS is still in need of saving. Given that Enfield's Chase Farm is publishing plans tomorrow to cut A&E and maternity services will the next 24 hrs with a new PM make it more or less likely that these local heath services will be saved?"
The PM answered by endorsing Sir George Alberti's plans to downgrade A&E and maternity services. The PM pointed to apparent extra investment and services in Enfield.
David said, "I was pleased to put the future of Chase farm's A&E and maternity services at the top of the agenda for Tony Blair's last PMQs. It was an historic occasion where I wanted to ensure that Chase farm's A&E and consultant led maternity services have a future and are not consigned to history. As usual I was disappointed that Tony Blair failed to answer the question and give the people of Enfield the necessary assurances. His suggestion of additional resources and services for Enfield will hold little weight in Enfield Southgate which has not seen improvements in local primary care services. I will now be pressing Gordon Brown to answer my colleague Nick de Bois' letter requesting his intervention to save local services."
I am opposing the plans to cut A&E services at Chase Farm Hospital. I am firmly against plans to downgrade our local A&E. It can only lead to a diminished service for my constituents. The latest plan is another step in the wrong direction for Chase Farm. Hospital managers have not learnt from the Trusts own debt-ridden history that merging and centralisation provides a less responsive and effective service. Local patients should not have to pay the consequences of Government and management failures by losing our A&E.
I have seen first hand with my family the life saving value of our A&E.
A transfer of the emergency services to Barnet is unacceptable and will put patient safety at risk., I am using every opportunity to raise the issue in Parliament and seek confirmation of the guarantee given by the Government before the election to safeguard Chase Farm’s A&E. I have also been campaigning locally, challenging hospital managers about the plans and supporting the community campaign against cuts to our A&E. Please complete the form on the back to register your opposition to the plans and attend the public meetings I am holding!
The message from Enfield Southgate is "Keep off our A&E and Women and Children’s Services". Demand that Chase Farm stays open, with all of its services intact.
Make your pledge online http://www.handsoffourhospital.org
We will deliver your pledge to the Government and the health managers implementing its policy.
Questions: 'To ask the Secretary of State for Health, whether the option to retain Chase Farm Hospital's (a) accident and emergency department and (b) consultant-led maternity services is in accordance with the Government's national clinical strategy'
As part of the work leading up to the launch of the formal public consultation on the Barnet, Enfield and Haringey clinical strategy, National Health Service London has asked Professor Sir George Alberti, the NHS National Director for Emergency Access, to work with the local NHS and offer an independent view on the clinical case for change. It is for the local NHS in partnership with strategic health authority and other local stakeholders to plan, develop and improve services for local people. Any change to local services would only happen after full public consultation with local people.
Mr. David Burrowes (Enfield, Southgate) (Con): I am pleased to follow the hon. Member for Hartlepool (Mr. Wright), and I recognise his passionate concern for his local community and about the lack of access to proper health care there. I share his concern, which I hope will be heard by the Minister, about his community being let down by the Government in relation to reconfiguration. I suggest that his reflection of the health care in his community is much more in touch with reality than that of the hon. Member for Kingswood (Roger Berry), who suggested that reconfiguration had nothing to do with the Government or with finance.
Enfield is also going through the reconfiguration process, and Government and finance both have their hands on the reconfiguration plans there. That has been the case for a number of years. The plans have been talked about for years, as in other areas, but they were actually formed in 2003 with the healthy hospitals programme. It was clear from the consultation papers that the proposals were all about trying to manage what was then £22 million worth—and rising—of deficit, and trying to manage what was seen as a duplication of services. That, rather than clinical concerns, was at the forefront of people’s consideration then and, sadly, it still is.
The new clinical strategy sets out several criteria: one is to replace poor buildings at Chase Farm hospital; another is to make better use of the new facilities in Barnet; and another is to meet the clinical standards set out and required by the Healthcare Commission. Everyone would want to sign up to those. The final two are the driving forces: achieving and maintaining financial sustainability; and the national policy environment. The financial viability of Enfield is of great concern. The hospital trust is trying to deal with an £8 million deficit, and there are also London-wide financial issues, with a £90 million deficit to deal with. Those are the pre-eminent concerns for local people about the health care strategy.
What was the national policy environment in 2005? It was outlined by Cabinet Ministers who made clear promises about health care to the people of Enfield during the election campaign. The Secretary of State for Defence promised a new £80 million building at Chase Farm hospital. The Secretary of State for Work and Pensions said categorically that the accident and emergency department at Chase Farm hospital was safe. That is certainly not the reality now.
