David Burrowes MP

DAVID SPEAKS UP IN DEFENCE OF CHASEFARMHOSPITAL – 21 FEBRUARY 2007

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 'wny 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.