Consultation has been mentioned a great deal in the debate. The Secretary of State said that the consultation process was real, but I share the cynicism of the hon. Member for Hartlepool: lip service is paid to consultation. In Enfield, it is a sham. We recently received the leaflet, “In Your Hands”, though our letterboxes—if only health care provision were in our hands. Local people and politicians are united in opposition to the plans. All the local Members of the Parliament—the Under-Secretary of State for the Home Department, the hon. Member for Enfield, North (Joan Ryan), the hon. Member for Edmonton (Mr. Love), and my hon. Friends the Members for Chipping Barnet (Mrs. Villiers) and for Broxbourne (Mr. Walker)—are united in opposition to the plans to downgrade the accident and emergency unit and to transfer the consultant-led maternity services. They are joined by all 63 councillors in Enfield, all the councillors in Broxbourne, a majority of GPs, some 22,000 people who signed a petition delivered to Downing street last year, 5,000 people who marched last December, the thousands who will no doubt march on 3 March to register their disapproval of the proposals, and the thousands who are signing the “Hands off our hospitals” petition each week—a campaign led ably by Nick de Bois in Enfield, North.
The national policy environment now is the key driver. Certainly, it does not seem to be sensitive to what is happening in Enfield. Concerns to centralise services for care closer to home are often spewed out by Ministers, but they are not sensitive to the real needs in Enfield. The district general hospital model of the 1960s anticipated smaller community hospitals in clusters. In Enfield, the community hospital, which eventually became Highlands hospital, is now a housing development, and the concern is that Chase Farm hospital will follow the same path. That is a great worry, especially as Chase Farm hospital has a substantial catchment area and an accident and emergency department with admissions of some 20,000, and a maternity service with at least 2,000, a year. Health service managers, clinicians and others have not made the case as to where, if not to Chase Farm hospital, those seeking maternity services and accident and emergency care will go.
We must therefore rely on the national case for change. What is that national case? Will there be better care through ever more centralisation of services? Let us look at the evidence. In relation to configuring hospitals for London, in 2004, the Department of Health concluded that research to date did not support “any general prescription...that service concentration leads to improved outcomes for patients”.
Is there evidence of greater access to services? More recently, the Academy of Medical Royal Colleges made the point that bigger is not necessarily better, and pointed to the risks for those living in remote areas if emergency services are concentrated in fewer hospital sites. Enfield may be seen as just another concentrated suburb and site, but if we examine the catchment area in more detail, we see that it extends, for instance, to the constituency of my hon. Friend the Member for Broxbourne. If he were here, he would make the point that the lack of mobility, transport and services in Cheshunt means that access is a real problem for those in Enfield and beyond.
The case that is made by the Minister and others is that primary care services will pick up what is left from those centralised services. Any reorganisation will depend on how those services in the community are organised and specifically on whether the community and primary care facilities can succeed in providing effective alternative services.
In Enfield, the primary care trust is being top-sliced and is having to make £7 million savings. There has been 3.6 per cent. top-slicing in the past year. What is the reality of those primary care services? One only has to take the example of the baby care clinics that have recently been put further out of reach of my constituents. One sees the suspension of developmental checks. Primary care services are not necessarily improved when they are transferred to the community. We have improvements in diabetes, but it is not universal. The case has not been made out in Enfield that primary care services can pick up what is left from any downgraded Chase Farm hospital.
Let us hear from the primary care managers. They say with reference to managing change: “it will be very challenging to deliver the required organisational change, management cost savings, meet existing financial and service targets and play our full role in developing, consulting and delivering the...clinical strategy. There may be an element of planning blight with a slow down in the development of LIFT projects”.
Earlier in the debate, Members extolled the virtues of LIFT projects, but the PCT in Enfield says that that would be slowed down and suspended because of the impact of any downgrading of Chase Farm. That issue needs to be borne in mind when anyone considers the serious impact in Enfield.
Let us deal with the finance. Would the changes provide better value for money? The local evidence is not made out and, nationally, it is variable. Cost-effectiveness seems to vary between different types of community or primary care-based services. In Enfield the Government have sought to rely not on local cases but on the Kaiser programme in California. They have sought to rely on that as evidence of how better value for money is provided within the community. But there one cannot treat like for like. There are considerably more specialists per 100,000 of the population in California than in the NHS. The case is not made out nationally.
One only has to look at a recent report by the NHS National Leadership Network, which concluded that there was no guarantee that reconfiguration would necessarily lead to cost savings and recommended that the cost impacts of different service models should be monitored at a national level “as a matter of urgency”. The reality in Enfield and, as we have heard, beyond is that the case is not made out. Nationally, and certainly in Enfield, we are still waiting. One only needs to see the conclusion of the King's Fund: “The partial nature of the evidence base and the potential for short term financial and political concerns to influence local decisions make it all the more important that there is real transparency about the costs and benefits of proposed changes.”
We have not seen real transparency in Enfield. What is more important, local people need to be listened to. They are saying loud and clear, and will no doubt say loud and clear on 3 March: let us retain our A and E and our maternity services.
Furthermore, during the course of the debate, Shadow Secretary of State for Heath, Andrew Lansley, referred to his visit to Chase Farm and the proposed plans for changes to our hosptial.
Andrew Lansley MP: On accident and emergency services, I accept that there are cases in which a blue-light ambulance is called, and it does not go to the nearest hospital, and of course we have to accept the argument for that. However, as a consequence, across the country, primary care trusts and strategic health authorities are saying, “We’ve got to downgrade units.” I went to Chase Farm hospital accident and emergency unit, and people there were saying, “We want to become a minor injuries unit.” Frankly, the choice is not between having a full-service accident and emergency department and having a minor injuries unit. As George Alberti makes clear in his document, it is perfectly valid for us to retain accident and emergency departments.
If we add up all the myocardial infarctions, strokes, major head injuries, aneurisms and demands for vascular surgery, they still account for only about 300,000 out of 13 million attendances at type 1 accident and emergency departments. We cannot have a situation in which the NHS, because of financial deficits and the impact of the working time directive, shut accident and emergency departments across the country, so that 97 per cent. of the people visiting those departments lose access to them, on the excuse that 3 per cent. of patients need to be blue-lighted to a more specialised centre.
Mr. David Burrowes (Enfield, Southgate) (Con): I am grateful to my hon. Friend for referring to Chase Farm, and I share his concern about its move towards having a minor injuries unit; that is simply one option among many concerning accident emergency. Does he welcome the fact that Sir George Alberti is now to report on Chase Farm specifically, and the options open to it? Will he make the point that Chase Farm has a wide catchment area, and we should not move quickly to downgrade, simply in the interests of saving money?
Mr. Lansley: I entirely agree, and I hope that George Alberti, for whom I have a lot of respect, will come to the right conclusions in his report. I will not go on about maternity services in detail, because our debate on 10 January covered that subject, or most of it, but since 10 January, the Government have produced a document from the national clinical director for children, young people and maternity services. Fascinatingly, what is does not tell us is far more significant than what it does. It does not tell us anything about whether there are enough midwives to provide maternity services, and it does not tell us what might be regarded as safe transfer times between a midwife-led unit and a consultant-led unit. It does not tell us how swiftly, and under what circumstances, mothers should be able to have an emergency caesarean section.
In fact, at one point the report commends the fact that, in Huddersfield, a unit shut down because it could not maintain eight consultants and at least 2,500 births a year, but two pages later, it says: “There is no optimum number of births to make a unit sustainable.” There is no evidence in that report, published by the Department, that informs thinking on the delivery or configuration of maternity services across the country. It does not help at all. Indeed, I am afraid that across the country, campaigners are having to put together the arguments themselves, because the arguments are not presented in the work done by the Government.
Who is standing in the way of change? Let us have a look. The Labour party chairman, in Salford, does not agree with the Government’s policy. The Labour Chief Whip, who stood outside the Alexandra hospital in Redditch, does not agree with the Government’s policy. The Home Secretary does not agree with the Government’s policy, because of the closure of his local accident and emergency department up in Lanarkshire. I could go on; the list even extends to the Prime Minister. Back in September 2004, there were proposals for the reconfiguration of acute hospital services in north Teesside, and the Prime Minister, with the then-Secretary of State for Health, now the Home Secretary, came to Hartlepool. As it happens, it was in the middle of a by-election, but of course I would not suggest for a minute that, in the heat of a by-election, the Prime Minister would say something that he did not believe, and that he was not prepared to deliver on subsequently. He arrived and said: “There is no question of the hospital closing or being run down.” Subsequently, it was proposed that precisely that should happen.
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